Initiative 185 isn’t really that complicated.
I-185, the Extend Medicaid Expansion and Increase Tobacco Taxes Initiative, would raise the tax on cigarettes by $2 per pack, and extend the tax to vaping products for the first time. The money raised — calculated at more than $74 million a year by 2023 — will go to fund Medicaid Expansion, smoking prevention and tobacco cessation programs, veterans’ services and community-based Medicaid waiver services.
Its opponents would like voters to think that it's not as simple as that. They are on the side of the tobacco companies paying for an advertising blitz that’s trying to poke holes in I-185’s airtight reasoning. The group Montanans Against Tax Hikes has already spent millions trying to convince voters that the initiative is unfair, unsustainable — possibly even unconstitutional.
On the other hand, a long list of health advocacy organizations and hospitals are urging voters to support I-185 to relieve taxpayers of the expense of treating tobacco-related illnesses and return more of that burden to those who use tobacco products. Research shows this tough-love move will be beneficial for tobacco users in Montana — and has broader benefits for Montanans as well, both immediately and over the long term.
First, it’s important to note that Montana’s Medicaid expansion program, the Health and Economic Livelihood Partnership (HELP) program, is scheduled to sunset in June 2019. It will be up to the 2019 Legislature to decide whether to extend the program, and if so, what changes to make to it first. Several Republican legislators have already stated that they would like to see more restrictions on Medicaid eligibility, such as minimum work hours or community service requirements.
With I-185, voters can send a strong message to legislators that Medicaid Expansion should indeed be continued, and further, provides a funding source for doing so: up to $26 million per fiscal year. While leaving legislators free to debate the particulars of how the program should work and who should qualify, the initiative’s passage would provide them with a clear directive to support this important program.
In Montana, more than 18 percent of adults are smokers. More than 16 percent of pregnant women are smokers. Another 12 percent of Montana high-school students smoke — and nearly twice as many use e-cigarettes.
The rising use of e-cigarettes among youth pushed the U.S. Food and Drug Administration last week to order five of the largest companies that sell vaping materials to come up with a plan to prevent teens from using them within 60 days, or see their candy-flavored products pulled from store shelves. The Centers for Disease Control and Prevention reported that in 2017, more than 2 million middle- and high-school students said they used e-cigarettes.
While advocates of vaping are quick to relay anecdotal stories about adult smokers who successfully quit thanks to vaping, the FDA has not approved e-cigarettes as a smoking cessation device. There are several other tried-and-true cessation methods smokers are strongly urged to try first.
There is little doubt that vaping creates new tobacco addicts. The amount of nicotine, as well as other harmful chemicals, can vary wildly from product to product, and teens drawn to flavors such as gummy-flavored vapors are especially likely to be hooked.
Fortunately, they are also the population that is most likely to be deterred by an increase in price. And I-185 contains a significant boost for prevention and cessation programs to help tobacco users quit, directing up to $3 million toward such programs each year.
Some 1,600 Montanans die each year due to their own tobacco use, according to the Montana Campaign for Tobacco-Free Kids. The estimated health-care costs directly attributed to smoking amount to a whopping $440 million a year.
The Medicaid program alone covers more than $81 million of these smoking-related costs. It seems only fair to ask tobacco users to pay a larger portion of these costs. Of course, if they quit buying tobacco, they also quit paying.
Right now, all Montanans are picking up the tab for their habit, not to mention the indirect harm caused by second-hand smoke or fires caused by cigarettes. The average Montana household is already paying $779 in taxes to offset tobacco-related costs, according to the Campaign for Tobacco-Free Kids.
Federal support for Medicaid Expansion currently covers about 95 percent of the costs, and this is expected to drop to 90 percent by 2020. I-185 is a smart way to plan ahead and make up the difference, as well as lead to lower costs over the long term.
The heads of Missoula’s two major hospitals — Dr. Dean French, CEO of Community Medical Center, and Joyce Dombrouski, chief executive of Providence Health and Services Montana — sat down with the Missoulian’s editorial board last week to say that Medicaid expansion is working. After an anticipated initial bump in enrollees and costs as patients finally sought treatment for long-deferred health problems, prevention and screenings are trending up. As more patients catch and treat more problems earlier on, instead of relying on “expensive, chaotic” emergency treatment, they are having their health needs met in a way that is lending much-needed stability to the healthcare market.
Most importantly, I-185 will save lives. It will encourage more tobacco users to quit, prevent more young people from starting in the first place, and fund important health care for those whose tobacco use is wrecking their health.
One final point: Montanans passed a previous tax on tobacco by initiative in 2004. The Montana Tobacco Sales Tax Initiative, I-149, increased tobacco taxes by 140 percent, to $1.70 per pack of cigarettes. The money raised by this tax was allocated in much the same way as the current initiative proposes: to health services, veterans’ care and the general fund. And it was passed by more than 64 percent of voters. It wasn’t unconstitutional then, and it isn’t unconstitutional now.
Vote “for” I-185, the Extend Medicaid Expansion and Increase Tobacco Taxes Initiative.