Association of the Affordable Care Act With Smoking and Tobacco Treatment Utilization Among Adults Newly Enrolled in Health Care

Abstract

Objectives To examine rates of smoking and tobacco treatment utilization by insurance coverage status (Medicaid, commercial, exchange) among newly enrolled patients in the post ACA era. Methods We examined new members who enrolled in Kaiser Permanente Northern California (KPNC) through Medicaid, the California exchange, or non-exchange commercial plans (N=122,298) in the first six months of 2014 following ACA implementation. We compared these groups on smoking prevalence and tested whether smokers in each group differed on sociodemographic characteristics and in their utilization of tobacco treatment (pharmacotherapy and counseling) in 2014. Results Smoking prevalence was higher among Medicaid (22%) than exchange (13%) or commercial (12%) patients (p<.0001). Controlling for key sociodemographic and clinical characteristics, Medicaid (OR=1.49, 95% CI=1.29–1.73) smokers had greater odds of tobacco treatment use than commercial smokers. Other groups at risk for underuse included men, younger patients, Asians and Latinos. Conclusions In this cohort of newly enrolled patients after ACA implementation, Medicaid patients were more likely to be smokers compared to exchange and commercial patients, but they were also more likely to use tobacco treatment. Low tobacco treatment use among exchange and commercial plan smokers, as well as younger men, Asians and Latinos poses a significant obstacle to improving public health and additional targeted outreach strategies may be need to engage these patients with available health services.

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