Iowa Democrats on Wednesday announced a plan to provide health care coverage to the poor by raising the state's cigarette tax by $1.00 per pack. This initiative is estimated to raise $134 million, half of which would be used to "plug the gaps in current health care programs for the elderly and poor, such as Medicaid and free clinics," according to an article in the Charles City Press.
According to the article: "Democrats unveiled a plan Wednesday that would offer universal health coverage, with funding coming from a $1 per pack increase in the state's cigarette tax. 'We cannot reach universal health care without a large infusion of public dollars,' said Sen. Jack Hatch, D-Des Moines. ... Under the plan, the cigarette tax increase would be approved this year, raising about $134 million. About half of that money would plug the gaps in current health care programs for the elderly and poor, such as Medicaid and free clinics. The state currently offers health coverage to the children of the working poor, and the measure unveiled Wednesday would expand that program to cover their parents. At the same time, a special commission would be named to design a plan to offer health care to the roughly 250,000 Iowans who don't have coverage. ... 'The Democrats have campaigned on universal health care for 25 years,' Foege said. 'With a Democratic Legislature and a Democratic governor, there's no better opportunity to cover every Iowan.'"
The Rest of the Story
Not so hasty on this one.
At first blush, the idea of using cigarette tax revenues to fund universal health care coverage may sound like a great one. A cigarette tax increase would reduce cigarette consumption and at the same time provide revenue that would increase health care access for Iowans.
However, there is a major problem with this proposal. By tying health care coverage for Iowa residents to cigarette tax revenues, lawmakers would essentially be tying health care coverage to continued smoking by Iowans. In other words, the state would become dependent upon high levels of cigarette consumption in order to be able to provide health care to its citizenry. This is a potentially nasty situation that could remove incentives to reduce smoking in the state as well as threaten the ability of state residents to obtain health care if smoking does decrease.
The very idea makes me cringe. It would not be a good feeling to know that the critical thing allowing for universal health care coverage of Iowans is high smoking rates by their fellow Iowans. It's kind of like shooting yourself in your right foot to save your left one. While you'll be improving health care access, you'll be doing so at the expense of maintaining high levels of smoking and therefore high rates of smoking-related disease. It may seem like an attractive short-term fix, but in the long run, it creates a dependence of the health care system on smokers. This is absolutely the last thing in the world that you would want to do!
Perhaps the Iowa legislature should start putting up signs that say: "Support universal health care coverage. Smoke heavily."
Or how about: "Help your fellow Iowans obtain access to health care. Buy a carton of Marlboros."
Or this T-shirt for Iowa smokers to wear: "I support universal health care coverage. I smoke."
And here's one to think about: "The health of Iowa's poor depends on cigarette sales. Please do your part. Buy by the carton."
Try this one: "Step up to the plate for the poor. Light up early and often."
Don't get me wrong. The idea of universal health care coverage is a great one, and I support it. But you need a stable source of revenue, and preferably, not one that is dependent upon a product that endangers health and therefore relies upon disease in order to garner that revenue.
This is not a perspective that you're going to hear from almost any other tobacco control practitioner, and certainly not from any anti-smoking groups. But it's one that I think needs to be considered. And that's why we have The Rest of the Story.