Inclusion of tobacco control in the U.S. Health Equity and Accountability Act

Achieving health equity—the highest level of health for all—is a critical imperative for all countries. In the United States, the Health Equity and Accountability Act of 2020 provides a comprehensive strategy to address health disparities in the country, including those caused by tobacco use. This new legislation would significantly increase tobacco taxes and expand coverage of smoking cessation services under the Medicaid[1] and private health plans, which are proven strategies to reduce smoking and therefore the illnesses and deaths attributable to it.

This legislation is particularly welcome in the context of the COVID-19 pandemic, which is particularly affecting certain communities (ethnic minorities). It also highlights long-standing health disparities that can only be reduced through urgent national action.

Smoking is the cause of many heart and lung diseases, cancers, diabetes and it increases the risk of serious complications related to COVID-19. These minorities are particularly affected by these pathologies.

Although the United States has made great strides in reducing smoking, there are large health disparities by smoking and nonsmoking status. Smoking rates are highest among people with low incomes, those who are uninsured, or those who receive the equivalent of Medicaid., ethnic minorities[2]-[3], residents of the Midwest and South, the LGBT community and people with mental illness[4].

The Health Equity and Accountability Act of 2020 requires comprehensive coverage of all tobacco cessation treatments for all Medicaid beneficiaries without out-of-pocket costs or prescriptions. These services include individual, group, and telephone counseling, as well as seven medications approved by the U.S. Food and Drug Administration. While states have made progress in providing cessation coverage under Medicaid, only 15 states currently cover all available treatments, and only two states cover all treatments without any barriers to access.[5]-[6].

Full Medicaid coverage of smoking cessation services is essential because Medicaid beneficiaries smoke twice as much as those with private insurance. Medicaid spends more than $40 billion[7] per year in health care costs for smoking-related illnesses. The amended legislation is therefore expected to achieve significant savings. In addition, the bill provides funding to allow states to conduct awareness campaigns to inform Medicaid beneficiaries about the program.

After Massachusetts provided full Medicaid coverage of smoking cessation services in 2006[8] and conducted an awareness campaign about these services, smoking rates among beneficiaries decreased by $261,300 in the first two years. Studies have shown that the state has significantly reduced hospitalizations for heart attacks and cardiovascular disease among Medicaid beneficiaries, saving more than $3,100 for every dollar spent on cessation services.[9]. In addition, the bill doubles the excise tax on cigarettes and creates tax parity for other tobacco products. Raising taxes on tobacco products is one of the most effective ways to reduce tobacco use and helps fund actions to help people quit and prevent them from starting to smoke.

©Tobacco Free Generation

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[1] Medicaid is a program created in the United States that aims to provide health insurance to individuals and families with low income and resources. It is managed by the states which subsidize it jointly with the federal government.[2] Cox LS, Okuyemi K, Choi WS, Ahluwalia JS. A review of tobacco use treatments in US ethnic minority populations. Am J Health Promot. 2011;25(5 Suppl):S11–S30. doi:10.4278/ajhp.100610-LIT-177[3] Tobacco use among US racial/ethnic minority groups Tobacco Control 1998;7:198-209.[4] https://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm[5] https://www.cdc.gov/statesystem/factsheets/medicaid/Cessation.html[6] https://www.cdc.gov/mmwr/volumes/69/wr/mm6906a2.htm?s_cid=mm6906a2_x[7] https://www.cdc.gov/statesystem/factsheets/medicaid/Cessation.html[8] Land T, Warner D, Paskowsky M, et al. Medicaid coverage for tobacco dependence treatments in Massachusetts and associated decreases in smoking prevalence. PLoS One. 2010;5(3):e9770. Published 2010 Mar 18. doi:10.1371/journal.pone.0009770[9] Ibid©National Committee Against Smoking |