Holy cow! Welcome to Chicago everybody!

"Take me out to the ball game, Take me out with the crowd. Buy me some peanuts and Cracker Jack, I don't care if I never get back, So lets root, root, root for the Cubbies, If they don't win it's a shame. For it's one, two, three strikes, you're out, At the old ball game."

State Tobacco Cessation Policy Update Matt Barry Campaign for Tobacco Free Kids May 4, 2005 Chicago, IL

Today’s Keen Insights Medicaid Private Insurance Excise Taxes Smokefree Laws Technical Assistance Make It Your Business

Current CMS Policy On Cessation: Medicaid General Policy - Smoking cessation benefits, such as counseling and drug therapy, are optional benefits under Medicaid (except for kids covered under EPSDT). Smoking cessation drugs are specifically classified as those drugs that may be excluded from coverage under Medicaid. Smoking cessation counseling services may be provided under a variety of Medicaid benefit categories. Pregnant Women - There are no mandatory smoking cessation benefits for pregnant women under Medicaid. A state may elect to provide smoking cessation services in a State plan.

Number of State Medicaid Programs Covering Tobacco Dependence Treatments (N=51), Telephone Counseling 1110Group Counseling 1417Individual Counseling 2726Gum 2827Patch 2728Nasal Spray & Inhaler 3640Zyban Tobacco Dependence Treatment Source: Halpin, HA, MMWR, January 30, 2004 / 53(03); Source: Analysis by the Center for Health and Public Policy Studies, University of California at Berkeley of the State Medicaid Tobacco Dependence Treatment Survey, bin/healthfacts.cgi?action=compare&category=Health+Status&subcategory=Smoking&topic=Cessation+Treatment+Under+Medicaid. bin/healthfacts.cgi?action=compare&category=Health+Status&subcategory=Smoking&topic=Cessation+Treatment+Under+Medicaid

Informing Medicaid Tobacco Users about Benefits, 2003 Methods for Informing Medicaid Recipients # States 2002 # States 2003 Inform tobacco users about benefits918 Through primary care provider58 Mailer56 Newsletter/magazine34 Television spots33 Member services/information line38 Website23 New member packet28 Source: Analysis by the Center for Health and Public Policy Studies, University of California at Berkeley of the State Medicaid Tobacco Dependence Treatment Survey, bin/healthfacts.cgi?action=compare&category=Health+Status&subcategory=Smoking&topic=Cessation+Treatment+Under+Medicaid. bin/healthfacts.cgi?action=compare&category=Health+Status&subcategory=Smoking&topic=Cessation+Treatment+Under+Medicaid

COVERAGE CONSISTENT WITH PHS GUIDELINES Source: Halpin, HA, MMWR, January 30, 2004 / 53(03); States Offer Comprehensive* Coverage: California Indiana Maine Minnesota New Jersey New York Oregon Pennsylvania West Virginia * = Zyban, NRT Gum, Patch, Nasal Spray, Inhaler, and at least one type of counseling (individual, group or proactive telephone).

States with Private Insurance Mandates for Cessation New Mexico – Mandates coverage of both pharmacotherapy and counseling for all private health plans in the state (effective March 1, 2004). Maryland – Mandates coverage of prescription NRTs for all private health insurance in the state (passed by legislature April 2005). California (?) – There is a bill pending before the CA legislature to mandate private health plan coverage of pharmacotherapy and counseling services.

STATE AND LOCAL POLICIES AND PROGRAMS THAT MAXIMIZE TOBACCO CESSATION

TOBACCO EXCISE TAXES

“The single most direct and reliable method for reducing consumption is to increase the price of tobacco products, thus encouraging the cessation and reducing the level of initiation of tobacco use.” - National Academy of Sciences, Institute of Medicine, 1998

“It is clear that price has a pronounced effect on the smoking prevalence of teenagers and that the goals of reducing teenage smoking and balancing the budget would both be served by increasing the Federal excise tax on cigarettes.” - Myron Johnson, Philip Morris Research Executive, 1981

EFFECTS OF A 10% INCREASE IN THE TOBACCO TAX Nearly 7% decline in youth prevalence A 2% decline in adult prevalence A 4% decline in overall consumption

CALIFORNIA NEVADA 80 OREGON 118 WASHINGTON ARIZONA 118 NEW MEXICO 91 TEXAS 41 OKLAHOMA 103 UTAH 69.5 COLORADO 84 KANSAS 79 NEBRASKA 64 IDAHO 57 MONTANA 170 NORTH DAKOTA 44 SOUTH DAKOTA 53 MINNESOTA 48 IOWA 36 MISSOURI 17 ARKANSAS LOUISIANA MS 18 ALABAMA 42.5 GEORGIA 37 FLORIDA 33.9 SOUTH CAROLINA 7 NORTH CAROLINA 5 TENNESSEE 20 KENTUCKY 30 ILLINOIS 98 WISCONSIN 77 MICHIGAN 200 IN 55.5 OHIO 55 WV VIRGINIA PENNSYLVANIA 135 NEW YORK 150 MAINE 100 VT NH: 52 MA CT: 151 RI: 246 NJ: 240 DELAWARE: 55 MARYLAND: 100 DC: 100 HAWAII 140 ALASKA 160 States that have recently passed or implemented a cigarette tax increase (since 1/1/2002) WYOMING 60 April 5, 2005 Recent Cigarette Tax Increases CT MA: VT: 119 Oregon actually decreased its cigarette tax by 10 cents on 1/1/04. Kentucky’s tax rate increases from 3 to 30 cents on 6/1/05; Virginia’s tax rate increases from 20 to 30 cents on 7/1/05.

The Pennsylvania Tax Experience From.31 to 1.00 on 7/15/02 Revenue -14.0% Packs Sold %

The Indiana Tax Experience From.155 to.555 on 7/1/02 Revenue -16.7% Packs Sold %

The Kansas Tax Experience From.24 to.79* Revenue -21.6% Packs Sold % *KS raised its cigarette tax from.24 to.70 on 7/1/02 and then to 79 on 1/1/03

The New York City Tax Experience From.08 to 1.50 on 7/01/02 Revenue -45.8% Packs Sold %

SMOKEFREE WORKPLACE LAWS

100 MILLION PEOPLE!!

Smoke free workplace laws:  Prompt more smokers to try to quit;  Increase the number of successful quit attempts;  Reduce the number of cigarettes that continuing smokers consume; and  Discourage kids from ever starting to smoke.

The U.S. Surgeon General has concluded that smoke free laws “… have been shown to decrease daily tobacco consumption and to increase smoking cessation among smokers.” [Source - U.S. Department of Health and Human Services (HHS), Reducing Tobacco Use: A Report of the Surgeon General, 2000] The National Cancer Institute concluded that: “… workplace smoking restrictions are accompanied by an increase in cessation attempts and a reduction in number of cigarettes smoked per day by continuing smokers.” [Source - National Cancer Institute, Population Based Smoking Cessation: Proceedings of a Conference on What Works to Influence Cessation in the General Population, Smoking and Tobacco Control Monograph No. 12, NIH Pub. No , November 2000] WHAT DO GOVERNMENT HEALTH AUTHORITIES SAY?

QUITLINES

WHERE ARE THE QUITLINES AND WHO RUNS THEM? 44 states are covered by 38 quitlines 36 state-managed quitlines 5 states have formal agreement with Federal quitline service 3 states receive quitline service from Legacy 2 states announcing “request for proposals” 5 states without formal arrangement for quitline services For more information on quitlines, see: or

CALL VOLUME TO QUITNOW According to data gathered by MCI for the National Cancer Institute’s Cancer Information Service, calls to the national portal number, QUITNOW, have been as follows for the period November March 2005: November 2004 – 2,243 December 2004 – 5,883 January 2005 – 7,821 February 2005 – 9,505 March 2005 – 11,714 Total* – 37,166 * Ohio uses the QUITNOW number as its state quitline number and has done extensive promotions of the number. As a result, Ohio accounts for 23,641 of all calls to the national portal number (64%). In addition, neighboring States of Kentucky and West Virginia (which share media markets), accounted for 2,081 (5.6%) and 1,915 (5.2%) calls respectively.

EXAMPLES OF OTHER STATE AND LOCAL ACTIVITY

TECHNICAL ASSISTANCE FOR MEDICAID CESSATION PROJECT

Toolkit Contains Information On - Actions states can take now to provide coverage (administrative actions to changes in statute). The clinical benefits of cessation. Calculating state-specific costs/savings due to cessation services. Joint CDC-CMS document on the cost effectiveness of cessation and clinical benefits. Case studies of how states have implemented effective programs. Tips for coordinating between Medicaid and other state agencies. Basic terminology for Medicaid. Tobacco's toll on Medicaid budgets and health impact.

Follow-Up to Release of Medicaid Toolkit TA Group Consists Of: TFK, CTC, MoD, AMCHP, Porter Novelli, Smokefree Families, and CDC. Conference calls with state program managers, health departments, tobacco control coalitions. Identification of target states for possible outreach and policy activity. Working with several states, including Pennsylvania, Kentucky, Alaska, Massachusetts and others. Resulted in actual Medicaid benefit changes in PA and KY.

Make It Your Business Tobacco-Free Coalition of Oregon Based on the idea: Oregon businesses would pay far less to prevent tobacco-related diseases than to treat them (based on an actuarial study) Toolkit to Help Employers Step-by-step guide for businesses to insure a tobacco-free workforce and to promote tobacco cessation benefits and services.