Tobacco War Chokes Off Health Programs

In the recent trench warfare over the Senate’s tobacco control legislation, one casualty has gone hardly noticed: funding for programs to help smokers quit, to prevent nonsmokers from starting and to keep children from buying cigarettes.

To gain support for the legislation, the Senate added a substantial income tax cut and a grab bag of antidrug programs, among other provisions. With each addition, fewer dollars were left for the public health programs that were initially one of the core reasons for the legislation.

In fact, the measure has become so laden with new provisions that Senate Majority Leader Trent Lott (R-Miss.) is warning that it may collapse under its own weight.

“This bill is so bad right now, I just don’t think it should be passed in this form,” Lott said Sunday on ABC-TV’s “This Week” news program. “Everybody that has touched it has made it worse.”

The bill that arrived on the Senate floor last month would have set aside $11.5 billion in the first five years exclusively for smoking prevention and related programs.

Now, with the bill facing further Senate action this week, there is no money dedicated exclusively to public health.

“This is typical of what politicians do when they get their hands on money,” said longtime tobacco foe Michael Pertschuk of the Advocacy Institute. “Public health invariably takes a back seat.”

Public health accounts are not the only losers. The nation’s governors are up in arms over what they say amounts to a midnight raid by the Senate.

“The nation’s governors are no longer able to support the state financing section of the Senate bill,” the National Governors Assn. wrote Thursday in a letter to the Senate leadership. The politically powerful group urged senators to restore their funding before completing action on the bill.

The tobacco control legislation arose out of a proposed national settlement reached in June 1997 between the cigarette manufacturers and 40 states that sued them to recover their share of the costs of treating smoking-related illnesses.

“After bearing all of the risk initiating the suits and all of the expense of years of arduous negotiations and litigation . . . it is only reasonable and sensible that any final settlement include a protected core of funding for states,” the governors wrote.

The bill, which the Senate has been debating for three weeks with no clear end in sight, creates a tobacco trust fund made up of the revenues from the bill’s proposed $1.10-a-pack increase in the price of cigarettes and the penalties paid by the tobacco companies if youth smoking fails to drop to specified levels.

The trust fund would be divided into accounts to pay the states to settle their lawsuits with cigarette manufacturers, to help tobacco farmers whose livelihoods would be threatened, to pay for antismoking programs and to enforce tough new Food and Drug Administration standards for the cigarette manufacturers. A separate account would fund research into tobacco-related diseases.

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Scott Williams, a spokesman for the tobacco industry--which strongly opposes the legislation--was quick to point out that, after this week’s “Christmas-tree-in-June amendments,” the states and the public health community would have done as well or better financially under last year’s proposed settlement.

“What the industry offered--and still stands behind--goes far beyond what the Senate is about to offer the American people,” Williams said.

Mississippi attorney Richard Scruggs, who played a critical role in negotiating last year’s deal, said: “I feel like we delivered a medicine chest and they turned it into a pork chest.”

For months, observers have been predicting that the hardest issue in the tobacco legislation would be how to spend the money generated by an increase in the price of cigarettes. Now, that fight is turning out to be even more complicated than anyone imagined.

For instance, the amendment cutting the marriage tax penalty, which was designed to make Republican senators feel more comfortable with the bill, alienated the governors, the majority of whom are Republicans.

But no area has been hit quite as hard as public health.

The reason is twofold. When the Senate proposed to cut the marriage tax by $16 billion over the next five years, it paid for the tax cut by reducing the amount of revenue from the proposed legislation that would be available for states, farmers and public health. Similarly, a $3-billion program to help veterans with tobacco-related diseases cut into all the bill’s spending programs.

Those two changes reduced the pot for public health from $11.5 billion over five years to about $7 billion.

Then the Senate approved spending for antidrug programs from the same pot as the one that would fund the public health programs. Under the appropriation process, Congress would decide annually how much money should go to smoking cessation and how much to antidrug programs.

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That leaves in doubt how much money Congress would dedicate to helping smokers quit and to pay for antitobacco advertising, which is considered one of the most effective tools in discouraging children from starting to smoke.

Even if public health ends up with only a fraction of the pot, that will be substantially more than it gets now. Still, the bill had promised so much that now many in the public health community are furious.

“It’s shameful that the Senate would vote to effectively strip out all the money for the only programs in the bill specifically designed to reduce tobacco use,” said Matthew Myers, general counsel for the National Center for Tobacco-Free Kids.

Not all public health advocates view the situation in such dire terms. They point out that key steps to stop young people from smoking, such as raising the price of cigarettes, making them harder to buy and putting strict limits on cigarette advertising, are still in the Senate bill.

“It’s more important to raise the price than to fight over how to spend the money,” said former FDA Commissioner David A. Kessler, who is now dean of Yale Medical School.

“In the end, I’m confident there will be enough money for public health programs or the president won’t sign the bill,” Kessler said.