U.S. Federal Issues

Health Care Reform

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Investing in Prevention to Save Lives and Money

The new federal health care reform law makes vital investments in disease prevention, including tobacco prevention and cessation programs that will help reduce the staggering health and financial toll of tobacco use.

The reforms in the Patient Protection and Affordable Care Act of 2010 include:

  • New coverage under Medicaid to help beneficiaries quit smoking.

  • Expanded private insurance coverage of treatments that help smokers quit.

  • Investments in proven prevention, wellness and public health activities in communities across the nation.

Medicaid

Before the new law, there were no national requirements for tobacco cessation coverage under Medicaid. The new law expands Medicaid cessation coverage in several ways:

  • As of October 1, 2010, all state Medicaid programs must provide a comprehensive cessation benefit for pregnant women with no cost-sharing by the patient.

  • Beginning January 1, 2013, state Medicaid programs that voluntarily cover all recommended preventive services, including smoking cessation, will get increased federal reimbursements.

  • Beginning January 1, 2014, state Medicaid programs will no longer be able to exclude smoking cessation drugs from their prescription drug coverage.

Medicaid coverage of smoking cessation treatment is critical as about 37 percent of Medicaid recipients smoke compared to 20.6 percent of the total adult population, according to the Centers for Disease Control and Prevention. Medicaid expenditures attributable to smoking total $30.9 billion annually.

Remarkable results in Massachusetts underscore the benefits of comprehensive Medicaid coverage that helps smokers quit.

Smoking rates among beneficiaries in the MassHealth program dropped by 26 percent after it began providing coverage and promoting use of smoking cessation services in 2006. Among enrollees 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.

Though many states face severe budget constraints, funding for tobacco cessation yields long-term savings by reducing disease and health care costs. The federal government and the states should provide Medicaid cessation coverage for all beneficiaries, not just pregnant women.
 

Private Insurance

As of September 23, 2010, private group and individual health plans must cover all recommended preventive services, including smoking cessation, without cost-sharing (plans in existence before enactment of the law are exempt from this requirement until they make significant changes to coverage or premiums).
 

Prevention Funds

The health reform law establishes a Prevention and Public Health 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. Effective prevention will mean fewer premature deaths, less disease and more cost-effective health care spending.