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If Ohio cut its smoking rate, it would save lives and potentially millions in health-care costs.
There's a lot of room for improvement, according to a new report from the Health Policy Institute of Ohio.
In Ohio, 22 percent of adults smoke; that's 43rd among the 50 states and the District of Columbia.
Even worse, more than 10 percent of Ohio's children live in homes with tobacco users and are regularly exposed to secondhand smoke; that's 49th highest in the nation.
Overall, Ohio ranks 46th in the nation for how healthy we are and how much we spend on health care.
"States with lower adult smoking rates are more likely to have a better health-value rank -- meaning better population health outcomes and lower health-care spending," the report found.
Amy Rohling McGee, president of the Health Policy Institute, said, "Tobacco use and secondhand smoke is a key factor contributing to cancer, cardiovascular disease, infant mortality and other conditions."
Tobacco use also is driving up health-care costs, particularly among poor and disabled adults enrolled in Ohio's tax-funded Medicaid program.
According to the report, 42 percent of working-age Medicaid beneficiaries were smokers in 2015.
Researchers estimate that 15 percent of Medicaid costs nationwide were attributed to smoking, and a recent Indiana study found that per-member, per-month program costs were 51 percent higher for smokers than non-smokers. Ohio spent $25 billion in state and federal funds on Medicaid last year, suggesting that a drop in the smoking rate could bring significant savings. The program covers more than 3 million poor and disabled Ohioans.
"Most people who smoke want to stop, and smoking-cessation coverage through Medicaid is good, but there seems to be lack of awareness because few are using" programs to stop smoking, said Amy Bush Stevens, vice president for prevention and public-health policy for the institute.
Medicaid covers smoking-cessation counseling and medications to curb cravings, but, according to state statistics, only 5 percent of beneficiaries received medication last year, and only 2 percent got counseling.
"Given that 42 percent are smoking, that's low," Stevens said.
State Medicaid officials agree. Starting this year, Medicaid is requiring managed-care plans and health-care providers to report the number of patients screened for tobacco use and the number receiving smoking-cessation counseling.
"Once we get data, we will set standards for providers and coverage to help lower smoking," said Melissa Ayers, spokeswoman for Ohio Medicaid.
The state does not have estimates on Medicaid costs associated with tobacco use.
Stevens said, "We have decades of evidence to show what works to reduce tobacco use."
The report makes several recommendations, starting with an increase in the state tax on cigarettes and tobacco products.
Gov. John Kasich's budget plan calls for increasing the cigarette tax by 65 cents per pack, from $1.60 to $2.25. It also would increase the tax rate on other tobacco products from 17 percent of the wholesale price to 69 percent, and extend the tax on other tobacco products to vapor products such as e-cigarettes at the new 69 percent rate.
The plan is under consideration in the Legislature, which is generally reluctant to raise taxes.
"Decreasing the prevalence of smoking is critical to preventing and reducing infant mortality and the burden of chronic disease in Ohio. The most recommended and proven strategy for decreasing smoking prevalence and preventing nonsmokers, including youth, from starting to smoke is to increase the price of tobacco," Ayers said.
Other strategies recommended in the report included expanded media campaigns; access to cessation counseling and medication such as services offered through the Ohio Tobacco Quitline; and smoking bans and smoke-free policies.