Across the country health insurance coverage for smoking cessation treatment – both counseling and medications – has been extremely patchy. For example, we ask all the new patients attending our smoking cessation clinic in New Jersey if their insurance covers smoking cessation treatment, and the vast majority have no idea. Typically its also not easy for either the patient or provider to find out either. It doesn’t just depend on the insurer, but on the plan, the type of service, what they’ve already had in terms of preventive care. We’ve had many occasions where we call the insurer twice on the same day and get a different answer. And New Jersey is a state that is supposed to have relatively good insurance coverage for tobacco cessation! So it’s a mess nationwide, and the net result is that fewer patients get the treatment they need because they are put of by the uncertainty about the cost and difficulty finding out how much it is.
In the United States we are also seeing a growing gap in smoking rates between those on a low income and those on a higher income. Recently the State of Massachussetts decided to conduct a pilot study to try to address some of these problems. The plan was to create a new smoking cessation benefit for all of Massachusetts Medicaid beneficiaries covered by the MassHealth plan. The benefit was pretty comprehensive in that it covered all the FDA-approved smoking cessation medicines, plus both group and individual counseling as provided by an approved Medicaid provider or a trained smoking cessation counselor working with that provider.
On November 18, Massachusetts released a study showing that their comprehensive cessation programs have saved lives and money. The study released by Massachusetts found that in the two years since this coverage has been in place, 26 percent of smokers on Medicaid quit – that’s 33,000 fewer smokers in Massachusetts! The study also found a decrease in the number of hospitalizations for heart attacks, emergency room visits for asthma, and claims for maternal birth complications.
The Boston Globe reported on these results here.
Last week I participated in a webinar meeting in which those responsible for evaluating the MassHealth study explained the results they have so far. Their analyses are not yet completed but the results so far are already clear enough to conclude that this experiment was a resounding success. I am sure we will be hearing a lot more about these results once the investigators have had time to properly write them up and get them published. But it is appropriate for them to release these initial results because they are highly relevant to the healthcare plans being formulated by US legislators right now.
This study comes at a time when the U.S. Senate is debating health care reform, including whether or not to cover smoking cessation for Medicaid recipients. This report makes it clear that Medicaid should cover comprehensive cessation services. This means covering all FDA-approved smoking cessation medicines and both individual and group counseling when provided by an approved provider. This will also require that in many states, including Mass. More health professionals will have to be trained to provide quality smoking cessation counseling.
For me the main conclusions from this study were:
1. Medicaid covered smokers ARE interested in quitting smoking and will use a cessation benefit if they know about it and barriers to using it are eliminated.
2. A comprehensive Medicaid insurance benefit can be used by a significant proportion of covered smokers, AND reslts in a significant reduction in smoking rates.
3. The reduction in smoking rates resulting from the benefit are of sufficient magnitude to result in measurable reductions in hospital rates of heart attack, asthma and pregnancy complications.
4. Because these smoking-caused diseases are very expensive to treat, the smoking cessation benefit is actually cost saving rather than expensive.