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Stateline: Should the Smoking Age Be 21? Some Legislators Say Yes

By Jenni Bergal, Stateline | Pew Charitable Trust
While a growing number of states have turned their attention to marijuana legalization, another proposal has been quietly catching fire among some legislators—raising the legal age to buy cigarettes.
This summer, Hawaii became the first state to approve increasing the smoking age from 18 to 21 starting Jan 1. A similar measure passed the California Senate, but stalled in the Assembly. And nearly a dozen other states have considered bills this year to boost the legal age for buying tobacco products.
“It really is about good public health,” said Democratic Hawaii state Sen. Rosalyn Baker, who sponsored the legislation. “If you can keep individuals from beginning to smoke until they’re at least 21, then you have a much greater chance of them never becoming lifelong smokers.”
Supporters say hiking the legal age to 21 not only will save lives but will cut medical costs for states. But opponents say it would hurt small businesses, reduce tax revenue and violate the personal freedom of young adults who are legally able to vote and join the military.
Measures to raise the smoking age to 21 also were introduced this year in Massachusetts, New York, Oregon, Rhode Island, Utah, Vermont, Washington and the District of Columbia, according to the Preventing Tobacco Addiction Foundation, an advocacy group aimed at keeping young people from starting to smoke. Iowa and Texas considered measures to increase the legal age to 19. None of those bills passed. And just last week, a Pennsylvania legislator introduced a bill to up the minimum age there to 21.

Cities Act First

In almost every state, the legal age to buy tobacco products is 18. Four states—Alabama, Alaska, New Jersey and Utah—have set the minimum at 19.
Anti-tobacco and health care advocates say that hiking the smoking age to 21 is a fairly new approach in their effort to reduce young people’s tobacco use. Until recently, research on the topic has been somewhat limited, they say.
That hasn’t stopped a growing number of local governments from taking action on their own in the last few years. As of late September, at least 94 cities and counties, including New York City, Evanston, Illinois, and Columbia, Missouri, had passed measures raising the smoking age to 21, according to the Campaign for Tobacco-Free Kids, an advocacy group that promotes reducing tobacco use.
One of those communities is Hawaii County, the so-called “Big Island” of Hawaii, where the law changed last year after a grassroots effort by health care advocates, anti-smoking groups and local high school students. That coalition, joined by teens from across Hawaii, continued its fight at the state level, and legislators heard the message, said Sen. Baker, whose bill also included e-cigarettes, battery-powered devices that deliver vaporized nicotine, which have become popular among young people.
Supporters of raising the smoking age to 21 say that a turning point was a March report by the Institute of Medicine, the health arm of the National Academies of Sciences, Engineering and Medicine, which predicted that raising the age to 21 would cut smoking by 12 percent by the time today’s teenagers are adults. It also would result in about 223,000 fewer premature deaths.
The institute’s report also supported health care advocates’ argument that preventing or delaying teens and young adults from experimenting with smoking would stop many of them from ever taking up the habit. About 90 percent of adults who become daily smokers say they started before they were 19, according to the report.
“Raising the age to 21 will keep tobacco out of high schools, where younger kids often get it from older students,” said John Schachter, state communications director for the Campaign for Tobacco-Free Kids. “If you can cut that pipeline off, you’re making great strides.”
California state Sen. Ed Hernandez, a Democrat who sponsored a measure to raise the smoking age, said it’s good public policy.
“If we make it a law to drive with your seatbelt on to protect the consumer, or to require helmets for people on motorcycles, why can’t we raise the smoking age to protect young adults from becoming addicted to tobacco?” he said.
Supporters also point out that 21 became the national legal drinking age after President Ronald Reagan signed legislation in 1984 that forced states to comply or risk losing millions of dollars in federal highway funds. That has resulted in reduced alcohol consumption among young people and fewer alcohol-related crashes, national studies have found.
“President Reagan thought young people were not ready to make this decision to drink or to drink and drive before they turned 21,” said Rob Crane, president of the Preventing Tobacco Addiction Foundation. “Smoking kills more than six times as many people as drinking.”

Personal Choice

Opponents say that raising the smoking age to 21 would have negative consequences for businesses, taxpayers, and 18-year-olds who should be free to make a personal choice about whether they want to smoke.
Smokers’ rights groups, retailers and veterans’ organizations are among those who’ve opposed such legislation.
“If you’re old enough to fight and die for your country at age 18, you ought to be able to make the choice of whether you want to purchase a legal product or not,” said Pete Conaty, a lobbyist for numerous veterans groups who testified against the California bill. “You could enlist in the military, go to six months of training, be sent over to Iraq or Afghanistan and come back at age 19½ to California and not be able to buy a cigarette. It just doesn’t seem fair.”
Opponents say it’s wrong to compare cigarettes with alcohol. “If you smoke one or two cigarettes and get behind the wheel of a car, you’re not driving impaired,” Conaty said.
Opponents also say taxpayers would take a financial hit if the smoking age is raised because it would mean less revenue from cigarette taxes.
In New Jersey, where a bill to hike the smoking age to 21 passed the Senate last year and remains in an Assembly committee, a legislative agency estimated that tax revenue would be reduced by about $19 million a year.
In California, a fiscal analysis by the Senate appropriations committee estimated that raising the age to 21 would cut tobacco and sales tax revenue by $68 million a year. That would be offset by what the analysis said could be “significant” health care cost savings to taxpayers—reaching as much as $2 billion a year.
Stores that sell tobacco products and e-cigarettes also fear the effect. The Hawaii Chamber of Commerce opposed the measure there.  And Bill Dombrowski, president of the California Retailers Association, suggested that raising the smoking age would simply drive young people to the black market.
“If you raise the age, people under 21 will find the cigarettes somewhere else,” he said.

Health Care Savings

Cigarette smoking is the leading cause of preventable death in the U.S. and is responsible for more than 480,000 deaths a year, according to a 2014 U.S. Surgeon General report, which said the direct medical costs of smoking are at least $130 billion a year.
Supporters of the 21 smoking age say that the savings in health care costs, especially through Medicaid, the federal-state health insurance program for the poor and disabled, will far outweigh any loss in tax revenue for states.
Schachter and other advocates say Hawaii’s action, along with that of dozens of cities, will help spark legislation in other states and create a new standard for when young people take their first puff.
“There is momentum on this issue, and I think you’re going to see more and more states and cities moving in that direction,” Schachter said.
http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2015/10/14/should-the-smoking-age-be-21-some-legislators-say-yes

Forbes: Alcohol, Drug Addicts Far More Likely to Smoke Tobacco

CJ Arlotta , Contributor – Forbes| Pharma & Healthcare

Turn on the television at any point of the day to find anti-smoking commercials sprinkled throughout a sports game or nightly sitcom. As many organizations and levels of government focus efforts on eliminating tobacco use from the general population, one sub-population in particular continues to be ignored: individuals addicted to alcohol and drugs in treatment recovery programs.
Published in Addiction – a peer-reviewed journal that covers research related to alcohol, illicit drugs, tobacco and other addictions – a new report concluded that the overall rate of smoking among addicts in treatment for drug and alcohol use was 84%, compared with a rate of 31% for individuals of the general public.
Lead study author Joseph R. Guydish, a professor of Medicine and Health Policy at the University of California, San Francisco (UCSF), said in an interview that tobacco use isn’t just an issue for addiction recovery programs; it’s also a problem for both county and state public health offices supporting rehabilitation facilities.
“At the federal level this means the Substance Abuse and Mental Health Services Administration, the Center for Substance Abuse Treatment, the National Institute on Drug Abuse and the National Cancer Institute,” he said. “Internationally this means the WHO, its Framework Convention on Tobacco Control and its MPOWER principles. These are the agencies that can exert leadership in the area of smoking and addiction treatment, and provide programs with resources needed to better address smoking.”
Researchers reviewed 54 studies, which were published from 1987 to 2013, involving a total of 37,364 participants in 20 countries on six continents. All the reports analyzed were written in English.
“Anyone interested in tobacco control, whether nationally or internationally, should take note,” he said. “We cannot reduce adult smoking much further (at least in the United States) without addressing smoking in sub-populations where smoking rates are high.”
When asked about how often addicts switch over from their drug of choice to nicotine during the recovery process, Guydish admitted that he’s unaware of any relevant data available on the topic. He did note, however, that he believes the “answer would be not very often.”
“Nicotine operates in the same reward pathways of the brain as other addictive drugs, however its effect is relatively weaker than the effect of those other drugs,” he said. “We know that nicotine potentiates the effects of other drugs, but it seems unlikely that a person would stop drug use (for example) and then begin smoking as a replacement. But it is possible.”
He added: “The scenario we hear of more often is one where a person quits smoking, sometimes because they have been in a smoke-free jail or prison, but relapses to smoking in the context of drug treatment where they are surrounded by smokers.”
“Tobacco control researchers have done a great job of implementing tobacco control policies and evaluating their effects in the general population, in healthcare settings and on college campuses,” Guydish said. “Further research should follow this lead and develop, implement, and evaluate a range of policy interventions in addiction treatment programs, such as smoke-free grounds, no evidence of smoking among staff during working hours, and funding to increase availability of smoking cessation interventions.”
http://www.forbes.com/sites/cjarlotta/2015/09/22/alcohol-drug-addicts-far-more-likely-to-smoke-tobacco/

USA Today: A year later, CVS says stopping tobacco sales made a big difference

Jayne O’Donnell, USA TODAY
The decision to stop tobacco sales at all of its drugstores a year ago caused people to buy 95 million fewer packs of cigarettes in 13 states, CVS Health says in a new study out Thursday.
The new study compared total sales of tobacco products at all types of stores in the 13 states where CVS has more than 15% of market share with sales in states that don’t have any CVS stores.
The study, conducted by CVS’ Health Research Institute, evaluated cigarette pack purchases at drug, food, mass merchandise, dollar, convenience and gas station stores in the eight months after CVS stopped selling tobacco products. Over the same period, the average smoker in these states purchased five fewer cigarette packs. The 95 million fewer packs sold, CVS said, was a 1% decrease in the number of packs sold.
During 2014, nearly 264 billion cigarettes were sold in the United States, a decrease from approximately 273 billion sold in 2013, according to the Centers for Disease Control.
The CVS study also showed a 4% increase in nicotine patch purchases in the 13 states in the period immediately following the end of tobacco sales, which the company says shows there also was “a positive effect on attempts to quit smoking.”
CVS and its foundation also announced Thursday that it is funding a new school-based tobacco-prevention curriculum through the textbook company Scholastic.
The effort might have been able to influence Troyen Brennan, a physician who is CVS Health’s chief medical officer. In an interview, Brennan said he smoked for a few years while in his teens.
Brennan says he expects the study results should address critics who said CVS’ move was “not going to make a difference overall.”
But at least one critic says CVS is making a questionable leap by taking credit.
“CVS only sold a very small percentage of the nation’s cigarettes to start with, and financial analysts have said the impact of CVS’ move wouldn’t have a major impact on smoking rates,” says Jeff Stier, a senior fellow at the free market-oriented National Center for Public Policy Research. “But the bold claim that its decision to stop selling cigarettes actually got a significant number of smokers to just buy the mostly ineffective nicotine patches and quit smoking only illustrates how little the company knows about the difficulty of quitting.”
Stier’s group receives 1.4% of its funding from the tobacco and e-cigarette industry.
“We know that more than two-thirds of smokers want to quit – and that half of smokers try to quit each year,” Brennan says. “We also know that cigarette purchases are often spontaneous. And so we reasoned that removing a convenient location to buy cigarettes could decrease overall tobacco use.”
The new data, Brennan says, show CVS’ decision “did indeed have a real public health impact.”.
Junk food often is an impulse purchase as well. CVS spokeswoman Carolyn Castel says the company also is placing healthier foods —such as yogurt and fresh fruit — in key locations in the front of the store.
http://www.kare11.com/story/news/2015/09/02/cvs-stopping-tobacco-sales/71606590/

HuffPo: The U.S. Smoking Rate Just Hit A Historic Low

, Senior National Correspondent, The Huffington Post
Chalk up another big win for public health: The smoking rate among U.S. adults appears to have hit a new low.
New survey data, which the U.S. Centers for Disease Control and Prevention released Tuesday morning, suggests that just 15.2 percent of American adults are now using cigarettes on a regular basis. That smoking rate is nearly 2 percentage points lower than what the same survey reported for calendar year 2014.
The basis for the findings are responses to the National Health Interview Survey, which the Census Bureau operates on behalf of the CDC and is among the most reliable instruments government has for measuring health habits and status. The data is preliminary, because it comes from January through March and the smoking rate might yet creep up before the year ends. Among other factors, people have been known to quit in January, after making a New Year’s resolution, and then resume a few months later.
But even allowing for that possibility, and the margin of error that all surveys have, it’s likely the adult smoking rate for the full 2015 calendar year will be lower than it was in 2014.
“This result is absolutely exciting and maybe even astonishing, if this decrease holds up when we see data for the full year,” Kenneth Warner, a professor of health policy and management at the University of Michigan, told The Huffington Post.
http://www.huffingtonpost.com/entry/us-smoking-rate-historic-low_55e4a96be4b0b7a96339de51?ncid=fcbklnkushpmg00000063

FDA issues warning letters to 3 tobacco companies over "additive-free" claims

Associated Press
NEW YORK (AP) — The Food and Drug Administration issued warning letters to the makers of Winston, Natural Spirit and Nat Sherman cigarettes over their “additive-free” and “natural” label claims.
The agency issued the warnings to ITG Brands LLC, Santa Fe Natural Tobacco Company Inc. and Sherman’s 1400 Broadway N.Y.C. Ltd. The issue over the claims is that they may lead consumers to believe the products pose a lower risk. That claim has to be scientifically proven.
In a statement, the FDA said it has determined that the products under the warning letter need what is called a “modified risk tobacco product order” before they can be marketed in that way. It has not issued any orders for modified-risk products to the market and this is the first time it is using its authority to take action against “natural” or “additive-free” claims.
The companies have 15 days to respond with a plan or dispute the warnings.
There was no immediate response from the companies.
Imperial Tobacco Group Plc. owns ITG Brands, which also makes Kool cigarettes and USA Gold. Reynolds American Inc. owns Santa Fe Natural Tobacco.
The warning comes several days after a large group of anti-tobacco organizations sent the FDA a letter urging the agency to enforce regulations against Santa Fe Natural Tobacco over marketing claims. That letter, sent on Monday, was signed by 29 groups including the American Heart Association, American Legacy Foundation and Campaign for Tobacco-Free Kids.
The anti-tobacco group’s letter alleged that Natural American Spirit’s advertising in magazines such as Sports Illustrated and Vanity Fair violated the Smoking Prevention and Tobacco Control Act.
“The potential for irreparable damage to public health from the marketing of tobacco products with modified risk claims is well illustrated by the industry’s years of deceptive advertising of ‘light’ and ‘low-tar’ cigarettes,” the letter stated.
http://www.usnews.com/news/business/articles/2015/08/27/fda-issues-warning-letters-to-natural-tobacco-makers

LA Times: $2 more for cigarettes? California tobacco tax proposal revived in special session

A proposal to raise the tobacco tax by $2 per pack of cigarettes in California was given new life Wednesday when legislation was announced as part of a special session on healthcare.
Supporters say the new bill has a better chance of passing than one that stalled in the regular session because the $1.5 billion raised by such a tax could help the state pay for healthcare costs for low-income residents, a key goal of the special session.
Sen. Richard Pan (D-Sacramento) said he will introduce the tobacco tax, noting that California’s current 87-cent-per-pack tobacco tax makes the state 33rd in the nation, far below New York, which charges a tax of $4.35 a pack. There is also a $1.01 federal tax on cigarettes.
A rally for the proposal was held Wednesday next to the Capitol by the Save Lives California coalition, made up of groups including the California Medical Assn., the American Cancer Society, the American Lung Assn. and the Service Employees International Union.
The coalition said that if the Legislature fails to muster the two-thirds vote to pass the tax, it will put the tax proposal on the 2016 ballot.
“We know raising the tobacco tax has been proven to prevent and reduce smoking, especially among young people,” Pan told the nearly 100 people at the rally. He said 40,000 people die each year in California from tobacco-related diseases, and treating such illnesses costs taxpayers $18.1 billion annually.
A Field Poll released Wednesday indicates a $2 tobacco tax to pay for healthcare costs is supported by 67% of Californians.
The tax is one of several anti-tobacco bills being considered during the special session, including one raising the smoking age to 21 and another restricting the use of electronic cigarettes in public.
“The special session is an opportunity for lawmakers to take long-overdue action to prevent young people from falling prey to the No. 1 cause of preventable death in California: tobacco addiction,” said Claudia Alvarez, an SEIU delegate and family medicine resident at Harbor-UCLA Medical Center.
Those in the audience at the rally included Jennifer Kent, the governor’s appointee as director of the California Department of Health Care Services.
“To the extent we have an ongoing need for revenues we’re obviously willing to consider both this tax and any other revenue sources,” Kent said in an interview afterward. “We’re here and interested and willing and able to partner” with the coalition.
She said there is a strong link between tobacco use and illnesses covered by Medi-Cal.
The regular-session tobacco tax bill was opposed by groups including the Cigar Assn. of America and the Howard Jarvis Taxpayers Assn., which argued it creates a regressive tax on a declining revenue source.
“At a time when state revenue has recovered and the governor says there is even a surplus, there is no reason for a tax increase,” said Jon Coupal, president of the taxpayers group.
Proponents of the bill estimate 295,000 smokers will kick the habit the first year if the tax goes up $2 per pack, and many others will not start smoking to begin with.
http://www.latimes.com/local/political/la-me-pc-california-tobacco-tax-proposal-revived-for-special-session-20150826-story.html

NDSU Study: "Tobacco Goes to College" Shows Battle for Youth Market Began Early

Source Newsroom: North Dakota State University
Newswise — While the character Don Draper in the television show Mad Men looked for a way to first save his cigarette advertising accounts, and then to distance himself from them, a new book—“Tobacco Goes to College”—shows the power of advertising impacted would-be-smokers long before the Mad Men era.
Elizabeth Crisp Crawford, associate professor in the Department of Communication at North Dakota State University, Fargo, studied how tobacco advertising from 1920 to 1980 targeted college students.
“The tobacco industry had a strong presence on campus and an influence on college media,” said Crawford. “Tobacco’s influence on college media included campus newspapers, radio, and sporting events. This influence affected students on campus the most—due to a high level of advertising exposure. However, the viewing audiences for college sports also were exposed to cigarette promotion facilitated by the NCAA.”
In her research for “Tobacco Goes to College: Cigarette Advertising in Student Media, 1920-1980,” Crawford found the advertising plans and creative tactics to be extremely strategic over the six decades studied. Social pressure and social appeals hit the mark with potential college consumers.
“The advertising campaigns were well organized and sophisticated,” said Crawford. “In this way, tobacco was ahead of its time. The ads are really an important piece of advertising history for these reasons.”
The successful advertising tactics, said Crawford, are still being used today for a variety of products.
“I see the industry using many of the same tactics it used 50 years ago with cigarettes—especially the filtered brands. When we discuss the promotion of e-cigarettes, I think that we need to look at the history of tobacco advertising,” said Crawford.
Key insights into the target market make these ads successful.
“The tobacco industry has an excellent understanding of the psychology of human need,” said Crawford. “People use substances to cope with their lives. Sometimes life can be stressful and people lack the needed human support. Tobacco has always positioned itself as a way to fill a social or emotional void.”
Crawford’s book contains an in-depth analysis of vintage cigarette ads.
“Jane Wyman – famous Barnard Alumna says: ‘Chesterfields always give me a lift. They’re wonderfully mild and taste so good. They’re my favorite cigarette,’” according to an ad which ran in NDSU’s student newspaper, The Spectrum, on April 7, 1950.
Similar ads ran in student newspapers across the country including Smith College, University of Portland, Elon University, and in football programs at colleges, including the University of Tennessee at Knoxville (Crawford’s alma mater), at Chattanooga, and Illinois vs. Stanford.
“Tobacco advertisers knew college students’ needs and positioned their product in a way that could help fulfill these needs,” said Crawford.
In 1963, the Tobacco Institute pulled tobacco advertising from college publications. Crawford points out that nearly 2,000 publications then looked for ways to recover what amounted to as much as 50 percent of lost revenue from the ads.
Crawford’s interest in this particular area of research also has a personal link. “Of my four grandparents, the two that attended college smoked. I found this connection to be interesting,” she said.
“Tobacco Goes to College” was named an Outstanding Academic Title by Choice Magazine in 2014. The list comprises about 10 percent of more than 7,000 titles reviewed by Choice each year. According to Choice reviewer N.E. Furlow, “In short, the book offers a detailed inside look at the tobacco industry’s calculating strategy to entice a young population to use its products.” The book is published by McFarland & Company, Inc.
In reviewing the book in American Journalism, Stephen Siff wrote: “It is on the final point, about the quality and inventiveness of cigarette advertising, that the book is most effective and, ultimately, makes its greatest contribution.”
In Journalism History, reviewer Kari Hollerbach wrote: “By examining the broader social and legal trends that buffeted the tobacco industry, the targeted effort to recruit and retain college-age smokers, and the actual advertisements and their thematic narratives, she offers a very compelling explanation as to how and why several generations of American youth were persuaded to smoke, smoke, smoke that cigarette.”
Figures show the continued compelling force of advertising. According to a CDC report, tobacco companies spent $9.6 billion marketing cigarettes and smokeless tobacco in the United States alone in 2012. That’s equivalent to more than $1 million every hour, based on $26 million daily. A Federal Trade Commission report shows $9.2 billion spent on cigarette advertising and promotion in 2012. The report notes the expenses include magazine ads, distribution of samples and coupons, retail ads, discounts, retailer payments, rebates and direct-mail advertising.
A Gallup-Healthways Well-Being Index showed the national smoking rate at 19.7 percent in 2013, with North Dakota’s smoking rate dropping from 24.1 percent in 2008 to 18.5 percent in 2013. Kaiser Family Foundation data show the national smoking rate at 18.1 percent in 2013 and North Dakota at 21.2 percent.
Crawford’s research has been published in Journalism and Mass Communication Educator, Social Marketing Quarterly, and the Journal of Health and Mass Communication. Crawford joined NDSU in 2009. She received a doctorate degree in communication and information from the University of Tennessee, Knoxville, and a master’s degree in advertising and public relations from Marquette University, Milwaukee, Wisconsin.
About NDSU
NDSU, Fargo, North Dakota, USA, is notably listed among the top 108 U.S. public and private universities in the Carnegie Commission on Higher Education’s category of “Research Universities/Very High Research Activity.” NDSU is listed in the top 100 research universities in the U.S. for R&D in agricultural sciences, chemistry, computer science, physical sciences, psychology, and social sciences, based on research expenditures reported to the National Science Foundation. As a student-focused, land grant, research institution, NDSU serves the state’s citizens. www.ndsu.edu/research
http://newswise.com/articles/tobacco-goes-to-college-shows-battle-for-youth-market-began-early

TFND calls on GNDC to support tobacco prevention

Upon reading the New York Times article entitled, “US Chamber works globally to fight antismoking measurers”, TFND communicated its disappointment with the Greater North Dakota Chamber’s work in our state alongside Big Tobacco.
In doing so, we sent this letter: TFND Letter to GNDC – 7.1.15.

GNDC responded: GNDC – TFND Letter – 7.2.15

And our final communication back to GNDC: TFND response to GNDC – 7.2.15

The Dickinson Press: Several businesses caught selling tobacco to minors

By Andrew Haffner

The Southwestern District Unit Health caught six Dickinson businesses selling tobacco to a minor Monday in a quarterly compliance check of 25 city retailers.

The businesses that failed the check are M & H Gas Station, Cenex Convenience Store on Villard Street, Simonson’s Store on Villard Street, Rosie’s Food & Gas, and Family Fare supermarkets at both 18th Street West and Roughrider Boulevard.

Tobacco Treatment Specialist Jennifer Schaeffer said in a release that compliance checks are conducted with a trained minor student with a police officer present. Dickinson municipal code prohibits selling tobacco to minors, with punishments tiered to the persistence of retailer offenses.

First-time offenders can face a fine of $100, while those who sell illegally three times within two years may receive a $500 fine and tobacco license revocation.

Schaeffer said in the release that the Southwestern District Unit Health offered a training course for tobacco retailers to prepare them for subsequent compliance checks.

“We are trying to educate them and the public that this is an important issue in keeping our children safe,” she said in the release.

http://www.thedickinsonpress.com/news/local/3777389-several-businesses-caught-selling-tobacco-minors

The Sacremento Bee: California cigarette tax backers commit $2 million

BY JEREMY B. WHITE

Hoping to influence a special health care budget session, a coalition of labor and medical groups has put $2 million into an initiative to raise California’s tobacco tax and use the revenue to fund health care for low-income Californians.

The money flowed from a coalition of groups that include SEIU California State Council – a union umbrella group whose members include thousands of health care workers – the California Medical Association, the California Dental Association, the American Cancer Society and groups promoting heart and lung health.

Their twin ballot initiatives would impose a $2-per-pack tax on cigarettes to fund health programs that include smoking prevention and Medi-Cal, California’s health insurance program for low-income residents.

The money is another move in an ongoing political fight over Medi-Cal reimbursement rates.

A similar coalition of medical and labor groups has pushed to have California increase how much it pays doctors and other providers, saying existing rates are making it hard to obtain health care. Some of the cigarette tax revenue would flow into a new fund that could be used to augment Medi-Cal provider rates.

“We are serious about increasing these rates and improving access and keeping California healthy,” said Laphonza Butler, president of SEIU California.

Proponents have yet to decide which ballot measure they would pursue – one of the two would tax electronic cigarettes – but they will be able to begin collecting signatures soon.

A Senate bill to boost the tax cleared committees but still awaits a floor vote, a dubious proposition given that it would need votes from Republicans unlikely to back a new tax. Outside groups often float ballot initiatives as a way to pressure legislators: pass the bill or we will go directly to voters.

“We strongly support securing a legislative remedy that’s in the best interest of Californians, but we are ready and willing to go to the ballot if necessary,” said Mike Roth, a spokesman for the campaign.

The $2 million announcement coincides with Gov. Jerry Brown convening lawmakers for a special budget session to deal with Medi-Cal’s finances. It is “yet to be determined” if an agreement to raise reimbursement rates would lead the coalition to drop the tobacco tax initiatives, Roth said.

Advocates have lost the tax fight at the ballot before, in 2006 and most recently in 2012, after being vastly outspent by a tobacco industry intent on defeating Proposition 29.

Tobacco companies donated tens of thousands of dollars directly to lawmakers last election cycle. The Legislature is considering a number of tobacco-related bills this year: one would raise the age to purchase tobacco to 21; one would treat e-cigarettes like conventional cigarettes; and another would ban major-league baseball players from chewing tobacco at California ballparks.

http://www.sacbee.com/news/politics-government/capitol-alert/article25118476.html#storylink=cpy