Public Insurance Expansions and Smoking Cessation Medications

Abstract

We study the effect of public insurance on smoking cessation medication prescriptions and financing. We leverage variation in insurance coverage generated by recent Affordable Care Act expansions to Medicaid. We estimate differences‐in‐differences models using administrative data on the universe of Medicaid‐financed prescriptions sold in retail and online pharmacies 2011–2017. Our findings suggest that these expansions increased Medicaid‐financed smoking cessation prescriptions by 34%. This increase reflects new medication use and a shift in payment from private insurers and self‐paying patients to Medicaid. Adjusting our estimate for changes in financing implies that Medicaid expansion led to a 24% increase in new medication use. (JEL I1, I13, I18)

The Effects of Traditional Cigarette and E-Cigarette Taxes on Adult Tobacco Product Use

“…We hypothesize that adoption of an e-cigarette tax increases the price of a potential smoking cessation device (Hajek et al 2019), which dissuades some smokers from attempting to quit or reduce smoking by taking up vaping in response to a traditional cigarette tax increase. Indeed, traditional smoking cessation devices (e.g., Food and Drug Administration-approved nicotine replacement therapies such as Zyban, Chantix, or Nicotrol) are expensive (Maclean, Pesko, and Hill 2019), particularly without insurance, and may not be feasible for smokers, who are on average lower-income (Remler 2004). Moreover, ecigarettes are perceived as effective smoking cessation devices, and more effective than traditional smoking cessation options among some groups of smokers (Glasser et al 2017, Harrell et al 2014.…”

The Effect of E-Cigarette Taxes on Pre-pregnancy and Prenatal Smoking

“…Medicaid expansion plans covered a range of effective cessation medications and (non-pharmacological) treatments with low cost-sharing for enrollees (Maclean, Pesko, and Hill 2019). All monetary values are consumer price index-adjusted to 2010 dollars.…”

Effects of improvements in the CPS on the estimated prevalence of medical financial burdens

“…A necessary assumption for the DD model to recover estimates of causal effects is that, had the intervention group not received the intervention, the intervention and comparison groups would have trended similarly in the postperiod in terms of the studied outcomes (ie the “parallel trends” assumption). While this assumption is inherently untestable as the counterfactual for the intervention group in the postperiod is not observed, a standard approach to providing suggestive evidence that the data can satisfy the parallel trend assumption is to compare trends in the intervention and comparison groups in the preintervention period . A limitation of our study is that we have only one preintervention period (calendar year 2013) and cannot test this assumption.…”

“…While this assumption is inherently untestable as the counterfactual for the intervention group in the postperiod is not observed, a standard approach to providing suggestive evidence that the data can satisfy the parallel trend assumption is to compare trends in the intervention and comparison groups in the preintervention period. 28,32,33 A limitation of our study is that we have only one preintervention period (calendar year 2013) and cannot test this assumption. Table 1 reports estimated summary statistics for the intervention and comparison groups in calendar years 2013 and 2014.…”