Gov. Paul LePage’s administration says it is committed to investing in effective strategies to help more of the 20 percent of Maine residents who smoke to kick the habit. For administration officials, the main strategy is an investment in primary care providers who can motivate their patients to live healthier lives.
We’re happy to see the LePage administration speak about prioritizing smoking cessation and primary care. But in its proposal for a new two-year state budget, the administration largely abandons one initiative that can reduce smoking rates and entirely overlooks another policy that could grow access to primary care.
LePage hasn’t always made smoking cessation a priority. He has long opposed raising the state’s $2-per-pack cigarette tax, one of a number of strategies shown to make a dent in teen smoking rates. And in 2012, LePage’s Department of Health and Human Services eliminated coverage for anti-smoking medications through MaineCare, the state’s Medicaid program, although MaineCare recipients are twice as likely to smoke as the general population.
LePage subverted the Legislature’s near-unanimous efforts to restore that coverage before a provision of the Affordable Care Act kicked in last year and required all state Medicaid programs to cover anti-smoking medications.
Now, although the administration says it’s trying to shift state spending where it will be most effective, the LePage budget proposes to cut in half the amount Maine spends on statewide smoking prevention and cessation. The budget also cuts all state funding for a network of regional public health alliances whose mission is to work in communities throughout the state to reduce smoking.
The budget instead shifts the money — $10 million a year that Maine receives from tobacco companies through a 17-year-old settlement — to primary care. The $10 million wouldn’t pay for an initiative that guarantees doctor visits for more low-income people; it would merely retain increased Medicaid reimbursement rates for primary care providers that were in effect for the past two years under the federal Affordable Care Act and expired Dec. 31, 2014.
LePage has firmly opposed a policy option that would — at minimal state cost — expand access to primary care by ensuring tens of thousands of low-income Maine adults have the means to pay for a doctor’s appointment. That policy is the Medicaid expansion states can implement under the Affordable Care Act.
Primary care providers are certainly a key part of efforts to reduce smoking. But they’re only a part, and the LePage budget emphasizes the services of primary care providers at the expense of nearly everything else that can reinforce the anti-smoking messages they share with their patients.
Over time, research has shown that effective smoking prevention programs are all-encompassing. They involve mass and targeted marketing broadcasting anti-smoking messages; cessation services to help smokers quit (through Maine’s quit line, for example); state and local policies to limit exposure to second-hand smoke in public places; concerted efforts — such as working with retailers — to restrict minors’ access to tobacco; and aggressive community education in schools, in homes and with community groups.
Another component of effective smoking prevention programs is sustained commitment. That’s an area where Maine has been lagging in recent years. Its tobacco cessation spending this year, about $8 million, is less than half what Maine spent at its peak — $17.6 million in 2009. It’s about half what the U.S. CDC recommends Maine spend to combat tobacco effectively.
It’s no coincidence that Maine’s progress in cutting teen smoking rates has stalled in recent years. And if the budget proposals to further cut smoking cessation spending take effect, it will be no coincidence if Maine loses even more ground in the fight against tobacco.
