Nov. 26 2012
WASHINGTON, DC – Many health insurance plans are failing to provide coverage mandated by the health care reform law for treatments to help smokers and other tobacco users quit, according to a study of insurance contracts by Georgetown University researchers. The authors recommend that federal and state regulators give insurers detailed guidance on what tobacco cessation coverage is required under the landmark Affordable Care Act (ACA).
The ACA requires all new private health insurance plans to cover preventive health services recommended with an A or B grade by the U.S. Preventive Services Task Force (USPSTF), with no cost-sharing such as co-pays. These recommendations include tobacco cessation treatments, which received an A grade. The USPSTF recommends that clinicians ask adults about tobacco use and provide cessation interventions for tobacco users. It found that more or longer counseling sessions improve quit rates and combining counseling with medication is more effective for treating tobacco dependence than either therapy used alone.
To determine how the cessation coverage requirement is being implemented, insurance experts at the Georgetown University Health Policy Institute analyzed 39 health insurance plans sold in six states, including individual, small group, federal employee and state employee plans. The study was commissioned by the Campaign for Tobacco-Free Kids with funding from Pfizer, Inc.
The researchers found that many policies are rife with confusing and conflicting language that could leave consumers uncertain if tobacco cessation treatments are covered and discourage them from seeking these treatments. It also found that many policies included gaps in coverage for cessation counseling and medication and cost-sharing requirements that appear to conflict with the law.
Specific findings include:
"The Affordable Care Act recognized that coverage for preventive care, including helping people quit tobacco, is a critical part of improving health and reducing health care costs in our country," said Matthew L. Myers, President of the Campaign for Tobacco-Free Kids. "Tobacco use is a leading risk factor for cancer, heart and lung disease and other serious chronic conditions. Covering effective tobacco cessation treatments is a smart way for insurers to avoid the cost of future illness, and it is the law."
"It is shocking to see the huge variation in what appears to be a straight forward inexpensive benefit that has significant medical evidence on treatment that works," Mila Kofman, principal author of the report and former Maine Superintendent of Insurance said, "It is even more disappointing to find that some in the insurance industry are trying to avoid covering tobacco cessation treatment as required by the Affordable Care Act."
The report made the following recommendations to federal and state regulators:
"Absent detailed guidance, huge variations in benefits will continue to be a problem, and tobacco users’ access to tobacco treatment will continue to be limited. Finally, absent additional steps by federal or state regulators, the promise of reducing tobacco use — saving lives and saving health care resources — will not be realized fully," the report concludes.
Tobacco use is the leading cause of preventable death in the United States, killing more than 400,000 Americans and costing the nation $96 billion annually in direct medical costs.
The study can be found at http://tfk.org/coveragereport/.