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Report: Ohio's tobacco cessation coverage is lacking

Norwalk Reflector Staff • Dec 3, 2012 at 12:01 PM

The American Lung Association's "Helping Smokers Quit: Tobacco Cessation Coverage 2012" report shows that Ohio is lacking in key cessation resources for its citizens at a time when its smoking rates are the fourth highest in the country (22.5%) and its Medicaid smoking rates (42%) exceed about twice the rate of the general population.

The report, released today, also shows that the United States is at a tipping point when it comes to policies that help smokers quit. The annual report provides a comprehensive review of each state's tobacco cessation coverage and an up-to-date look at federal coverage and requirements under the Affordable Care Act.

"Over the next year, key decisions will be made by the state of Ohio and the federal government about whether or not they will help save lives, prevent disease and reduce health costs," said Shelly Kiser, Director of Advocacy, the American Lung Association in Ohio. "We know that the vast majority of smokers want to quit, but the complex web of state and federal coverage for effective quit smoking programs and treatments prevents too many from getting the help they need. States and the federal government can reduce the enormous health burden of tobacco use by providing access to these proven interventions."

The report's key findings are:

Medicaid Coverage:

• Ohio provides coverage for all recommended cessation medications and nicotine replacement therapy.

• Ohio provides no coverage for any of the three recommended forms of cessation counseling.

• Ohio requires a copayment for tobacco cessation medications which is a barrier to coverage.

State Employee Health Plan and Private Insurance Coverage:

• Ohio's state employee health plan only provides four of the seven recommended cessation medications/nicotine replacement therapies.

• It only covers phone counseling and does not cover individual or group counseling.

• Ohio also does not require private health plans to cover cessation treatment.

Investment in State Quitlines:

• Ohio only spends $0.40 per smoker on the state quitline, though the CDC recommends that the state spend $10.53 per smoker. Also, the Quitline is only available to a limited group of people.

"Giving all smokers access to a comprehensive cessation benefit is not only the right thing to do, it's the smart thing to do. Ohio needs to add counseling to the benefits it provides to Medicaid recipients, and it needs to provide all forms of medication and counseling for its employees," said Kiser. "The bottom line is that quitting smoking saves lives and saves money."

Federal Coverage:

On November 26, the U.S. Department of Health and Human Services (HHS) published a proposed rule that requires the Essential Health Benefit coverage mandated by the Affordable Care Act to cover preventive services, including tobacco cessation. However, because HHS has not yet defined what insurers must include as part of a tobacco cessation benefit, the Administration missed a crucial opportunity. Now, each state can choose its own benchmark plan, which will then serve as the Essential Health Benefit standard for plans in that state's health insurance exchange. Until HHS officially defines a comprehensive tobacco cessation benefit, it has missed a crucial opportunity to provide many smokers with new access to help quitting, and to establish tobacco cessation as a truly essential health benefit for all health insurance coverage.

HHS's failure to act provides an opportunity for states like Ohio, according to the report. Ohio policymakers can now help Ohio smokers quit by including comprehensive tobacco cessation benefits as they implement state health insurance exchanges and Medicaid expansions.

Ohio has notified the federal government that they will not be implementing a state exchange. However, Ohio will retain regulatory control over health insurance plans offered through a federally-operated exchange, as well as retain the authority to determine who is eligible for Medicaid benefits.

"Ohio has an excellent opportunity to help improve the health of its citizens and save taxpayer dollars when it sets up its health insurance exchange," said Kiser. "It's essential that it include a comprehensive tobacco cessation benefit as part of the coverage offered under the exchange."

Tobacco use is the leading preventable cause of death in the United States. The annual healthcare costs in Ohio due to smoking total $4.37 billion annually. Providing comprehensive quit-smoking treatments is crucial in both saving lives and curbing health costs – one recent study showed that providing this help has a 3-to-1 return on investment.

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