Prevention Matters

The success of a recent Massachusetts program hat provides virtually free access to tobacco cessation treatments has left CDC officials shocked and encouraged lawmakers to look at expanding the approach nationwide.

When the program was launched two years ago, about 38 percent of poor Massachusetts residents smoked. By 2008, the smoking rate for poor residents had dropped to about 28 percent, a decrease of about 30,000 people in two and a half years, or one in six smokers. There are also indications that the drop has lowered rates of hospitalization for heart attacks and emergency room visits for asthma attacks, she said.

Senators Richard J. Durbin of Illinois and Bernard Sanders of Vermont have introduced an amendment that would provide similar new Medicaid coverage for tobacco addiction as nationwide, and the Senate could vote on it by the weekend. If the amendment fails, Senator Tom Harkin of Iowa said he would try another avenue: seeking an expansion through a conference committee that will ultimately reconcile the House and Senate bills.

"We should be able to find an opening," Mr. Harkin said in an interview. "This is one demonstrable way we can actually bend the cost curve and keep people healthy."

Terry F. Pechacek, associate director for science for the CDC's Office on Smoking and Health, told the New York Times that he found the numbers “shocking,” since smoking rates around the nation have barely budged since 2004. He said the U.S. smoking rate has only decreased from 20.9 percent in 2004 to 20.6 percent in 2008, while smoking-related illnesses cost the Medicaid system more than $22 billion a year - or about 11 percent of overall Medicaid expenditures.

Pechacek says if the federal health care overhaul includes smoking-cessation coverage, publicizing it will be as crucial to its success as the cessation tools themselves.

"Even in the some of the states that offer wider coverage,” he said, “there’s been minimal promotion. People have to know about a benefit for it to have an effect.”