Health Equity and Accountability Act of 2018 Will Help Smokers Quit and Reduce Health Care Costs

Statement of Matthew L. Myers, President, Campaign for Tobacco-Free Kids
May 23, 2018

WASHINGTON, D.C. –The Campaign for Tobacco-Free Kids applauds Rep. Barbara Lee (D-CA) and Sen. Mazie Hirono (D-HI) for introducing the Health Equity and Accountability Act of 2018, legislation that addresses racial and ethnic health disparities, including disparities in tobacco use in our country. The bill was introduced in the House today and will be introduced in the Senate in the near future. This legislation includes important provisions expanding coverage of comprehensive tobacco cessation services in Medicaid and private health insurance.

This legislation recognizes that tobacco use plays a key role in health disparities in the United States. While the U.S. has made enormous progress in reducing smoking, there are large disparities in who still smokes and who suffers from tobacco-related diseases and death. Smoking rates are highest among people with lower income and less education, American Indians/Alaska Natives, residents of the Midwest and South, LGBT Americans, those who are uninsured or on Medicaid, and those with mental illness. More than a quarter (25.3 percent) of Medicaid beneficiaries smoke, compared to 15.5 percent of all U.S. adults and 11.8 percent of those covered by private insurance.

The Health Equity and Accountability Act requires comprehensive tobacco cessation coverage for all Medicaid recipients and assures that all available forms of evidence-based tobacco cessation treatments – currently individual, group and telephone counseling and seven FDA-approved medications – are available to Medicaid beneficiaries without cost-sharing or preauthorization. A recent CDC report found that, while states have made progress in providing such coverage, only 12 states provided Medicaid coverage for individual and group counseling and the seven FDA-approved medications as of July 1, 2017 (only two states, Kentucky and Missouri, provided such coverage without barriers such as co-payments and preauthorization).

The bill provides funding for states to conduct outreach campaigns to educate providers and Medicaid beneficiaries about the benefit so that those who need it utilize it. It also prohibits group and individual health plans from requiring preauthorization for tobacco cessation counseling or cessation drugs that have received an “A” or “B” rating from the U.S. Preventative Services Task Force.

Expanded Medicaid coverage of tobacco cessation services will help more tobacco users quit, saving lives and reducing tobacco-related health care costs, which total $39.6 billion under Medicaid alone. After Massachusetts provided comprehensive Medicaid coverage of smoking cessation services in 2006 and conducted an outreach campaign to raise awareness of the benefit, the smoking rate among beneficiaries declined by 26 percent in the first 2.5 years. The state dramatically reduced hospitalizations for heart attacks and cardiovascular disease among Medicaid recipients, saving more than $3 for every $1 spent on cessation services, studies have shown. The legislation introduced today is inspired by the Massachusetts model.

Tobacco use is the No. 1 cause of preventable death in the United States, killing more than 480,000 Americans and costing the nation $170 billion in health care bills each year. We applaud Rep. Lee and Sen. Hirono for their leadership in addressing this enormous problem, especially among populations hurt the most by tobacco use.