The final installment in a five-part series examining the impacts of NY State’s recent tax hike on cigarettes
by Alex Cole
photo by Talbot Eckweiler
Rick Johnson smoked a pack of Marlboro Menthol Lights each and every day for 30 years.
He spent well over $40,000 on smoking in his lifetime. That’s not including the money he spent trying to kick the habit. And it was all for an addiction he couldn’t quite understand.
“It’s very stupid to spend money on something that might kill you,” he admits.
Rick’s third craving kicks in around 5 o’clock at night. He usually has four of these “moments” throughout the day, and they’re never predictable.
He’s in the midst of cooking a hearty corned beef and cabbage dinner for his family of five. But it’s time for a nicotine break. After checking on the roast, he wipes his hands on a towel and fumbles around in his pocket for some relief.
One would suspect a green pack of Marlboros. But it’s nowhere in sight. Rick instead pulls out a strip of silver foil filled with pieces of gum.
He doesn’t chew the gum to freshen his breath. Rick uses it to curb his smoking addiction.
He pokes a hole through the foil, slides a piece of the nicotine gum onto his palm, and pops it into his mouth. His teeth grind against the gum’s surface as his taste buds soak in the initial flavor.
Sweet. Fruity. Juicy. Just as advertised.
But then the chemical sets in. Bitter. Tangy. Tart.
Rick started using the gum in April. It’s his second attempt at butting out – he quit for a few years before returning to the addiction in 2003.
But times have changed since then. Finances have changed.
“The first time I quit it was a lot cheaper than smoking,” he says. “The second time I quit it was more expensive.”
Rick didn’t use the nicotine gum during his first attempt. He tried the Nicotrol Inhaler, a device that still fed the chemical into his system.
“You put a nicotine cartridge into [the inhaler] and inhale it like you would a cigarette,” Rick explains. “It gives you a certain dosage of nicotine that’s usually equivalent to a cigarette.”
He paid $23 for a one-month supply of the product in 2003. His insurance company, MVP Health Care in New York, covered the rest of the costs.
Rick decided to use the inhaler again in his second attempt at quitting. But the price had changed.
“The second time I quit, my insurance had changed and [the inhalers] weren’t covered at all,” Rick says. “So I had to pay $205 for a one-month supply.”
Regardless, he continued to use the inhaler for six more months before switching over to the nicotine gum. The price wasn’t quite as high, and he only chews about four pieces a day.
“You get 100 pieces for about $40,” he says. “They’re a lot less expensive.”
It’s also cheaper than the $38 a week Rick paid for a carton of smokes. But that was months before New York State increased its tax on cigarettes – A tax that has today’s smokers comparing the price of feeding their habit to the price of quitting for good.
A Taxing Addiction
Gov. Paterson and the New York State legislature enacted the new cigarette tax increase on June 3, effectively raising the price for a pack of smokes to $2.75.
That’s a $1.50 more than the state’s previous tax. And it’s even higher in New York City, where residents pay a grand total of $4.25 in state and county taxes for a pack of cigarettes.
Why raise the tax? State officials say they’re doing it to help people quit.
“Raising the price of cigarettes is one of the most effective ways to get smokers to quit and prevent youth from starting,” says Richard Daines, state health commissioner. “We expect that an unprecedented number of New York smokers will try to quit.”
And the initial numbers suggest that Daines is right. The number of calls to the New York State Smokers’ Quitline tripled in June 2008, surpassing last year’s volume by over 12,000.
“We provide a two-week starter kit of patches, gum, or lozenges as well as written materials,” says Patricia Bax, marketing coordinator of the Smokers’ Quitline. “You can call the Quitline directly and ask for the Ready to Quit information packet.”
But the trend didn’t stay that way for long. The Smokers’ Quitline admits that fewer smokers have called in recent months.
“[We] actually slowed down for a bit as folks adjusted to the tax hike and perhaps focused more on the state of the economy,” Bax says.
Local cessation programs aren’t faring much better. The Olean General Hospital holds a month-long smoking cessation program every three months, and participation continues to be a problem.
“The last time we had the course in May or June, nobody signed up,” says Liz Reed, coordinator of the cessation program. “[The tax] was instituted by New York State to get people to quit. That’s why I was surprised I didn’t have more attendance in the course.”
Reed held the same class again in September. Only one person signed up for it.
“[The tax] doesn’t look like it’s really stopping people,” Reed admits. “For them to be able to purchase cigarettes is kind of baffling to me because I don’t know how they’re affording it.”
The cost of kicking the habit is an expense in itself. Health insurance providers offer few options for smokers trying to quit.
“There is no easy answer other than to say cessation coverage is not a core benefit for plans,” Bax explains. “Each plan has different coverage guidelines of what it does and doesn’t cover.”
Recent studies by the Canadian Medical Association show that using nicotine replacement therapies is the most effective means of quitting. These methods, also called NRTs, have been proven to double the chances of quitting in the long-term.
Regardless, most insurance companies don’t cover NRTs.
“They don’t cover patches, the gum, or lozenges,” Reed reveals.
A number of NRTs have become over-the-counter drugs as a result. The most expensive of the lot – the nicotine patch – costs about $4 a day. That’s still cheaper than buying a pack of smokes in New York.
Some insurance companies even refuse to cover prescription NRTs such as the nicotine inhaler. Quitters like Rick Johnson are stuck paying close to $300 for a method that works best for them.
“Feeling that [the inhaler] what was able to help me quit, I really wanted to stick with it,” Rick says. “I have no idea why my insurance stopped covering it. I was not made aware.”
Only 50 percent of New York healthcare providers assist patients with smoking cessation. These providers tend to support nicotine-free medication that eliminates cravings.
The most popular of these medications is Chantix, a pill that stimulates the brain to cut the pleasure of smoking and reduce withdrawal symptoms.
“Chantix therapy has proven to be effective in smokers motivated to quit and will provide another tool for physicians to use for the millions of smokers who want to quit,” says Dr. Steven Galson, director of the FDA’s Center for Drug Evaluation and Research.
The drug boasts success rates of up to 44 percent. But recent controversy surrounding Chantix makes it less appealing to potential quitters.
“There’s been a lot of advertisements about Chantix on TV, about how it creates suicidal ideation in people,” Reed explains. “When I talk to inpatients about it they say, ‘Oh, I don’t want to try that.’”
Reed refers to last year’s investigation of Chantix by the FDA. Over 5,000 complaints concerning the medication were released. Suicide was reported 55 times, and suicidal thoughts were mentioned in 199 cases.
The FDA issued a public health advisory against the drug in February, leaving insurance companies scrambling to justify their coverage.
“Sometimes with the Chantix, they require that you have to take a course along with taking it,” Reed says.
Not all insurance coverage focuses on Chantix and medication. Most insurance providers will cover the costs to take a cessation course like the one Reed teaches.
“We charge $50,” Reed says. “A patient pays it but then they get reimbursed by their insurance company.”
But limited coverage leaves most smokers trying to quit on their own. The Department of Health reports that 55 percent of New York smokers attempted to quit last year.
Most tried to quit without effective treatment. Most went back to smoking.
The Uneasy Uninsured
Disputes over NRTs and medical coverage don’t concern all smokers in New York, especially those who have no insurance to begin with.
According to a study by the State Health Department, nearly half of all smokers are either on Medicaid or have no health insurance. This population includes smokers with annual incomes of less than $30,000.
How can low-income smokers afford cessation materials?
Some options are available. The Smokers’ Quitline offers free NRTs and counseling to those who need it.
“Medicaid and uninsured residents can receive up to four proactive coaching calls and six weeks of NRTs,” Bax says. “We send out [a two-week supply], then call for a follow-up. If they still want the additional NRTs, a four-week supply will be shipped and coaching calls scheduled.”
Low-income families that do have insurance can still count on the Quitline for financial help.
“The Quitline also works with health plans to leverage the NRTs and provide more coverage than the starter kit,” Bax adds.
The state legislature is also doing its part. New York is one of 38 states that cover stop-smoking treatments through its Medicaid program.
Last year, the state Medicaid system spent more than a billion dollars on tobacco dependence treatments. Prescription medications and over-the-counter NRTs are covered by the program.
But the Smokers’ Quitline argues that the cost of quitting shouldn’t even be a problem if low-income smokers are still finding ways to light up under the new tax.
“If you calculate what people spend on cigarettes each week, the cost of NRTs is in many cases still cheaper,” she says.
Tobacco’s Lingering Shadow
Dinner is just about ready in Rick Johnson’s kitchen. He bustles in the kitchen and makes final preparations to the corned beef and cabbage. A little salt here. A little pepper there. Nothing to do except wait.
He takes a seat at the table, chewing his nicotine gum until the flavor goes stale. The fruit disappears. The chemical disappears. The craving dies down.
But another craving will come. Rick has no doubt about that.
“Absolutely,” Rick says, “Especially during high stress times at work.”
Silence follows. He shifts uncomfortably in his seat. A quick glance toward the window. A quick glance down at the floor.
He opens his mouth to speak. Nothing.
Rick recuperates. He closes his eyes and tilts his head back. One deep breath.
The words form slowly.
“I actually have had one cigarette since quitting,” he admits.
His wife gasps. She gazes at him, dropping to a whisper.
“When?” she asks.
“Two weeks ago,” he responds. “I was stressed out a work. It was either that or I’d kill somebody.”
Rick’s eyes flash to the living room. His children sit in silence.
“I asked one of the guys that worked for me if I could have one,” he continues. “He was very hesitant, but he could see it in my eyes that it would be to his benefit to give me one.”
Nothing else mattered at that one moment except the bittersweet taste of tobacco and nicotine.
“I didn’t smoke the whole thing,” he quickly adds. “It tasted horrible. I maybe took four or five drags off it, and that was it.”
Prices. Taxes. Coverage. Methods. All of it’s forgotten for a few puffs.
“But I only had one in the last seven months,” he reminds his wife. “Only one.”
Disappointment lingers in the air. But it doesn’t last long. Rick’s wife moves past the subject. His children move past the subject.
That’s all they can do. Rick continues to focus on quitting his addiction one piece of gum at a time.
He reaches in his mouth, plucks the wad of gum off his tongue, and flicks it into the trash.
Alex Cole is a freelance writer and recent graduate of St. Bonaventure University in New York. He currently resides in Syracuse, NY.
Categories: scholars and rogues