The American Health Care Act Would Lead To More Smoking, Disease And Tobacco Industry Profits

(Credit: AP Photo/J. Scott Applewhite) House Republicans introduced their American Health Care Act on March 7 to “repeal and replace Obamacare” (the Affordable Care Act). Neither the bill nor Speaker Ryan’s website announcement mentions “tobacco.” But as tobacco researchers, we believe it would have a substantial negative impact on control efforts. The ACA includes a Prevention and Public Health Fund that supports prevention and public health programs, including tobacco prevention (US$931 million for all programs in 2016). In addition, the ACA Medicaid Incentives for Chronic Disease Prevention Program includes $85 million for state Medicaid for tobacco cessation and other goals. The ACA also: Requires most private and public insurers to cover tobacco cessation as one of 10 “essential health benefits” at no cost to the patient Requires most insurers to cover treatment of substance use disorders, which may include tobacco dependence, as another essential health benefit on an equal basis with other medical and surgical benefits Allows insurers to charge tobacco users up to 50 percent higher premiums Allows employers to reward or penalize employees up to 50 percent of the cost of insurance coverage based on participation in wellness programs that include reducing tobacco use Encourages community-based prevention through Community Health Needs Assessment requirements for nonprofit hospitals and funding for public health fellowship training, promotion of community health workforce and community health centers. What the American Health Care Act would change Most discussion of the AHCA has focused on the estimate that 24 million people would lose insurance and costs for many would go up. But by our reading of the bill, the AHCA would also damage health in other ways. It ends the Prevention and Public Health Fund that provides 12 percent of Centers for Disease Control and Prevention’s program funding, including tobacco control across the country.