Smoking report indicates problems with health insurance regulation

April 10--Insurers who sell plans on HealthCare.gov in Missouri are supposed to help people quit smoking but none offer adequate coverage, according to a new report by the American Lung Association.

Using information on the insurers' publicly available websites, the report concluded that no plan offered on the government-run health exchange in Missouri covers all seven Food and Drug Administration-approved devices designed to help smokers kick the habit.

The findings, which insurance companies dispute, point to a continuing issue with the Affordable Care Act.

While the law requires health plans to cover certain "essential benefits," such as tobacco cessation, enforcement is less than rigorous, especially in states like Missouri that rely on the federal government to act as watchdog.

Missouri is among the states that declined to create and run its own health insurance exchange, making the federal government provide that service instead. That meant Washington, instead of Jefferson City, was in charge of implementing this part of the Affordable Care Act. And that may have translated into less oversight.

The federal government's role in regulating multiple insurance plans is "difficult from a resources standpoint as well as a logistical standpoint," Georgetown University professor Sabrina Corlette said. "There are clearly shortcomings of having everything removed in Washington."

Tobacco cessation hasn't been the only issue where advocates and experts have urged more oversight from the federal government.

LGBT advocates have long complained about how HealthCare.gov plans treat prescription drug coverage for those with HIV. They've accused insurance companies of charging high cost-sharing amounts for those drugs used to treat the condition, in effect discriminating against HIV patients. The Affordable Care Act prohibits insurers from charging more to consumers who have a medical condition with one exception for tobacco use.

The Affordable Care Act requires state and the federal government to take a more pronounced role in regulating health insurance coverage.

But the American Lung Association says the issue of smoking cessation may have fallen through the cracks.

Its report finds that only 17 percent of health insurance carriers covered all seven FDA-approved smoking cessation treatments at no cost to the consumers. None were in Missouri and only one carrier in Illinois was defined as "compliant" by the association. The seven devices are nicotine gums, patches, lozenges, nasal sprays and inhalers, as well as bupropion and varenicline.

Insurance companies were very critical of the lung association's findings. They say that oftentimes smoking cessation treatments are covered under a policy but may not be listed on the publicly available drug formularies.

"It is important for members to understand that we do cover smoking cessation programs in accordance with the ACA and even though over-the-counter drugs or programs may not be in a formulary, they are still covered," said Rohan Hutchings, a spokesman for Coventry Health Care.

James Martinez, a spokesman for the lung association, said information not included in the formulary was not factored into the report and could mean that more insurers are covering more tobacco cessation treatments than laid out in the study.

America's Health Insurance Plans, an industry trade group, said carriers have had a long commitment to helping their customers quit smoking. It said insurers are following federal guidelines when it comes to tobacco cessation coverage and cited the government's regulatory authority.

"All of these plans and products have to be reviewed by regulators and approved," said Clare Krusing, a spokeswoman.

But to some, it's the regulatory process that could lead to cracks in the system. Corlette said it's unclear how often federal regulators are auditing the health plans for compliance. She also said that both the government and the insurance industry have been "drinking from fire hoses" since the health law was enacted, meaning some things have slipped through the cracks.

The problem is even more pronounced in Missouri, which doesn't have a robust regulatory system on the state level. Missouri is one of the five states that told the federal government it did not have the ability to regulate the Affordable Care Act's "market reforms."

In an emailed statement to the Post-Dispatch, the federal Department of Health and Human Services said it would continue to work with health carriers to seek reductions in the smoking rate.

"We are committed to reducing the burden tobacco has on our nation and has made preventing and reducing tobacco use a priority," the statement said.

Industry stakeholders acknowledged the challenge ahead.

"This is health care and it's very complex. There are multiple different pieces to it and it's relatively still new," Martinez said.

This report was prepared in collaboration with Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.

Jordan Shapiro -- 314-340-8114

@jordanshapiro13 on Twitter

jshapiro@post-dispatch.com

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