This article first appeared in the St. Louis Beacon, Jan. 21, 2011 - Twice in the past 10 years, Missouri public-health advocates have sought to raise the state's cigarette tax, only to come up short at the voting booth both times.
Now they're back with a new argument they hope will be persuasive: "I just think there is no justification for being the lowest in the nation on cigarette taxes," said state Rep. Mary Still, D-Columbia. "When I say that to people, it is shocking to them."
Missouri now has the nation's lowest state cigarette tax, at 17 cents a pack, after the South Carolina legislature raised the state's tax to 57 cents a pack from 7 cents last summer. The development has renewed interest among some state lawmakers and public-health groups for enacting a cigarette tax, even in a political climate that seems unfavorable for tax increases.
Still wants to raise the state's cigarette tax by about $1 a pack. She and other supporters contend that a tax hike would curb the state's smoking rate, often cited as one of the nation's highest. They also have argued that a cigarette tax hike would also save the state millions of dollars each year in health costs and bring in millions more in tax revenue.
But Still's proposal faces steep political hurdles in Jefferson City, where Democratic Gov. Jay Nixon has pledged no new taxes and Republicans in the GOP-dominated legislature likewise want to steer clear of tax increases.
The Missouri Petroleum and Convenience Store Association has come out swinging against Still's proposal, arguing that health groups are trying to tax cigarettes into prohibition and that the tax hike would hurt cigarette retailers. "Being a low-tax state is a good thing because it drives cross-border sales," said Ron Leone, the association's executive director.
Supporters such as the American Cancer Society and Campaign for Tobacco-Free Kids argue it's especially important to increase the tax because the current tax reflects a broader problem: They contend Missouri is arguably the worst state at combating tobacco use, creating widespread public-health issues.
"It has the lowest cigarette taxes at 17 cents; it spends next to no money on tobacco prevention and cessation; and it does not have a statewide comprehensive smoke-free law," said Peter Fisher, vice president of state issues at the campaign.
That view is echoed by the American Lung Association. Its report of the State of Tobacco Control 2010 graded the states on four measures: spending on tobacco control and prevention; cigarette tax rate; smokefree air laws; and treatments to stop smoking. Missouri received an "F" in all four categories.
Supporters say being the nation's worst at tackling tobacco use also has dire fiscal consequences. Tobacco-related illnesses cost Missouri's Medicaid system $641 million in fiscal 2009, including $256 million in state money, according to the Missouri Budget Project.
Implementing just one of the three policy ideas -- a tax hike, a smoking ban or more money for smoking prevention and cessation -- could both improve public health and bring down Medicaid costs, Fisher said. For now, he said, "Missouri fails miserably in all three."
Public-health advocates say a statewide smoking ban is unlikely this legislative session. Groups like the American Cancer Society are focusing their efforts to impose smoking bans on the local level, said Misty Snodgrass, regional government relations director for the society. Ban supporters have racked up a number of recent victories, in the St. Louis area and in places like Jefferson City and Fulton.
Health groups such as the cancer society and the American Heart Association also hope to win funding for smoking-cessation programs. A report out last October from several public-health groups said Missouri spends just $60,000 a year on smoking prevention and cessation -- less than 0.1 percent of the $73 million in spending that the federal government suggests for Missouri.
Still's cigarette-tax increase would be especially powerful, supporters say, because it does more than smoking bans and cessation programs. Beyond improving public health and reducing state Medicaid expenditures, it could raise hundreds of millions in additional tax money each year for the cash-strapped state. The Missouri Budget Project estimates a tax increase similar to Still's could generate roughly $500 million in new revenue a year.
"Why do we want to be so much lower than every other state?" Still said. "What's the justification for that, when we're going to be cutting so many other programs?"
Still wants to introduce either of her proposed tax increases sometime next week. Each would have its own political and procedural hurdles. One would implement a one-time tax hike of about $1, she said. The other would phase in the tax, with 12-cent increases each year for eight years.
The one-time increase would have to go before voters because the Missouri Constitution's Hancock Amendment requires the public to approve any tax increase above a certain fraction of total state tax revenue. Voters struck down similar referendums in 2002 and 2006 that ran into strong opposition from tobacco and business interests -- a sign of the challenges supporters would face if the one-time hike were to go to a vote.
The gradual approach would increase taxes slowly enough each year that it wouldn't have to go to voters. Some public-health advocates say the gradual approach would be less effective, though, keeping Missouri's cigarette tax unacceptably low for years.
Either approach would bring Missouri's cigarette tax closer to the national average, which Tobacco-Free Kids puts at $1.45.
MPCA's Leone argues the average is misleading because states with $3-plus taxes, such as New York and Rhode Island, skew the average upward. Leone also said the total tax on a pack of cigarettes is more like 30 or 40 percent after factoring in the federal cigarette tax and sales taxes. "No other retail product in Missouri is taxed at that rate, and the anti-tobacco zealots still say it's too low," he said.
It's unclear whether the governor, who has pledged no new taxes, would sign off on Still's proposal. A Nixon spokesman, when asked about Still's proposal, responded in a statement: "The governor has not indicated his support for new taxes in Missouri."
Still said it's better to view a cigarette tax more like a user fee. "Smokers should be able to pay their way, and that's one way to do it," she said.
Leone warned that by moving forward with a cigarette tax, lawmakers would ignore the message voters sent in 2002 and 2006: "How many times do the people have to say 'no' before it sinks in to our elected officials?"
Puneet Kollipara, a Washington University student, is a freelance writer and former Beacon intern.