Statements on Introduced Bills and Joint Resolutions

CONGRESSIONAL RECORD
SENATE
STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

Mr. DURBIN:

S. 2730. A bill to amend title V, XVIII, and XIX of the Social Security Act to promote cessation of tobacco use under the medicare program, the medicaid program, and the maternal and child health services block grant program; to the Committee on Finance.

Mr. DURBIN. Mr. President, I rise today to introduce legislation that expands treatment to millions of Americans suffering from a deadly addiction: tobacco. The Medicare, Medicaid and MCH Smoking Cessation Promotion Act of 2004 will help make smoking cessation therapy accessible to recipients of Medicare, Medicaid, and the Maternal and Child Health (MCH) Program.

We have long known that cigarette smoking is the largest preventable cause of death, accounting for 20 percent of all deaths in this country. It is well documented that smoking causes virtually all cases of lung cancer and contributes to coronary heart disease, peripheral vascular disease, chronic obstructive lung disease, and other deadly health ailments.

The harmful effects of smoking do not end with the smoker. A recent report issued by the American Legacy Foundation cites the effects of second-hand smoke on children of smokers. In addition to the cost of health complications of asthma and chronic ear infections in children, the report indicates that 43,000 children are orphaned every year because of tobacco-related deaths.

Still, despite enormous health risks, 45 million adults in the United States smoke cigarettes. Of those, low income and racial minorities make up a disproportionate share. While 22.5 percent of the general adult population in the U.S. are current smokers, the percentage is about 50 percent higher among Medicaid recipients. Thirty-six percent of adults covered by Medicaid smoke.

We are not only paying a heavy health toll, but an economic price as well. According to the Center for Tobacco Cessation, about 14 percent of all Medicaid expenditures on average are related to smoking. That's not surprising, given that smokers incur an average of $1,041 more in annual medical costs than non-smokers.

Today, however, we have identified clinically proven, effective strategies to help smokers quit. Advancements in treating tobacco use and nicotine addiction using pharmacotherapy and counseling have helped millions kick the habit. The Surgeon General's 2000 Report, Reducing Tobacco Use, concluded that "pharmacologic treatment of nicotine addiction, combined with behavioral support, will enable 10 to 25 percent of users to remain abstinent at one year of post-treatment.

Studies have shown that reducing adult smoking through tobacco use treatment pays immediate dividends, both in terms of health improvements and cost savings. Creating a new nonsmoker reduces anticipated medical costs associated with acute myocardial infarction and stroke by $47 in the first year and by $853 during the next seven years in 1995 dollars. Within four to five years after tobacco cessation, quitters use fewer health care services than continued smokers.

New Jersey and Oregon have provided Medicaid coverage for counseling and drugs as recommended by the Public Health Service, and both states now have among the lowest smoking-related Medicaid costs.

The health benefits tobacco quitters enjoy are also undisputed. They live longer, and after 15 years, the risk of premature death for ex-smokers returns to nearly the level of persons who have never smoked. Male smokers who quit between just the ages of 35 and 39 add an average of five years to their lives; women can add three years. Even older Americans over age 65 can extend their life expectancy by giving up cigarettes.

Former smokers are also healthier. They are less likely to die of chronic lung diseases, and after ten smoke-free years, their risk of lung cancer drops to as much as one-half that of those who continue to smoke. After five to fifteen years the risk of stroke and heart disease for ex-smokers returns to the level of those who have never smoked. They have fewer days of illness, reduced rates of bronchitis and pneumonia, and fewer health complaints.

Public Health Service Guidelines released a few years ago conclude that tobacco dependence treatments are both clinically effective and cost-effective relative to other medical and disease prevention interventions. The guidelines urge health care insurers and purchasers to include counseling and FDA-approved pharmacologic treatments as a covered benefit.

Unfortunately, the Federal Government, a major purchaser of health care through Medicare and Medicaid, does not currently adhere to its own published guidelines. It is high time that government-sponsored health programs catch up with science. That is why I am introducing legislation to improve smoking cessation benefits in government-sponsored health programs.

The Medicare, Medicaid, and MCH Smoking Cessation Promotion Act of 2004 improves access to and coverage of smoking cessation treatment therapies in three meaningful ways.

First, this bill adds a smoking cessation counseling benefit and coverage of FDA-approved tobacco cessation drugs to Medicare. The bill requires all prescription drug sponsors to provide coverage for tobacco cessation drugs under Medicare's prescription drug coverage. It also defines over-the-counter agents as covered drugs, as long as those drugs are prescribed by a doctor or other authorized medical professional. By 2020, 17 percent of the U.S. population will be 65 years of age or older. It is estimated that Medicare will pay $800 billion to treat tobacco-related diseases over the next twenty years. In a study of adults 65 years of age or older who received advice to quit, behavioral counseling and pharmacologic therapy, 24.8 percent reported having stopped smoking six months following the intervention. The total economic benefits of quitting after age 65 are notable. Due to a reduction in the risk of lung cancer, coronary heart disease and emphysema, studies have found that heavy smokers over age 65 who quit can avoid up to $4,592 in lifelong illness-related costs.

Second, this bill provides coverage for counseling, prescription and non-prescription smoking cessation drugs in the Medicaid program. The bill eliminates the provision in current federal law that allows states to exclude FDA-approved smoking cessation therapies from coverage under Medicaid. Despite the fact that the states have received payments from their successful federal lawsuit against the tobacco industry, less than half the states provide coverage for smoking cessation in their Medicaid program.

Even if Medicaid covered cessation products and services exclusively to pregnant women, we would see significant cost savings and health improvements. Children whose mothers smoke during pregnancy are almost twice as likely to develop asthma as those whose mothers did not. Over seven years, reducing smoking prevalence by just one percentage point among pregnant women would prevent 57,200 low birth weight births and save $572 million in direct medical costs.

Third, this bill ensures that the Maternal and Child Health Program recognizes that medications used to promote smoking cessation and the inclusion of anti-tobacco messages in health promotion are considered part of quality maternal and child health services

I hope my colleagues will join me not only in cosponsoring this legislation but also in working with me to see that its provisions are adopted. As the Surgeon General has said, "Although our knowledge about tobacco control remains imperfect, we know more than enough to act now."