Jan. 7 2010
Washington, D.C. — As Congress negotiates a final health care reform bill, lawmakers should seize this unprecedented opportunity to invest in proven measures that prevent costly diseases from occurring in the first place, which will improve health and reduce health care costs. These include measures to prevent and reduce tobacco use, which remains the leading cause of preventable death in the United States, killing more than 400,000 people and costing the nation $96 billion in health care expenditures annually.
The legislation now being crafted by House and Senate negotiators contains essential disease prevention programs that will improve health and reduce costs. These include: A requirement that Medicaid cover preventive services with demonstrated effectiveness, including treatment to help smokers quit, and creation of a prevention trust fund to finance proven, community-based prevention programs aimed at problems such as tobacco use and obesity.
Medicaid coverage of smoking cessation treatment: The final health care reform legislation should require comprehensive coverage of smoking cessation treatment, including medication and counseling with no cost-sharing requirements, for all Medicaid recipients, as the House-passed legislation would. The Senate bill would require such coverage only for pregnant women receiving Medicaid.
Medicaid coverage of smoking cessation treatment is critical as lower-income Americans have higher rates of smoking than the general population, and health care reform is expected to expand Medicaid coverage to millions of new beneficiaries. 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. Medicaid expenditures attributable to smoking total $22 billion annually, representing 11 percent of all Medicaid expenditures, according to the CDC.
Remarkable results recently reported by Massachusetts underscore the benefits of providing Medicaid coverage of smoking cessation treatment. The state found that smoking rates among beneficiaries in its MassHealth program dropped by 26 percent in the first two and a half years after it began providing coverage and promoting use of smoking cessation services in 2006. 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.
Massachusetts' results are early indicators of how much would be gained with a sustained national effort to reduce smoking among Medicaid beneficiaries. Yet, according to the CDC, only six states in 2007 provided coverage of all tobacco-dependence treatments (FDA-approved medications and counseling) to help smokers quit. Though many states are facing severe budget constraints, tobacco prevention and cessation will result in long-term savings for federal and state governments by reducing tobacco-related diseases and health care costs.
Prevention funds: Both the House and Senate bills also would establish a fund to finance proven community-based prevention programs targeting public health problems such as tobacco use and obesity. Americans spend more than $2 trillion a year to treat disease and manage illnesses, and almost three quarters of that money is spent on caring for people whose illnesses we know how to prevent. For example, smoking causes one in five deaths from heart disease, nearly one-third of all cancer deaths and nine in 10 deaths from lung cancer. The lifetime health care costs for individuals who smoke are $17,500 higher than they are for non-smokers.
The Trust for America's Health reviewed prevention programs that already have been tried and found that an investment of $10 per person, per year in proven initiatives to prevent smoking, promote physical activity and improve nutrition could save more than $16 billion a year within five years. That's a return of $5.60 for every dollar invested. While the Congressional Budget Office has not estimated short-term savings from prevention in the health reform bills, it has said that "certain types of preventive services have been found to yield substantial net savings, largely because the initial costs are low and the long-term benefits are large."
The final legislation should adopt the higher 5-year public health and prevention funding level in the House bill and the ongoing funding stream found in the Senate bill. These funds would help finance community-based prevention activities and media campaigns that promote disease prevention. Effective prevention will mean fewer premature deaths, less disease and more cost-effective health care spending.