Health Reform Bill Makes Vital Investments in Disease Prevention

Washington, D.C. — The health care reform bill approved by the House of Representatives tonight makes necessary investments in proven measures to prevent costly diseases, which will improve health and reduce health care costs. These include measures to prevent and reduce tobacco use, which is 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 contains essential disease prevention initiatives that will help reduce the staggering health and financial toll of tobacco use. These include:

• An expansion of coverage of smoking cessation and other services proven to prevent disease, without cost-sharing by the patient, by group health plans and insurers, including those selling within the newly created insurance exchanges;
• An expansion of Medicaid coverage for smoking-cessation treatments;
• Creation of a new prevention trust fund to finance proven prevention, wellness and public health activities in communities across the nation.

Medicaid: The measure prevents states from excluding tobacco cessation drugs from the medications covered by their Medicaid programs and requires Medicaid to cover smoking cessation treatment for pregnant women, including medication and counseling with no cost-sharing requirements. States that voluntarily cover all recommended preventive services and immunizations for all Medicaid enrollees will get an increase in their federal Medicaid reimbursements. These changes are an important first step to guaranteeing coverage for smoking cessation to all Medicaid recipients.

Medicaid coverage of smoking cessation treatment is critical as lower-income Americans have higher rates of smoking than the general population. About 33 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 $22 billion annual, about 11 percent of all Medicaid costs, according to the CDC.

Remarkable results recently reported by Massachusetts underscore the benefits of comprehensive Medicaid coverage for smoking cessation. The state found that smoking rates among beneficiaries in its 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 are facing severe budget constraints, tobacco prevention and cessation will result in long-term savings by reducing tobacco-related diseases and health care costs.

Prevention funds: The legislation establishes 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. The legislation allocates a total of $7 billion for Fiscal Years 2010 through 2015 to finance prevention, wellness, and public health activities. Funding after that will be $2 billion annually.

Effective prevention will mean fewer premature deaths, less disease and more cost-effective health care spending.