State Cessation Legislation and the Affordable Care Act American Lung Association Webinar March 4 th , 2011

1. State Cessation Legislation and the Affordable Care ActAmerican Lung Association WebinarMarch 4th, 2011

2. Jennifer Singleterry Manager, Cessation Policy jsingleterry@lungusa.org 202-329-2175

3. Agenda • What the Affordable Care Act did/will do • What states can do • Why?

4. Definitions • ACA = Affordable Care Act (healthcare reform) • HHS = U.S. Dept. of Health & Human Services • USPSTF = United States Preventive Services Task Force. • Gives letter grade recommendation to preventive services based on effectiveness • Tobacco cessation gets an ‘A’ • Comprehensive Cessation Benefit • All medications FDA-approved for tobacco cessation (7 currently) • All types of counseling recommended by PHS (3 currently)

5. High Income Low Income After ACA High Income Low Income Before ACA

6. Expands to up to 133% of poverty line Feds pay for most of newly eligibles Newly eligibles must have Essential Health Benefit Pregnant women must have comprehensive benefit (Oct. 1, 2010) States cannot exclude tobacco cessation medications (Jan. 1, 2014) FMAP percentage increase (Jan. 1, 2013)

7. For individuals and small businesses • Individuals who earn up to 400% of poverty line eligible for subsidies • Feds pay for subsidies • Must have Essential Health Benefit • Tobacco cessation? • How does this work with state mandates?

8. New Plans • Issued after March 2010 • Substantial change to coverage • ACA requirements apply Grandfathered • Issued before March 2010 • Many ACA requirements don’t apply

9. Employer-Sponsored Insurance: New Plans • Must cover all services given ‘A’ or ‘B’ by USPSTF • No cost-sharing • Ambiguous as to what this means for tobacco cessation • Until HHS clarifies definition (?) plans must cover some tobacco cessation treatment, but they get to decide which treatments, how many, and other parameters.

10. Where does this leave us? Up to the states, except for pregnant women Up to HHS, and if not, up to the states Must cover something, but specifics are up to the plans Medicaid State Exchanges Employer-Sponsored Insurance

11. In other words…there is a lot more to be done!

12. State Action Needed Medicaid – expand comprehensive coverage beyond pregnant women Exchanges – pending action from HHS Employer-Sponsored Insurance – legislation to require comprehensive coverage with no barriers for everyone

13. State Legislation Can Do What ACA Didn’t: • Require coverage from grandfathered plans • Define tobacco cessation comprehensively • Address issues of access other than cost-sharing

14. Eight States Already Have Laws Requiring Some Level of Tobacco Cessation Coverage

15. Elements of Model State Legislation Coverage requirements linked to most recent recommendations in Public Health Service Guideline, Treating Tobacco Use and Dependence Requirement should specify ALL treatments, including prescription & OTC. Address barriers to coverage Legislation should apply to as many plans as possible, including Medicaid

16. Addressing Barriers to Coverage No cost-sharing No prior authorization No annual or lifetime limits on quit attempts or costs (at least 2 quit attempts per year) No limits on treatment duration (at least 90 days) No requirements to pair counseling with medications No stepped care therapy Require plans to promote to members & clinicians

17. Alternatives – Good But Not Great • Requiring a dollar amount per year, but not specifying treatment coverage • Like Oregon, New Jersey • Requiring USPSTF A’s and B’s • Like Colorado • Requiring comprehensive coverage after the 1st attempt • Like California (hasn’t passed yet) • Requiring wellness appointments and follow up treatment that could include tobacco cessation • Like New Jersey

18. State of Tobacco Control • Bonus points are given in state cessation grade for these laws. • To receive all five points: • Coverage of all 7 medications must be required • Coverage of all types of counseling must be required

19. One Thing to Note So far it is unclear as to how state mandates will interact with the Essential Health Benefit in State Exchanges

20. Why? Will ensure that more people have access to a comprehensive cessation benefit. Solves the “turnover” problem Saves everyone money Good pairing with a new smokefree law or tobacco tax Easier to promote cessation if everyone has the same benefit (where applicable) Private insurance coverage should be as good as Medicaid coverage, right?

21. Tools for You Model cessation legislation (coming soon) www.lungusa.org/cessationcoverage Good explanation of possible congressional actions: http://www.rwjf.org/pr/product.jsp?id=71968 ACA chart (email Jennifer for it)

22. Questions?jsingleterry@lungusa.org202-785-3355

23. We will breathe easier when the air in everyAmerican community is clean and healthy. We will breathe easier when people are free from the addictivegrip of cigarettes and the debilitating effects of lung disease. We will breathe easier when the air in our public spaces andworkplaces is clear of secondhand smoke.We will breathe easier when children no longerbattle airborne poisons or fear an asthma attack. Until then, we are fighting for air.