By Charles Betley, Senior Policy Analyst, UMBC

Cigarettes have been known for years to cause many diseases. Tobacco companies now have to pay $9 billion each year to help states pay for the costs of treatment to people they sickened.

April 15 is Tax Day in the U.S., and it is a bitter pill for many.

For state Medicaid plans, though, which pay a heavy price for tobacco-related illnesses, it can be a shot in the arm of sorts. April 15 is also the day when the five largest tobacco companies pay US$9 billion dollars to state governments, each and every year, forever, because of a 1998 legal settlement meant to compensate states for the costs of tobacco-related illness such as cancer, emphysema and heart disease. Actual payments made by the tobacco companies vary year to year because of adjustment factors written into the settlement; each of the states’ payments varies as well.

Payments from tobacco companies, as well as tobacco taxes, help to support health care and other services for low-income people served by state Medicaid programs. Even though the federal government supports each state’s Medicaid program by paying at least half the costs, many states have difficulty finding revenues to pay the remaining share.

Determining how much tobacco use costs states’ Medicaid programs puts the payments from tobacco companies into perspective. One estimate found 15% of nationwide Medicaid costs were caused by tobacco use. But such estimates based on national surveys may not account for which tobacco-related diseases are most prevalent in a particular state. How many of the state’s Medicaid participants smoke, and how hospitals and doctors are paid, also affect a state’s Medicaid costs.

The Center for Mississippi Health Policy was interested in estimating the actual costs to Mississippi Medicaid for treating tobacco-related disease. The center wanted a price tag that more accurately reflected the health-related behaviors of people in Mississippi and health care services available in the state. Our team of researchers from The Hilltop Institute at the University of Maryland, Baltimore County (UMBC) conducted the study. We think our study is the first to focus on Medicaid costs using actual state Medicaid data.

Getting a truer picture

Instead of applying estimates of total costs of smoking from national surveys to individual states as previous studies have done, our research assessed how specific, individual smoking-related illnesses create costs for Mississippi. This lets the state better understand how much it differs from nationwide averages for both its total Medicaid costs and the sources of those costs.

First, we reviewed medical literature for studies that identified how tobacco use or exposure changes the risk of acquiring a particular illness. Many studies of how much smoking increases the risk of getting particular diseases have been conducted since the U.S. surgeon general first reported on the health hazards of smoking in 1964. In 2014, the surgeon general summarized many of these studies in a 50th anniversary report.

Some of the diseases we studied, such as prostate cancer, may have many causes in addition to tobacco use. Others, such as lung cancer, are almost always caused by tobacco. Once we found a number specifying how much smoking increased the risk for contracting each disease, we multiplied those risk scores by the percentage of people in Mississippi Medicaid who smoked. That enabled us to estimate what percentage of Mississippi Medicaid spending for each of these diseases was smoking-related. The Mississippi Medicaid program gave us data to determine the cost of each service paid to treat each person with the specific diagnosis.

We then adjusted this initial estimate for other factors that were not captured in the Medicaid payment data. We added adjusted costs for prescription drugs that could be used to treat smoking-related conditions. In addition, many Medicaid participants are in nursing homes because of diseases acquired from smoking. So we added the costs of nursing home stays based on residents’ diagnoses and the same risk scores.

Tobacco use can also affect the health of nonsmokers exposed to second-hand smoke. Mississippi had estimated the costs of second-hand smoke using national estimates. We updated those numbers based on relative risk of tobacco-related diseases we found in the more recent data.

An expensive set of illnesses

In total, we estimated that the cost of tobacco-related illness to Mississippi Medicaid was $388 million in 2016 and $396 million in 2017. This made up about 9% of Mississippi’s annual spending on Medicaid. Our estimates were somewhat lower than the national cost estimates of 15%. We believe this is because Mississippi Medicaid covers large numbers of children and younger adults – a tobacco-related disease may appear only after many years of smoking.

Many Mississippi Medicaid participants may still be too young to be diagnosed with tobacco-related illnesses. Furthermore, our estimates only included diseases with measures of increased risks because of smoking that are presented in the medical literature or the 2014 surgeon general’s report. So, our estimates are relatively conservative.

We believe our study results will help policymakers in Mississippi assess the benefits of policies affecting tobacco. These could include increasing tobacco cessation services, raising the minimum age for buying tobacco products, raising taxes on tobacco products and requiring smoke-free public places. Our approach to estimating costs could also be used by other states to conduct their own analyses of tobacco-related costs to Medicaid to inform their policy choices.

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Charles Betley, Senior Policy Analyst, University of Maryland, Baltimore County

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Header image courtesy of Public Domain Pictures from Pexels. 

Sexual Assault Awareness Month is a national campaign focused on preventing sexual assault, harassment, and abuse, and it’s a month of great significance for the UMBC community. This year’s programming at UMBC is especially meaningful as the University responds to a call by students, faculty, and staff to do more to prevent sexual assault and other forms of sexual misconduct.

Retriever Courage: Speak, listen, learn, act

Retriever Courage was formed in fall 2018 in response to specific recommendations from students, faculty, and staff on how the university administration could improve community safety and wellbeing. The initiative outlined a shared governance process to better prevent and respond to sexual assault and other forms of sexual misconduct in ways that are inclusive, proactive, caring, and transparent.

This work involves dozens of partners across the university. They include the University Steering Committee, Retriever Courage Implementation Team, student and faculty/staff advisory committees, a prevention and response training implementation team, and procurement groups that assisted with the selection of an external consultant team now reviewing all related UMBC policies, practices, and resources.

“The thoughtful efforts of students, and the responsiveness of the University administration, faculty, and staff has been groundbreaking,” says University Steering Committee Chair Adam Harvey ’17, Ph.D. ’21, physics, who also serves as vice president of the Graduate Student Association. “Retriever Courage is beginning to transform the culture at UMBC and how people support each other in the campus community.”

At the same time, Retriever Courage partners say continuing to increase campus-wide involvement is critical to the long-term work of creating lasting change and growing a community where everyone feels safe and supported.

“Preventing sexual violence and misconduct is a collective and ongoing responsibility,” says Susan McDonough, associate professor of history, and affiliate faculty of gender, women’s, and sexuality studies.

McDonough serves as faculty co-chair for the Retriever Courage Faculty/Staff Advisory Committee. She shares, “We have joined together to show up and do what we do best – to learn about the history of our own policies and practices, to research ways that other institutions have tackled these issues, and to educate for awareness and prevention.”

“Sexual violence is not a special interest issue, but rather a social justice issue that impacts us all,” says Student Advisory Committee Co-chair Aliya Weberman Ph.D. ’21, clinical and community psychology. “Whether it is attending a Sexual Assault Awareness Month event, such as Take Back the Night; joining a group or committee working on these issues, such as We Believe You or Retriever Courage; or just telling someone impacted by sexual violence that you believe them and it’s not their fault; we can all make a difference.”

Commitment to action

Committee members share that several Retriever Courage projects directly responding to UMBC community input have been completed or are underway.

UMBC is currently distributing new campus ID cards that prominently display emergency resource information, and two Retriever Courage displays, including both on- and off-campus resources, were installed in The Commons. The displays are part of a pilot project proposed by the student activist/advocacy group We Believe You.

UMBC hired Jody Shipper, J.D., and Cherie Scricca, Ed.D. of Grand River Solutions, Inc. to work with Retriever Courage partners and the UMBC community during the spring semester. The consultants are reviewing UMBC policies, practices, and resources related to sexual assault prevention and response, and will share their recommendations in May.

Over 2,000 UMBC community members have participated in mandatory, in-person Title IX/sexual misconduct prevention and response training since December, and faculty and staff also completed a complementary online training. About 200 students are participating in an in-person pilot training project in April that will help determine a plan for training all students.

Facilities Management also continues to repair and add lighting in areas of concern to students.

Elle Everhart, staff co-chair of the Faculty-Staff Advisory Group and program management specialist in gender, women’s, and sexuality studies, says, “We are only just beginning to address the broader issues of toxic masculinity and rape culture on our campus, but the work done to date is a strong first step.”

“A 365-days-a-year undertaking”

As this work moves forward, the Retriever Courage partners are continually thinking about how the university can better support survivors of all identities and experiences. “We truly all know survivors whether we know them by name or not,” says Jess Myers, director of UMBC’s Women’s Center. “Our efforts to support survivors and cultivate a survivor-responsive campus need to be a 365-days-a-year undertaking,” Myers adds. “We all are responsible for this work.”

Implementation Team Co-Chair and Vice President for Student Affairs Nancy Young feels heartened by the work to date and committed to the work ahead. “We are encouraged by the engagement and collaborative spirit of our Retriever Courage partners and the UMBC community,” she shares. “The safety and wellbeing of our students and our entire community have been and must remain our priority in the long term.”

“The work of Retriever Courage is just the beginning,” says Young. “We encourage everyone to be involved as we make broader and far-reaching improvements in order to have a lasting impact.”

The UMBC community is invited to participate in Sexual Assault Awareness Month workshops and events organized by the Women’s Center and campus partners, including Take Back the Night on Thursday, April 18, 6 to 9 p.m.

UMBC community members can also get involved with Retriever Courage by contacting committee members and learning other ways to help prevent and respond to sexual violence/misconduct at UMBC.

Featured photo: A Take Back the Night survivor speak-out event. Photo courtesy of the Women’s Center at UMBC.