Tobacco Control Policy at the State Level Progress and Challenges Danny McGoldrick Institute of Medicine Washington, DC June 11, 2012
The Tools of Tobacco Control Tobacco Taxes Smoke-free Laws Comprehensive Prevention & Cessation Programs Coverage for Smoking Cessation Services Limits on Industry Behavior (e.g., FDA) TO BRING ABOUT Social & Environmental Change Reduced Tobacco Use
THE STATE TRIFECTA Smoke-Free Tax Program Funding
Percent of adults who smoke 25 20 15 10 5 Impact of the Trifecta: Adult and Youth Smoking Prevalence in New York City Youth City and State tax increases 3-yr. average 3-yr. average 3-yr. average Smoke-free workplace 21.6% 21.5% 21.7% 21.6% 17.6% 19.2% 18.4% 18.9% 14.8% Adult 11.2% 17.5% 16.9% 15.8% 8.5% Ad Campaign/Patch GiveAway 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 4 Source: CDC. Decline in Smoking Prevalence -- New York City, 2002 2006. MMWR. 2007. 56(24);604-608; and New York City Department of Health and Mental Hygiene.
Policy and Program Progress 5
ALASKA 200 WASHINGTON 302.5 OREGON 87 118 CALIFORNIA NEVADA 80 HAWAII 320 IDAHO 57 ARIZONA 200 UTAH MONTANA 170 WYOMING 170 COLORADO 84 NEW MEXICO 166 States that have recently passed or implemented a cigarette tax increase (since 1999) 60 States that have not passed tax increases since 1999 Cigarette Tax Rates (cents per pack) State Average is $1.49 Per Pack NORTH DAKOTA 44 SOUTH DAKOTA 153 NEBRASKA 64 KANSAS 79 OKLAHOMA TEXAS 141 103 MINNESOTA 160 IOWA 136 WISCONSIN 252 MISSOURI 17 ARKANSAS 115 36 LOUISIANA ILLINOIS 198 MS 68 MICHIGAN 200 IN 99.5 60 KENTUCKY TENNESSEE 62 ALABAMA 42.5 OHIO 125 WV 55 GEORGIA 37 PENNSYLVANIA SOUTH CAROLINA 57 NEW YORK 435 160 30 VIRGINIA 45 NORTH CAROLINA FLORIDA 133.9 VT:262 VT NH CT MA MAINE 200 NH: 168 RI:346 CT:340 NJ:270 DELAWARE:160 MARYLAND:200 DC:286 June, 2012 MA:251
Federal Cigarette Excise Tax + Average State Cigarette Tax 2001 federal rate (34 ) + state average (43 ): 77 per pack federal rate ($1.01) + current state average ($1.49*): $2.50 per pack 1996 federal rate (24 ) + state average (33 ): 57 per pack * Includes Illinois s $1.00 per pack increase effective June 24, 2012, which is waiting for the governor s signature. June 2012
Smoke-Free Restaurant and Bar Laws (2002) State Smoke-free Laws Including Restaurants & Bars Local Smoke-free Laws Including Restaurants & Bars
Smoke-Free Restaurant and Bar Laws (2012) State Smoke-free Laws Including Restaurants & Bars Local Smoke-free Laws Including Restaurants & Bars April 2012
Percent of Population Covered By Smoke-Free Laws (Including Bars) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 1/1/1998: 12% CA becomes 1 st smoke-free state 1996: < 1% Smoke-free laws in 13 communities nationwide 2012: 64% 29 states and hundreds of communities are smoke-free 11/27/2002: 13% DE becomes 2 nd smoke-free state Includes state and local laws passed by January 2012
FY2012 Funding for State Tobacco Prevention Programs WASHINGTON OREGON NEVADA CALIFORNIA IDAHO UTAH MONTANA WYOMING COLORADO NORTH DAKOTA SOUTH DAKOTA NEBRASKA KANSAS MINNESOTA WISCONSIN IOWA ILLINOIS MISSOURI MICHIGAN OHIO IN KENTUCKY WV VIRGINIA VT NH MAINE MA NEW YORK CT RHODE ISLAND PENNSYLVANIA NEW JERSEY DELAWARE WASHINGTON, DC MARYLAND ARIZONA NEW MEXICO OKLAHOMA ARKANSAS MS TENNESSEE AL* NORTH CAROLINA GEORGIA SOUTH CAROLINA ALASKA HAWAII TEXAS LOUISIANA FLORIDA States that are spending 50% or more of CDC recommendation on tobacco prevention programs. States that are spending 25% - 49% of CDC recommendation on tobacco prevention programs. States that are spending 10% - 24% of CDC recommendation on tobacco prevention programs. States that are spending less than 10% of CDC recommendation on tobacco prevention programs. *Alabama s tobacco control prevention program budget for FY2012 was not available when this report went to press. In FY2011, Alabama budgeted $860,000, which is just 1.5 percent of the CDC s recommendation. November 2011
$30 $25 FY2012 Tobacco Money for Tobacco Prevention $25.6 Billion $20 $7.4 Billion Estimated Tobacco Settlement Revenues $15 $18.2 Billion Estimated Tobacco Tax Revenues $10 $5 $3.7 Billion $456.7 Million $0 Total State Tobacco Revenues CDC Recommended Annual Funding For Tobacco Prevention Actual Tobacco Prevention Spending
State Tobacco Prevention Spending, FY1999 - FY2012 $800.0 $700.0 $680.3 $737.5 $749.7 $674.4 $717.2 $670.9 $600.0 $597.5 $542.8 $538.2 $551.0 $569.3 $517.9 Millions $500.0 $400.0 $300.0 $300.1 $456.7 $200.0 $100.0 $0.0 FY1999FY2000FY2001FY2002FY2003FY2004FY2005FY2006FY2007FY2008FY2009FY2010FY2011FY2012 Only 3 states AZ, CA and MA - spent any money on tobacco prevention prior to 1999. Settlement payments to states began in 1999. All states were receiving payments by 2001. Funding amounts only include state funds ix
State Cessation Coverage (American Lung Association) Six states cover a comprehensive tobacco cessation benefit for all Medicaid enrollees Two states do not cover any tobacco cessation treatments for all Medicaid enrollees Five states cover a comprehensive tobacco cessation benefit for all state employees Two states do not cover any tobacco cessation treatments for state employees Nine states require private insurance plans to cover tobacco cessation treatments Four states invest in quitlines at or above the national minimum standard
Affordable Care Act Medicaid Coverage for Pregnant Women Essential Benefits Package for Exchanges and Other Plans (has been left to states to define) New Provider Organizations May Provide Opportunities
Innovative State & Local Policies Affect Availability, Attractiveness, Affordability at the Point of Sale (POS) Licensing, Display Bans (Havestraw NY) Warning Signs at POS (NYC), Flavor Bans (NYC, Providence) Marketing Restrictions (1 st Amendment Issues) Time, Place, Manner of Marketing Pack Size Restrictions (OTP) Coupon and Discounting Bans (Providence) Minimum Price Laws
Innovative Policies A complement to the tried and true Need evidence; states and locals can be labs Need to be carefully written expecting legal challenges Must be prepared for litigation and have resources Be strategic
Why Has Progress Slowed Our Success View that problem is solved Fewer places to work on some issues, and those are harder State Budgets -- Explains funding -- Should have led to more taxes Changed Political Environment Anti-government; Anti-spending Industry taking advantage Diminished Advocacy Resources on Ground
Tobacco Tax Example 112 tax increases 2001+ (46 were >.50) Despite worst state budgets in memory 5 tobacco tax increases of 50 cents+ in 10 0 in 2011 (and one tax CUT) 1 in 2012 California Ballot Lessons Taxes Work Media Works This is just a public display of opposition; it goes on behind the scenes in every state
State Advocacy Funding 1991-2009 $14.1 $14.1 $15.0 $14.7 $9.4 $9.8 $5.8 $6.4 $3.3 $3.3 $3.3 $3.3 $4.6 $4.6 $4.5 $3.5 $.84 $2.3 $1.5
Sorry, Grover, Illinois docs have more clout than you By Rich Miller 29 May 2012 Southtown Star Copyright 2012 Sun-Times Media Group. All Rights Reserved. Distributed by NewsBank Inc. As state legislative support for a cigarette tax increase grew over the past week or so, anti-tax crusader Grover Norquist and other conservatives stepped into the Illinois fray to try to stop it. In return for backing the higher cigarette tax, Republicans won concessions from the Democrats, particularly when it came to sparing doctors from Gov. Pat Quinn s proposed Medicaid provider rate cuts. For the past several decades, the House Republicans most reliable campaign supporter has been the Illinois State Medical Society. The House GOP always sticks with the docs, no matter what. But in Illinois, some things still trump national party interests. The state medical society is one of those things. Sorry, Grover. You may have all the Washington, D.C., Republicans scared out of their wits, but things are different here. Rich Miller also publishes Capitol Fax, a daily political newsletter, and CapitolFax.com
IMPACT of PROGRESS 23
National Youth Smoking 1997-2011 39.8% decline 17.3% decline 41.9% decline 34.0% decline Current cigarette use (smoked cigarettes on at least 1 day during the 30 days before the survey) Current frequent cigarette use (smoked cigarettes on 20 or more days during the 30 days before the survey) Data are from the Youth Risk Behavior Surveillance Survey
National Adult Smoking Trends 1994-2010 * 15.2% decline ( 94-03) 10.6% decline ( 03-10) N/A * Data are from the National Health Interview Survey
Due to these smoking declines: 3.2 million fewer current youth smokers 7.8 million youth kept from becoming addicted adult smokers 2.8 million fewer youth dying prematurely from smoking $136 billion in lifetime healthcare savings from smokers averted 10 million fewer adult smokers 2.3 million fewer adults dying prematurely from smoking $95 billion in lifetime healthcare savings from smokers averted