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Tobacco Tax Battle Could Torch Montana Medicaid Expansion

Montana legislators expanded Medicaid by a really shut vote in 2015. They handed the measure with an expiration date: It would sundown in 2019, and all who went onto the rolls would lose protection until lawmakers voted to reapprove it.

Fearing legislators won’t renew funding for Medicaid’s expanded rolls, Montana’s hospitals and well being advocacy teams got here up with a poll measure to maintain it going — and to pay for it with a tobacco tax hike.

If poll initiative I-185 passes Tuesday, it should imply a further $2-per-pack tax on cigarettes and levy a tax on e-cigarettes, that are at the moment not taxed in Montana.

The tobacco tax initiative has turn out to be the most costly poll measure race in Montana historical past — drawing greater than $17 million in opposition funding from tobacco corporations alone — in a state with fewer than 200,000 people who smoke.

Amanda Cahill works for the American Heart Association and is a spokeswoman for Healthy Montana, the coalition backing the measure. She mentioned coalition members knew massive tobacco would battle again.

“We poked the bear, that’s for sure,” Cahill mentioned. “And it’s not because we were all around the table saying, ‘Hey, we want to have a huge fight and go through trauma the next several months.’ It’s because it’s the right thing to do.”

Most of the $17 million has come from cigarette maker Altria. According to information from the National Institute on Money in Politics, that’s more cash than Altria has spent on any state proposition nationwide for the reason that heart began preserving observe in 2004.

Meanwhile, backers of I-185 have spent near $eight million on the initiative, with a lot of the cash coming from the Montana Hospital Association.

“What we want to do is — No. 1 — stop Big Tobacco’s hold on Montana,” Cahill mentioned. Also, she continued, it’s crucial that the almost 100,000 folks in Montana who’ve gotten Medicaid below the growth will have the ability to preserve their well being care.

Cahill mentioned I-185 will allocate loads of cash to cowl the growth, although some lawmakers say the state can’t afford the growth even with greater taxes.

Nancy Ballance, a Republican consultant within the Montana state Legislature, opposes the measure.

“In general I am not in favor of what we like to refer to as ‘sin taxes,’ ” Ballance mentioned. “Those are taxes that someone determines should be [levied] so that you change people’s behavior.”

Ballance additionally isn’t in favor of poll initiatives that, she mentioned, attempt to go round what she sees as core capabilities of the Legislature: deciding how a lot income the state wants, for instance, or the place it ought to come from, or the way it must be spent.

“An initiative like this for a very large policy with a very large price tag — the Legislature is responsible for studying that,” Ballance mentioned. “And they do so over a long period of time, to understand what all the consequences are — intended and otherwise.”

Most residents, she mentioned, don’t have the time or experience to develop that form of in-depth understanding of a sophisticated subject.

Montana’s initiative to maintain Medicaid’s growth going could be a “double whammy” for tobacco corporations, mentioned Ben Miller, the chief technique officer for the nonprofit Well Being Trust.

“People who are covered are more likely to not smoke than people who are uninsured,” mentioned Miller, who has studied tobacco tax insurance policies for years. He notes analysis exhibiting that folks with decrease incomes are extra doubtless than these with greater incomes to smoke; and in the event that they’re uninsured, they’re much less prone to stop.

Federal legislation requires Medicaid to supply beneficiaries entry to medical assist to stop smoking.

Plus, Miller added, each time cigarette taxes go up — thereby rising the worth per pack — that usually results in a decrease in the number of people smoking.

And that, he mentioned, works towards a tobacco firm’s enterprise mannequin, “which is, ‘you need to smoke so we can make money.’ ”

Ballance agrees that tobacco corporations doubtless see poll initiatives like I-185 as threats to their core enterprise. But, she mentioned, “for anybody who wants to continue smoking, or is significantly addicted, the cost is not going to prohibit them from smoking.”

The U.S. Centers for Disease Control and Prevention says tobacco use is the leading cause of preventable disease and death within the U.S.

Montana’s well being division says that every 12 months greater than 1,600 folks within the state die from tobacco-related sicknesses.

This story is a part of a reporting partnership with Montana Public Radio, NPR and Kaiser Health News.

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