Impact of Medicaid expansion on smoking prevalence and quit attempts among those newly eligible, 2011-2019.

Katy Ellis Hilts,Valerie Yeager,Paul Halverson,P Joseph Gibson,Justin Blackburn,Nir Menachemi

doi:10.18332/tpc/139812

Abstract

INTRODUCTIONLow-income populations have higher rates of smoking and are disproportionately affected by smoking-related illnesses. This study assessed the long-term impact of increased coverage for tobacco cessation through Medicaid expansion on past-year quit attempts and prevalence of cigarette smoking.METHODSUsing data from CDC’s annual Behavioral Risk Factor Surveillance System 2011–2019, we conducted difference-in-difference regression analyses to compare changes in smoking prevalence and past-year quit attempts in expansion states versus non-expansion states. Our sample included non-pregnant adults (18–64 years old) without dependent children with incomes at or below 100% of the Federal Poverty Level (FPL).RESULTSRegression analyses indicate that Medicaid expansion was associated with reduced smoking prevalence in the first two years post-expansion (β=-0.019, p=0.04), but that this effect was not maintained at longer follow-up periods (β=-0.006, p=0.49). Results of regression analyses also suggest that Medicaid expansion does not significantly impact quit attempts in the short-term (β=-0.013, p=0.52) or at longer term follow-up (β=-0.026, p=0.08).CONCLUSIONSExpanded coverage for tobacco cessation services through Medicaid alone may not be enough to increase quit-attempts or sustain a reduction in overall prevalence of smoking in newly eligible populations over time. Medicaid programs should consider additional strategies, such as public education campaigns and removal of barriers, to support cessation among enrollees.

Highlights

Low-income populations have higher rates of smoking and are disproportionately affected by smoking-related illnesses
Previous research on tobacco cessation in the context of the Affordable Care Act (ACA) has focused on how tobacco related provisions of the law are covered by various health plans across the country[10]; the potential impact of ACA allowable tobacco surcharges[11]; and whether or not expanded access to health insurance resulted in an increase in unhealthy behaviors, such as smoking[12,13]
We found that Medicaid expansion impacted smoking prevalence in the first two years post expansion, but this effect did not persist in the longer follow-up period

Summary

Introduction

Low-income populations have higher rates of smoking and are disproportionately affected by smoking-related illnesses. This study assessed the long-term impact of increased coverage for tobacco cessation through Medicaid expansion on past-year quit attempts and prevalence of cigarette smoking. Expanded coverage for tobacco cessation treatments has the potential to reduce the prevalence of smoking[5], increase the likelihood of a person attempting to quit[6,7], improve health outcomes[8], and reduce tobacco related healthcare spending[9]. Previous research on tobacco cessation in the context of the ACA has focused on how tobacco related provisions of the law are covered by various health plans across the country[10]; the potential impact of ACA allowable tobacco surcharges[11]; and whether or not expanded access to health insurance resulted in an increase in unhealthy behaviors, such as smoking[12,13]. Studies have examined state-specific impacts of Medicaid expansion on smoking cessation[14] or how changes

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Discussion

Conclusion