Health advocates cheered in 1998 when 46 states agreed to a $246 billion settlement of a lawsuit against tobacco manufacturers designed to recover public health costs of tobacco-related illnesses. They believed the money would be used to fund anti-smoking programs and help achieve broader health care goals.
Four years later, the promise of the settlement has yet to be realized. Despite the tobacco windfall, states are shortchanging the very programs settlement funds were supposed to pay for, advocates say.
This year, only six states - Hawaii, Maine, Maryland, Minnesota, Mississippi and Ohio - funded tobacco control programs at minimum levels recommended by the U.S. Centers for Disease Control and Prevention (CDC). CDC officials say they expect to add Arizona and Massachusetts to the list within the next few months.
Mississippi Attorney General Mike Moore, who played a key role in the settlement, has been traveling the country to encourage states to spend more on anti-smoking efforts. Last month he went to Louisiana, where he urged an appropriations panel to "remember what the fight was about," The Times-Picayune reported.
Current budget shortfalls have made the situation even worse. At least 15 states are filling budget holes with money from tobacco settlement payments.
Health-minded lawmakers are trying to change that. Mississippi, Idaho and Oklahoma debated measures this year to earmark tobacco trust monies for health programs. Oklahoma legislators put voters in the driver's seat, approving a resolutionnow known as question 701to dedicate a specific chunk from the settlement to a state fund.
Health groups in several other states are fighting back with ballot measures they hope will ensure tobacco settlement money is invested in anti-smoking and health care programs.
In Michigan, state hospital and medical group officials have gathered signatures to put a constitutional amendment on the November ballot that would divert most of the state's tobacco settlement money from college scholarship funds and research to health care causes, The Detroit News reported this month (6/4).
A similar drive is under way in Montana, says Erick Tombre of the Alliance for a Healthy Montana, a coalition of health-related organizations including state chapters of the American Cancer Society and the American Heart Association.
Former Montana Gov. Marc Racicot had budgeted $3.5 million a year for anti-smoking programs. But Gov. Judy Martz, who was elected to succeed him two years ago, cited budget woes and cut that figure down to $500,000, a move backed by the Legislature.
Tombre says the cutback means money isn't being used in the way it was intended under the Master Settlement Agreement. "Most (Montanans) are incensed about what's happened... This money was never intended to balance our budget, we want to go back and use it for what it was intended," he says.
The coalition wants 32 percent, or $9.1 million, of the state's $30 million yearly allotment to go towards tobacco prevention programs. In addition, the group wants 17 percent to beef up health insurance programs for kids and adults.
Tombre says 14 full-time workers have gathered 23,000 signatures across the state, and the drive is on target for a June 21 deadline. "We have had great responses from people, and they understand the issue," he says.
In Maine, activists took a different route.
Nearly one-third, or $221 million, of tobacco settlement money the state will have received by June 2003 has been diverted from health programsincluding anti-smoking projects, child care and dental careto fill budget gaps.
Edward Miller, CEO of the state's American Lung Association , says he wants that to stop. Miller's team and groups including the Maine Coalition on Smoking OR Health considered rounding up signatures for a constitutional amendment, but decided that wasn't such a good idea in the face of a budget deficit.
So they decided instead to get lawmakers to sign a pledge affirming that tobacco settlement money should stay in health-related programs, and that the tobacco monies shouldn't be considered "just another rainy day fund."
How did lawmakers respond? Miller says 115 legislators out of 188 signed the pledge within a week. To make sure the public knew it, the health groups published names of the pledge-signing politicians in local newspapers.