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By Bill Beggs
Jr.
Smokers and healthcare advocates throughout the State of Missouri
are drawing the lines for another skirmish in their continuing struggle.
Nationwide, local defeats over secondhand smoke and other public-health
issues continue to take their toll on Big Tobacco and organizations
that support smokers and retailers selling cigarettes and other
tobacco products. Meanwhile, nonsmokers and former smokers are linking
up with hospitals and powerful healthcare associations—such
as the American Lung Association—to continue forcing a retreat.
In Missouri, however, smokers have found a safe haven.
Missouri’s cigarette tax, at 17 cents a pack, is 80 percent
below the national average and was last increased in 1993. In Illinois,
the tax is 98 cents per pack; it’s 70 cents in Kansas. For
additional perspective, consider Rhode Island, where the tax increased
39 cents in 2003 and an additional 75 cents in 2004—the state
today assesses a whopping $2.46 in tax per pack.
National studies show that each year, more smokers are quitting—and
fewer people are starting in the first place. Teen smoking
continues to decline.
In 1965, 42.4 percent of Americans smoked, according to the Centers
for Disease Control. The percentage has dropped steadily ever since.
In 2004, the percentage had dropped to 20.9 percent.
But not so much in the Show-Me State, which has the third-highest
percentage of adult smokers in the United States—27.3 percent,
a rate surpassed only by Kentucky and West Virginia.
What’s more, Missouri has the nation’s second-lowest tobacco
tax. Studies have shown a direct correlation exists between smoking
rates and the level of tax on cigarettes. Research from the Campaign
for Tobacco Free Kids shows tens of thousands of lives will be saved
through the decrease in smoking resulting from a higher tax and
the proven success of smoking prevention programs.
In 1985, says USA Today, scarcely 200 ordinances were on the books
restricting smoking in restaurants and elsewhere. Today, there are
more than 2,000—many of them extended to smoking outside within
a certain distance of others.
Concerned citizens and healthcare advocates are gearing up for another
attempt to snuff out such statistics in hopes that tobacco rubs
out fewer Missourians. Presently, smoking-related diseases kill
28 Missouri residents every day, according to the Missouri Hospital
Association (MHA), a not-for-profit association based in Jefferson
City that represents 139 Missouri hospitals.
Kicked off in September by The Citizens for a Healthy Future, a
bold move is afoot: A referendum this November to add an 80-cent
tax per pack of cigarettes. This is no slam-dunk, considering that
a similar initiative, to raise the tobacco tax by 55 cents, failed
in 2002 by a slim margin.
“Every day, Missouri’s hospitals treat thousands of people
with diseases caused by smoking,” says Marc D. Smith, MHA
president. “There isn’t a more important health issue
hospitals could be addressing than reducing the prevalence of smoking
among young people and adults. This proposal is structured to directly
address
that priority.”
Some would beg to differ, among them some members of the Show-Me
Institute (www.showmeinstitute.org), which “ seeks a Missouri
which leads the nation in opportunity and economic growth for all,
and where
citizens treasure their liberty and trust one another.”
The premise that smokers place a burden on Medicaid, the Institute
claims, is erroneous—the government saves money because smokers
generally don’t live as long, placing less of a burden on the
retirement
system. What’s more, it’s not the business of government
to change smokers’ behavior, anti-smokers notwithstanding.
Supporters of the tax increase say the cigarette tax should save,
not cost, state residents. According to the Missouri Department
of Health and Senior Services, healthcare and disability costs related
to smoking will cost each and every Missourian $800 annually.
The revenue generated by the tax will be earmarked toward healthcare
issues, proponents say. The proposal creates a Healthy Future Trust
Fund in the state constitution to ensure the revenues only are used
to fund smoking prevention and cessation programs; affordable access
to doctors, trauma centers and emergency rooms; and healthcare assistance
for uninsured Missourians who suffer from
chronic diseases, including heart disease and other smoking-related
illnesses.
“The Committee for a Healthy Future has developed a mainstream
approach to improve healthcare for some of Missouri’s most
vulnerable citizens and to provide funding for programs that reduce
smoking and keep children from smoking. We are a broad based coalition
representing healthcare advocacy groups, grassroots organizations
and healthcare providers, and we are confident that this ballot
measure will be supported by Missouri voters in November,” says Cindy Erickson, CEO of the Lung Association of Missouri and
spokesperson for the Committee for a Healthy Future.
Nine types of cancer are known to stem from smoking, including cancer
of the lung, esophagus, throat, pancreas, uterus, mouth, bladder,
larynx and kidney.
“Daily, our caregivers observe the devastating health effects
of smoking on families,” says Ronald J. Levy, president and
CEO of SSM Health Care-St. Louis and chair of the MHA Board of Trustees.
“It is highly appropriate for Missouri’s hospital community
to support a tax increase on a product that is the direct cause
of many preventable diseases.
“Through this proposal, money specifically will be used to
prevent smoking and to fund healthcare for people who have been
harmed by smoking.”
Levy points out that Missouri ranks last in the nation in funding
for smoking prevention.
As healthcare groups organize their coalition, the Missouri Petroleum
Marketers & Convenience Store Association is gearing up to oppose
the initiative, as it did in 2002. According to the association,
Missouri’s low tobacco tax boosts cigarette sales, particularly
in metro areas such as St. Louis and Kansas City, which attract
cigarette buyers from nearby states that have higher taxes.
Still and all, unfortunately, everyone knows someone whose life
was cut short by smoking. Many others we felt we all knew
personally.
Peter Jennings, who died last year at 67 of lung cancer, said in
no uncertain terms that smoking was a factor, even though he had
quit many years ago. Johnny Carson died at 79 from emphysema, another
disease linked to smoking.
HOW THE 80-CENT TAX WOULD BE USED
In a compromise ballot measure now being proposed,
a tax of 80 cents produces $351 million (net of $11 million for
‘make-whole’ payment on existing 17-cent tax that provides
funds for education and other health initiatives) and those funds
are allocated to tobacco use prevention and access to healthcare.
17.5 % for Tobacco Use Prevention
$61 million
82.5% for Healthcare Access as allocated below:
35.25% for Medically Necessary Services through
Medicaid and SCHIP or any successor programs
$102 million, eligible for federal match
35.25% for Improving Access to Ambulatory and
Specialty Care by Adjusting Medicaid Physician Fee Scale
$102 million, eligible for federal match
15.25% for Trauma Centers and Hospital Emergency
Departments
$44 million, eligible for federal match
13% for Safety Net Clinics providing care for
Missourians with annual household incomes that are 200% or less
of federal poverty guidelines
$38 million, eligible for federal match
1.25% for Emergency Ambulance Services
$4 million, eligible for federal match |
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