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Medicaid helps people stop smoking

Dylan Scott covers health care for Vox. He has reported on health policy for more than 10 years, writing for Governing magazine, Talking Points Memo and STAT before joining Vox in 2017.

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Let's return to our favorite health care debate: Does insurance actually make people healthier? After all, isn't that supposed to be the point?

We have ample evidence that health coverage improves people's financial well-being — check out this new paper if you missed it — and their mental health. But while the preponderance of evidence tells us that insurance helps make people physically healthier as well, a lot of people, particularly those who chastise an obsession with coverage numbers, are doubtful.

Medicaid specifically is targeted with this critique. Well, today, we have some new evidence that seems to show unambiguously that Medicaid can help lead to better physical health.

The research — from NORC's J. Wyatt Koma, Pitt's Marian Jarlenski, and others, to be published in Medical Care this month — shows a demonstrable increase in people who receive Medicaid quitting smoking.

Their study, which tracked data from 2011 to 2015, found:

  • An 8.1 percent probability that low-income adult smokers in Medicaid expansion states had quit smoking recently
  • A 6 percent probability for low-income adult smokers in states that did not expand Medicaid
  • Therefore, Medicaid expansion seems to have increased the likelihood that low-income adult smokers would quit by 2.1 percentage points, a statistically significant increase

This is how the researchers summarized their findings:

This study provides empirical evidence suggesting that expanding Medicaid coverage to nonelderly low-income adult smokers without dependent children led to a sizable increase in recent smoking cessation. This finding is likely explained by greater access to preventive health care services,including evidence-based smoking cessation services, resulting from Medicaid coverage.

Quitting smoking is an unambiguously positive improvement in a person's physical health. You know all the research: lower risk of cardiovascular problems, lower risk of cancer, improved lung function, so on and so forth.

The authors said they don't have enough data to make further extrapolations from their findings, but they theorize that the reductions in smoking "might lead to significant reductions in morbidity and mortality caused by smoking" and — because smoking and its associated health effects increase health care spending — reduce state and federal costs.

Obviously, the rate of smoking cessation is still low, especially when you consider two-thirds of adult smokers say they want to quit. But this study provides some solid evidence that Medicaid coverage can help, and with a population — nearly 30 percent of low-income adults smoke — that's the most in need.

Tables of the Day


The stakes for partial Medicaid expansion. We've talked about partial Medicaid expansions before — allowing states to cover people up to 100 percent of the poverty level in Medicaid, instead of the usual 138 percent, and sending people above poverty to the Obamacare marketplaces.

This new research from Avalere puts those proposals in context. If states that have so far refused to expand Medicaid, leaving people in poverty totally without coverage, opted for a partisan expansion, they could cover nearly 7 million people.

But if states that already expanded decided to pare back to a partial expansion, as Arkansas and Massachusetts have proposed, nearly 4 million would be shifted to the marketplaces — where they might have to pay premiums and out-of-pocket deductibles.

Kliff’s Notes

With research help from Caitlin Davis

Today's top news

  • “Senate GOP nearing decision on repeal of ObamaCare mandate”: “GOP members of the Senate Finance Committee met Monday night to discuss the issue, Republican aides said. The full Senate Republican caucus will discuss the idea at its lunch meeting on Tuesday, and sources said a decision could be made as soon as Tuesday.” —Peter Sullivan, the Hill
  • “Democrats plan to use HHS pick Alex Azar to push Trump on high drug prices”: “Democrats plan to use President Trump’s pick for a top health post to press the president to follow through on his campaign promise to fight for lower drug prices. Trump on Monday picked Alex Azar to lead the Department of Health and Human Services, drawing immediate scrutiny from Democrats who pointed out his tenure at the helm of drug maker Eli Lilly’s U.S. division.” —Robert King, Washington Examiner
  • “GOP senators seek to 'gut' ACA via state waivers”: “Conservative lawmakers are circulating a proposal that would make it easier for states to provide less coverage at higher costs for their residents. Sens. Orrin Hatch (R-Utah) and Mike Crapo (R-Idaho) are mulling legislation that would overhaul the 1332 waiver process.” —Virgil Dickson, Modern Healthcare

Analysis and longer reads

  • “Pence’s health care power play”: “Vice President Mike Pence is exerting growing influence over the American health care system, overseeing the appointments of more than a half-dozen allies and former aides to positions driving the White House's health agenda.” —Adam Cancryn, Politico
  • “Some States Roll Back ‘Retroactive Medicaid,’ A Buffer For The Poor — And For Hospitals”: “This "retroactive eligibility" provides financial protection as patients await approval of their Medicaid applications. It protects hospitals, too, from having to absorb the costs of caring for these patients. But a growing number of states are rescinding this benefit.” —Michelle Andrews, Kaiser Health News
  • “Here's what Trump is doing on mental health after the Texas shooting”: “It's clear that Americans across party lines want some sort of change that will prevent the sickening frequency of mass shootings — there have been 388 in 2017 alone — that continue to shake our country. By suggesting that mental health should be focus of the debate, rather than gun control, Trump invited a closer look at his record — which includes budget cuts that have been criticized by mental health groups.” —Alayna Treene, Axios

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