holy cow! welcome to chicago everybody!. "take me out to the ball game, take me out with the...
TRANSCRIPT
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Holy cow!
Welcome to Chicago everybody!
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"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."
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StateTobacco
Cessation Policy Update
Matt Barry
Campaign for Tobacco Free Kids
May 4, 2005
Chicago, IL
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Today’s Keen Insights
• Medicaid
• Private Insurance
• Excise Taxes
• Smokefree Laws
• Technical Assistance
• Make It Your Business
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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.
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Number of State Medicaid Programs Covering Tobacco Dependence
Treatments (N=51), 2003
45Telephone Counseling
1110Group Counseling
1417Individual Counseling
2726Gum
2827Patch
2728Nasal Spray & Inhaler
3640Zyban
20032002Tobacco Dependence Treatment
Source: Halpin, HA, MMWR, January 30, 2004 / 53(03);54-57.Source: Analysis by the Center for Health and Public Policy Studies, University of California at Berkeley of the State Medicaid Tobacco Dependence Treatment Survey, 2003. http://statehealthfacts.org/cgi-bin/healthfacts.cgi?action=compare&category=Health+Status&subcategory=Smoking&topic=Cessation+Treatment+Under+Medicaid.
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Informing Medicaid Tobacco Users about Benefits, 2003
Methods for Informing Medicaid Recipients
# States 2002
# States 2003
Inform tobacco users about benefits 9 18
Through primary care provider 5 8
Mailer 5 6
Newsletter/magazine 3 4
Television spots 3 3
Member services/information line 3 8
Website 2 3
New member packet 2 8
Source: Analysis by the Center for Health and Public Policy Studies, University of California at Berkeley of the State Medicaid Tobacco Dependence Treatment Survey, 2003. http://statehealthfacts.org/cgi-bin/healthfacts.cgi?action=compare&category=Health+Status&subcategory=Smoking&topic=Cessation+Treatment+Under+Medicaid.
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COVERAGE CONSISTENT WITH PHS GUIDELINES
Source: Halpin, HA, MMWR, January 30, 2004 / 53(03);54-57.
9 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).
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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.
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STATE AND LOCAL POLICIES AND
PROGRAMSTHAT MAXIMIZE
TOBACCO CESSATION
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TOBACCO EXCISE TAXES
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“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
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“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
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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
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CALIFORNIA
NEVADA
80
OREGON
118
WASHINGTON
142.5
ARIZONA
118NEW MEXICO
91
TEXAS
41
OKLAHOMA
103
UTAH
69.5 COLORADO
84KANSAS
79
NEBRASKA
64
IDAHO
57
MONTANA
170NORTH DAKOTA
44
SOUTH DAKOTA
53
MINNESOTA
48
IOWA
36
MISSOURI
17
ARKANSAS
59
36
LOUISIANA
MS
18
ALABAMA
42.5GEORGIA
37
FLORIDA
33.9
SOUTH CAROLINA
7
NORTH CAROLINA5TENNESSEE
20
KENTUCKY30
ILLINOIS
98
WISCONSIN
77MICHIGAN
200
IN
55.5
OHIO
55WV55
30VIRGINIA
PENNSYLVANIA
135
NEW YORK150
MAINE100
VTNH:52
MA
CT:151RI:246
NJ:240
DELAWARE:55
MARYLAND:100DC: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:151
87
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.
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The Pennsylvania Tax ExperienceFrom .31 to 1.00 on 7/15/02
$320.1Million
$827.8Million
$0
$200,000,000
$400,000,000
$600,000,000
$800,000,000
$1,000,000,000
7/01 - 6/02 7/02 - 6/03
Revenue
-14.0%Packs Sold
+158.6%
0
200,000,000
400,000,000
600,000,000
800,000,000
1,000,000,000
1,200,000,000
7/01 - 6/02 7/02 - 6/03
1.07Billion
917.7Million
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The Indiana Tax ExperienceFrom .155 to .555 on 7/1/02
$110.3Million
$338.2Million
$0
$100,000,000
$200,000,000
$300,000,000
$400,000,000
7/01 - 6/02 7/02 - 6/03
Revenue
-16.7%Packs Sold
+206.5%
0
200,000,000
400,000,000
600,000,000
800,000,000
1,000,000,000
7/01 - 6/02 7/02 - 6/03
742.1Million 617.9
Million
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The Kansas Tax ExperienceFrom .24 to .79*
$47.9Million
$116.2Million
$0
$50,000,000
$100,000,000
$150,000,000
7/01 - 6/02 7/02 - 6/03
Revenue
-21.6%
Packs Sold
+142.7%
0
50,000,000
100,000,000
150,000,000
200,000,000
250,000,000
7/01 - 6/02 7/02 - 6/03
208.8Million
163.7Million
*KS raised its cigarette tax from .24 to .70 on 7/1/02 and then to 79 on 1/1/03
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The New York City Tax ExperienceFrom .08 to 1.50 on 7/01/02
$27.38Million
$278.01Million
$0
$50,000,000
$100,000,000
$150,000,000
$200,000,000
$250,000,000
$300,000,000
7/01 - 6/02 7/02 - 6/03
Revenue
-45.8%Packs Sold
+915.1%
0
100,000,000
200,000,000
300,000,000
400,000,000
7/01 - 6/02 7/02 - 6/03
342.35Million
185.34Million
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SMOKEFREE WORKPLACE
LAWS
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100 MILLION PEOPLE!!
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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.
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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 areaccompanied 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. 00-4892, November 2000]
WHAT DO GOVERNMENT HEALTH AUTHORITIES SAY?
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QUITLINES
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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:
http://www.naquitline.org/
or
http://www.smokefree.gov/
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CALL VOLUME TO 1-800-QUITNOWAccording to data gathered by MCI for the National Cancer Institute’s Cancer Information Service, calls to the national portal number, 1-800-QUITNOW, have been as follows for the period November 2004 - 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 1-800-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.
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EXAMPLES OF OTHER STATE AND
LOCAL ACTIVITY
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TECHNICAL ASSISTANCE FOR MEDICAID CESSATION
PROJECT
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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.
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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.
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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.
• www.tobaccofreeoregon.org