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The Dose

Welcome to The Dose, which tackles the business and economics inside the turbulent world of health care and life sciences in Indiana. Your host is John Russell. To contact me call 317-472-5383.
Health Care / Medicaid / Government Health Care / Health Care Providers / Health Care & Insurance / Health Care & Life Sciences

Light 'em if you got 'em—plenty of Hoosiers on Medicaid doing just that

December 12, 2016

Smoking, low incomes and health insurance. What do they have in common?

Plenty, especially in Indiana.

Nearly one-half of the 1.2 million Medicaid enrollees in Indiana are smokers, one of the highest rates in the nation.

A new report issued by the Centers for Disease Control and Prevention takes a look at the numbers, and has some harsh words for states that aren’t doing enough to help Medicaid enrollees kick the habit.

Incidentally, the study is part of the CDC's "Morbidity and Mortality Weekly Report," which was enough to get our morbid attention.

Cigarette smoking causes about one of every five deaths in the U.S. every year, or more than 480,000 deaths annually. That results in billions of dollars in health-care costs and lost productivity.

Indiana’s rate of 48.3 percent of Medicaid smokers is topped only by New Hampshire (48.8 percent), West Virginia (48.9 percent), Kentucky (50.1 percent) and Pennsylvania (53.2 percent).

The report doesn’t get into some obvious questions, like why low-income people (who make up the bulk of Medicaid enrollees) are more likely to smoke than middle- and high-income people.

But plenty of Medicaid enrollees seem to enjoy their smokes. As of December 2015, approximately 3.3 million adult cigarette smokers were enrolled in Medicaid expansion coverage nationally.

But most of the 32 states that had expanded Medicaid coverage under the Affordable Care Act were not doing enough to encourage people to quit smoking, the report said.

On the bright side, Indiana and eight other states covered all nine cessation treatments for all Medicaid expansion enrollees. Those treatments include individual counseling, group counseling, nicotine patch, nicotine gum, nicotine lozenge, nicotine nasal spray, nicotine inhaler, and prescription drugs bupropion and varenicline.

On the other hand, 13 states charge co-pays for the program, depending on the plan offered. Ten states did not offer group counseling. Many other states sometimes did not offer nasal spray or inhaler, depending on the plan.

That runs against the ACA mandate that preventative services be offered without extra cost to patients.

And all 32 states, including Indiana, “imposed one or more barriers to accessing at least one cessation treatment for at least some enrollees,” the study noted. Indiana requires prior authorization, limits on duration and “annual limits on quit attempts.” Indiana also might requires counseling for medication, depending on the plan.

“States that have expanded Medicaid can take further steps to help smokers quit by covering proven cessation treatments more fully, removing barriers to accessing covered treatments, making Medicaid enrollees and their health care providers aware of these treatments, and monitoring use of the treatments,” the study said.

The bottom line: Indiana and other states have taken Medicaid expansion money under the ACA, but could a lot more to encourage the newly enrolled to ditch the smokes and live longer.

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