Curb smoking to curb Medicaid costs

Gov. Matt Bevin has said he wants to improve health outcomes while controlling Medicaid costs — smart and urgent goals.

But he will have a hard time achieving either without reducing the number of Kentuckians who smoke and are exposed to secondhand smoke.

For a state that suffers so profoundly from its long addiction to tobacco, Kentucky’s response is laughably weak.

We have the nation’s highest incidence of cancer, yet our tobacco-control efforts earn all failing grades from the American Lung Association.

Cigarette taxes are especially effective at deterring youngsters from smoking, but only seven states have a lower cigarette tax than Kentucky.

About half the U.S. population is covered by comprehensive smoke-free laws that ban smoking in workplaces and enclosed public spaces; 2 out of 3 Americans are covered by less comprehensive smoking bans. But only 1 in 3 Kentuckians are afforded comprehensive protections from secondhand smoke on the job and in public.

Last year the House approved a statewide smoking ban that was killed by Senate President Robert Stivers, R-Manchester. The backers of smoke-free legislation will be back this year, but the Democrats who are struggling to keep control of the House will be leery of venturing onto that political limb unless the Senate acts first.

Bevin can show that he’s serious about curbing health-care costs by persuading his fellow Republicans in the Senate to approve a comprehensive smoke-free law.

As a candidate, Bevin said smoking bans should be left to local communities to decide. As governor, he must see that the costs are incurred statewide — upwards of $1.9 billion in medical expenses and $2.3 billion in lost economic productivity annually, according to the U.S. Centers for Disease Control and Prevention and the Kentucky Chamber of Commerce.

The chamber, which represents 3,800 Kentucky businesses, is a longtime advocate of a smoking ban and curbing state spending on Medicaid, the federal-state program that now covers 1.3 million Kentuckians. Adults covered by Medicaid smoke at more than double the rate of those who have private insurance, so reducing smoking would help put the program on sounder financial footing.

In fact, there is probably no more cost-effective way to advance Bevin’s goals than taking Kentucky smoke-free, considering the experiences of Lexington, Louisville and the 23 other Kentucky municipalities that have enacted smoke-free laws.

Some minor enforcement costs would fall on local health departments, but smoking bans are largely self-enforcing. And, as the Legislative Research Commission said in a 2014 fiscal note, “if this action results in an overall state decrease in smoking, both state and local governments could experience cost savings from insurance premiums due to a healthier workforce. Also, the state could incur savings from a decrease in health costs relative to Medicare, Medicaid and assistance to indigent persons due to a healthier state population.” Bingo.

While smoke-free laws push down smoking rates, the immediate direct benefit would be protection from secondhand smoke.

No one has ever studied secondhand smoke’s cost in Kentucky, but a study at Indiana University put the cost at $61.51 per Hoosier in 2007. In North Carolina, a study found that the costliest effects of secondhand smoke exposure were heart disease and heart attacks among those 18 and older, while low birth weight and asthma were the costliest consequences for youths. Medicaid pays for half of all births, so protecting pregnant women from secondhand smoke is bound to yield savings.

The Affordable Care Act expanded Medicaid coverage for smoking cessation, which Kentucky should leverage through advertising and other outreach, especially since almost 70 percent of smokers say they want to quit.

But as long as almost 1 in 3 Kentuckians are still spewing toxins into the air, the governor and legislature should protect the rest of us from their smoke.