Commentary: The Bottom Line for New Mandatory Insurance Coverage of Tobacco Cessation Services

At a time when financial resources for tobacco control are scarce, a new federal law expands insurance coverage to cover tobacco cessation services. Under the 2010 Patient Protection and Affordable Care Act (ACA), private insurance plans as well as Medicaid must now cover tobacco cessation services with little to no cost sharing for patients.

While we acknowledge this as an important step toward universal insurance coverage for comprehensive tobacco cessation services, it must be pointed out that the ACA law only requires mandatory coverage for pregnant women covered by Medicaid, leaving other Medicaid beneficiaries out of the mandatory coverage provision. Ironically, this population – mainly of low socio-economic status – represents the group most affected by the tobacco epidemic. Smoking rates among Medicaid enrollees is nearly double that of the general population (37% compared to 21% in 2009). Millions of smokers – who need this coverage the most – are being left behind, and the ACA’s requirement for expanded Medicaid coverage without tobacco cessation for low-income populations may cause this disparity to grow. No matter what side of the debate you are on in terms of universal health coverage, the gap in mandatory tobacco cessation services for most Medicaid enrollees is shortsighted.

Smoking is the single largest cause of preventable death and disease. The return on investment in efforts to reduce it is high in health care dollars saved, productivity gains and years of life. Take these facts: Tobacco cessation has long been regarded as the gold-standard for effective clinical preventive services, and in 2008, a study published in the American Journal of Preventive Medicine found tobacco cessation to be one of the three most effective clinical preventive measures available, equivalent to childhood immunizations and aspirin therapy for heart disease. This placed it ahead of commonly covered services such as colorectal cancer screening and influenza vaccinations.

Additionally, many studies have shown that coverage of cessation services results in cost savings. In 2007, a study sponsored by Legacy found that a 10 percent reduction in smoking in the Medicaid population would results in a savings to the program of $971 million after five years. These projections have come to light recently in states like Massachusetts. According to one study, the state saved more than $3 for every $1 it spent on services to help beneficiaries in its Medicaid program quit smoking. Looking at the provisions of ACA, a Bloomberg Government study found that cessation coverage would result in $115.5 million of savings in its fifth year.

In summary, there is little controversy regarding the effectiveness and efficiency of providing insurance coverage for tobacco cessation. Extending Medicaid coverage to the wider group of beneficiaries will not only save lives, it will save money, too.

David Dobbins
Chief Operating Officer
Legacy