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