Senators Ted Kennedy (D-MA) and Orrin Hatch (R-UT) have announced a proposal to increase the federal cigarette excise tax from 39 cents to one dollar per pack in order to fund the State Children's Health Insurance (S-CHIP) program, which is up for re-authorization this year.
According to a Cybercast News Service article, the proposal is supported by the American Academy of Family Physicians, which stated: "By discouraging smoking through an increase in the tobacco tax and using the resulting revenues to improve enrollment in children's health insurance programs, we are creating a win-win proposition in support of our children's health."
The proposal is also supported by the Campaign for Tobacco-Free Kids, which stated: "A higher cigarette tax is a win-win solution - a health win that will reduce tobacco use and save lives and a financial win that will raise much-needed revenue to fund important programs while also reducing tobacco-caused health care costs."
The Rest of the Story
While on the surface it may appear that this is a great idea that serves two purposes - reducing smoking and providing revenues to fund health insurance for children - a closer examination reveals that the idea is severely flawed and unacceptable from a public health perspective.
Essentially, what the proposal does is make the coverage of children's health care dependent upon the continued sale of cigarettes. In other words, it asks smokers to take on the responsibility of funding children's health care. And it depends on smokers continuing to smoke in order to continue the funding. As such, it greatly reduces any incentive for the federal government to take any action that might substantially reduce smoking rates and therefore cigarette tax revenues.
The tax is an unfair one because it places the burden of funding children's health care entirely on smokers, yet the benefits of the tax do not accrue to smokers at all. And it is a regressive tax because it places the burden of funding children's health care disproportionately on people who can least afford it.
The National Center for Policy Analysis recently released a report that explains why this proposal is a regressive one and exposes the financial burden that it places upon the poor. It provides a nice profile of exactly who is going to be funding children's health care under Kennedy and Hatch's proposal. In addition, the Tax Foundation issued a report which reveals that the poor in many states will shoulder the burden of paying for the S-CHIP program but without accruing any of the benefits.
I do not understand the knee-jerk support of anti-smoking groups for any cigarette tax increase under the sun. There seems to be no consideration of the fairness of the proposal, the regressiveness of the proposal, and the long-term consequences of tying a vital health care program to the continued consumption of cigarettes.
Especially at the federal level, funding for children's health insurance should be a top-level priority. It should not require the creation of revenue from the sale of cigarettes to fund health care for our nation's children.
By supporting this tax proposal, health and anti-smoking groups are actually stating that they do not believe that the federal government should fund children's health care out of the general revenues. They are actually stating that they do not believe that the wealthiest citizens and corporations should bear the burden of funding health care for the poorest. They are supporting the creation of a system in which one of the most critical public health programs imaginable will be entirely dependent upon high levels of cigarette consumption in order to remain solvent.
The American Academy of Family Physicians actually responded to this argument, by stating: "the fact of the matter is that we've got so many adults that still smoke that there's going to be tax money coming in to fund CHIP ... it's going to be a long time before there's any significant decrease of funding coming in through the tobacco tax."
This is a very disturbing defense of the proposal. The AAFP is essentially admitting that it has no interest in taking any initiative that would greatly reduce smoking. The Academy is convinced that there will be high rates of smoking well into the future and seemingly accepts that fact. I would think that our nation's family physicians would actually believe that it is worth trying to reduce smoking rates, rather than merely accepting the high rates well into the future, and being reassured that the money will keep coming through so that children's health care is covered and they do not have to provide as much free care.
I suggest that organizations like the American Academy of Family Physicians and the Campaign for Tobacco-Free Kids (and other anti-smoking groups that support this proposal) start a fund-raiser to help raise money to promote this proposed policy. My idea is simple - a T-shirt sale. Here is what the T-shirts would say:
Support children's health. Smoke cigarettes.
I support children's health. I smoke.
Light up as often as you can. Support the health of our nation's children.
Contribute your share to help the children. Buy cigarettes.
I really care about our kids. I buy by the carton.
Children's health supporter.
You may not like my smoke, but my money is paying for your kids' health care.
I welcome readers' suggestions for additional T-shirt slogans.