Alabama    CHAPTER

The Alabama Chapter of the American College of Cardiology

2010 Smoking Cessation

THE RIGHT PRESCRIPTION:  SMOKING CESSATION BENEFITS FOR ALABAMA MEDICAID RECIPIENTS

(Published in The Montgomery Advertiser, March 31, 2010)

The financial obligations our state faces in 2010 are some of the toughest in its history.  The economic downturn and level of unemployment have strained many of our State resources including the Alabama Medicaid Budget.  That’s why is never been a better time to focus resources on Smoking Cessation which has the unique opportunity to improve heath and save costs for the State.

Patients in 84% of the nation's Medicaid programs have access to tobacco-dependence treatment, but the availability and extent of coverage varies significantly.  Adult tobacco use has halved since the 1960s, but low-income populations, including Medicaid users, have maintained a higher rate of smoking than the general population (33% versus 20%).   A report from the Centers for Disease Control and Prevention (CDC) found quitting rates increased when patients were given access to comprehensive tobacco-dependence treatment, such as those available through Medicaid programs.  Effective ways to break the habit — from counseling and support groups to nicotine patches, gum and new prescription remedies like Chantix and bupropion are effective but are added costs for those of limited means attempting to quit.

Every state in the US struggles to provide necessary services through Medicaid but now over 44 states have made the wise decision to provide funding for Smoking Cessation.  In part, these decisions were made because of the savings, which can amount to tens of millions of dollars, are real.  In fact, studies have shown that for every dollar spent on smoking cessation, states realize an estimated $1.90 to $5.75 in economic gains.  For instance, a study of state-level Medicaid expenditures shows 52% of Medicaid recipients smoked in 2004. This means almost $1 in every $10 spent by Medicaid (9%) is attributable to the effects of smoking.  In all, Alabama spent $285 million in 2004 on Medicaid payments that could be eliminated if we could wipe out smoking.

 A similar attempt to provide smoking cessation in Massachusetts was made by Medicaid, and the program saw a stunning one-quarter decline in the rate of smokers in only 2½ years, after decades of stable smoking rates. Additional dramatic results were reported by the Massachusetts Department of Public Health showing that the hospitalizations for heart-attacks dropped 38 percent, asthma visits dropped 17 percent, and complications in childbirth declined 17 percent for Medicaid clients in the smoking cessation program.  These results speak for themselves and the opportunity to show the same stunning results in Alabama are upon us.

Alabama’s Medicaid program did take a step forward earlier this year and began offering smoking cessation benefits to pregnant women.  Through this effort Alabama is taking the first critical step to save money and more importantly the lives of Alabama’s newest citizens.  Smoking has been proven to slow fetal growth and significantly increase a woman’s risk of having a low birth weight baby.  It also increases the risk of preterm delivery.  These infants have a greater risk of serious health problems and an overall a greater risk for mortality.  This is important not only because the health of these children can be affected long term, but also because Alabama Medicaid paid for more than 40% of all live births in Alabama.

Expanding these services to all of Alabama Medicaid stands to make our State one of the biggest gainers based on the CDC data that more than one million people in Alabama are smokers.  Yet, when a Medicaid patient comes to his or her doctor seeking help in the fight to kick this addictive substance, he is told that Medicaid does not cover the costs of prescription drugs, over-the-counter medications, or even counseling sessions to help the patient kick the habit.

Medicaid services should attempt to pay for the CDC recommendations of a smoking cessation programs includes at least four counseling sessions of at least 30 minutes each and appropriate prescriptions or over-the-counter medications.  Studies show smokers who take part in such cessation programs are more likely to successfully quit smoking.

 The savings we would realize in our state extend far beyond that $285 million, but also include lost productivity and wages, the savings from dealing with the effects of second-hand smoke on children who, in turn, have higher incidences of asthma attacks and respiratory illness—some of which result in costly hospitalizations.  The savings begin almost immediately—as soon as the number of cigarettes smoked declines.

All citizens of Alabama, not just those on Medicaid benefit from these expenditures. Every time a Medicaid patient incurs a cost related to smoking, the tab comes to you and me, the taxpayers.  Businesses and families would benefit in other ways, particularly through a reduction in the cost of state employee insurance programs and other statewide healthcare programs.

The best pay-off of all: A reduction in the average of 7,400 people who die annually in our State as a result of smoking. What would it be worth to us to have more of our mothers and fathers, sisters and brothers remain with us far longer just by kicking the habit?

We need to move quickly. The consequences are clear: Tobacco is the No. 1 preventable cause of death in Alabama, killing 7,400 adults each year and costing the state $1.49 billion.  The right prescription is clear:  Medicaid should step up and make smoking cessation a priority in Alabama.

Sincerely,

Paul B. Tabereaux, M.D., F.A.C.C.
Alabama Chapter of the American College of Cardiology

19 South Jackson Street
Montgomery, AL  36104
334-954-2574
 

Other Materials

• Photo Gallery from the February 17 Tobacco Free Press Conference
• Article by Paul Tabereaux, M.D.: It's time to outlaw public smoking