Will Smoking Cuts Add to Health Care Costs?

Finding ways to cut health care costs is all the rage under the Pink Dome — and curbing smoking is a proven way to do it. But both the House and Senate budget proposals slash tobacco cessation programs by more than 80 percent, or $20 million over the biennium.

Health care advocates say such cuts would devastate programs that deter children from smoking and eliminate regional efforts that have curbed tobacco use among adults. And they argue that the money, which comes from a multibillion-dollar lawsuit settled with big tobacco companies in the late 1990s, is supposed to be used for anti-smoking education.

“If you ask what the biggest health threats are to the state, tobacco is in the top three, but we’re not putting money where our mouth is,” said Troy Alexander, associate director of advocacy for the Texas Medical Association, one of several groups gathering at the Capitol this morning to oppose cuts to tobacco control and obesity reduction efforts. “If you look at how we’re taxing tobacco, we’re not hesitating to benefit from the use of tobacco, but we aren’t doing much to reduce consumption.”

The move to use smoking cessation funds to help balance the budget comes as several lawmakers work to ban smoking in most public places. According to the advocacy group Smoke-Free Texas, that would save Texas more than $400 million every two years — including $250 million in health care savings. They also estimate that nearly 33,000 Texans would kick the habit.

But with an estimated $15 billion to $27 billion budget shortfall, lawmakers say they’re being forced to make painful cuts across agencies and programs — even highly effective ones like the anti-smoking initiatives.

When Texas settled a roughly $17 billion lawsuit with big tobacco companies in the late 1990s, lawmakers chose to set aside $200 million for tobacco prevention. For years the state has used the interest — more than $10 million a year — to fund anti-smoking efforts, including phone hotlines for tobacco cessation counseling and programs to target convenience stores selling to underage kids. 

The programs have paid off, supporters say. In the Houston-Beaumont area, the Department of State Health Services has reported a 41 percent drop in smoking among high school students, a 32 percent drop among middle school students and a nearly 19 percent drop in smoking among adults. The agency has asked lawmakers to restore the programs in their “exceptional items” — budget requests that go above and beyond available funds.

“Under the current legislative budget proposals,” said DSHS Spokeswoman Christine Mann, “we couldn’t continue doing what we do today for tobacco prevention.”

Already, the state spends just 2 percent of the amount recommended by the Centers for Disease Control and Prevention on smoking cessation — and tobacco costs Texas an estimated $11 billion in annual medical costs, health advocates say. Without the smoking cessation funds, and with tobacco companies continuing to pour billions of dollars into national advertising campaigns, they say Texas’ smoking-related medical bills will spike.  

“There has already been a return on the investment,” said Joel Romo, an advocate for the American Heart Association in Texas. “For us, this is really going against the word of the agreement that was made.”

But former state Sen. Bill Ratliff, who was one of the Legislature’s key budget writers when the tobacco settlement was signed, said there was no such agreement. He said that when Attorney General Dan Morales proposed a settlement with the tobacco companies in the late 1990s that would’ve dedicated the money specifically to anti-smoking education, lawmakers intervened. After tense negotiations, they decided the Legislature could appropriate the money as it saw fit, but that as the budget allowed, money would be dedicated to tobacco cessation. “There was no commitment to that effect. We didn’t want to be told where to dedicate it,” Ratliff said.

True, the settlement money wasn’t set aside for smoking programs, said Harry Potter, who was a special assistant attorney general at the time of the suit.

“But certainly it’s against the spirit and the intent of the original lawsuit settlement," he said, "which was brought to do two things: help reduce underage smoking, and reimburse the state for health care costs.”

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