Snuffing out smoking

At the turn of the last century, a group of national health experts made a resolution: Their objective was to reduce smoking among adults to 12% by 2010. The 45 million Americans who are still lighting up, including a disproportionate share of the nation’s poorest residents, apparently did not get the memo from Healthy People 2010. Although the number of smokers has decreased, it remains well above the target number, at nearly 20% of the adult population, down from about 24%.

This meager reduction is all the more disappointing because in the late 1990s, it seemed as if the country could be weaned from its habit. Most states had enacted bans, restricting smoking in enclosed public spaces, workplaces and restaurants. Smoking’s devastating effects on individual health and the public purse were widely publicized: more than $96 billion a year in medical expenditures, and another $97 billion in lost productivity. Then came the Tobacco Master Settlement Agreement in 1998, which required major tobacco companies to alter some marketing practices and to pay about $206 billion over 25 years to 46 states -- compensation for tobacco-related public healthcare costs.

Yet there is a spark of hope. New data from the Massachusetts Tobacco Cessation & Prevention Program point the way to future policy and progress. In 2006, as part of its universal healthcare program, the Bay State began covering most expenses for smoking cessation counseling and prescription drugs for Medicaid recipients. The result has been an astonishing drop in the population of poor people who smoke -- from 38% to 28%. There is also evidence of a parallel reduction in hospitalization for heart attacks and treatments for asthma.

National experts have taken notice, and there is a move in Congress to create a national program modeled on Massachusetts’. The House healthcare reform bill would provide broader Medicaid coverage for smoking cessation, while the Senate’s would extend such coverage only to pregnant women on Medicaid. Studies have long acknowledged that people with low incomes and those with low educational attainment are more likely to smoke, and the Massachusetts results indicate that targeting them yields a big bang for the buck. As the House and the Senate begin what is sure to be a contentious process of reconciling their healthcare proposals, legislators should commit to including broad Medicaid coverage for smoking cessation treatment in the final bill.

The goals of Healthy People 2010 weren’t met, but we can make a new resolution: By 2020, if we use our resources wisely, millions of Americans will have stopped smoking.