© 2015 Association of Schools of Allied Health Professions, Wash., DC. The smoking rate in America has decreased substantially over the past 50 years; however, this decrease is disproportionately accounted for by the high quit rates and lower initiation rates of middle class smokers with no medical or psychiatric comorbidities. The majority of modern smokers' cessations efforts are complicated by one or more forms of "disadvantage," such as social, economic, legal, or psychiatric problems. The next step in reducing the national smoking prevalence is to reduce the prevalence in the most neglected portions of the population. In this paper, the characteristics of modern smokers are discussed in light of the 2014 Surgeon General's Report and the Affordable Care Act. Implications for current treatment and future research are suggested in an effort to take advantage of the progress that has been made and the new opportunities provided by healthcare reform.