Reduction in Smoking Prevalence Linked to Reduced Medicaid Costs

man smoking a cigarette
man smoking a cigarette
Investigators assessed 1-year changes in healthcare expenditures, particularly Medicaid costs, linked to a 1% decrease in smoking consumption in all US states.

A reduction in smoking prevalence among Medicaid recipients can reduce healthcare costs in the short term, according to study results published in JAMA Network Open.

Researchers evaluated the relationship among state-level Medicaid expenditures, smoking prevalence among Medicaid recipients, and healthcare costs. The primary outcome of the study was the 1-year change in healthcare costs. Data were pulled from the 2017 Behavioral Risk Factors Surveillance System, the 2018 National Health Interview Survey (NHIS), and the Kaiser Family Foundation Total Medicaid Spending (fiscal year 2017). NHIS data were aggregated by census region (Northeast, Midwest, South, and West); the data were then used to compare smoking rates between the general population and Medicaid recipients by region. For the study, smokers were defined as “persons who had smoked ≥100 cigarettes during their lifetime.”

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The total sample size was 26,630 participants. Overall, Medicaid recipients in the Midwest had the highest rate of smoking prevalence (36.1% vs 16.9% among all adults in the region). Comparatively, the West had the lowest rate of smoking prevalence among Medicare recipients (15.1% vs 11% among all adults in the region).

Study results indicated a reduction in absolute smoking prevalence of 1% in each state could be linked to “substantial Medicaid savings the following year”: a total of $2.6 billion. Median state savings was $25 million (interquartile range, $8 million-$35 million).

One study limitation included the uncertainty introduced by the use of the NHIS data. In addition, the results are limited by the estimates reflecting healthcare costs associated with the indirect health effects of secondhand and thirdhand smoke.

“This analysis focused on reductions in [smoking] prevalence,” the study author concluded. “Reductions in consumption by continuing smokers may also be followed by reductions in healthcare costs. Because some of the risks of smoking, such as cancer, emerge more slowly over time, these medical cost savings would likely grow with time.”


Glantz SA. Estimation of 1-year changes in Medicaid expenditures associated with reducing cigarette smoking prevalence by 1%. JAMA Netw Open. 2019;2(4):e192307.

This article originally appeared on Medical Bag