Health Equity and Accountability Act of 2020 Is Critically Needed to Address Health Disparities, Including Those Caused By Tobacco

WASHINGTON, D.C. – The Campaign for Tobacco-Free Kids applauds U.S. Senator Mazie Hirono (D-HI) and eight Senate colleagues for announcing that they plan to introduce the Health Equity and Accountability Act of 2020, which provides a comprehensive strategy for addressing health disparities in the United States, including disparities caused by tobacco use. Among other things, this legislation would significantly increase tobacco taxes and expand coverage for tobacco cessation treatments under Medicaid and private health plans, which are proven strategies to reduce tobacco use and the death and disease it causes.

Senator Hirono is introducing the bill along with Senators Kirsten Gillibrand (D-NY), Jeff Merkley (D-OR), Tammy Duckworth (D-IL), Richard Blumenthal (D-CT), Bernie Sanders (I-VT), Cory Booker (D-NJ), Ben Cardin (D-MD) and Tim Kaine (D-VA). U.S. Rep. Jesus “Chuy” Garcia (D-IL) has introduced companion legislation in the House of Representatives with support from the Congressional Tri-Caucus. 

This legislation comes at a critical time as the COVID-19 pandemic continues to disproportionately harm communities of color and expose longstanding health disparities that must be addressed with urgent national action. Smoking is a major cause of underlying health conditions, including heart disease, lung disease and diabetes, that increase risk of severe complications from COVID-19 and disproportionately impact communities of color. There is also growing evidence that e-cigarette use can harm lung health and increase risk for COVID-19.

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, those who are uninsured or on Medicaid, American Indians/Alaska Natives, residents of the Midwest and South, LGBT Americans, and people with mental illness. In addition, the tobacco industry’s long history of targeting Black Americans with marketing for menthol cigarettes has had a devastating impact. The evidence is clear that menthol makes it easier for kids to start smoking and harder for smokers to quit. African Americans quit smoking at lower rates and die at higher rates than other groups from tobacco-related diseases such as cancer, heart disease and stroke.

The Health Equity and Accountability Act requires comprehensive tobacco cessation coverage for all Medicaid enrollees without cost sharing or preauthorization. These services include individual, group and telephone counseling, as well as seven FDA-approved medications. While states have made progress in providing cessation coverage under Medicaid, only 15 states currently cover all available treatments and only two states cover all treatments without any barriers to access. 

Comprehensive Medicaid coverage of tobacco cessation services is critical as Medicaid enrollees smoke at twice the rate of those with private insurance. It is also cost-effective as Medicaid spends nearly $40 billion a year each year on health care for smoking-related diseases. Importantly, the bill provides needed funding to allow states to conduct outreach campaigns to educate Medicaid enrollees about the program.

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 enrollees, saving more than $3 for every $1 spent on cessation services, studies have shown. 

In addition, the bill doubles the cigarette tax and creates tax parity for other tobacco products. Raising the price of tobacco products is one of the most effective ways to reduce tobacco use, especially among price-sensitive kids.

We applaud Senator Hirono and her colleagues for their leadership in tackling the enormous problem of health disparities at this critical time, including disparities caused by tobacco use. This legislation will improve health and save lives among the most vulnerable Americans.