Navigate Up

UPMC/University of Pittsburgh Schools of the Health Sciences
For Journalists
Allison Hydzik
Manager
Telephone: 412-647-9975
Senior Director
Telephone: 412-586-9777

Want to Make an Appointment or Need Patient Information?

Contact UPMC at
1-800-533-UPMC (8762).

Go to Find a Doctor to search for a UPMC doctor.​



Medicaid Expansion under Affordable Care Act Linked to Higher Rate of Smoking Cessation by Low-Income Adults

PITTSBURGH, Nov. 13, 2017 – When low-income adults were newly covered by Medicaid under the Affordable Care Act (ACA), they were more likely to quit smoking cigarettes than their counterparts in states that did not offer Medicaid expansion, according to a new analysis from the University of Pittsburgh Graduate School of Public Health.
 
The findings, published online and scheduled for an upcoming issue of the journal Medical Care, support a policy-driven approach to reduce high smoking rates among low-income adults by giving greater access to smoking cessation programs.
 
“Smoking cessation is notoriously difficult to achieve,” said senior author Marian Jarlenski, Ph.D., M.P.H., assistant professor in Pitt Public Health’s Department of Health Policy and Management. “The sizable increase we found in smoking cessation might lead to significant reductions in death and diseases caused by smoking, and the taxpayer-funded health care expenditures that come with treating them.”
 
Smoking is responsible for 9 percent of annual health care spending in the U.S., and 30 percent of low-income adults smoke cigarettes, double that of the U.S. average.
 
The ACA provided states the opportunity to expand Medicaid coverage to all low-income people at or below 138 percent of the federal poverty level. As part of the expansion, the state Medicaid programs were required to offer smoking cessation services.
 
Jarlenski and lead author J. Wyatt Koma, B.S., a recent graduate of Pitt’s Honors College, analyzed answers from more than 36,000 low-income adults ages 18 to 64 without dependent children to an annual telephone survey of health behaviors administered by the Centers for Disease Control and Prevention. They then compared the answers to smoking-related questions among residents in the 31 states that had expanded Medicaid coverage with residents in the states that had not.
 
In the states with Medicaid expansion, 8.1 percent of the newly covered low-income adults reported that they’d quit smoking in the prior year, compared with 6 percent of low-income adults in the states without expansion. This was after the researchers took into account the effect on smoking rates of demographics, as well as differences in cigarette taxes and state indoor clean air laws.
 
“There are many explanations for why new Medicaid enrollees may be motivated to quit smoking when they engage with health care services,” said Koma, now a research assistant in health care with NORC at the University of Chicago. “During the Medicaid enrollment process, people are asked whether they smoke, so it’s possible that this question might prompt them to start contemplating smoking cessation. After enrollment, they have access to primary care visits, where their clinician is likely to counsel them about quitting. And studies have shown that people in states with Medicaid expansion are much more likely to get prescriptions for smoking cessation medications, which are covered by Medicaid.”
 
However, Koma went on to note that the 8.1 percent rate of smoking cessation is still low, especially compared to the 68.9 percent of adults who say they want to quit.
 
“The question remains whether or not there will be sufficient funds and support to continue to improve the health outcomes of these vulnerable populations moving forward,” he said.
 
Additional authors on this research are Julie M. Donohue, Ph.D., of Pitt Public Health; Colleen L. Barry, Ph.D., M.P.P., of Johns Hopkins University; and Haiden A. Huskamp, Ph.D., of Harvard University.
 
This research was funded by the Pitt Honors College Chancellor’s Research Fellowship and the National Institutes of Health’s Building Interdisciplinary Research Careers in Women’s Health program grant K12HD043441.

UPMC | Affiliated with the University of Pittsburgh Schools of the Health Sciences Supplemental content provided by Healthwise, Incorporated. To learn more, visit www.healthwise.org

For help in finding a doctor or health service that suits your needs, call the UPMC Referral Service at 412-647-UPMC (8762) or 1-800-533-UPMC (8762). Select option 1.

UPMC is an equal opportunity employer. UPMC policy prohibits discrimination or harassment on the basis of race, color, religion, ancestry, national origin, age, sex, genetics, sexual orientation, gender identity, marital status, familial status, disability, veteran status, or any other legally protected group status. Further, UPMC will continue to support and promote equal employment opportunity, human dignity, and racial, ethnic, and cultural diversity. This policy applies to admissions, employment, and access to and treatment in UPMC programs and activities. This commitment is made by UPMC in accordance with federal, state, and/or local laws and regulations.

Medical information made available on UPMC.com is not intended to be used as a substitute for professional medical advice, diagnosis, or treatment. You should not rely entirely on this information for your health care needs. Ask your own doctor or health care provider any specific medical questions that you have. Further, UPMC.com is not a tool to be used in the case of an emergency. If an emergency arises, you should seek appropriate emergency medical services.

UPMC
Pittsburgh, PA, USA | UPMC.com