Health Reform and Tobacco Prevention

November 4th 2009

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Posted by Amy Barkley, Director
Tobacco States and Mid-Atlantic
Campaign for Tobacco Free Kids
 
The House could debate health care reform legislation on the floor as early as this week, with a final vote on a bill likely before Veterans’ Day next week. Meanwhile, the U.S. Senate is still finalizing a bill that should go to the floor for debate later in the month or early December.

 

A critical component of health care reform is disease prevention.  It's often said that the American health care system is more like "sick care" with too much emphasis on treating disease and little effort toward preventing it in the first place. With a greater emphasis on wellness and prevention, a reformed health care system would be a more effective use of health care dollars by addressing the underlying causes of poor health. Nowhere is a focus on prevention more important than in Kentucky, where we have the embarrassing distinction of being number #1 in a host of diseases and health problems, many of which can be avoided with changes in lifestyle and various health behaviors. Chief among them is tobacco use.

 

Keeping kids from ever using tobacco and providing treatment for tobacco addiction will save lives and reduce disease and will lower health care costs over the long run. Each year, tobacco use is responsible for more than 400,000 deaths nationwide and 7,800 in Kentucky. Nearly $100 billion is spent nationwide treating tobacco related illness, and $1.5 billion of that is spent in Kentucky alone. About one in five deaths from coronary heart disease, nearly one in three deaths from cancer, and almost 9 in 10 deaths from lung cancer are attributable to smoking.

To reduce the devastating toll that tobacco takes on our nation, our state and our families, we and other health organizations recommended to the Obama Administration and Congressional leaders that health reform should include the following components:

Require private and public health insurance coverage of tobacco cessation services. Tobacco users should have access to the tools that will improve their chances of quitting. The U.S. Preventive Services Task Force (USPSTF) and the Public Health Service recommend coverage of FDA-approved medications (both prescription and over-the-counter) and counseling sessions. Use of these services has been shown to increase the proportion of smokers who attempt to quit and quit successfully. Private health insurance and state Medicaid programs should be required to cover USPSTF-recommended tobacco cessation services and impose no cost-sharing requirements for using them.

Invest in community-based prevention. State-based, community-based, and school-based tobacco prevention programs and national mass media campaigns have successfully reduced tobacco use. According to best practice guidelines developed by the CDC, state tobacco control programs should include: public education efforts to prevent kids from starting to smoke and encourage people to quit; community-based programs that target populations most impacted by tobacco use where they live, work, play and worship; and cessation programs to help tobacco users quit such as providing access to counseling (e.g., quitlines) and FDA-approved medications. While state tobacco prevention programs and well done national mass media campaigns work, they have been chronically underfunded. In fiscal year 2009, no state committed the level of resources that the CDC recommended for tobacco prevention. Health reform legislation should include a new source of mandatory funding for evidence-based prevention programs with a proven track record of impact, such as tobacco control.

The health reform bills that have been approved at the committee level would make great progress in preventing disease by enhancing coverage of cessation services and investing in prevention.  As these bills move to the House and Senate floor, we and other health organizations will be advocating for preserving these provisions in the final bill.  There's a danger that, in an effort to find a compromise and keep the cost down, investments in prevention could be reduced.  Lawmakers should be reminded that health reform presents an important opportunity to create a health care system that values prevention of disease as much as treatment of disease. There are enormous health gains to be had from reducing tobacco use. Clinical- and community-based efforts have proven to be effective at reducing tobacco use and should be included in health reform legislation.

 

 

 

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