funds, and the federal government collects an additional $15 billion per year in cigarette tax revenues (see Figure 9).

“The only way we have any chance of even staying equal in the game is if we have resources, because we are David against Goliath,” Stevens stressed, and Fong added, “You don’t want to bring a knife to a gun fight.” McGoldrick pointed out, “When we spend less money on tobacco prevention and cessation, that means more kids are starting to smoke, fewer adults are quitting, more people are dying and more health care dollars are being spent treating tobacco-caused diseases.” Sneegas added, “We know what works, and that state programs will give us a return on investment, but we need the funding in the states in order to make it happen.”

Funding for Tobacco Cessation Programs

Another major financial impediment is lack of funding for tobacco cessation programs. Gritz noted that these programs often rely on hospital budgets and clinical revenue, and therefore are underfunded or never even come into existence because of a lack of funds. Another financial barrier is the frequent lack of insurance reimbursement for tobacco cessation therapy. Although Medicare recently expanded coverage of tobacco cessation therapy to all beneficiaries who use tobacco (CMS, 2012), there is variable coverage for cessation therapy. “This is a real barrier because so many people don’t have coverage,” Hurt noted. “A gold standard institution should provide coverage for [tobacco cessation therapy] for their employees with no copays,” he argued. Given their reimbursement difficulties, Hurt’s institution, Mayo Clinic, established a charitable fund for tobacco cessation therapy that is composed of money donated by grateful patients for others who cannot afford the treatment.

Fiore pointed out that the ACA will expand coverage for smoking cessation counseling and medications20 (see section on Antismoking Laws and Regulations) (Koh et al., 2010). He added that as insurance companies are recognizing the rapid return on investment in tobacco cessation therapy, more are expanding coverage to include this service. He reiterated that Massachusetts has provided evidence that there is a $2 return on investment for every dollar spent within just a few years of implementation of a smoking cessation treatment program (Richard et al., 2012). “There is

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20 Patient Protection and Affordable Care Act of 2010, H.R. 3590, 111th U.S. Congress. 2nd Sess. (March 23, 2010).



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