Tobacco Users in Medicaid Expansion States More Likely To Get Help To Quit

Tobacco users in states that expanded Medicaid had a one-third higher chance of quitting tobacco and a one-half greater chance of getting the medication they needed compared with tobacco users in states that didn’t expand Medicaid, according to an AHRQ-funded study. Using electronic health record data from more than 300 community health centers (CHCs) in 10 states that expanded Medicaid in January 2014 and six states that did not, researchers found patients in expansion states were 35 percent more likely to quit, had a 53 percent greater chance of having a tobacco cessation medication ordered, and had 34 percent higher odds of having six or more follow-up CHC visits compared with patients in nonexpansion states. Increased access to insurance through the Medicaid expansion likely led to higher tobacco quit rates among patients who get their care through CHCs, according to the article. Access an abstract of the article, published in Nicotine & Tobacco Research

2019 May 23. pii: ntz087. doi: 10.1093/ntr/ntz087. [Epub ahead of print]

Tobacco Cessation in Affordable Care Act Medicaid Expansion States versus Non-ExpansionStates.

Bailey SR1, Marino M1,2, Ezekiel-Herrera D1, Schmidt T3, Angier H1, Hoopes MJ3, DeVoe JE1, Heintzman J1,3, Huguet N1.

Author information

Abstract

INTRODUCTION:

Community health centers (CHCs) care for vulnerable patients who use tobacco at higher than national rates. States that expanded Medicaid eligibility under the Affordable Care Act (ACA) provided insurance coverage to tobacco users not previously Medicaid-eligible, thereby potentially increasing their odds of receiving cessation assistance. We examined if tobacco users in Medicaid expansionstates had increased quit rates, cessation medications ordered, and greater health care utilization compared to patients in non-expansionstates.

METHODS:

Using electronic health record (EHR) data from 219 CHCs in 10 states that expanded Medicaid as of 1/1/2014, we identified patients aged 19-64 with tobacco use status documented in the EHR within six months prior to ACA Medicaid expansion and ≥1 visit with tobacco use status assessed within 24 months post-expansion (1/1/2014-12/31/2015). We propensity score matched these patients to tobacco users from 108 CHCs in 6 non-expansion states (n=27,670 matched pairs; 55,340 patients). Using a retrospective observational cohort study design, we compared odds of having a quit status, cessation medication ordered, and ≥6 visits within the post-expansion period among patients in expansion versus non-expansion states.

RESULTS:

Patients in expansion states had increased adjusted odds of quitting (aOR=1.35, 95% CI:1.28-1.43), having a medication ordered (aOR=1.53 95% CI:1.44-1.62), and having ≥6 follow-up visits (aOR=1.34, 95% CI:1.28-1.41) compared to patients from non-expansionstates.

CONCLUSIONS:

Increased access to insurance via the ACA Medicaid expansion likely led to increased quit rates within this vulnerable population.

IMPLICATIONS:

Community health centers (CHCs) care for vulnerable patients at higher risk of tobacco use than the general population. Medicaid expansion via the Affordable Care Act (ACA) provided insurance coverage to a large number of tobacco users not previously Medicaid-eligible. We found that expanded insurance coverage was associated with increased cessation assistance and higher odds of tobacco cessation. Continued provision of insurance coverage could lead to increased quit rates among high risk populations, resulting in improvements in population health outcomes and reduced total health care costs.

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