The governor wants to force health insurers to pay for the programs.

01:00 AM EST on Saturday, March 4, 2006

BY SCOTT MAYEROWITZ
Journal State House Bureau

PROVIDENCE -- Governor Carcieri has slashed financing for stop-smoking programs but says there will be little loss in service, because he hopes to force private insurers to pick up the tab.

The move is part of a larger push by the Republican governor to get Rhode Islanders to lead healthier lifestyles.

The idea is that by compelling insurers to pay for smoking-cessation programs and the related cost of nicotine patches and gum, they will have a greater vested interest in reducing smoking.

Carcieri says people need a financial incentive to change behavior and ultimately hopes insurers will offer premium discounts to those who don't smoke. He is considering such an enticement for state workers.

"We're not cutting back, we're shifting it," Carcieri said. "If you really believe that this is the solution, long-term, for better, healthier people . . . then the insurers have to get behind this."

The governor's bill, sponsored by Rep. Richard W. Singleton, R-Cumberland, is scheduled for a hearing Tuesday.

Debora M. Spano, spokeswoman for UnitedHealthcare of New England, said New Mexico and Maryland are the only states to require such coverage.

"For every mandate enacted by the legislature there is an increased cost to employers and health-plan members," she said.

Blue Cross & Blue Shield of Rhode Island doesn't take a position on specific mandates, said spokeswoman Kim Keough. But, she said, they generally "drive up the cost of health care."

Keough said Blue Cross members can get free counseling by phone. Some members -- depending on their plan -- can also get free in-person counseling.

Carcieri's plan calls for a $1.2-million cut in the state's $2.2-million tobacco-control budget. Currently, $1.36 million is spent on advertising and $835,000 for treatment programs. Carcieri wants to eliminate the smoking-cessation programs and trim the advertising budget by $225,000.

Between the programs and hikes in the cigarette tax, the number of Rhode Islanders smoking has dramatically declined. Today 16 percent of youths smoke, down from 35 percent in 1997, Carcieri said.

The governor has no problem with the current treatment options. It's just a policy decision about who should be paying.

About 75 to 80 percent of the people using in-person cessation programs have private insurance, Carcieri said. For some of those without insurance, Medicaid would pick up the cost.

However, there still will be a group -- the governor's office couldn't say how small -- that wouldn't be covered by either private insurance or Medicaid.

Elizabeth M. Gemski, director of government relations and advocacy for the American Cancer Society's New England division, said it's wrong to cut a program "that saves lives from cancer and other tobacco-related illnesses and decreases health-care costs."

Gemski said the society supports the concept of insurers paying for these services, but only as a complement -- not a substitution -- to the state's tobacco-control program.

Rhode Island is expected to collect $127 million this year from its $2.46-per-pack tax on cigarettes, one of the highest taxes in the nation. Yet, Gemski points out, the state spends less than 2 percent of that tax on quit-smoking programs.

This week marks the one-year anniversary of the state's smoking ban, which prohibited smoking in virtually all public places.

In the weeks leading up to the ban, the state saw a large spike in the number of people seeking treatment. Last year there were 3,882 calls to the state's hot line, 889 people who received telephone counseling and another 1,631 who received free in-person counseling.

The state expects the numbers to return to a more-normal level this year, with 580 people seeking telephone counseling and another 867 estimated to have face-to-face treatment.

Several private groups throughout the state are subcontracted by the state to provide the in-person counseling.

East Bay Mental Health Center, in Barrington, is one of those providers. The group received $45,000 from the state for its group counseling services.

Robert A. Crossley, the center's CEO, said the governor has a good idea, but that he is worried about what happens if the budget is cut butCarcieri's legislation forcing the insurers to pay doesn't pass.

"He's basically cutting funding with the hope that they will pick it up, but what happens if they don't?" Crossley said. "The risk is -- that in the interim -- people don't have access to the service."

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