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Gaps Remain in Medicaid Efforts to Help People Kick Smoking Habit

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By Shefali Luthra, Kaiser Health News

 

The 2010 federal health law has a provision that was supposed to make it easier for people on Medicaid to quit smoking. But in a number of states, it’s not, so far, having widespread success.

 

That’s the main takeaway from a study published Tuesday in the journal Health Affairs. The law says all state Medicaid programs have to cover tobacco cessation drugs — meaning they have to pay for things like nicotine patches, Chantix, nicotine gum or Wellbutrin, when patients are using them to try to quit smoking. But it leaves states relative freedom in how they go about doing so and what conditions they place on how the benefit is applied.

 

That flexibility has consequences, according to the study’s authors. They examined Medicaid data and found that very few enrollees — about 10 percent nationwide in 2013 — got medicine that might help them stop smoking, even though Medicaid recipients are around twice as likely as average Americans to be smokers.

 

Both from a public health standpoint and an economic one, that’s a problem, said Leighton Ku, director of the Center for Health Policy Research at George Washington University and the study’s lead author. Figures from the U.S. surgeon general indicate about 15 percent of Medicaid’s expenses — $40 billion in 2010 — are caused by smoking. The authors estimated that number will reach $75 billion this year. By contrast, Medicaid spent $103 million in 2013 on smoking cessation drugs.

 

“This is something where you can improve health, you can save you money,” he said. “And we’re just not very effective at it.”

 

In 2013, the study found, about 1.7 million prescriptions were filled or refilled for drugs to help Medicaid patients quit smoking. That’s estimated to be enough to treat about 830,000 people — out of about 8.3 million Medicaid patients whom the researchers estimated were smokers in 2013.

 

Some states have done a markedly better job than others. In Minnesota, for example, almost 27 percent of smokers on Medicaid were using medications to help them quit smoking, the researchers found. In Texas, only 1 percent did.

 

Ideally, Ku said, 100 percent of smokers on Medicaid would get help quitting. But even the Minnesota experience — which has the highest proportion of Medicaid smokers getting those prescriptions — indicates the extent to which other states currently fall short, he said.

 

It’s not entirely clear why, according to the researchers. But there are a number of factors that could be at play. In some states, patients have to make co-payments toward the medication, or get prior authorization from the Medicaid program before getting the drug. Those are more or less “functional barriers” that keep Medicaid beneficiaries from getting the medicine that could help them quit, said Michael Fiore, a professor of medicine and director of the University of Wisconsin Medical School’s Center for Tobacco Research and Intervention. Fiore wasn’t involved in the study.

 

And often, the study notes, people don’t realize Medicaid covers smoking cessation drugs.

 

“This is still a new thing,” Ku said. “It’s underappreciated, under-recognized.” The federal government hasn’t placed much emphasis on the regulation, he added, though he thinks more state Medicaid agencies are starting to prioritize it.

 

The study also notes another wrinkle. When it comes to states where smokers on Medicaid have less frequently gotten cessation drugs, most declined to expand Medicaid to cover a larger number of childless adults, a component of the health law the Supreme Court made optional in 2012.

 

That connection, Fiore said, is probably because the same states that declined the expansion are often ones that haven’t emphasized preventive care — though that isn’t always the case. He also pointed out that Wisconsin has actively publicized the smoking cessation benefit, despite choosing not to expand the low-income health insurance program.

 

When states don’t help people quit smoking, Ku said, they will ultimately face greater health care costs, since smoking helps cause diseases such as lung cancer and chronic obstructive pulmonary disease.

 

“If [those states] would expand Medicaid, more people would have access to Medicaid that would cover tobacco cessations,” he said.

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Not Just a Southern Issue: Advocates Say SCOTUS Voting Rights Decision Has Already Started to Reshape Black Political Power

OAKLAND POST — Following the Civil War and Reconstruction, constitutional amendments expanded Black citizenship and voting rights across the South, leading to dramatic increases in Black political representation. But those gains were quickly met with violent backlash and the rise of Jim Crow laws designed to suppress Black voting through poll taxes, literacy tests, and other “race-neutral” restrictions.

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By Edward Henderson, California Black Media

U.S. Rep. Sydney Kamlager-Dove (D-CA-37), a member of the Congressional Black Caucus (CBC) whose district spans parts of Los Angeles County, joined fellow CBC member U.S. Rep. Troy Carter (D-LA-2) for a May 21 briefing with Black media outlets in California. 

The lawmakers highlighted what they describe as a mounting threat to Black political representation resulting from an April 29 U.S. Supreme Court ruling that weakened key protections under the federal Voting Rights Act.  

Kamlager-Dove and Carter warned that the decision, which narrowed the role of race in redistricting, is already reshaping congressional districts across the South and undermining Black voters’ ability to elect candidates of their choice.

“While we are a super blue state, we have far to go when it comes to Black representation; we tend to take that for granted,” Kamlager-Dove said of California, noting that the Golden State has the fifth largest Black population in the country and only has three Black members of Congress.   

“While I support building coalitions, we have to make sure that as a Black community we are not yielding our power,” she added.

Calling the fight “not unique to the South,” Carter urged Black communities nationwide to recognize the broader implications of the legal and political battles unfolding in Southern legislatures and courtrooms. 

The Supreme Court ruling centers on Section 2 of the Voting Rights Act of 1965, the portion of the law that prohibits voting systems or district maps that dilute the voting strength of racial minorities. For decades, Section 2 allowed civil rights groups to challenge district maps that weakened Black political representation even when lawmakers did not openly state discriminatory intent.

Now, advocates fear that standard has fundamentally changed. 

“You have to have smoking gun evidence,” said Mitchell Brown, senior voting rights counsel at the Southern Coalition for Social Justice, during a recent media briefing hosted by American Community Media on May 15. “Legislators are not going to say the quiet part out loud.” 

The implications could stretch far beyond congressional elections, Brown said.  

Section 2 protections have historically applied not only to U.S. House districts, but also to state legislatures, school boards, county commissions, judgeships, and local governing bodies. Voting rights advocates warn that weakening those protections could reshape political representation throughout the South, particularly in states with large Black populations. 

“This is not just a Southern issue,” said Amir Badat, manager of Black Voters on the Rise and voting special counsel at the NAACP Legal Defense and Educational Fund.

Badat described the current moment as part of a much longer historical pattern. 

Following the Civil War and Reconstruction, constitutional amendments expanded Black citizenship and voting rights across the South, leading to dramatic increases in Black political representation. But those gains were quickly met with violent backlash and the rise of Jim Crow laws designed to suppress Black voting through poll taxes, literacy tests, and other “race-neutral” restrictions. 

“This is the same move,” Badat said.

Advocates also emphasized that the consequences of weakened voting protections extend into everyday life. 

Local elected offices such as school boards, city councils, county commissions, and judgeships often determine funding priorities, public safety policy, education standards, and infrastructure investments.

“These are not abstract numbers,” Badat said. “These have real political consequences and policy consequences on people’s day-to-day lives.” 

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Rest in Peace: A.M.E. Pastor and L.A Civil Rights Icon Cecil “Chip” Murray Passes

The Rev. Dr. Cecil L. “Chip” Murray, former pastor of First African Methodist Episcopal Church (FAME) in Los Angeles, died of natural causes April 6 at his Windsor Hills Home. He was 94. “Today, we lost a giant. Reverend Dr. Cecil Murray dedicated his life to service, community, and putting God first in all things. I had the absolute honor of working with him, worshiping with him, and seeking his counsel,” said Los Angeles Mayor Karen Bass of the dynamic religious leader whose ministry inspired and attracted millionaires as well as former gang bangers and people dealing with substance use disorder (SUD).

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The Rev. Dr. Cecil L. “Chip” Murray, former pastor of First African Methodist Episcopal Church (FAME) in Los Angeles, died of natural causes April 6 at his Windsor Hills Home. He was 94.

“Today, we lost a giant. Reverend Dr. Cecil Murray dedicated his life to service, community, and putting God first in all things. I had the absolute honor of working with him, worshiping with him, and seeking his counsel,” said Los Angeles Mayor Karen Bass of the dynamic religious leader whose ministry inspired and attracted millionaires as well as former gang bangers and people dealing with substance use disorder (SUD).

Murray oversaw the growth of FAME’s congregation from 250 members to 18,000.

“My heart is with the First AME congregation and community today as we reflect on a legacy that changed this city forever,” Bass continued.

Murray served as Senior Minister at FAME, the oldest Black congregation in the city, for 27 years. During that time, various dignitaries visited and he built strong relationships with political and civic leaders in the city and across the state, as well as a number of Hollywood figures. Several national political leaders also visited with Murray and his congregation at FAME, including Presidents George W. Bush and Bill Clinton.

Murray, a Florida native and U.S. Air Force vet, attended Florida A&M University, where he majored in history, worked on the school newspaper and pledged Alpha Phi Alpha Fraternity.  He later attended Claremont School of Theology in Los Angeles County, where he earned his doctorate in Divinity.

Murray is survived by his son Drew. His wife Bernadine, who was a committed member of the A.M.E. church and the daughter of his childhood pastor, died in 2013.

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Court Throws Out Law That Allowed Californians to Build Duplexes, Triplexes and RDUs on Their Properties

Charter cities in California won a lawsuit last week against the state that declared Senate Bill (SB) 9, a pro-housing bill, unconstitutional. Passed in 2021, SB 9 is also known as the California Housing Opportunity and More Efficiency Act (HOME). That law permits up to four residential units — counting individual units of duplexes, triplexes and residential dwelling units (RDUs) – to be built on properties in neighborhoods that were previously zoned for only single-family homes.

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Charter cities in California won a lawsuit last week against the state that declared Senate Bill (SB) 9, a pro-housing bill, unconstitutional.

Passed in 2021, SB 9 is also known as the California Housing Opportunity and More Efficiency Act (HOME). That law permits up to four residential units — counting individual units of duplexes, triplexes and residential dwelling units (RDUs) – to be built on properties in neighborhoods that were previously zoned for only single-family homes.

A Los Angeles Superior Court Judge ruled in favor of the cities, pointing out that SB 9 discredited charter cities that were granted jurisdiction to create new governance systems and enact policy reforms. The court ruling affects 121 charter cities that have local constitutions.

Attorney Pam Lee represented five Southern California cities in the lawsuit against the state and Attorney General Rob Bonta.

“This is a monumental victory for all charter cities in California,” Lee said.

However, general law cities are excluded from the court ruling as state housing laws still apply in residential areas.

Attorney General Bonta and his team are working to review the decision and consider all options that will protect SB 9 as a state law. Bonta said the law has helped provide affordable housing for residents in California.

“Our statewide housing shortage and affordability crisis requires collaboration, innovation, and a good faith effort by local governments to increase the housing supply,” Bonta said.

“SB9 is an important tool in this effort, and we’re going to make sure homeowners have the opportunity to utilize it,” he said.

Charter cities remain adamant that the state should refrain from making land-use decisions on their behalf. In the lawsuit, city representatives argued that SB 9 eliminates local authority to create single-family zoning districts and approve housing developments.

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