[Congressional Record Volume 146, Number 111 (Tuesday, September 19, 2000)]
[Senate]
[Pages S8763-S8766]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself and Mr. Brownback):
  S. 3073. A bill to amend titles V, XVIII, and XIX of the Social 
Security Act to promote smoking cessation under the Medicare Program, 
the Medicaid Program, and the Maternal and Child Health Program; to the 
Committee on Finance.


 THE MEDICARE, MEDICAID AND MCH SMOKING CESSATION SERVICES ACT OF 2000

  Mr. DURBIN. Mr President, I rise today to introduce legislation that 
expands treatment to millions of Americans suffering from a deadly 
addiction: tobacco. I am pleased to have Senator Brownback join me in 
this effort. The Medicare, Medicaid and MCH Smoking Cessation Promotion 
Act of 2000 will help make smoking cessation therapy accessible to 
recipients of Medicare, Medicaid, and the Maternal and Child Health 
Program.
  We have long known that cigarette smoking is the largest preventable 
cause of death, accounting for 20 percent of all deaths in this 
country. It is well documented that smoking causes virtually all cases 
of lung cancer and a substantial portion of coronary heart disease, 
peripheral vascular disease, chronic obstructive lung disease, and 
cancers of other sites. And the harmful effects of smoking do not end 
with the smoker. Women who use tobacco during pregnancy are more likely 
to have adverse birth outcomes, including babies with low birth weight, 
which is linked with an increased risk of infant death and a variety of 
infant health disorders.
  Still, despite enormous health risks, 48 million adults in the United 
States smoke cigarettes--approximately 22.7 percent of American adults. 
The rates are higher for our youth--36.4 percent report daily smoking. 
In Illinois, the adult smoking rate is about 24.2 percent. And perhaps 
most distressing and surprising, data indicate that about 13 percent of 
mothers in the United States smoke during pregnancy.
  We have also learned the hard way that in addition to the heavy 
health toll of tobacco, the economic costs of smoking are also high. 
The total cost of smoking in 1993 in the U.S. was about $102 billion, 
with over $50 billion in health care expenditures directly linked to 
smoking. The Centers for Disease Control and Prevention (CDC) reports 
that approximately 43 percent of these costs were paid by government 
funds, primarily Medicaid and Medicare. Smoking costs Medicaid alone 
more than $12.9 billion per year. According to the Chicago chapter of 
the American Lung Association, my state of Illinois spends $2.9 billion 
each year in public and private funds to combat smoking-related 
diseases.
  Today, however, we also know how to help smokers quit. Advancements 
in treating tobacco use and nicotine addiction have helped millions 
kick the habit. While more than 40 million adults continue to smoke, 
nearly as many persons are former smokers living longer, healthier 
lives. In large part, this is because new tools are available. 
Effective pharmacotherapy and counseling regimens have been tested and 
proven effective. The just-released Surgeon General's Report, Reducing 
Tobacco Use, concluded that ``pharmacologic treatment of nicotine 
addiction, combined with behavioral support, will enable 10 to 25 
percent of users to remain abstinent at one year of posttreatment.''
  Studies have shown that reducing adult smoking through tobacco use 
treatment pays immediate dividends, both in terms of health 
improvements and cost savings. Creating a new nonsmoker reduces 
anticipated medical costs associated with acute myocardial infarction 
and stroke by $47 in the first year and by $853 during the next seven 
years in 1995 dollars. And within four to five years after tobacco 
cessation, quitters use fewer health care services than continued 
smokers. In fact, in one study the cost savings from reduced use paid 
for a moderately priced effective smoking cessation intervention in a 
matter of three to four years.
  The health benefits tobacco quitters enjoy are undisputed. They are 
living longer. After 15 years, the risk of premature death for ex-
smokers returns to nearly the level of persons who have never smoked. 
Male smokers who quit between age 35 and 39 add an average of five 
years to their lives; women can add three years. Even older Americans 
over age 65 can extend their life expectancy by giving up cigarettes.
  Former smokers are also healthier. They are less likely to die of 
chronic lung diseases. After ten smoke-free

[[Page S8766]]

years, their risk of lung cancer drops to as much as one-half that of 
those who continue to smoke. After five to fifteen years the risk of 
stroke and heart disease for ex-smokers returns to the level of those 
who have never smoked. They have fewer days of illness, reduced rates 
of bronchitis and pneumonia, and fewer health complaints.
  New Public Health Service Guidelines released this summer conclude 
that tobacco dependence treatments are both clinically effective and 
cost-effective relative to other medical and disease prevention 
interventions. The guideline urges health care insurers and purchasers 
to include the counseling and FDA-approved pharmacotherapeutic 
treatments as a covered benefit.
  Unfortunately, the Federal Government, a major purchaser of health 
care through Medicare and Medicaid, does not currently adhere to its 
own published guidelines. It is high-time that government-sponsored 
health programs catch up with science. As a result, I am introducing, 
along with my colleague Senator Brownback, legislation to improve 
smoking cessation benefits in government-sponsored health programs.
  The Medicare, Medicaid and MCH Smoking Cessation Promotion Act of 
2000 improves access to and coverage of smoking cessation treatment 
therapies in four primary ways.
  Our bill adds a smoking cessation counseling benefit to Medicare. By 
2020, 17 percent of the U.S. population will be 65 years of age or 
older. It is estimated that Medicare will pay $800 billion to treat 
tobacco-related diseases over the next twenty years. In a study of 
adults 65 years of age or older who received advice to quit, behavioral 
counseling and pharmocotherapy, 24.8 percent reported having stopped 
smoking six months following the intervention. The total economic 
benefits of quitting after age 65 are notable. Due to a reduction in 
the risk of lung cancer, coronary heart disease and emphysema, studies 
have found that heavy smokers over age 65 who quit can avoid up to 
$4,592 in lifelong illness-related costs.
  Our measure provides coverage for both prescription and non-
prescription smoking cessation drugs in the Medicaid program. The bill 
eliminates the provision in current Federal law that allows states to 
exclude FDA-approved smoking cessation therapies from coverage under 
Medicaid. Ironically, State Medicaid programs are required to cover 
Viagra, but not to treat tobacco addiction. Despite the fact that the 
States are now receiving the full benefit of their federal lawsuit 
against the tobacco industry, less than half the States provide 
coverage for smoking cessation in their Medicaid program. On average, 
states spend approximately 14.4 percent of their Medicaid budgets on 
medical care related to smoking.

  Our legislation clarifies that the maternity benefit for pregnant 
women in Medicaid covers smoking cessation counseling and services. 
Smoking during pregnancy causes about 5-6 percent of perinatal deaths, 
17-26 percent of low-birth-weight births, and 7-10 percent of preterm 
deliveries, and increases the risk of miscarriage and fetal growth 
retardation. It may also increase the risk of sudden infant death 
syndrome (SIDS). The Surgeon General recommends that pregnant women and 
parents with children living at home be counseled on the potentially 
harmful effects of smoking on fetal and child health. A new study shows 
that, over seven years, reducing smoking prevalence by just one 
percentage point would prevent 57,200 low birth weight births and save 
$572 million in direct medical costs.
  Our bill ensures that the Maternal and Child Health (MCH) Program 
recognizes that medications used to promote smoking cessation and the 
inclusion of anti-tobacco messages in health promotion are considered 
part of quality maternal and child health services. In addition to the 
well-documented benefits of smoking cessation for maternity care, the 
Surgeon General's report adds, ``Tobacco use is a pediatric concern. In 
the United States, more than 6,000 children and adolescents try their 
first cigarette each day. More than 3,000 children and adolescents 
become daily smokers each day, resulting in approximately 1.23 million 
new smokers under the age of 18 each year.'' The goal of the MCH 
program is to improve the health of all mothers and children. This goal 
cannot be reached without addressing the tobacco epidemic.
  I hope my colleagues will join me not only in cosponsoring this 
legislation but also in working with me to see that its provisions are 
adopted before the year is out. As the Surgeon General states in his 
report: ``Although our knowledge about tobacco control remains 
imperfect, we know more than enough to act now.''
                                 ______