Seventy percent of smokers say they'd like to quit, and now, just days into the new year, many may already be struggling to stick to their resolution to make 2012 a smoke-free year. Nearly one in five adults smoke, a figure that hasn't budged much in several years.
Smoking is the No. 1 cause of preventable death in this country. Nearly half a million people die prematurely because of smoking-related illnesses, including lung cancer, heart disease and chronic obstructive pulmonary disease, according to the Centers for Disease Control and Prevention.
Most smokers need some sort of assistance to quit, but budget-strapped states this year will spend less than 2 percent of their tobacco-tax and tobacco-settlement billions on programs to help people quit smoking or prevent them from starting, according to a recent report by a coalition of public-health organizations. In the past four years, state spending on tobacco prevention and cessation has declined by 36 percent, to $457 million.
Tobacco-related health-care spending is nearly $100 billion annually, according to the CDC.
"It's a travesty," says Danny McGoldrick, vice president for research at the Campaign for Tobacco-Free Kids. "These programs more than pay for themselves."
While public funding falters, a growing number of companies offer smoking-cessation programs to their workers. At the same time, more companies are also penalizing employees who don't kick the habit by hitting them with higher health insurance premiums.
At firms with more than 20,000 employees, 24 percent vary premiums based on whether someone smokes, as do 12 percent of companies with 500 or more workers, according to the 2011 survey of employer-sponsored health plans by human resources consultant Mercer.
Public-health advocates generally agree that this punitive approach isn't ideal. "The issue isn't smokers; it's smoking," says McGoldrick. Higher premiums may just make smokers drop their coverage, he says.
But employers argue that charging smokers more is fair. "The cost of medical care for smokers is considerably higher," says Helen Darling, chief executive of the National Business Group on Health, an employer group. "Employers are increasingly saying that if someone costs the pool more, they should pay more."
For Tommy Piver, 59, the combination of pricier cigarettes and looming insurance penalties motivated the two-pack-a-day smoker to give up the habit he'd started at age 13. The Naples man learned his insurance carrier was going to triple his premium and reduce coverage.
"Kicking and screaming," Piver quit on Jan. 1, 2010. About a week later, he saw a television ad for an online stop-smoking program developed by Legacy, a nonprofit created under the settlement between the states and the tobacco industry. Piver joined the free EX program and hasn't had a cigarette in two years.
The 2010 federal health law expanded coverage for smoking cessation, requiring that states provide tobacco-cessation coverage for all pregnant women in their Medicaid programs at no cost. But antismoking activists want broader coverage: Although 19 percent of adults smoke overall, 31 percent of adults living below the poverty line are smokers.
The health law also requires that new plans screen adults for tobacco use and provide free interventions.