Will the Affordable Care Act require coverage of quit-smoking programs?
The law requires all new private health insurance plans and Marketplace plans to cover services recommended by the U.S. Preventive Services Task Force, with no cost-sharing fees. That includes tobacco cessation treatments.
What will quit-smoking treatments or programs include?
That is unclear.
Insurance companies don’t have a consistent approach to quit-smoking programs, says Erika Sward, a spokeswoman for the American Lung Association. "What we have seen is a patchwork quilt."
While the Affordable Care Act requires that new plans cover services recommended by the task force, the task force does not give specifics. It recommends that doctors ask adults about tobacco use, provide cessation programs, and provide counseling for women who smoke during pregnancy.
But there are no ''typical'' tobacco cessation programs, according to a survey conducted by Georgetown University researchers.
What's needed, Sward says, is a comprehensive approach. According to the American Lung Association, tobacco cessation benefits should include the choices recommended by the Public Health Service. These include:
- Nicotine -- from a patch, gum, lozenge, nasal spray, or inhaler
- Medications -- bupropion (Zyban) and varenicline (Chantix)
- Counseling -- individual, group, and phone
In one area, the law is specific: It requires that pregnant women on Medicaid be offered the treatments recommended by the U.S. Public Health Service. Those include asking about tobacco use and offering counseling, with no recommendation about medication use in pregnancy.
Who supports higher premiums for tobacco users?
The insurance industry supports higher rates because smokers have much higher health care costs than nonsmokers, according to Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade industry group.
"There is clear documentation of so much greater health care costs [for tobacco users], and we think that should be reflected in the rates," she says.
In 2004, smoking cost the U.S. $97 billion in lost productivity and $96 billion in direct health care costs, or $4,260 per adult smoker, according to the CDC.
More than half of Americans favor charging smokers more for insurance, according to a Gallup poll released in mid-August.