Should State Help Smokers Kick Habit?

JEFFERSON CITY -- Helping people quit smoking doesn't just boost their health. In the long run, it can boost state budgets.

That's the pitch health care advocates are using to urge the Legislature to pay for counseling, medication, nicotine gum and patches for low-income people who want to kick the habit.

Missouri is one of only six states that don't cover tobacco cessation programs for people on Medicaid, the state and federal health care program for the poor. An oversight committee set up by the Legislature to recommend Medicaid policies will consider the issue today.

One-third of the adults on Medicaid in Missouri smoke. The cost: $532 million in medical expenses related to smoking, according to the federal Centers for Disease Control and Prevention's latest estimate in 2004.

State Medicaid officials sought $20.8 million in state and federal money to pay for counseling and anti-smoking aids next year. But Gov. Jay Nixon rejected the request.

"The governor felt it was most important to provide health care to as many Missourians as possible before we begin adding particular medical services," said Jack Cardetti, Nixon's spokesman.

Nixon wants to focus on recruiting eligible children and covering parents who live in poverty. In all, 62,000 people would gain Medicaid benefits under his proposal. The governor also backed spending $1.5 million on education programs aimed at preventing youths from smoking.

The March of Dimes wants the Legislature to fund both youth prevention and Medicaid anti-smoking assistance. The organization says smoking is a prime cause of the rising number of premature births in the state.

"The only silver bullet we know to stop the epidemic is, stop smoking," said Deborah Kersting, Missouri executive director of the March of Dimes.

To drive home the "lifelong disabilities" that premature babies face, Kersting brought a "micro-diaper" to a recent legislative budget hearing. Two inches by two inches, the diaper would fit a baby weighing less than 1 pound.

"What we're trying to do is prevent this," Kersting said.

Pregnant women aren't the only targets of anti-smoking programs. People with asthma and chronic lung disease, for example, would end up making fewer trips to the emergency room with smoking cessation classes, said Ian McCaslin, director of Missouri's Medicaid program.

"They will have fewer hospitalizations, fewer episodes of respiratory illness, fewer myocardial infarctions, fewer strokes," McCaslin said.

Alice May Brock, 48, of St. Louis, knows the risks firsthand. Brock, a smoker for 28 years, has suffered two heart attacks.

"The doctor told me to quit smoking," said Brock, who is on Medicaid. "I'm trying."

But she struggles to quit. Brock said she goes to a counseling program run by Catholic Charities and has tried nicotine gum, but wishes Medicaid furnished nicotine patches.

"I keep praying, asking God to give me a helping hand to stop smoking. I want to live to see my grandkids -- I've got eight -- grow up."

While no smoking cessation program is effective in all circumstances, many studies have found that smokers have a better chance of quitting if they get counseling and use nicotine replacement products, such as gum, inhalers and patches, or non-nicotine medications, such as Zyban and Chantix.

For example, a report for the National Commission on Prevention Priorities in 2007 concluded that 42,000 additional lives would be saved each year if the United States increased to 90 percent the portion of smokers who are advised by a health professional to quit and are offered medication or other assistance. Only 28 percent of smokers receive such services, the commission's study found.

The study was funded by the federal Centers for Disease Control and Prevention, Robert Wood Johnson Foundation and WellPoint (NYSE:WLP) Foundation.

The Legislature recently has opposed adding any services to the $6 billion Medicaid budget. Last year, the Senate killed former Gov. Matt Blunt's request for $8.6 million in state and federal funding for smoking cessation. This year the budget is even tighter.

"We're clearly not in an environment where we have the luxury of looking at any program expansion," said Senate Appropriations Committee Chairman Gary Nodler, R-Joplin.

Others say smoking cessation is a smart investment that would save money in the long run.

"It is so foolhardy, so foolish to not be helping people on Medicaid stop smoking," said Sen. Joan Bray, D-University City, "because smoking is at the root of so many health problems."

The only help Missouri offers smokers now comes through private funding. Some smokers can get one month's worth of nicotine patches or gum thanks to a $3 million, three-year grant from the Missouri Foundation for Health, a nonprofit group.

About 2,500 people have received the free products in the last year, said Victoria Warren, the program's coordinator at the Missouri Department of Health and Senior Services. She said the state doesn't publicize the program widely out of fear of overwhelming demand.

"We have not tried to do big news releases on it because the last time we did that, the quit line was just overrun with calls," she said. "All the funding for nicotine replacement therapy was gone in like 10 days."

The lack of smoking cessation coverage earned Missouri an F from the American Lung Association last month. The other states with no coverage are Alabama, Connecticut, Georgia, Kentucky and Tennessee.

The topic is expected to be discussed today by the MOHealthNet Oversight Committee at the urging of Dr. Heidi Miller, a task force member from St. Louis. Miller said she frequently sees Medicaid patients who want to quit but can't afford the tools that would help them.

"Almost none of my MOHealthNet patients can afford tobacco cessation products without insurance coverage," Miller said.

Meanwhile, some states have begun beefing up their anti-smoking programs.

Oklahoma, for example, pays doctors to counsel smokers to quit. Also, when they get medications to deal with the addiction, patients aren't required to go through the lengthy prior authorization process.

"People just don't need barriers" to quitting, said Sally Carter, who directs tobacco use prevention for the Oklahoma Department of Health. "Prevention is going to help us in the long run."