SAN FRANCISCO -- Health advocates have long supported the idea of increasing taxes on tobacco products, both to discourage consumption and to help pay for health-care services. But two competing propositions that could be headed for the ballot next year, adding $1.50 to the price of a pack of cigarettes in California, have stirred up controversy among groups that are usually united against tobacco.
Hospitals are pitted against doctors, nurses and health advocates, and even divided among themselves. Cancer-fighting groups can't agree with lung disease [image-nocss] organizations. The dispute centers on where the money -- about $1.4 billion a year -- would go.
The hospital industry is gathering signatures to place the Emergency Services and Tobacco Tax Act of 2006 on the ballot. Most of the receipts would fund hospital emergency care services. The measure could go head to head against another measure, the Tobacco Tax, Disease Prevention and Children's Health Insurance Act of 2006, which is supported by several disease and children's organizations.
Neither proposition has yet qualified for the state ballot, but the hospital-backed measure could get enough signatures to go before the voters in June. The health-advocacy-group measure is still awaiting approval from the state attorney general before its petition effort may begin. If the hospital-backed proposition is not approved for the June election, the two measures could both end up on the November ballot.
Already several groups, including the California Medical Association, the California Nurses Association, Health Access California and the Campaign for Tobacco-Free Kids, have come out against the hospital-backed proposal. These critics say the emergency-services measure gives hospitals too much power in how the money is spent.
"This is a scarce resource -- a one-time raising of the tobacco tax to a level similar to many other urban states," said Peter Warren, spokesman for the California Medical Association, a statewide organization of 35,000 doctors. "We have the hospitals running to the ballot with a proposal ... that basically ignores everyone else in health care."
Emergency-department physicians and hospital officials say California's emergency-care system is in crisis and the money is needed to fund urgently needed services. "The disagreement seems to be over particulars and not in line with the overall concept that our emergency system seems to be collapsing," said Dr. Loren Johnson, past president of the California chapter of the American College of Emergency Physicians.
Health advocates consider California ripe for a tobacco tax. At 87 cents per pack, the state's cigarette levy falls below the national average of 91 cents. Cigarette taxes have not increased in California since 1998.
Both of the proposed California measures would devote the new revenue to a wide range of causes, including nursing education and smoking cessation. But there are large differences of opinion over how the money would be allocated.
The Hospital Association measure would devote nearly 65%, or $906 million, to hospital emergency-care services. About 9% each, or $126 million, would go to nursing education and smoking prevention. The remaining 17% would fund other programs, such as emergency doctors, including specialists to be available on call, and breast cancer research. It would also help finance crime-prevention initiatives, including programs to counter tobacco tax evasion and cigarette smuggling.
Health Access California, a coalition of labor and consumer groups, opposes the measure because it is concerned that the money would not be shared equitably among hospitals in affluent areas and those in low-income communities, said Anthony Wright, the group's executive director.
Under the competing proposition, which is backed by the American Lung Association and the American Cancer Society, about 35%, or $450 million, would support a wide range of disease prevention and treatment efforts, including breast cancer, strokes and lung disease. In addition, 34%, or about $435 million, would fund health coverage for uninsured children, and 21%, or nearly $270 million, would be devoted to anti-smoking programs.
The measure is causing conflict among patient advocacy groups. Some groups say their causes are getting short shrift. "Once again, lung cancer gets ignored," said Kim Norris, whose husband died from the disease in 1999.
Norris said the measure supported by advocacy groups commits more money to lung-disease research than the hospital measure, but only about 3% of its research fund would be devoted to lung disease. Lung cancer is the leading cause of cancer deaths in the United States.
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