December 19, 2018
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Senator rethinks bill to deny health care to smokers

A woman smokes a cigarette outside a smoke shop in Lewiston in 2007. A Wilton lawmaker had proposed to deny MaineCare benefit to smokers, but revised the legislation after sensing opposition.

AUGUSTA, Maine — Sen. Tom Saviello knew his bill to prohibit smokers from qualifying for MaineCare would attract attention.

And then there were the likely insurmountable legal issues of denying federal health care benefits to lower-income Mainers who light up.

But Saviello, R-Wilton, said he believes more needs to be done to address the disproportionately high numbers of MaineCare recipients whose smoking habit ends up costing the state — and taxpayers — more in health care costs.

“I’m not anti-smoker,” Saviello told the Health and Human Services Committee on Tuesday. “I simply wanted to start a dialogue.”

Ultimately, the constitutional issues were enough to convince Saviello to rewrite his original bill before Tuesday’s committee hearing.

Instead of barring smokers from participation in MaineCare, LD 216 would now direct the Maine Department of Health and Human Services to work with other groups to increase awareness about smoking cessation programs offered by the state.

That change appeared to head off a wall of opposition from organizations concerned about the morality, legality and practicality of denying smokers access to MaineCare, which is Maine’s name for the federal Medicaid program.

But the would-be opponents of Saviello’s original bill unanimously agreed that Maine should do more to address the rampant smoking problem among MaineCare recipients — fixes that would ultimately save the state money.

“Investing in comprehensive smoking cessation benefits for the MaineCare population is a smart investment, one that could not only reduce costs in the program but also could greatly reduce the burden of death and disease by tobacco and keep children healthy,” Hilary Schneider with the American Cancer Society said in testimony.

Approximately 17 percent of Maine’s adult population smokes, compared to 41 percent of Mainers on Medicaid, according to statistics provided to the committee on Tuesday. Tobacco use results in more than $600 million in health care costs in Maine annually, according to the Campaign for Tobacco-Free Kids.

Maine already offers a number of smoking cessation programs through the Partnership for a Tobacco-Free Maine, the Maine Center for Disease Control and Prevention and other public agencies or nonprofit organizations.

But Saviello and others said the message about cessation programs obviously is not reaching MaineCare participants.

“This is an issue that cannot be ignored,” Saviello said. “The health and financial burden of tobacco use has to be addressed.”

Speakers also pointed toward Massachusetts as a possible model.

The Bay State’s Medicaid program, MassHealth, has been able to decrease the prevalence of smoking among program participants by 26 percent in 2½ years by offering comprehensive coverage of tobacco cessation medications.

That has resulted in an estimated $1.2 million in savings in hospitalization costs for tobacco-related heart problems, according to information from the Massachusetts Department of Public Health.

Saviello said his amended bill does not recommend any new programs. And it is unclear whether the increased emphasis on tobacco cessation programs would cost additional money, which could be a challenge given the budget constraints.

Nonetheless, the amended bill garnered endorsements from a variety of health advocacy groups, including the Maine Public Health Association, the American Lung Association and the Maine Osteopathic Association.

No one testified in opposition to the rewritten bill.

The Health and Human Services Committee is expected to hold a work session on LD 216 on Friday at 9 a.m.

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