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Public Health Experts Call on Insurers to Comply with the ACA Requirement to Provide Tobacco Cessation Assistance to All Tobacco Users

Statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids
November 19, 2014

WASHINGTON, DC – An article published today in The New England Journal of Medicine by leading public health experts underscores why it is critical for health insurers to comply with the Affordable Care Act (ACA) requirement that all smokers are entitled to screening, counseling and FDA approved medication to help them quit smoking. The article concludes that the law “should substantially increase tobacco users’ access to proven cessation treatments that could help thousands of smokers quit,” and that doing so will reduce health care costs.

In May, the Obama Administration took a much-needed step to ensure compliance with the law by clarifying for insurers the minimum, evidence-based tobacco cessation services they are required to cover. This guidance informed insurers they must cover, without cost-sharing, screening for tobacco use and at least two quit attempts per year. Coverage for each quit attempt should include four tobacco counseling sessions of at least 10 minutes each (including telephone, group and/or individual counseling) and all Food and Drug Administration-approved tobacco cessation medications, including both prescription and over-the-counter (OTC) medications.

In today’s NEJM article, authors Tim McAfee, Stephen Babb and Simon McNabb of the CDC’s Office on Smoking and Health and Michael Fiore of the Center for Tobacco Research and Intervention, University of Wisconsin School of Medicine and Public Health, stress the importance of ensuring compliance with the law and this guidance. They write, “Physicians, insurers’ associations, and state health and insurance officials can play key roles in ensuring that health plans and insurers are aware of and follow this guidance. If all insurers provide such coverage, they will all benefit when people quit smoking, even when those people switch insurers.

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, with no cost-sharing such as co-pays. Tobacco cessation treatments received an A grade, with the task force finding that a combination of medication and counseling is most effect at helping tobacco users quit.

The Administration’s guidance established a minimum standard for what insurers must cover and provides tobacco users with an important tool to help them get the required coverage and treatment. It is critical that federal and state governments effectively enforce this standard and ensure that insurers provide the necessary coverage, especially given evidence that many may have so far failed to do so.

However, prior to the Administration’s guidance, there was evidence that health plans were not providing the required cessation coverage. A 2012 report conducted for the Campaign for Tobacco-Free Kids by Georgetown University researchers found that tobacco cessation treatment coverage mandated by the ACA varies significantly across private health insurance contracts.

The new Surgeon General’s report released in January (The Health Consequences of Smoking – 50 Years of Progress) underscored the importance of doing more to help tobacco users quit. The report found that smoking is even more hazardous and takes an even greater toll on the nation’s health than previously reported. It found that smoking annually kills 480,000 Americans – causing about one in every five deaths – and costs at least $289 billion in medical bills and other economic losses. As the Surgeon General’s report notes, in 2011 nearly 70 percent of adult smokers indicated they wanted to stop smoking and 43 percent had made a quite attempt.

Noting that the “current rate of progress in tobacco control is not fast enough,” the report called for a number of specific actions, including “fulfilling the opportunity of the Affordable Care Act to provide access to barrier-free proven tobacco use cessation treatment including counseling and medication to all smokers.”