Before the Joint Committee on Health Care
Financing
October 3, 2011
The Tobacco Free Mass coalition strongly supports Senate Bill
540, "An Act to Provide for Tobacco Cessation Benefits,"
legislation which would expand access to comprehensive smoking
cessation treatment to individuals who receive their health
insurance coverage through the Commonwealth Care Health Insurance
Program and the Group Insurance Commission (GIC). The measure
would reduce illness and death caused by tobacco use, as well as
reduce health care treatment costs.
Background: The Cost of Tobacco Use
Tobacco is still the top preventable public health killer in
America today. Over 440,000 Americans prematurely die each
year as a result of tobacco use - more Americans than who die of
automobile crashes, alcohol and drug use, AIDS, murder and suicide
combined. Tobacco causes cardiovascular and pulmonary
disease, as well as a vast array of cancers. Nearly 9,000
Massachusetts residents prematurely lose their lives to tobacco
every year!
The incidence of tobacco use is highest among people with lower
income and lower educational attainment. People with lower
income are also exposed to tobacco smoke to a far greater extent
than individuals with higher income. According to the
Department of Public Health ("A Profile of Health Among
Massachusetts Adults, 2009"), low-income individuals (with
incomes under $25,000 per year) are 2.5 times more likely to be
smokers, 1.3 times more likely to be exposed to environmental
tobacco smoke, and, almost 1.4 times more likely to live in a
household where smoking is allowed than the higher income group
(over $75,000 per year).
Tobacco use does more than cause illness and prematurely take
lives. These illnesses also result in costly unnecessary
health care expenditures. According to the American Lung
Association ("Smoking Cessation: The Economic Benefits," 2010),
tobacco use costs Massachusetts over $3.65 billion in direct health
care expenditures each year and in excess of an additional $1.2
billion in lost workplace productivity. We can no longer
afford to ignore these costs - costs borne by the taxpayers and by
purchasers of private health insurance policies!
Over the past two decades, Massachusetts has been slowly eroding
the use of tobacco products by adopting strategies that have been
evidence-based. The Legislature has been a key partner in
those strategies through the passage of the Smoke-free Workplace
Law (including restaurants and bars) in 2004, enactment of a
MassHealth smoking cessation benefit as part of the landmark Health
Reform Law in 2006, and periodic legislation that raised the excise
tax on tobacco products. We urge the Legislature to continue
to support those and other successful evidence-based strategies -
including the strategy set forth in this legislation: The expansion
health insurance coverage for smoking cessation!
Expand Access to Comprehensive and Affordable Smoking
Cessation Benefits
Nicotine is highly addictive, so it's not easy for most smokers
to quit. Earlier this year, the Federal government's first
ever "National Prevention Strategy" listed the expansion of smoking
cessation services as one of four recommended strategies to reduce
the preventable death and illness caused by tobacco
use. They reported that more than 70 percent of smokers
want to quit (citing Dube SR, Asman K, Malarcher, A, Carabollo R.
Cigarette smoking among adults and trends in smoking
cessation--United States, 2008. MMWR 2009;58:1227-32) and the CDC
has indicated that about 47 percent of all smokers actually try to
quit (Centers for Disease Control and Prevention. National Center
for Health Statistics. National Health Interview Survey, 2009), but
because the addiction to nicotine is powerful, only about 4 - 7
percent of those attempts are successful. Tobacco cessation
service, including counseling and medications, are effective in
helping people to quit using tobacco. (Fiore MC, Bailey WC,
Cohen SJ, et al. Treating Tobacco Use and Dependence. A Clinical
Practice Guideline. US Department of Health and Human Services.
Public Health Service, 2008.) Most individuals need
assistance - nicotine replacement therapy, prescription medications
and/or counseling - in order to succeed. The DPH has reported
that: "When a smoker makes a quit attempt, using medications and/or
support more than doubles the chances of quitting for good"
("Cancer Prevention: A Focus on Smoking," presented 3/4/2010).
Tobacco cessation services are also highly cost-effective and
offer a positive return on investment. An American Lung
Association study conducted by researchers at Penn State University
indicated a baseline cost effectiveness ratio of 1.17 - 2.28
depending on the type of intervention. This return on
investment should not surprise us in Massachusetts, given the
success of the comprehensive and affordable MassHealth smoking
cessation benefit implemented in 2006. That program has
now been documented by the DPH in a study of the first 30 months of
its utilization. It reduced the incidence of smoking in the
MassHealth population by 26 percent (from 38.3 percent to 28.3
percent), resulting in significant reductions in hospitalizations
for myocardial infarctions (heart attacks) and coronary
atherosclerosis. Within the 30-month study period, the
Commonwealth saved more than twice as much money as the entire
program cost - and that was just from in-patient savings
resulting from those cardio-vascular illnesses! The study did
not calculate the other savings that also accrued - savings from
other in-patient services avoided (especially those responding to
ectopic pregnancies and hemorrhaging in pregnancy and childbirth),
emergency room visits avoided (including those for asthma attacks),
out-patient visits avoided (to treat smoking-related illness) - nor
did it include long-term savings from cancers avoided, or, savings
from the improved health of people living in households when the
smoker quits. As research on the data continues, it will be
clear that the two-to-one return on investment from
hospitalizations avoided for myocardial infarction and coronary
atherosclerosis is just the tip of a very large iceberg of health
care cost savings.
The lesson learned from the MassHealth experience is that a
cessation program will optimally succeed in saving lives, reducing
illness and reducing costs, if it is comprehensive, affordable and
easy to access. Thus, any smoking cessation initiative should
include coverage for all FDA-approved therapies (and counseling),
allow patients to choose the approach that is most convenient to
them with few restrictions, and, minimize out-of-pocket costs to
patients. It is also important that the availability of a
tobacco cessation benefit be well-publicized and that smokers be
strongly encouraged to utilize it!
This legislation would build on the success of the MassHealth
initiative. It would expand access to smoking cessation
medications, devices and counseling to all other individuals who
receive their health insurance coverage through the Commonwealth of
Massachusetts. Over 160,000 lower-income adults are covered
through the Commonwealth Care Health Insurance Program, and, over
350,000 state employees, retirees and dependents are covered
through the Group Insurance Commission. Not only would
the health status of those individuals be improved by the creation
of a tobacco cessation benefit replicating the MassHealth benefit,
but the cost of their health care would also be lowered for the
taxpayers of the Commonwealth. The DPH has calculated
that if all Commonwealth Care plans were to adopt the gold-level
treatment benefit akin to the successful MassHealth benefit - an
investment costing only about $160,000 in the first year - the
return on investment in medical cost savings would be two-to-one
starting in year two and would grow to about five-to-one by year
five, with total five year savings of over $2.1 million.
Similarly, DPH has calculated that if the GIC plans were to adopt
the gold-level treatment benefit akin to the successful MassHealth
benefit - an investment costing only about $440,000 in the first
year - the return on investment in medical cost savings would be
almost three-to-one starting in year two and would grow to almost
nine-to-one by year five, with total five year savings of over
$10.3 million.
Thus, this legislation would reduce illness and death caused by
tobacco use and save millions of dollars for the Commonwealth of
Massachusetts.
We urge the Committee to report out this measure favorably.
