New Jersey has some of the strictest public smoking restrictions nationwide and high tobacco taxes, and has worked hard to expand access to healthcare — all positives when it comes to preventing and addressing cancer.
But the Garden State can do more to address the disease, especially when it comes to investing in public anti-smoking campaigns or cessation programs, and should fill gaps in several existing efforts that aim to protect the public.
These are among the key findings in the American Cancer Society Cancer Action Network’s 17th annual assessment of state policies and programs designed to reduce cancer rates and mortality often associated with the disease.
In New Jersey, more than 53,000 people are expected to die of cancer this year alone, according to Samantha DeAlmeida, state government relations director for the network. “We owe it to them — and to everyone at risk of developing this disease — to do everything in our power to prevent cancer and improve access to screenings and treatment,” she said.
The report, “How Do You Measure Up?” reviews how all states are doing in eight areas: access to care for Medicaid members; palliative care policies; pain control laws that don’t penalize cancer patients; public smoking restrictions; investment in anti-smoking campaigns and quit programs; smoking cessation coverage under Medicaid; and indoor tanning restrictions for minors.
While the report considers multiple types of cancer, there is significant focus on tobacco-related issues; according to ACS, more than a quarter of all cancer deaths in New Jersey are due to smoking. DeAlmeida said the network is looking to include additional benchmarks in future reports, like breast and cervical cancer screening rates, and metrics to assess healthy eating and lifestyles, including electronic cigarette use.
High marks for Medicaid, tobacco tax
The 2019 report gives the Garden State a green light — its highest mark — for expanding Medicaid participation through the federal Affordable Care Act, which added nearly 500,000 people to the insurance rolls since 2014, and for its high tobacco tax rate and anti-smoking laws. New Jersey charges $2.70 tax per pack, more than a dollar higher than the national average, and prohibits smoking in restaurants, bars, public buildings, parks, beaches, and at historic sites.
ACS gives the state a yellow light — its mid-level mark — for its pain-control policies, which it fears could leave some cancer patients without access to medicine. In 2017, former Gov. Chris Christie signed one of the nation’s strictest limits on first-time opioid prescriptions, but the law is written to exempt those with cancer or other terminal illness.
New Jersey gets a red light — the report’s lowest mark — in four areas, but these assessments are more nuanced. The report encourages states to establish advisory palliative care councils, now lacking in the Garden State, although a bill to create such a panel has passed the Legislature and now awaits approval by Gov. Phil Murphy.
DeAlmeida said that while the state does have an end-of-life care commission, which issued a report in November, there is room for a more detailed examination of palliative care — or treatment that is focused on comfort, not cure or extending life — as well. “The (state) does not have to reinvent the wheel,” she said, suggesting there could be significant overlap between the work of both groups.
New Jersey also gets a red mark for its laws governing how minors can use tanning beds. While the state tightened these restrictions significantly in 2013, it still permits youth under age 17 to use these machines with parental permission. “It’s the only category that doesn’t have yellow,” or a mid-level mark, in the ACS report, DeAlmeida said, while acknowledging that the Garden State’s laws are “kind of yellow.”
In addition, the ACS report gives the state a low grade for how Medicaid covers smoking cessation products and services — an assessment that the state Department of Human Services, which oversees the program, questioned. In 2018, the state expanded coverage to include all seven federally approved medications to help people quit, as well as individual and group counseling, officials said, and eliminated the requirement that patients get plan approval before they begin treatment.
“These were important steps to help fight cancer, and another example of how the Murphy administration is working to remove barriers to create a healthier New Jersey,” DHS communications director Tom Hester Jr. said.
Push for phone-based counseling
But DeAlmeida said this expansion failed to include coverage for certain phone-based counseling programs, something ACS would like to see included in order to boost the state’s grade to green.
Among ACS’ top concerns is spending on tobacco prevention and cessation programs, an area where New Jersey has underperformed for years. One of the most effective ways to reduce cancer rates and mortality is to stop people from smoking in the first place, the group notes, a need that has been exacerbated by the explosion in e-cigarette use, especially among young people. The state has sought to address this with a targeted campaign launched by the Department of Health last year.
The report compares what states spend on anti-smoking campaigns and quit programs to spending levels that are recommended by the federal Centers for Disease Control and Prevention; while no states achieve 100 percent of these levels, Alaska expends more than 89 percent and California invests 72 percent. New Jersey is one of more than two dozen states that fall into the report’s red zone, investing between 1 percent and 25 percent of the CDC recommendation.
According to ACS, the Garden State now spends $7.2 million on this work, or just 7 percent of the more than $103 million the CDC believes it should invest in this work. DeAlmeida noted this has actually increased significantly in recent years, as Murphy and lawmakers have committed new funds to prevention and quit programs. (Under Christie, the state had fallen into the report’s black zone, with other states that spend less than 1 percent of the CDC level.)
“It’s a step in the right direction,” DeAlmeida said of the spending, which involves funds generated through the state’s tobacco tax. DOH’s Donna Leusner said it is actually closer to $10.8 million when you consider other federal and state funds.
“I’m not naive,” DeAlmeida continued, acknowledging that the full $100 million allocation is unfeasible, but ACS would like to see greater investment in this work. “And DOH is utilizing these funds to the best of their ability,” she added.