As congressional leaders negotiate a final health-care reform measure, they should look to Massachusetts for a striking example of why emphasizing prevention should be a priority for all Americans, and for a simple way to help achieve this goal: By getting those insured by Medicaid to quit smoking.
Though the nation as a whole has made progress in reducing tobacco use, low-income people continue to have higher rates of smoking than the general population. In 2007, 33 percent of adult enrollees in Medicaid smoked, according to the Centers for Disease Control and Prevention. The overall rate of smoking among adults in 2008 was 20.6 percent.
This persistently high rate of smoking doesn't have to continue. And it shouldn't.
Massachusetts recently announced extraordinary results from an effort to get more Medicaid enrollees to quit. The state found that smoking rates among beneficiaries in its MassHealth program dropped by 26 percent in just two and a half years.
Costly medical procedures also were reduced substantially. Among the group that enrolled in the smoking cessation program, there were 38 percent fewer hospitalizations for heart attacks and 17 percent fewer emergency-room visits for asthma symptoms in the first year. There were 17 percent fewer claims for maternal birth complications since the benefit was implemented.
Promise for nationwide cost savings
These short-term results are early indicators of just how much would be gained from a sustained national effort to reduce smoking among Medicaid enrollees. Yet states rarely provide coverage of all approved medications and counseling programs to help patients give up tobacco.
As part of the effort to cover the uninsured, the health reform legislation calls for millions of new beneficiaries to be brought into the Medicaid program. We have a genuine chance to improve their health and reduce spending by requiring comprehensive Medicaid coverage of treatment to help smokers to quit. This includes medication and counseling with no cost-sharing requirements, as the House-passed legislation requires. The Senate bill would mandate such coverage only for pregnant women.
Medicaid costs attributable to smoking total $22 billion annually, and represent 11 percent of all Medicaid expenditures. Though many states are facing severe budget gaps, reducing smoking among Medicaid enrollees is a proven way to reduce health care costs among poor adults and children.
Progress is quick
As the Massachusetts experience shows, the gains to health are immediate. The benefits to state budgets materialize quickly as fewer expensive hospitalizations and other treatments are required.
Tobacco use continues to be the leading cause of preventable death in the United States, killing more than 400,000 people each year--more than AIDS, alcohol, car accidents, illegal drugs, murders and suicides combined. It imposes staggering costs on society, including $96 billion in health spending.
Helping Medicaid beneficiaries quit will help spread the gains the country has made in reducing smoking to those who suffer disproportionately from the adverse health affects of tobacco, a killer we know how to defeat.