Association for Public Policy Analysis & Management

Background: Cigarette smoking is still a problem in the United States (US). Cessation intervention coverage was changed due to the implementation of the Affordable Care Act (ACA). Little is known about the impact of the ACA on the practice of cessation counseling, and prescription of cessation medication in the US.

Purpose: The objectives of this study was to estimate the impact of the ACA on cessation counseling and prescription of cessation medication in the US.

Methods: An observational study using Medical Expenditure Panel Survey was used. This was a cross-sectional design comparing pre- and post-ACA implementation using multivariate logistic regression. Pre-ACA years were 2007, 2008, and 2009, while post-ACA years were 2011, 2012, and 2013. There were 23,849 smokers aged 18+ years included in the analysis. The variable of interest was the proportion of smokers who received smoking cessation counseling or smoking cessation medication. The covariates included ACA, gender, age, race, ethnicity, insurance status, and region.

Results and Conclusion: The odds of receiving cessation counseling was 8% higher (p=0.0452) and the odds of receiving prescription of cessation medication was 10% higher (p=0.4399) after the implementation of the ACA. However, young adult, male, the uninsured, non-White and Hispanic population, and people who live outside of the Northeast region significantly had lower odds of receiving cessation counseling. The results of this study will be useful to policymakers as they modify cessation interventions to be more targeted towards population with unmet needs identified in this study.