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The federal government missed several important opportunities to improve access to smoking cessation medications and counseling this year, according to a new American Lung Association report. States’ records were more mixed, but many failed to ensure coverage, the group says.

“Over the next year, key decisions will be made by the federal government and the states about whether or not they will help save lives, prevent disease and reduce health costs,” Paul Billings, Senior Vice President of Advocacy and Education at the American Lung Association, said in a news release. “We know that the vast majority of smokers want to quit, but the complex web of state and federal coverage for effective quit-smoking programs and treatments prevents too many from getting the help they need. States and the federal government can reduce the enormous health burden of tobacco use by providing access to these proven interventions.”

The U.S. Department of Health and Human Services (HHS) published a proposed rule in November that requires the Essential Health Benefit coverage mandated by the Affordable Care Act to cover preventive services, including a tobacco cessation benefit. HHS has not defined what insurers must include as part of that coverage, however. “Until HHS officially defines a comprehensive tobacco cessation benefit, it has missed a crucial opportunity to provide many smokers with new access to help quitting, and to establish tobacco cessation as a truly essential health benefit for all health insurance coverage,” the American Lung Association states.

The report found only Indiana and Massachusetts provide comprehensive Medicaid coverage to help people quit, according to HealthDay. Alabama and Georgia provide no Medicaid coverage for smoking cessation. Maine and South Dakota are the only states that fund quit-smoking hotlines at or above the recommended amount.

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