American Lung Association Report Says Affordable Care Act Offers Michigan Opportunities

To Save Lives, Money by Helping Smokers Quit - Coverage in Michigan is mixed

DETROIT MI (07/22/2014)(readMedia)-- With more than 8 million Americans now accessing health insurance through new options in the Affordable Care Act (ACA), there has never been a more crucial time for policymakers and insurance plans to act to save lives–and public dollars-by expanding and easing access to tools and treatments to help smokers quit, according to the American Lung Association's "Helping Smokers Quit: Tobacco Cessation Coverage 2014" report.

Released today, the annual report notes that many lives and billions of state and federal dollars– including over $800 million in Medicaid spending –could be saved by ensuring that coverage under the ACA comprehensively helps smokers end their nicotine addiction.

The Lung Association's annual report reviews each state's efforts to help smokers quit and provides an up-to-date look at federal coverage and requirements for quit smoking treatments under the Affordable Care Act.

The state of Michigan's coverage of cessation services was mixed this year. Michigan does cover individual and phone counseling for cessation and some of the FDA-approved cessation medications for Medicaid recipients, but other cessation services vary by plan. The tobacco cessation coverage for state employees is mixed, with the cessation counseling and medications covered varying by plan.

"Smoking costs the state Medicaid program $1.1 billion a year in Michigan. Comprehensive coverage of cessation services for Medicaid recipients is a smart move that would help reduce those costs," said Shelly Kiser, Director of Advocacy for the American Lung Association in Michigan. "However, holes in Michigan's coverage of cessation services both for Medicaid recipients and others leave people without coverage, increasing costs to the state, individuals and employers. We must fill these gaps, because cessation coverage is cost effective and saves lives."

States Could Save Up to $833 Million in Medicaid Spending

The report noted that significant savings in public spending could be achieved by making sure smokers on Medicaid have broader access to comprehensive smoking cessation resources. People enrolled in traditional Medicaid smoke at much higher rates than the general population (30.1 percent versus 18.1 percent for ages 18–65). Smoking-related diseases cost Medicaid programs an average of $833 million in taxpayer dollars per state in 2013. The Lung Association's report determined that:

• Several states, including Alabama, Connecticut, Georgia, Maine, Ohio and Vermont, improved Medicaid cessation coverage for smokers since last year;

• Only two states provide comprehensive cessation coverage for all Medicaid enrollees: Indiana and Massachusetts;

• Thirty five states charge copays for tobacco cessation treatments for individuals enrolled in Medicaid – even though evidence shows copays discourage use of treatment and many plans with higher-income enrollees are prohibited from charging them.

Tobacco use is the leading preventable cause of death in the United States, costing our economy up to $333 billion annually. In the report, the American Lung Association asserts that:

• Every smoker, including those on Medicaid, needs access to a comprehensive tobacco cessation benefit

• Quit smoking treatments must be provided at no cost and be easy to access

• Insurance plans and employers should publicize what treatments are available and how to access them

• Insurance plans and employers should not make it harder for tobacco users to afford health insurance by charging them more in premiums

A comprehensive quit smoking benefit includes all medications FDA-approved for smoking cessation and three types of cessation counseling recommended by the Public Health Service Guideline on Treating Tobacco Use and Dependence:

• Nicotine gum

• Nicotine patch

• Nicotine lozenge

• Nicotine nasal spray

• Nicotine inhaler

• Bupropion

• Varenicline

• Individual counseling

• Group counseling

• Phone counseling

In addition to making all these treatments available, the American Lung Association says that insurance plans and policymakers must help smokers by not requiring copays or prior authorization, and not limiting the number of times a smoker can get the benefit per year or lifetime.

"Investing in smoking cessation programs has shown up to a 3-to-1 return on investment," said Kiser. "And we know the 2014 Surgeon General's report concluded that today's cigarette is more deadly and addictive than ever, making this investment not only smart, but necessary."

Tobacco Surcharges May Put Health Insurance Out of Reach for Families

The ACA allows individual and small group insurance plans to charge tobacco users up to 50 percent more in premiums than nonsmokers. This surcharge can be a difference of thousands of dollars per year for a smoker, and the Lung Association is concerned surcharges could make health insurance unaffordable for tobacco users and their families. Eleven states, however, have chosen to limit or prohibit these surcharges. Michigan, however, does not limit surcharges.

Lack of Information about What Private Health Plans Cover Makes it Hard for Patients to Make Healthcare Choices

With new requirements for preventive services being implemented and more patients enrolling in health coverage through the ACA, the public is encountering barriers to accessing information on what treatments health plans actually cover, including smoking cessation treatments. Patients need this information to make informed choices when selecting and enrolling in healthcare plans. Additionally, this transparency is needed to evaluate whether plans are providing the right treatments to smokers who want to quit and other patients. The American Lung Association urges HHS and state policymakers to require that health plans make this information publically available.

To help inform decisions and address outstanding needs for providing comprehensive smoking cessation coverage, the American Lung Association created an Action Plan for Policymakers, listing critical steps to be taken by the federal government, state governments and health plans, employers and health systems to ensure that those who want to quit get the help they need to succeed. The plan can be found as part of the entire report, found at www.lung.org/helpingsmokersquit.

Three Bold Goals

In January 2014, the American Lung Association and our public health and medical partners announced our plans to end tobacco use through the creation of three bold goals:

1. Reduce smoking rates, currently at about 18 percent, to less than 10 percent within 10 years;

2. Protect all Americans from secondhand smoke within five years; and

3. Ultimately eliminate the death and disease caused by tobacco use.

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About the American Lung Association in Michigan

As the oldest voluntary health organization in the United States, the American Lung Association's mission is to prevent lung disease and promote lung health. As a charter member of the nationwide organization, the American Lung Association in Michigan is committed to carrying out this mission in Michigan. In communities throughout the state, the American Lung Association is working to improve life one breath at a time through education, advocacy and research. The American Lung Association in Michigan is funded by public donations, along with gifts and grants from corporations, foundations, government agencies and nongovernmental organizations. From tuberculosis to asthma, from tobacco control to clean indoor and outdoor air, the lung health successes achieved during the American Lung Association's century of service have been gained only through the work of thousands of committed volunteers, dedicated staff and generous supporters. For more information about the American Lung Association or to support the work it does, call 1-800-LUNG-USA (1-800-586-4872) or log on to www.alam.org.