Wednesday, October 19, 2005

Massachusetts Looks to Balance Budget on Backs of Smokers

Faced with a budget shortfall by which there is not enough money to provide health care coverage for low-income parents and children, state legislators in Massachusetts are looking to increase the tax on cigarettes by 60 cents per pack to help balance the budget.

According to an article in the Boston Globe: "Massachusetts House leaders are considering a tax increase on cigarettes or alcohol to pay for a major healthcare expansion, proposing to add 147,000 low-income parents and children to Medicaid and to subsidize private insurance coverage for 200,000 more people, according to legislative sources."

While a tax on cigarettes or alcohol are both being considered, an increased cigarette tax is apparently more likely, as the Senate leadership senses that such an approach to balancing the budget would be more politically popular: "One of [Senate President] Travaglini's key lieutenants said he detects more support for a cigarette tax increase than a tax on alcohol. ''That one has potential,' said Senator Richard T. Moore, an Uxbridge Democrat and cochairman of the Joint Committee on Health Care Financing."

The Rest of the Story

This is a public policy proposal that I don't think has any public health justification.

It is simply a fiscal policy proposal, not a public health policy proposal. The debate is, clearly, not about how to address any particular public health problem. Instead, the debate is narrowly focused on how to balance the state budget in the most politically desirable way.

That the legislators proposing this tax increase are not being motivated by the desire to reduce tobacco-related diseases and deaths in the state, or to help provide support and services for smokers, is clear. If they were truly interested in that, they would first and foremost, restore funding for the services for smokers that they previously eliminated, and restore funding for the prevention of these diseases and deaths.

The reality is that there is already plenty of money in the budget to both restore services for smokers and programs to prevent deaths from tobacco, and to cover health care for low-income parents and children. That money is readily available from the Question 1 proceeds, which are attributable to a 25 cent per pack increase in the cigarette tax approved by voters in 1992, of which a substantial portion of the money is supposed to be allocated to these causes.

Any rational public health policy would first restore the Question 1 revenue to its voter-mandated use. Then there would be no need for additional cigarette tax increases to cover government services that should already be provided.

I think it is important for public health and tobacco control advocates to understand that the intent of a legislative proposal is an important part of the consideration of the merit of that proposal. While anti-smoking organizations would like to (and do it all the time), I don't think you can properly separate the intent of a proposal from an evaluation of its merits.

That means that even if a proposal would have positive effects for the public's health (such as reducing cigarette use), that doesn't justify the proposal if the intent of the legislature is to use smokers in order to balance the budget.

When it comes down to it, what the Massachusetts legislature is trying to do is balance the budget on the backs of smokers, because they don't have the integrity to increase taxes on the wealthiest citizens and corporations in the Commonwealth in order to obtain the needed revenue. Instead, they'll get it from the poorest citizens, the ones who are least able to exert the political power to challenge their decisions, and the ones for whom few members of the public will come to complain.

It is politically expedient, but quite cowardly. And it is inappropriate from a public health perspective.

I oppose this decision, and I would hope that under the circumstances (especially given the expressed intent behind the proposal), public health organizations (including anti-smoking groups) would oppose it (or at least not support it) as well.

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