U.S. Flunks on Tobacco Control Report Card

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The report card also faulted the federal government for not doing more to increase access to smoking-cessation programs, Billings said. "While the Medicare drug program covers smoking-cessation drugs, the federal government does not require state Medicaid programs to cover cessation treatments and services for Medicaid recipients," he said. This, despite the fact that people receiving Medicaid smoke at almost a 60 percent higher rate than the national average, he added.

On the state level, no state earned a straight A. "Hawaii, Maine, Massachusetts and Rhode Island received the best grades," Billings said.

But even these states fell short in at least one grading categories, including smoke-free air laws, amount of state cigarette tax, funding for tobacco-cessation programs, and covering tobacco-cessation treatments for Medicaid recipients and state employees, Billings said.

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The states with the worst grades -- all Fs -- were Alabama, Kentucky, Missouri, North Carolina, South Carolina, Virginia and West Virginia, according to the report.

Twenty-three states plus the District of Columbia and Puerto Rico have enacted comprehensive smoke-free air laws that protect almost all workers from exposure to secondhand smoke, Billings said. Fourteen states got an "F" in this category, he said.

In 2008, only Massachusetts, New Hampshire, New York and the District of Columbia raised cigarette taxes. The average state tax is $1.19 per pack, Billings said. New York state has the highest tax at $2.75 a pack; South Carolina has the lowest at 7 cents a pack.

Billings said that only Alaska and Delaware funded tobacco-cessation programs to the level recommended by the U.S. Centers for Disease Control and Prevention. "Tragically, 42 states received "Fs" in this category," he said.

The CDC estimates that smoking costs the U.S. economy more than $193 billion each year, including $96 billion in health-care costs and $97 billion in lost productivity, Connor said.

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