Tobacco Settlement Pits Health Advocates Against States


National Conference of State Legislatures (NCSL). Legislatures have dedicated a full 46 percent of tobacco money for programs that aim to stop people from smoking and to shore up Medicaid, prescription drug programs for older Americans, children's health insurance plans and biomedical research.

But if you look a little closer at the numbers, the percent of money being spent to stop smoking is measly and has dropped significantly from last year, anti-tobacco advocates say. Though 36 states put money aside for such programs, tobacco prevention comes in as 5 percent of total spending. What's more, predictions show the percent will drop even more next year.

"This is further confirmation that the vast majority of states are not living up to the terms of the tobacco settlement," says Pete Fisher of the Campaign for Tobacco-Free Kids, an anti-smoking group based in Washington, D.C.

Fisher says states should spend 25 percent of settlement money on tobacco prevention programs, which would put them in line with what groups like the U.S. Centers for Disease Control and Prevention (CDC) suggest. "It's not a problem they're spending the money on health care, but it's unconscionable that states are not spending more money on prevention," he says.

NCSL's Lee Dixon says advocates' claims are exaggerated. "States have spent a billion dollars over the last three fiscal years on prevention, which is three times what CDC has spent on prevention and control in the same period of time. That point gets lost when advocates say, 'look how little is being done,'" he says.

Dixon says state spending on prevention may look low, but it will increase in the future, once groundwork is laid for anti-smoking campaigns and programs. In Indiana, lawmakers last year put aside $35 million for things like TV and billboard advertisements aimed at getting people to stop smoking. This year the state only earmarked $5 million for prevention.

"It's not that they're giving the issue less attention. They've got balances left over from last year. Even last year policymakers were talking about the fact that infrastructure isn't there and that it will take states two to three years to get the programs up and running," Dixon says.

Several states grappling with serious budget deficits this year decided to fill the gap with tobacco settlement money. Wisconsin will use $450 million, while Tennessee plans to spend $560 million in tobacco dollars. Dixon says actions like these will no doubt raise questions. "You could call into question actions in Wisconsin or Tennessee, but it was either that or cut programs. The fact lawmakers used it for budget shortfalls isn't unreasonable, just unfortunate," he says.

Advocates say this type of action, on top of a cut in prevention spending, is extremely shortsighted. "If I were a state legislator, I'd take a longer view and see how I could help cut long term health care costs by increasing prevention spending now," says the Campaign for Tobacco-Free Kids' Fisher.

In other state action this year:

  • Arizona now provides 50,000 working poor people with health care, thanks to a ballot initiative that called for tobacco settlement money to increase health care access.
  • Illinois doubled the amount of money it uses for tobacco prevention, to $51.5 million.
  • Maryland launched a tobacco farmer buyout program to stop the production of tobacco. Nearly half the state's farmers have signed up for the plan.
  • New Hampshire continues to use most of its money for its public schools, as does Ohio.
  • South Carolina created an endowment fund with its dollars and is using most of the money earned to help the elderly purchase prescription drugs.

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