Who will win the tobacco tax debate?

And groups on both sides of the issue are out in force.

Proponents say the tax – an additional 80 cents per pack of cigarettes and 20 percent on other tobacco products – would provide as much as $499 million a year for tobacco cessation programs and health care for those unable to afford it.

Opponents say the proposal is a 470 percent tax increase that would put Missouri businesses at a disadvantage and could constitute an unfunded mandate.

There are three major sticking points in the tobacco tax issue:

• why a constitutional amendment is necessary;

• where the money will go; and

• what the impact will be on Missouri businesses and taxpayers.

Why amend the constitution?

Ironically, both sides agree that state politicians can find ways to divert money to other programs. The way to combat the practice, however, is cause for debate.

Proponents, including the American Heart Association, American Cancer Society and the Missouri Hospital Association, say a constitutional amendment is required to make sure the tobacco-tax money will go where it is supposed to go.

They cite past examples, such as the money the state received from the Tobacco Master Settlement Agreement, where less than 0.2 percent of the $1 billion Missouri has received since 2000 has been used for tobacco-related diseases or illnesses.

Opponents, though, say a constitutional amendment is not foolproof.

“I’ve never seen a lock box that a politician can’t pick,” said Ron Leone, executive director of the Missouri Petroleum Marketers and Convenience Store Association.

On Oct. 4, Leone spoke to the governmental relations committee of the Springfield Area Chamber of Commerce. “We’re very concerned that there aren’t enough financial safeguards in this measure, and we don’t trust the government with this money,” he told them.

Opponents, including Attorney General Jay Nixon and the leaders of both the state house and senate, argue that a constitutional amendment would set mistakes in stone.

Missouri Senate President Pro Tem Michael Gibbons, R-St. Louis County, said he’s fundamentally against the amendment because it’s not an appropriate addition to the constitution.

“Our federal constitution has served us well for over 200 years, and it’s a 4,000-word document,” Gibbons said. “Our state constitution is a mess – it’s 170,000 words and involved in all kinds of issues that really belong to the statutory process. I just don’t think this belongs in the constitution.”

John Fougere, Nixon’s press secretary, said the attorney general is against the amendment’s financial premise.

“We have already recovered over $1 billion from tobacco companies that was supposed to be used for reducing teen smoking and improving access to health care,” Fougere said. “To date, we’ve seen no indication that any additional funds would be well-used for these unmet needs.”

Who gets the money?

The legislation calls for 17.5 percent of money collected from the tax to be put into a new Tobacco Use Prevention, Education and Cessation Account. State departments would use that money to fund tobacco cessation programs in accordance with Centers for Disease Control guidelines.

The remaining 82.5 percent will be put into a new Health Care Access and Treatment Account. Money from that account will provide “medically necessary health care services for individuals with incomes that are 200 percent or less of the federal poverty guidelines.”

The health care access money is the source of concern for opponents, who worry that the provision could be interpreted as an unfunded mandate. That means it would have to be paid for each year, regardless of how much revenue the tax actually generates.

Supporters say only the collected money would be spent on health care provision.

Opponents also say health care access funds would be a source for hospitals and drug companies to increase revenues. Amendment supporters, however, say that’s not the case.

“Payments to physicians would be capped at the Medicare level,” said Dr. Jim Blaine, spokesperson for supporting group Committee for a Healthy Future, who addressed the Springfield chamber. “It would get people out of our emergency rooms and in with primary care physicians, thereby reducing the cost for everybody.”

Whether or not hospitals will make money off the tax, CoxHealth is not taking a stance on the issue, said Corporate Communications Director Chris Whitley.

“Our administration and board is encouraging our employees to vote, and to vote their conscience,” Whitley said. “Whether it passes or (not) is going to be immaterial.”

He added that even if the bill passes, it wouldn’t guarantee more money for hospitals – especially in the legislature, where appropriations change rapidly.

What’s the impact?

Perhaps the biggest point of contention between the two sides is determining the impact of the proposed tax on the state’s businesses and taxpayers.

Supporters say that in addition to creating revenue for tobacco prevention and health care, the tax would save the state money. The costs, they say, are highest for poorer citizens, who are disproportionately represented in the ranks of those who smoke; while a quarter of the total state population uses tobacco, the number among the state’s poor is about a third, according to the Centers for Disease Control. Much of the cost of health care for those citizens is paid for through state programs such as Medicare and Medicaid.

Opponents point back to the unfunded mandate issue, which they say would cost hundreds of millions of dollars. They also point out the loss of the competitive advantage held by the state’s tobacco resellers over neighboring states.

In the end – whether it’s said that “Big Tobacco” needs children to keep smoking for profitability or that the amendment is just a cash cow for greedy hospitals and drug companies – both sides are at the mercy of the voters.

Physician Jim Blaine and Attorney Ron Leone square off on the tobacco tax issue:

Pro: Amendment 3 provides for a healthier future

Con: Follow the money before voting on tobacco tax[[In-content Ad]]