S.C.R. NO.



S.D. 1














     WHEREAS, smoking is costly to employers in terms of smoking-related medical expenses and lost productivity and is the leading preventable cause of death in the United States; and


     WHEREAS, on average, smokers who quit will live longer and have fewer years of living with disability; and


     WHEREAS, tobacco use cessation treatments, which have been found to safe and effective, include counseling and medications, or a combination of both; and


     WHEREAS, studies indicate that face-to-face counseling and interactive telephone counseling are more effective than services that only provide educational or self-help materials, and the effectiveness of counseling services increase as the number and lengths of the sessions increase; and


     WHEREAS, tobacco use cessation medications include nicotine replacement therapies, such as nicotine gum, patch, nasal spray, inhaler, and lozenge, that relieve withdrawal symptoms, and non-nicotine medication, such as Bupropion SR, that reduce the urge to smoke by affecting the same chemical messengers in the brain that are affected by nicotine; and


     WHEREAS, the Public Health Service-sponsored Clinical Practice Guideline, Treating Tobacco Use and Dependence, and the Community Preventive Services Task Force recommend that all insurers provide tobacco cessation benefits that:


     (1)  Cover at least four counseling sessions of at least thirty minutes each;


     (2)  Cover prescription and over-the-counter nicotine replacement medications and non-nicotine cessation medications;


     (3)  Provide counseling and medication coverage for at least two tobacco use cessation attempts per year; and


     (4)  Eliminate or minimize co-pays or deductibles for counseling and medications because even small copayments reduce the use of proven treatments; and


     WHEREAS, employers who provide a tobacco use cessation benefit have reported an increase in the number of smokers who are willing to undergo treatment and an increase in the percentage of those who successfully quit smoking; and


     WHEREAS, over time, tobacco use cessation coverage generates financial returns for employers, including:


     (1)  Reduced health care costs;


     (2)  Reduced absenteeism;


     (3)  Increased on-the-job productivity; and


     (4)  Reduced life insurance costs; and


     WHEREAS, according to the American Lung Association's 2012 State of Tobacco Control report, which tracks progress on key tobacco control policies at the state and federal levels and assigns grades based on tobacco control laws and regulations in effect as of January 1, 2012, Hawaii received a "D" in tobacco use cessation coverage; and


     WHEREAS, the report indicated differences between the State's Medicaid program and the state employee health plans in terms of the number of cessation medications covered and the types of counseling services covered; and


     WHEREAS, barriers to coverage included prior authorization, limits on the duration of counseling services or medication use, and co-payment requirements; and


     WHEREAS, section 23-51, Hawaii Revised Statutes, requires that "[b]efore any legislative measure that mandates health insurance coverage for specific health services, specific diseases, or certain providers of health care services as part of individual or group health insurance policies, can be considered, there shall be concurrent resolutions passed requesting the auditor to prepare and submit to the legislature a report that assesses both the social and financial effects of the proposed mandated coverage"; and


     WHEREAS, section 23-51, Hawaii Revised Statutes, further provides that "[t]he concurrent resolutions shall designate a specific legislative bill that:


     (1)  Has been introduced in the legislature; and


     (2)  Includes, at minimum, information identifying the:


        (A)   Specific health service, disease, or provider that would be covered;


        (B)   Extent of the coverage;


        (C)   Target groups that would be covered;


        (D)   Limits on utilization, if any; and


        (E)   Standards of care.


For purposes of this part, mandated health insurance coverage shall not include mandated optional"; and


     WHEREAS, section 23-52, Hawaii Revised Statutes, further specifies the minimum information required for assessing the social and financial impact of the proposed health coverage mandate in the Auditor's report; and


     WHEREAS, S.B. No. 654 (Regular Session 2013) mandates all individuals and group accident and health or sickness insurance policies to provide tobacco use cessation treatment coverage with no copayment, deductible, or coinsurance restrictions; and


     WHEREAS, the Legislature believes that mandatory health insurance coverage for tobacco use cessation treatment, as provided in S.B. No. 654 (Regular Session 2013) will substantially reduce illness, health care costs, life insurance costs, and employee absenteeism while increasing employee productivity; now, therefore,


     BE IT RESOLVED by the Senate of the Twenty-seventh Legislature of the State of Hawaii, Regular Session of 2013, the House of Representatives concurring, that the Auditor is requested to conduct an impact assessment report pursuant to sections 23-51 and 23-52, Hawaii Revised Statutes, of the social and financial effects of mandating health insurance coverage for tobacco use cessation treatments as further described by S.B. No. 654 (Regular Session of 2013); and


     BE IT FURTHER RESOLVED that the Auditor is requested to submit findings and recommendations to the Legislature, including any necessary implementing legislation, no later than twenty days prior to the convening of the Regular Session of 2014; and


     BE IT FURTHER RESOLVED that certified copies of this Concurrent Resolution be transmitted to the Auditor and to the Insurance Commissioner, who, in turn, is requested to transmit copies to each insurer in the State that issues health insurance policies.

Report Title: 

Mandatory Health Insurance Coverage; Tobacco Use Cessation Treatment; Auditor