Coverage for tobacco cessation mandated by health care reform in Massachusetts has made quit smoking assistance more accessible to residents receiving Medicaid and has reduced smoking rates, according to a study published on 18 March 2010 in the journal PLoS ONE.
Studies have shown that despite recent declines in smoking prevalence in the United States, smoking among people receiving Medicaid – government health insurance for the poor – has remained 65 percent higher than in the rest of the population.
“Tobacco cessation treatment is cost-effective and should be made available to all smokers via health insurance benefits,” the study suggested.
Tobacco Cessation Coverage in Massachusetts
In April 2006, Massachusetts passed a health care reform law requiring all residents to have health insurance. The law also mandated tobacco cessation coverage for all Massachusetts residents under Medicaid. The new benefit included behavioral counseling and all medications approved for tobacco cessation treatment by the U.S. Food and Drug Administration (FDA).
Between July 2006 and December 2008, more than 70,000 Massachusetts Medicaid subscribers – 37 percent of all smokers under Medicaid – used the newly available benefit. Prior to 2006, MassHealth (the Massachusetts Medicaid program) did not provide tobacco cessation benefits.
MassHealth subscribers are allowed two 90-day courses per year of FDA-approved medications for smoking cessation, including over-the-counter medications like nicotine replacement therapy, and up to 16 individual or group counseling sessions. Co-payment for medication is minimal at $1 or $3. Detailed information on the benefit design and reimbursement rates is available from the Massachusetts Department of Public Health’s QuitWorks program.
Smoking Rates Reduced by Tobacco Cessation
The smoking rate among adults aged 18-64 years subscribed to MassHealth declined 26 percent from 38 percent before the mandated tobacco cessation benefit to 28 percent after the benefit.
Successful quit attempts increased from seven percent to 19 percent even though the percentage of smokers who attempted to quit remained about the same (62-67 percent). The highest reductions in smoking rates were among men (32 percent decline), adults aged 18-24 (41 percent decline), and high school graduates and those with some college (26 percent decline each).
Additional Measures Contributing to Declines in Smoking Rates
Around the same time the study was conducted, an anti-smoking media campaign ran in Massachusetts from November 2007 to January 2008; pharmaceutical companies advertised products for cessation; and in July 2008, the state excise tax increased by $1 per pack and the state quitline began offering free nicotine patches to callers.
The proportion of MassHealth subscribers among quitline callers did not change between 2005 and 2008. “Thus, it seems unlikely that broad-based actions such as advertising, as opposed to the tobacco cessation treatment itself, are the primary explanations for MassHealth subscribers' higher quit rate over the last two years,” the study said.
Reference:
- Land T, Warner D, Paskowsky M, et al. Medicaid coverage for tobacco dependence treatments in Massachusetts and associated decreases in smoking prevalence. PLoS ONE 2010;5(3): e9770.
Juan Ramos - Juan Ramos is a health communication specialist based in Boston, Massachusetts, USA. He has worked in the non-profit sector for more than ...
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