Expert Commentary

Tobacco cessation: Gaps in efforts to get Medicaid recipients to quit smoking

2016 study in Health Affairs that looks at the effectiveness of Medicaid programs in getting enrollees, who are twice as likely to smoke as the general population, to stop using tobacco.


In 2014, almost 17 percent of U.S. adults smoked cigarettes, and the rate was much higher within poor communities, according to the U.S. Centers for Disease Control and Prevention (CDC). More than 26 percent of adults living below the federal poverty level smoked.

State and federal policymakers strive to reduce the number of low-income adults who use tobacco because of the serious health consequences but also because treatment for smoking-related illnesses is expensive, costing the American public billions of dollars a year. Medicaid, which is jointly funded by the states and the federal government, provides health insurance for low-income individuals.  A 2014 study published in the American Journal of Preventive Medicine estimates that 15 percent of all Medicaid spending – about $40 billion a year — went toward treating smoking-related illnesses between 2006 and 2010.

Four researchers from George Washington University who specialize in health policy teamed up to take a closer look at how Medicaid could do a better job reducing the number of Medicaid enrollees who are smokers. The group, led by Leighton Ku, director of the Center for Health Policy Research at George Washington, looked specifically at how effectively Medicaid programs in each state promote smoking cessation. The study, “Medicaid Tobacco Cessation: Big Gaps Remain In Efforts to Get Smokers to Quit,” was published in 2016 in the journal Health Affairs.

For their analysis, Ku and his colleagues collected data from the federal Centers for Medicare & Medicaid Services to determine how often Medicaid enrollees received prescriptions for smoking-cessation medications. They focused on the drugs bupropion and varenicline as well as nicotine-replacement therapies such as the nicotine patch and gum. The study’s authors focused on medications prescribed between 2010 and 2013.

The key findings include:

  • In 2013, at least 40 percent of all adult Medicaid enrollees were smokers in the following states: Arkansas, Kentucky, Ohio, West Virginia, Alaska, Missouri, Oklahoma and Tennessee. In Tennessee and West Virginia, 47 percent of adults on Medicaid smoked.
  • In most states, only a fraction of smokers who were in Medicaid in 2013 accessed cessation benefits. Fewer than 5 percent of smokers on Medicaid were prescribed tobacco cessation medications in these states: Alabama, Arkansas, Delaware, Kansas, Mississippi, Rhode Island, Tennessee and Texas. Nationally, approximately one-tenth of adult smokers using Medicaid received tobacco cessation medications in 2013.
  • In 2013, Medicaid spent $103 million nationwide on medication to help smokers quit. That equates to about one-quarter of 1 percent of Medicaid’s estimated cost of covering smoking-related illnesses in a year.
  • The number of prescriptions for smoking cessation medications rose from almost 1.5 million in 2010 to almost 1.8 million in 2011 and then declined to less than 1.7 million in 2013.

The authors note that promoting tobacco cessation should be an important policy objective for Medicaid. But medications prescribed to help people quit smoking are “seriously underused” among Medicaid enrollees in most states. “Most smokers want to quit but need help both to try and to succeed,” the authors state. “The gains from even modest reductions in smoking or from moderate periods of abstinence can be substantial.”

Related research: A 2015 study published in Health Economics, “Cigarette Taxes and Older Adult Smoking: Evidence from the Health and Retirement Study,” indicates that older adults reduce their smoking only modestly when the cigarette tax is raised. A 2014 report released by the Office of the Surgeon General, “The Health Consequences of Smoking — 50 Years of Progress: A Report of the Surgeon General, 2014,” chronicles the long-term impacts of tobacco use in the U.S.


Keywords: tobacco industry, lung cancer, secondhand smoke, antismoking campaign, Zyban, Chantix, Nicorette

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