California may be gearing for another row with health insurers, but this time it's not over increasing insurance rates.
A new bill in California would require health insurers to cover the costs of quitting smoking.
Earlier this week, state lawmakers introduced a bill to require health insurers to cover services that help people stop smoking.
But concerns over cost, the dragon that's slayed similar efforts in the past, may come back for a new battle.
The bill, which was introduced by Senator Leland Yee, D-San Francisco, would mandate that insurers cover up to $500 of smoking cessation services. "That means, patches, nasal spray, gum, counseling -- any cessation services," said Adam Keigwin, Sen. Yee's Chief of Staff.
The California Association of Health Plans, which represents the state's HMOs, says they don't currently have a position on the bill. "But, generally speaking, we oppose benefits mandates because they increase the cost of health care and hinder consumer choice," spokesperson Nicole Kasabian Evans told Shots.
The California chapter of the American Lung Association and Sen.Yee's office, among others, disagree.
They say helping smokers kick the habit actually saves money in the long run.
One 2006 study called smoking cessation programs" one of the three most important and cost-effective preventive services that can be provided in medical practice," and estimated savings of up to $1100 in health care expenditures per smoker.
"It's a return on investment," Paul Knepprath, VP Advocacy and Health Initiatives for the California ALA told Shots. "You can reduce cost to the employer, to the smoker, to the state, to the health care companies, all by investing in cessation programs."
Last time such a mandate was attempted in the Golden State, it didn't get very far. Then-Senator Deborah Ortiz, D-Sacramento introduced a bill in 2005. But after the legislature passed it, Gov. Arnold Schwarzenegger gave it a big fat "X."
Schwarzenegger cited worries over rising costs of insurance as justification for the veto.
And at least for now, he's still in power, and the state's budget crisis is still going strong.
So what makes Sen. Yee et al. think they can get this bill through now?
"Other states have done this and it's seen a great reduction in the number individuals smoking and it's cost effective," said Keigwin. "We [now] have significant data to give us reason to think he may reconsider his position on this bill."
Seven other states now have some sort of standards for insurers to cover smoking cessation services, though the details of the mandates for health insurers vary from state to state.
"California has seen itself as a leader in the issue of tobacco control," Knepprath said, noting that the Governor's own 2007 health care proposal -- which was itself subsequently defeated -- actually acknowledged the need for greater accessibility smoking cessation tools. But it promoted a different, non-insurance based cessation program
Evans said that's the way it should be: "In California there's already a tobacco tax that supports a free tobacco cessation program that's available to everyone," Evans said. She added that several plans offered by California health insurers already have smoking cessation programs they support, "but those are market driven, and we think that's the best approach."
But Keigwin remains hopeful, though he realizes the insurance companies may be a bigger obstacle than the Governor. "The insurers will probably try to fight this bill. But... if you can prevent someone from needing long term treatment for, say, cancer, that's going to save money," he said.