Most states are failing to curb tobacco use, according to a new report from the American Lung Association. Only Alaska and North Dakota are funding their state tobacco prevention programs at levels recommended by the Centers for Disease Control and Prevention (CDC).

The report found 41 states and the District of Columbia spent less than half of the recommended amount, HealthDay reports. Only Indiana and Massachusetts provide a comprehensive tobacco cessation benefit for Medicaid enrollees. Several states, including Connecticut, Maine and Ohio, made progress toward a comprehensive benefit.

Almost 500,000 people die each year from tobacco-related diseases in the United States, the report notes. “Despite cutting U.S. smoking rates by half in the last 51 years, tobacco’s ongoing burden on America’s health and economy is catastrophic,” said American Lung Association President and CEO Harold Wimmer.

The group found no state passed a comprehensive smoke-free law or significantly increased tobacco taxes in 2014. No state earned an “A” grade for providing access to quit-smoking treatments.

The report did find several bright spots. The federal government last year told insurance companies that all seven smoking-cessation medications approved by the Food and Drug Administration (FDA), as well as three forms of smoking-cessation counseling, should be covered. The group also applauded the FDA’s youth prevention mass-media campaign, as well as the CDC’s highly successful “Tips from Former Smokers” campaign.