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Montana’s health care industry pushed back against Big Tobacco Wednesday during a pro-Ballot Initiative 185 rally at Community Medical Center in Missoula.

Doctors, nurses, veterans and Gov. Steve Bullock gathered under a perfect autumn sky to urge their peers to speak out in favor of the measure, as part of the effort to counter the roughly $8 million in anti-I-185 advertising by R.J. Reynolds and by Altria Client Services, which represents Philip Morris USA.

Speakers at the rally took a two-pronged attack, arguing that the tax on tobacco products might lessen the number of people who smoke, vape or chew, and that the current Medicaid expansion, whose extension would be paid for by the tax, already is creating healthier Montanans.

“We in Montana don’t have unlimited money to try to confuse people. But we have the facts,” Bullock said. “We need to continue to educate our fellow Montanans on how important it is to our livelihoods, to our veterans, seniors and working families.

“We have one thing Big Tobacco doesn’t. We have neighbors. We have friends. We have frenemies. … Talk to folks about how important this is.”

I-185 would add a $2 tax to a pack of cigarettes, on top of the $1.70 tax already in place. It also would increase the tax on vaping products and electronic cigarettes by 33 percent, and on moist snuff either by 83 percent of the wholesale price or $3.70 per 1.2 ounces, whichever is greater.

Proceeds from the tax — estimated to raise $61.5 million per year — would be used to cover the $60 million annual cost of Medicaid expansion, which began in 2016 and is slated to sunset in 2019. It also would provide funding for health-related programs including veterans’ services and long-term care for seniors and disabilities.

Dr. Carter Beck, a neurosurgeon and past president of the Montana Medical Health Association, said he typically votes along Libertarian or Republican lines, and was opposed to the Affordable Care Act because he wanted the government out of health care. But he supports I-185 because he’s seen how many people have benefited already from Medicaid expansion.

“I don’t want to abandon those people for political reasons,” Beck said. “I want two things — for patients to smoke less and to have access to health care. Without the money from the cigarette tax, we are at risk of losing Medicaid expansion.”

Others who spoke at the rally told of their personal experiences with patients who now are able to receive health care with the expanded Medicaid coverage. Dr. Dean French, the chief executive officer at Community, mentioned a couple of his patients, including a 39-year-old cancer center patient who was able to be successfully treated because she finally was covered by Medicaid.

“We treated her diligently and with empathetic care. She was not just a number or statistic,” French said. “Regardless of your political stance, you should vote for this. If we don’t look out for each other, who will?”

Dr. Mark Mentel noted that so many people are walking on tightropes throughout their lives, and the Medicaid expansion provides a safety net against unpredicted injuries, accidents and sicknesses.

“I’ve personally witnessed at my clinic people who have not engaged in health care for years who come see me to get treatment now,” Mentel said. “They need health care, they need their health restored so they can get back on that tightrope.”

Dr. Kristin Anderson added that smoking is the No. 1 preventable cause of death in the United States, and that “children are being abused” as targets of the tobacco industry’s advertising.

“It is a relentless and highly focused attack,” Anderson said. “It is our responsibility to protect families we care for by preventing disease. It is our job to reduce the number of kids that smoke and we can do that by voting yes on I-185.”

Dr. Pam Cutler noted that nine out of 10 smokers begin using tobacco products by the time they’re 18.

“That’s 19,000 kids in Montana who will fall for Big Tobacco promotions … and will end up dying from smoke-related illnesses,” Cutler said “More importantly, raising the cost of tobacco is a proven method for stopping tobacco use, especially with kids.”

Kim Ryan-O’Hara, who manages the diagnostic imaging center at Community, watched the rally unfold and said she plans on voting for the measure.

“I believe this will provide an overall benefit to healthy Montanans,” she said. “It really angers me that the tobacco companies are sinking so much into this because they have so much to lose. But they don’t care about Montanans.”

Caring for one another also was a theme carried by Capt. Andrew Person, who served in Iraq and Afghanistan from 2001 to 2006.

“In Iraq, no matter what your job was … everybody was taken care of. Your basic needs were taken care of. We looked after each other because that’s what we did," Person said, adding that "9,500 Montana vets are counting on us to pass the initiative. It’s very important to them.”

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