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Nebraska’s job unfinished in smoking-cessation push

Dr. Morrow is an associate professor of medicine in the Pulmonary, Critical Care and Sleep Medicine Division at Creighton University. Wadum is director of advocacy for the American Lung Association in Nebraska.

By Lee Morrow, M.D. and Mike Wadum

Nebraska’s Clean Indoor Air Act has been in place for six months, prompting many smokers to kick the habit.

And, thanks to the hard-won efforts of Gov. Dave Heineman, state lawmakers and others, Nebraska Medicaid recipients and state employees are aided by health plans that offer comprehensive smoking cessation coverage.

This is good news considering that the national adult smoking rate rose last year for the first time in 15 years, according to the U.S. Centers for Disease Control and Prevention (CDC).

Clearly, the battle is not over — not nationally nor in Nebraska, where many of the state’s estimated 245,800 adult smokers still lack access to comprehensive smoking cessation plans that include multiple quit attempts, support and FDA-approved medications.

Given that national studies indicate 70 percent of smokers want to quit but that without assistance only 5 percent remain tobacco-free for three to 12 months, this is a serious oversight. With a comprehensive smoking cessation program, studies show that up to 52 percent of smokers remain tobacco-free for up to six months.

Seven states — Colorado, Maryland, New Jersey, New Mexico, North Dakota, Rhode Island and Oregon — recognize this and have mandated that public and private health insurers provide tobacco cessation coverage. These states recognized that there is enormous potential for saving lives, reducing health care costs and boosting workplace productivity through such legislation.

Consider these facts:

— Tobacco use is the leading cause of preventable deaths in the United States, directly killing some 392,600 Americans — including nearly 2,400 Nebraskans — each year.

— The CDC estimates that the U.S. economy loses $75.5 billion a year to the medical costs of tobacco use. Nebraskans pay $537 million in tobacco-related health costs each year.

— Tobacco use is the leading cause of lost productivity in the workplace, costing the United States $92 billion annually, according to the CDC. In Nebraska, tobacco use accounts for $500 million in lost productivity each year.

— A definitive report, “The Price of Smoking,” finds that the cost to the smoker and society is $220,000 for a 24-year-old man and $106,000 for a 24-year-old woman over a lifetime.

Study after study finds that the best way to combat these statistics is through universally available and comprehensive tobacco cessation programs. According to a report released in November by the American Lung Association (ALA), “State Cessation Coverage 2009 — Helping Smokers Quit,” smoking cessation ranks among the top three services for preventing health consequences.

And the price is right. Research funded by the Robert Wood Johnson Foundation and published in the journal Inquiry found that coverage of smoking cessation services would have a net cost to a managed care or- ganization of just 61 cents or less per member per month.

Among the recommendations in the new ALA report:

— All health care plans fully cover comprehensive smoking cessation programs for all of their members. The CDC defines comprehensive coverage as programs that include first-line medications, multiple quit attempts and group counseling.

— Health care plans provide smoking cessation programs free of barriers such as co-pays, duration limits, prior authorization requirements and other requirements for cessation medications and counseling.

— State legislatures and/or insurance regulators require all insurance companies operating in the state to cover defined, comprehensive smoking cessation treatments as a standard benefit and require these companies to publicly and annually report the number of covered lives with access to comprehensive treatment.

The American Heart Association (AHA) also recommends state action to curb tobacco use. According to AHA CEO Nancy Brown, “legislators in states with high smoking rates must redouble their efforts to increase tobacco excise taxes, use that money to fund comprehensive programs to prevent children from starting to use tobacco and help current smokers quit.”

Over the past two years, despite significant opposition, Nebraska lawmakers passed the Clean Indoor Air Act and provided comprehensive smoking cessation coverage to two major groups of residents — Medicaid recipients and state employees.

Now it’s time to finish the job by enacting legislation to require all commercial insurers in the state to include comprehensive smoking cessation coverage. Only then will every insured Nebraskan have the best chance possible of kicking the tobacco habit.

Published Monday December 7, 2009 in the Omaha World-Herald

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