For many Missouri health advocates, an increase in the state鈥檚 tobacco tax is long overdue. But onlookers might be surprised to hear that tobacco companies are spending a fortune this election year to get one or another increase in that tax passed, while health groups are urging a no vote.
What鈥檚 going on? The tax increases that聽the companies want are so low that tobacco researchers聽say they would have no effect on smokers buying their products 鈥斅爋r quitting a dangerous habit.
At 17 cents for a pack of cigarettes, Missouri鈥檚 tax is the 鈥 a fraction of what you鈥檇 pay in many states. New York鈥檚 tax is the highest at $4.35 a pack, for example, and Florida ranks around the middle of the states at $1.34 a pack. Missouri鈥檚 cigarette tax hasn鈥檛 changed since 1993.
Health groups like the American Lung Association say Missouri鈥檚 low cigarette prices to one of the highest smoking rates of any state in the country: Twenty-two percent of adults in Missouri , according to data compiled by the Centers for Disease Control and Prevention. Compare that to New York, where 15 percent of adults smoke.
On Nov. 8, Missouri voters will decide whether to approve not one, but two tobacco tax increases 鈥斅爋ne backed by large tobacco companies and another backed by small manufacturers.
The current tobacco tax debate got its start as way to expand early childhood education. In Missouri, just 19 percent of 4-year-olds attend a preschool or a Head Start program.
To Linda Rallo, an early childhood education advocate in St. Louis, a small increase in the tax seemed like an easy way to fund the schooling expansion. But then she took the idea to lawmakers in Jefferson City.
After years of failed attempts to increase the tax in the legislature, lawmakers and others in the capital seemed to consider another attempt to do so almost laughable.
鈥淲e had big, right-leaning people mocking us,鈥 Rallo said. 鈥淚t was rough.鈥
So Rallo and supporters decided instead to try to create a tax through a ballot measure. Their polling showed voters might approve an additional 60 cents a pack 鈥 and that鈥檚 the tax increase they鈥檙e proposing.
They estimated that their plan, which became on this month鈥檚 Missouri ballot, would generate around $300 million a year to fund mostly early education, with some funds going to smoking cessation and to health facilities that provide health care for children.
Rallo said her group reached out to get the help of health organizations like the American Lung Association. But there was a problem with her amendment, some public health researchers told her. Public health the size of the tax in Rallo鈥檚 amendment is too small to make a difference in smoking rates.
鈥淩aising prices of tobacco products, we know, is the most effective way to prevent people from starting to smoke, to help people not get addicted to tobacco products and 鈥 for those who are smoking 鈥 to help them quit,鈥 explained聽, director of the Center for Public Health Systems Science at Washington University in Saint Louis. But the size of the tax, research shows, has to be big enough to make people think twice before buying that pack of cigarettes.
Washington University has Amendment 3, as has the American Lung Association, which argues that the amendment鈥檚 schedule of gradual increases in tax over four years would also keep it from having a big influence on smoking rates.
Rallo said it was this sort of disagreement over the size of the tax that caused her talks with health groups to break down.
鈥淚t was basically, 鈥業t鈥檚 my way or the highway.鈥 So we took the highway,鈥 Rallo said. 鈥淎nd when you鈥檙e going down the highway, you might pick up an interesting companion.鈥
That 鈥渋nteresting companion鈥 is tobacco giant R.J. Reynolds. Since December of 2015, the company has donated more than $12 million to committees supporting Amendment 3.
In a written , R.J. Reynolds said this is the first time the company has supported a cigarette tax increase.
But that鈥檚 not the end of the campaign鈥檚 complications. Amendment 3 also pits the Big Tobacco giant against smaller manufactures, known collectively as 鈥淟ittle Tobacco.鈥
As the result of a national settlement in the late 1990s, Big Tobacco companies must pay the state a special fee that their smaller competitors don鈥檛 face.
Rallo said the fee allows these smaller companies to undercut firms like R.J. Reynolds, in their price per pack.
鈥淵ou have such a low price on cigarettes 鈥 such a discounted price 鈥 that it鈥檚 very easy for low income people to buy cigarettes,鈥 Rallo said.
Amendment 3 creates an additional tax increase for the Little Tobacco companies that don鈥檛 pay the fee. Rallo said that extra tax is meant to stop the small companies from being able to sell cigarettes at bargain prices.
But Little Tobacco has fired back. They鈥檝e thrown their weight behind a different ballot measure 鈥 , which would add a smaller tax (23 cents a pack) on all brands. That way, the smaller producers would still be less expensive than Big Tobacco鈥檚 cigarettes.
Two of the smaller manufacturers, Xcaliber International and Cheyenne International, have donated nearly $5 million in support of the smaller tax.
Meanwhile, many education advocates aren鈥檛 crazy about how the tax money raised by Rallo鈥檚 proposed amendment would be spent. Rather than earmarking it for public schools, the money raised by Amendment 3 would be available as grants that could alternatively go to religious or private education groups.
Rallo said these other institutions provide a lot of pre-K programs in Missouri and are better prepared than public schools to expand in many parts of the state. Money raised under Proposition A would fund infrastructure projects.
The numerous debates and controversies that have arisen from Amendment 3 have led to some alliances never seen before, and to shifts in many of these groups鈥 default positions on tobacco and taxes.
鈥淭his becomes very confusing to the public,鈥 said Luke. 鈥淭hey see multiple bills on the ballot. They hear that public health groups are arguing about this. And even the tobacco industry is fighting itself, which is very unusual.鈥
Groups like Tobacco Free Missouri, the Health Care Foundation of Greater Kansas City and Campaign for Tobacco-Free Kids have joined fiscal conservatives in opposing Amendment 3. These anti-smoking groups worry that creating such a small tax now might eliminate the chance of future tax that would be big enough to significantly change smokers鈥 behavior.
鈥淭here is a sense here of, 鈥楢t some point we need to get something passed,鈥欌 said Luke. 鈥淏ut that鈥檚 not how you do sound policy.鈥
This story is part of a partnership that includes , and Kaiser Health News.