Health Care

Quitters can get more help

Seniors and low-income pregnant women soon will be able to get help kicking a smoking habit. In January, Medicare, the federal health coverage plan for seniors, will begin to cover counseling — up to eight sessions a year — to quit smoking as part of federal health care reform.

Most private insurers have covered counseling for people trying to quit, but Medicare has covered it only for smokers diagnosed with a tobacco-related disease.

States also will be required to offer stop-smoking counseling to pregnant women through Medicaid, the state and federal health care coverage for low-income families and children, starting Oct. 1.

The reforms are likely to help people quit, said Marshall Post, a respiratory therapist at Wesley Medical Center and a facilitator with the American Lung Association's Freedom from Smoking program.

"I think the proposal is a great proposal if we can get folks to do it," Post said. "People in Medicare and Medicaid are more likely to go to smoking cessation if they don't have to pay for it."

An estimated 9.3 percent of adults 65 and older are smokers and 22.6 percent of adults 45-64 are smokers nationwide, according to the Centers for Disease Control and Prevention. That equals about 4.5 million Medicare users who smoke.

The new Medicare benefit will cover two individual counseling attempts each year. Each attempt may include up to four sessions.

Anybody who receives Medicare benefits qualifies for the sessions.

All they have to do is find a doctor who offers the sessions, or get a referral from their own doctor, said Don McLeod, public affairs specialist for the Centers for Medicare and Medicaid Services.

More coverage needed?

The American Lung Association praises the reforms, but wants them to be more comprehensive. Medicare and Medicaid should have covered three different forms of counseling and all seven FDA-approved cessation medications, said Diane Tinker, development director for the American Lung Association's Plains-Gulf region, which includes Kansas.

A comprehensive benefit "has been proven to help the most smokers quit," she said.

Counseling should include at least four individual, group or telephone therapy sessions lasting no less than 10 minutes each, she said. Those are the forms of counseling recommended by the Department of Health and Human


The medications include over-the- counter and prescription nicotine-replacement-therapies, and two non-nicotine prescription drugs: bupropion and varenicline, Tinker said.

Candace Ayars, director of the Kansas Department of Health and Environment's Tobacco Use Prevention Program, also would have liked the reforms to include drug therapies with counseling. Research shows using drugs as well as counseling doubles the success rate, she said.

Drugs remove cravings, while counseling requires a lot of behavioral therapy to help smokers shed daily habits that trigger their smoking, Ayars said.

Without the drugs, she said. it can take a smoker up to 10 attempts to finally quit. Drugs can shorten the number of attempts to two, and some kick tobacco on the first try.

For that reason, the reforms would be more cost-effective if they included both types of therapy, Ayars said.

Eight sessions can be enough to quit, she said, but many smokers give up before they make it that far.

The Kansas Tobacco Quit Line, 1-800-QUIT-NOW (784-8669), a free telephone-based counseling service paid for by the KDHE, uses five sessions for regular callers, and up to nine for pregnant women, Ayars said. Only 15 percent of the callers make it all the way through five sessions, she said.

Smokers on Medicare likely are die-hard tobacco users who probably will need at least five quit attempts to kick the habit, Ayars said.

"If they don't go through it all in one time, they're much less likely to quit," she said, "and if they get in the middle of a quit attempt when the allocation for the year expires, they're out of luck."

But Ayars praised the reforms as a move in the right direction.

"The fact they're even going in that direction and recognize this as something that needs to be done is a good, positive step," she said.

Benefits of quitting

Quitting is never a bad idea even for a lifelong smoker, said Ginger Park, media and policy coordinator for the Kansas Tobacco Youth Use Prevention Program, which runs the state's tobacco quit line.

"There are definitely benefits at any age," she said.

The Centers for Disease Control and Prevention estimates that tobacco use causes one in five deaths in the country annually and that adult smokers die 14 years earlier than their non-smoking counterparts.

Tobacco-related diseases are expected to cost Medicare about $800 billion between 1995 and 2015.

Park cited information from the Centers for Disease Control showing that within 12 hours after your last cigarette, the body's carbon monoxide levels will have dropped to normal. Within two weeks to three months the risk of heart attack drops.

"There are lifestyle benefits. People will just start getting better and being able to be more active," she said.

Post, the respiratory therapist, predicted that more smokers in Kansas are likely to try to quit now, not only because of health reasons.

They are watching the territory shrink, thanks to lawmakers who passed a new public smoking ban.

"Personal health isn't always the only reason people quit," Post said. "The word is getting out that you can' t just go anywhere and light up anymore."