[Congressional Record Volume 147, Number 42 (Tuesday, March 27, 2001)]
[Senate]
[Pages S2981-S2983]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. DURBIN (for himself, Mr. Brownback, Mr. Graham, and Mr. 
        Bingaman):
  S. 622. A bill to amend titles V, XVIII, and XIX of the Social 
Security Act to promote tobacco cessation under the medicare program, 
the medicaid program, and maternal and child health services block 
grant program; to the Committee on Finance.
  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 Senators Brownback, Bingaman, 
and Graham of Florida join me in this effort. The Medicare, Medicaid 
and MCH Smoking Cessation Promotion Act of 2001 will help make smoking 
cessation therapy accessible to recipients of Medicare, Medicaid, and 
the Maternal and Child Health, MCH, 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. Perhaps most 
distressing and surprising, data indicate that about 13 percent of 
mothers in the United States smoke during pregnancy.
  Today, the Surgeon General released a new report that documents the 
health effects for women who smoke. Women now represent 39 percent of 
all smoking related deaths in the United States each year, more than 
double the percentage in 1965.
  More than 21 percent of women in my state of Illinois smoke. Lung 
cancer is the leading cancer killer among women surpassing breast 
cancer in 1987, and smoking causes 87 percent of lung cancer cases. In 
fact, lung cancer death rates among women increased by more than 400 
percent between 1960 and 1990. And smoking among girls is on the rise 
as well. From 1991 to 1999, smoking among high school girls increased 
from 27 to 34.9 percent.
  There is no doubt that smoking rates among women and girls are linked 
to targeted tobacco advertising. The Centers for Disease Control and 
Prevention's National Health Interview Survey showed an abrupt increase 
in smoking inititation among girls around 1967, about the same time 
that Philip Morris and other tobacco companies launched advertisements 
for brands specifically targeted at women and girls. Six years after 
the introduction of Virginia Slims and other such brands, the rate of 
smoking initiation of 12-year-old girls increased by 110 percent.
  The report released today echoes this concern, highlighting the 
targeting of women in tobacco marketing. Between 1995 and 1998, 
expenditures in the United States for cigarette advertising and 
promotion increased from $4.90 billion to $6.73 billion. In 1999, these 
promotional expenditures leaped another 22 percent, to a new high of 
$8.24 billion.
  As a result, we are not only paying a heavy health toll, but an 
economic price as well. 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 Surgeon General's 2000 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 
just three to four years.
  The health benefits tobacco quitters enjoy are undisputed. They live 
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 just the ages of 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 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 last summer conclude 
that tobacco dependence treatments are both clinically effective and 
cost-effective relative to other medical and disease prevention 
interventions. The guidelines urge health care insurers and purchasers 
to include counseling and FDA-approved pharmacotherapeutic treatments 
as a covered benefit.
  Unfortunately, the federal government, a major purchaser of health 
care

[[Page S2982]]

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. That is why we are introducing 
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.
  First, 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.
  Second, 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.
  Third, 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. And a recent study published in the 
American Journal of Respiratory and Critical Care Medicine shows that 
children whose mothers smoke during pregnancy are almost twice as 
likely to develop asthma as those whose mothers did not. 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.
  Fourth, our bill ensures that the Maternal and Child Health 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.
  This legislation has been endorsed by ENACT, a coalition of more than 
60 national health organizations including the Campaign for Tobacco 
Free Kids, the American Cancer Society, the American Heart Association, 
the American College of Chest Physicians, the Association of Maternal 
and Child Health Programs, and the American Public Health Association.
  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 has said, 
``Although our knowledge about tobacco control remains imperfect, we 
know more than enough to act now.''
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 622

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicare, Medicaid, and MCH 
     Tobacco Cessation Promotion Act of 2001''.

     SEC. 2. MEDICARE COVERAGE OF COUNSELING FOR CESSATION OF 
                   TOBACCO USE.

       (a) Coverage.--Section 1861(s)(2) of the Social Security 
     Act (42 U.S.C. 1395x(s)(2)), as amended by section 105(a) of 
     the Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000 (as enacted into law by section 
     1(a)(6) of Public Law 106-554), is amended--
       (1) in subparagraph (U), by striking ``and'' at the end;
       (2) in subparagraph (V), by inserting ``and'' at the end; 
     and
       (3) by adding at the end the following new subparagraph:
       ``(W) counseling for cessation of tobacco use (as defined 
     in subsection (ww));''.
       (b) Services Described.--Section 1861 of the Social 
     Security Act (42 U.S.C. 1395x), as amended by section 105(b) 
     of the Medicare, Medicaid, and SCHIP Benefits Improvement and 
     Protection Act of 2000 (as enacted into law by section 
     1(a)(6) of Public Law 106-554), is amended by adding at the 
     end the following new subsection:

               ``Counseling for Cessation of Tobacco Use

       ``(ww) The term `counseling for cessation of tobacco use' 
     means the following:
       ``(1)(A) Counseling for cessation of tobacco use for 
     individuals who have a history of tobacco use.
       ``(B) For purposes of subparagraph (A), the term 
     `counseling for cessation of tobacco use' means diagnostic, 
     therapy, and counseling services for cessation of tobacco use 
     which are furnished--
       ``(i) by or under the supervision of a physician; or
       ``(ii) by any other health care professional who is legally 
     authorized to furnish such services under State law (or the 
     State regulatory mechanism provided by State law) of the 
     State in which the services are furnished,

     as would otherwise be covered if furnished by a physician or 
     as an incident to a physician's professional service.
       ``(C) The term `counseling for cessation of tobacco use' 
     does not include coverage for drugs or biologicals that are 
     not otherwise covered under this title.''.
       (c) Payment and Elimination of Cost-Sharing for Counseling 
     for Cessation of Tobacco Use.--
       (1) Payment and elimination of coinsurance.--Section 
     1833(a)(1) of the Social Security Act (42 U.S.C. 
     1395l(a)(1)), as amended by section 223(c) of the Medicare, 
     Medicaid, and SCHIP Benefits Improvement and Protection Act 
     of 2000 (as enacted into law by section 1(a)(6) of Public Law 
     106-554), is amended--
       (A) by striking ``and'' before ``(U)''; and
       (B) by inserting before the semicolon at the end the 
     following: ``, and (V) with respect to counseling for 
     cessation of tobacco use (as defined in section 1861(ww)), 
     the amount paid shall be 100 percent of the lesser of the 
     actual charge for the service or the amount determined by a 
     fee schedule established by the Secretary for each service''.
       (2) Elimination of coinsurance in outpatient hospital 
     settings.--The third sentence of section 1866(a)(2)(A) of the 
     Social Security Act (42 U.S.C. 1395cc(a)(2)(A)) is amended by 
     inserting after ``1861(s)(10)(A)'' the following: ``, with 
     respect to counseling for cessation of tobacco use (as 
     defined in section 1861(ww)),''.
       (3) Elimination of deductible.--The first sentence of 
     section 1833(b) of the Social Security Act (42 U.S.C. 
     1395l(b)) is amended--
       (A) by striking ``and'' before ``(6)''; and
       (B) by inserting before the period the following: ``, and 
     (7) such deductible shall not apply with respect to 
     counseling for cessation of tobacco use (as defined in 
     section 1861(ww))''.
       (d) Effective Date.--The amendments made by this section 
     shall apply to services furnished on or after the date that 
     is 1 year after the date of enactment of this Act.

     SEC. 3. PROMOTING CESSATION OF TOBACCO USE UNDER THE MEDICAID 
                   PROGRAM.

       (a) Dropping Exception From Medicaid Prescription Drug 
     Coverage for Tobacco Cessation Medications.--Section 
     1927(d)(2) of the Social Security Act (42 U.S.C. 1396r-
     8(d)(2)) is amended--
       (1) by striking subparagraph (E);
       (2) by redesignating subparagraphs (F) through (J) as 
     subparagraphs (E) through (I), respectively; and
       (3) in subparagraph (F) (as redesignated by paragraph (2)), 
     by inserting before the period at the end the following: 
     ``except agents approved by the Food and Drug Administration 
     for purposes of promoting, and when used to promote, tobacco 
     cessation''.

[[Page S2983]]

       (b) Requiring Coverage of Tobacco Cessation Counseling 
     Services for Pregnant Women.--Section 1902(e)(5) of the 
     Social Security Act (42 U.S.C. 1396a(e)(5)) is amended by 
     adding at the end the following new sentence: ``Such medical 
     assistance shall include counseling for cessation of tobacco 
     use (as defined in section 1861(ww)).''.
       (c) Removal of Cost-Sharing for Tobacco Cessation 
     Counseling Services for Pregnant Women.--Section 1916 of the 
     Social Security Act (42 U.S.C. 1396o) is amended, in each of 
     subsections (a)(2)(B) and (b)(2)(B), by inserting ``, and 
     counseling for cessation of tobacco use (as defined in 
     section 1861(ww))'' after ``complicate the pregnancy''.
       (d) Effective Date.--The amendments made by this section 
     shall apply to services furnished on or after the date that 
     is 1 year after the date of enactment of this Act.

     SEC. 4. PROMOTING CESSATION OF TOBACCO USE UNDER THE MATERNAL 
                   AND CHILD HEALTH SERVICES BLOCK GRANT PROGRAM.

       (a) Quality Maternal and Child Health Services Includes 
     Tobacco Cessation Counseling and Medications.--Section 501 of 
     the Social Security Act (42 U.S.C. 701) is amended by adding 
     at the end the following new subsection:
       ``(c) For purposes of this title, the term `maternal and 
     child health services' includes counseling for cessation of 
     tobacco use (as defined in section 1861(ww)), any drug or 
     biological used to promote tobacco cessation, and any health 
     promotion counseling that includes an antitobacco use 
     message.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall take effect on the date that is 1 year after the date 
     of enactment of this Act.
                                 ______