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Guest commentary / Disease prevention

Helping folks quit smoking should be at core of health insurance

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By Jeff Harris
Imagine the following scenario. Doctors identify a major cause of cancer and heart disease. Those at risk from this cause overwhelmingly want to take action to eliminate the risk. Helping these folks would save huge sums of money both for them and taxpayers. And the solution is fairly simple.
The problem? Nobody wants to take the first step.
This is the situation we face today with regard to helping people quit smoking and using tobacco, by providing them access to the effective treatments now available to help the 70 percent who would like to quit. Many insurance companies don't offer coverage for these treatments to most of their members, despite the fact that many of the insurers admit they would save money even in the near term.
The problem is that the playing field isn't level for those insurers, making it risky to take the first step. Fortunately there is a solution before the Legislature, Senate Bill 5039, which would level the playing field and allow Washington to access the significant savings from helping people quit. Passing this bill would allow Washington to benefit from four simple, but powerful, truths about tobacco.
First, smoking is still too common, and most smokers want to quit. In 2009 in Washington, 14.9 percent of adults aged 18 years and older smoked. Of smokers, 70 percent want to quit.
Second, tobacco cessation treatments work. Most smokers attempt to quit more than once before they succeed, and using recommended cessation treatment increases success. The more help smokers get, the better the odds of quitting. Smokers receiving professional counseling can double their quitting success. Smokers receiving FDA-approved cessation medications can also double their quitting success. Smokers receiving combined counseling and medications can almost quadruple their quitting success.
Third, tobacco cessation treatments are inexpensive to insurers. At Group Health Cooperative, the cost of providing full insurance coverage for tobacco cessation treatment was only 41 cents per member per month 15 years ago when smoking was much more common. A more recent analysis of insurance data from Wisconsin found that the cost of fully covering cessation medications was 13 cents per member per month.
Fourth, when smokers quit, the savings add up quickly. America's Health Insurance Plans, the organization that represents the U.S. health insurers, has created a website to make the business case for covering tobacco cessation treatment to their members. It estimates a positive return on investment in the third year to insurers who cover tobacco cessation treatment.
Additionally, the Massachusetts Medicaid program found that in the two-and-a-half years after providing coverage to help people quit, smoking prevalence among Medicaid beneficiaries plummeted, from 38 percent to 28 percent. Among those who used cessation treatment, hospitalizations for heart attacks and coronary disease each dropped by nearly half. Savings to the Medicaid program were three times the costs of the treatment.
To realize these savings, however, we need to give those trying to quit access to treatment, and insurance coverage for tobacco cessation treatment remains largely unavailable in Washington. The 2008 WA Healthy Worksite Survey found that only 34 percent of Washington employers offer insurance coverage for tobacco cessation treatment.
Now is the time to act. In the past two years, Washington has dramatically cut funding for one of the most effective state tobacco control programs in the country. One of the services most heavily cut has been tobacco cessation treatment available through the State Quit Line. An insurance mandate for tobacco cessation treatment would not replace the State Quit Line, but it would go a long way toward providing access to cessation treatment for Washington's smokers trying to end their deadly tobacco use.

Jeff Harris is director of the Health Promotion Research Center at the University of Washington, a CDC Prevention Research Center, emphasizing chronic disease prevention.

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