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Use of Tobacco Settlement Funds Up for Debate

October 09, 2001
By: Amanda Joyce
State Capital Bureau
Link: Table showing settlement money allocation.

JEFFERSON CITY - Sixty five years of two-pack-a-day smoking eventually caught up with Virginia Hutton.

In 1985 Hutton had a heart attack and realized it was time to take the doctor's orders. She hasn't smoked since.

For Hutton, who is now 81 years old and lives in Macon, the national settlement with the tobacco industry and the ensuing debates on where the money should go are a world away. She hasn't heard about the settlement and doesn't expect it to effect her in any way.

"For people who smoked their whole lives like me, it's my own fault [I got sick]," Hutton said. "I don't think I'm entitled to that money."

Dr. Daniel Longo, on the other hand, would like to see smokers benefit in some way from the settlement.

Longo is a Professor of Family and Community Medicine at the University Medical School, and he provided evidence and research support to the Missouri State's Attorney office during the 1998 tobacco settlement.

He knows what it takes to get smokers to quit, having been a smoker off and on for ten years.

"What do you do about a patient who could use nicotine replacement therapy, but it's not covered by their insurance?" Longo said.

Nicotine replacement therapy is not cheap, and it's frustrating that so many patients go without, he said.

"We're missing the boat," Longo said. "You use that money to do things that aren't related to tobacco use--[it's a] very unfortunate decision."

Of the various programs getting tobacco settlement money, 15.6 percent will go to smoking prevention efforts this current fiscal year, according to legislative staff.

When other factors, such as money taken to balance the budget or money used for senior prescription drugs, are considered that percentage shrinks even more.

Hutton and Longo represent the personal side of a debate about tobacco settlement money that has gotten little attention -- in the public arena or even in the governmental arena.

The settlement awarded states with billions to compensate for the added medical costs of patients with tobacco-related diseases.

Donald Jeffries is the current head of the Missouri Partnership on Health or Smoking Prevention, a conglomeration of groups interested in reducing Missouri's smoking rates.

Jeffries said that the Missouri Partnership is working to ensure that tobacco settlement dollars are used for prevention.

"It's our personal feeling that the money should be spent on smoking control because it will eventually help the average guy," Jeffries said.

Missouri will receive approximately $4.5 billion during the next 27 years; $160 million for the 2002 fiscal year.

Peter De Simone is the Executive Director of the Missouri Association for Social Welfare, a group that has worked on social programs since 1901.

He questions how the settlement money will be divvied up.

"If this money came to Missouri because of health care expenses, shouldn't all the money go to health?" De Simone said.

"I would not be a purist about it," De Simone said, "but a simple formulation is that money created by health care problems should be used to solve health care problems-not distant issues like research."

According to De Simone, there are 700,000 people uninsured in the state and perhaps another 30,000 who are underinsured.

Missouri's smoking rates are the fifth worst in the US, and little has been done by the state government to provide funding for anti-smoking programs.

"It's just not been a high enough priority," said Sen. Wayne Goode, D-St. Louis County. "We're always strapped for money."

"The government is like an individual: those needs that are most immediate are a higher priority," Goode said.

Longo said that smoking is often seen the same way.

"The health consequences of smoking are seen as very long-term...to teenagers lung cancer is an eternity away," Longo said.

The first state-wide program should be ready in the spring of 2002 when the State Health Department receives its first payment of $22.2 million.

"The Center for Disease Control recommends between $35 and $95 million be spent on smoking prevention," Nancy Miller, the assistant to the Director of the Division of Chronic Disease and Health Promotion SHORTEN TITLE?, said. "$22 million is shy of that, so we're hoping to get closer next year."

The $22 million being spent on smoking prevention is 20 percent of the total funds coming to the state this fiscal year.

For Jeffries, 20 percent is not enough. Citing the CDC's recommendation that an effective program needs $33 million minimum, he wants the state to give more.

Hutton says she never considered quitting until after the heart attack.

"It [smoking] was the thing to do," she said. "You were right up with the crowd if you smoked."

Times have changed. Today the Surgeon General's warning labels adorn every pack of cigarettes and the link between smoking and deteriorated health is fully documented.

Medicare and Hutton's secondary insurance payed for all of her expenses after the heart attack. It also covered her husband Lester Hutton's costs when he developed lung cancer and had three-fourths of a lung removed.

Lester died in November 2000 from lung cancer related pneumonia.

"You hear about Social Security and Medicare going bankrupt," Hutton said. "I think Medicare would be the best place for that money."