Janice Milliman, Quit Coach, Service Delivery

The American Lung Association released in December its annual publication “Helping Smokers Quit: Tobacco Cessation Coverage 2011,” which highlights disparities in tobacco cessation benefits across the United States. The top five “quit-friendly” states are Maine, North Dakota, Delaware, Oklahoma and Wyoming. Count yourself fortunate if you live in one of those states, whether you’re a tobacco user or not. The bottom five, or least “quit-friendly” states include Georgia, Louisiana, Alabama, Maryland and New Jersey. Tobacco users in those states not only have a harder time quitting due to lack of support, but the economic impact of tobacco use affects all residents by straining the state’s budget.

The Centers for Disease Control (CDC) recommends that states spend $10.53 for cessation coverage per smoker. Appendix F of the Lung Association’s publication outlines how much each state actually spends. States like Louisiana only spend $0.39 per smoker, and Maine spends $13.56 per smoker. The recommended cessation benefits include, but are not limited to, access to all seven FDA approved medications for the FDA-approved duration of use, at least four counseling sessions per quit attempt and at least two quit attempts per year, eliminated or reduced copays and other cost-sharing for medications and counseling, and elimination of prior authorization which slows down treatment and can decrease a smoker’s motivation and momentum to quit.

Supporting tobacco cessation is one of the most cost effective ways a state can reduce unnecessary expenditures. The Lung Association has a detailed map that provides a state-by-state analysis of the average cost for a pack of cigarettes, the return on investment per dollar spent and the real cost per pack to society and the state's economy. For example, tobacco use in Maine costs the state’s economy almost $1.6 billion. For every dollar the state spends on tobacco cessation it saves $1.41. That means each year the potential savings is over $5 million. Tobacco use costs Georgia over $9 billion. If Georgia fully funded tobacco cessation it could save $22 million, or a return on investment of $1.28 for every dollar spent.

Disparities also exist across economic lines. While 20 percent of the total US population smokes, the percent for those on Medicaid or who are uninsured is 36 percent and 33 percent, respectively. Only five states have comprehensive coverage to help tobacco users on Medicaid quit, and two states (both in the bottom 5) have absolutely no coverage for Medicaid enrollees. That means a Medicaid enrollee in Pennsylvania has a greater chance of quitting because of the comprehensive benefits.

If the benefit of supporting tobacco cessation are so transparent and obviously outweigh the costs, then why don’t more states participate? Many states are simply short sighted about funding tobacco cessation. The healthcare system of the United States is known for being more reactionary than proactive. More money is spent on treating diseases when preventing them in the first place is so much less expensive. However, during a budget crunch with cuts to Medicare and Medicaid funding you’d be hard pressed to convince the state to spend more money, regardless of the long term outcome.

If you’re feeling hopelessly discouraged at this point, be reassured that good things are happening too. Military families are much closer to achieving long-overdue tobacco cessation coverage. Medicaid programs are now required to provide a comprehensive tobacco cessation benefit to pregnant enrollees. On January 1, 2013 when the Medicaid Preventive Services Incentive Begins, Medicaid programs that cover preventive services will receive an increase in matching funds from the federal government. By 2014, state Medicaid programs will no longer be able to exclude tobacco cessation medications from coverage.

What you can do:

• Advocate for improved cessation benefits by sending a message to Kathleen Sebelius, Secretary of Health and Human Services
• If you use tobacco, call 1-800-QUIT-NOW to find out what benefits you may be entitled to