Tobacco Tax Battle Could Torch Montana Medicaid Expansion
Amanda Cahill, a supporter of Montana's tobacco tax measure, I-185, at a press conference near the state capitol last August. Tobacco firms have spent $17 million in opposition to the initiative, compared to an $8 million campaign by those in favor of it. (Corin Cates-Carney/Montana Public Radio)
Montana legislators expanded Medicaid by a very close vote in 2015. They passed the measure with an expiration date: It would sunset in 2019, and all who went onto the rolls would lose coverage unless lawmakers voted to reapprove it.
Fearing legislators might not renew funding for Medicaid鈥檚 expanded rolls, Montana鈥檚 hospitals and health advocacy groups came up with a ballot measure to keep it going 鈥� and to pay for it with a tobacco tax hike.
If ballot initiative聽passes Tuesday, it will mean an additional $2-per-pack tax on cigarettes and levy a tax on e-cigarettes, which are currently not taxed in Montana.
The tobacco tax initiative has become the most expensive ballot measure race in Montana history 鈥� drawing more than $17 million in opposition funding from tobacco companies alone 鈥� in a state with fewer than 200,000 smokers.
聽works for the American Heart Association and is a spokeswoman for聽, the coalition backing the measure. She said coalition members knew big tobacco would fight back.
鈥淲e poked the bear, that鈥檚 for sure,鈥� Cahill said. 鈥淎nd it鈥檚 not because we were all around the table saying, 鈥楬ey, we want to have a huge fight and go through trauma the next several months.鈥� It鈥檚 because it鈥檚 the right thing to do.鈥�
Most of the $17 million has come from cigarette maker Altria. According to records from the聽, that鈥檚 more money than Altria has spent on any state proposition nationwide since the center started keeping track in 2004.
Meanwhile, backers of I-185 have spent close to $8 million on the initiative, with most of the money coming from the Montana Hospital Association.
鈥淲hat we want to do is 鈥� No. 1 鈥� stop Big Tobacco鈥檚 hold on Montana,鈥� Cahill said. Also, she continued, it鈥檚 imperative that the nearly 100,000 people in Montana who have gotten Medicaid under the expansion will be able to keep their health care.
Cahill said I-185 will allocate plenty of money to cover the expansion, though some lawmakers say the state can鈥檛 afford the expansion even with higher taxes.
Nancy Ballance, a Republican representative in the Montana Legislature, opposes the measure.
鈥淚n general I am not in favor of what we like to refer to as 鈥榮in taxes,鈥欌�� Ballance said. 鈥淭hose are taxes that someone determines should be [levied] so that you change people鈥檚 behavior.鈥�
Ballance also isn鈥檛 in favor of ballot initiatives that, she said, try to go around what she sees as core functions of the legislature: deciding how much revenue the state needs, for example, or where it should come from, or how it should be spent.
鈥淎n initiative like this for a very large policy with a very large price tag 鈥� the legislature is responsible for studying that,鈥� Ballance said. 鈥淎nd they do so over a long period of time, to understand what all the consequences are 鈥� intended and otherwise.鈥�
Most citizens, she said, don鈥檛 have the time or expertise to develop that sort of in-depth understanding of a complicated issue.
Montana鈥檚 initiative to keep Medicaid鈥檚 expansion going would be a 鈥渄ouble whammy鈥� for tobacco companies, said聽, the chief strategy officer for the nonprofit Well Being Trust.
鈥淧eople who are covered are more likely to not smoke than people who are uninsured,鈥� said Miller, who has studied tobacco tax policies for years. He notes research showing that people with lower incomes are more likely than those with higher incomes to smoke; and if they鈥檙e uninsured, they鈥檙e less likely to quit.
Federal law requires Medicaid to offer beneficiaries access to medical help to quit smoking.
Plus, Miller added, every time cigarette taxes go up 鈥� thereby increasing the price per pack 鈥� that typically leads to a聽.
And that, he said, works against a tobacco company鈥檚 business model, 鈥渨hich is, 鈥榶ou need to smoke so we can make money.鈥欌��
Ballance agrees that tobacco companies likely see ballot initiatives like I-185 as threats to their core business. But, she said, 鈥渇or anybody who wants to continue smoking, or is significantly addicted, the cost is not going to prohibit them from smoking.鈥�
The U.S. Centers for Disease Control and Prevention says tobacco use is 聽in the U.S.
Montana鈥檚 health department says that each year more than 1,600 people in the state die from tobacco-related illnesses.
This story is part of a reporting partnership with , 补苍诲听Kaiser Health News.