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Health Currents
November 9, 2005
By George Lauer
Last month when Gov. Arnold Schwarzenegger
(R) vetoed a bill to help expand health coverage for uninsured
children in California, he said he endorsed the idea, but
there was no way the state could pay for it.
Waiting in the wings, anticipating the veto
and the rationale behind it, a newly formed alliance was ready
with an answer: a new tobacco tax.
Coalition for a Healthy California--a consortium
of eight groups ranging from the American Cancer Society to
The Children's Partnership--has launched a campaign to increase
the state's tax on cigarettes by $1.50 a pack. The coalition
is mounting a statewide signature gathering effort to put
an initiative on the November 2006 ballot that would generate
about $1.4 billion annually. The new money would be used to
bolster smoking prevention programs, counteract tobacco's
impacts on health care and provide health insurance for uninsured
children.
The idea of raising money for health care
by levying new taxes on products known to cause health problems
is not new or unique. In fact, the California Association
of Hospitals and Health Systems also is campaigning for a
$1.50 per pack increase in the state tobacco tax to help keep
emergency departments in business.
Children's Health Care
For CHC, the right time to launch their effort was swift on
the heels of Schwarzenegger's veto of the statewide Healthy
Kids legislation, according to Wendy Lazarus, founder and
co-president of The Children's Partnership, a national children's
advocacy group based in Santa Monica.
"The initiative is indeed a response
to the governor's explanation for his veto of the Healthy
Kids bill," Lazarus said. "His main reason for
vetoing it was there was no money to pay for it and no vehicle
to get the money. Well, here's the vehicle."
Lazarus said, "This is an unprecedented
coalition of major, influential groups, and I think we can
really get this done. Both the Legislature and the governor
say they really want to get every child in California covered.
They keep saying 'Where's the money?' We're saying, 'Here's
a way to get it.'"
CHC--which consists of ACS, the American Heart
Association, American Lung Association, California Primary
Care Association, Campaign for Tobacco-Free Kids, Children
Now, The Children's Partnership and PICO California--plans
to work in tandem next year with the second iteration of a
statewide Healthy Kids bill. Although the legislation sailed
through the Legislature with much support, politicians and
health care policymakers didn't think the first bill--AB 772
by Wilma Chan (D-Oakland)--had much of a chance of being signed
into law.
Another Healthy Kids bill, identical to Chan's,
will be introduced in the Senate by Martha Escutia (D-Montebello),
chair of the California Latino Legislative Caucus. This time,
the bill will be paired with a funding mechanism--the tobacco
tax--when it reaches the governor's desk.
"We're thinking that our initiative and
Escutia's bill together make a very good policy vehicle,"
Jim Keddy at PICO California, which co-sponsored both Healthy
Kids bills in the Legislature, said. "California voters
understand the damage done to our state by smoking and I
think the public is ready to endorse this kind of policy.
This is really a very positive approach on an issue that
people--all the people, the Legislature, governor and the
voters--can come together in agreement on. Children's health
coverage is something we all want."
Money from the coalition's Tobacco Tax, Disease
Prevention and Children's Health Insurance Act would be used
to augment and expand existing smoking prevention efforts
and prevention, treatment and research programs associated
with diseases linked to tobacco usage, such as stroke, cancer
and heart and lung disease. A good portion of the money would
be used to underwrite a statewide Healthy Kids program similar
to smaller-scale programs now operating in about half the
state's counties. Healthy Kids programs are designed to provide
coverage for the roughly 10% of the state's under-18 population
who aren't eligible for Medi-Cal or covered by any other form
of insurance.
"Many local communities are doing it
now through the private sector, but no one should count on
that money being there year to year," Lazarus said. "And
there are many communities that can't afford it on their
own.
"More than 800,000 children in California
are without even the most basic health care coverage and the
overwhelming majority of Californians believe that providing
affordable insurance for kids is the right thing to do. We
think this is the right way to do it," Lazarus said.
Georjean Stoodt, president of the California
division of the American Cancer Society, says the tobacco
tax will do double duty for California kids.
"Taxing tobacco will save lives,"
Stoodt says, by helping to discourage children from taking
up the habit in the first place and by providing services
to help smokers quit.
It could also save the state money in the
long run. Estimates on smoking-related medical expenses in
California are as high as $8.6 billion a year.
Hospital Measure
The first tobacco initiative out of the blocks--CAHHS' Emergency
Services and Tobacco Tax Initiative--got the green light last
week from the attorney general's office to begin collecting
signatures. Organizers hope to have the proposition on the
June ballot, but they make no predictions. Most of the money
from the hospital association's proposition would go to EDs
across the state. Funds also would be earmarked for nurse
education, smoking prevention and disease research.
Neither group will call the twin initiatives
a competition, exactly. But both acknowledge that the existence
of the other may have an impact on voters' perceptions as
well as the tobacco industry's response.
"It's unfortunate that there's another
initiative underway at the same time," Lazarus said,
"but at least there's a slight difference in timing.
They're starting sooner and shooting for the June ballot."
Kristine Deutschman, spokesperson for the
hospital association's campaign, said voters may be willing
to pass both initiatives.
"We don't see these as opposing measures,"
Deutschman said. "They're actually going toward similar
goals, but with differences in priorities."
Looking Forward
California voters next year might be presented with back-to-back
tobacco tax initiatives, each calling for $1.50 per pack increases
on cigarettes and similar increases in other tobacco products.
(State law requires taxes on one tobacco product be applied
to other tobacco products as well, such as snuff, chewing
tobacco and cigars).
Representatives from Schwarzenegger's office
said the governor "has not taken a position" on
the coalition's tobacco tax initiative. Neither the governor
nor his staff speculated on how the tax might influence his
dealing with another Healthy Kids bill.
A spokesperson for the Department of Health
Services declined to comment on either the coalition's or
the hospital association's initiatives.
CHC and CAHHS are expecting significant opposition
from smokers and the tobacco industry. If both propositions
pass, the price of a pack of cigarettes in California--now
about $5--would increase to $8. Representatives of two major
tobacco companies--Philip Morris and RJ Reynolds--said they
have not formulated specific strategies for these two initiatives
yet, but both plan active campaigns to defeat them.
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