Editor's note: As part of our continuing election coverage, we're taking a closer look at amendments and propositions that will be on the Colorado ballot in November. Today, we examine Amendment 72 by way of an interview with a spokesman for the campaign. Tomorrow, we'll highlight a Q&A with a representative of the opposition.
Amendment 72 would increase state taxes on tobacco products. For example, the tax on cigarettes would go up by $1.75 per pack under the theory that the higher cost will prevent children from starting to smoke and encourage current smokers to quit.
Speaking on behalf of Healthy Colorado, the organization backing the amendment, is Dr. David Goff, who describes his background and credentials in the answer to the first question below. He offers reasons to support the measure and tackles issues raised by opponents.
The following transcription is supplemented by images from the Healthy Colorado Facebook page, as well as by occasional links and insertions for purposes of fact-checking and clarification.
Why should folks vote in favor of Amendment 72?
I'll start by letting you know a little bit about me, so people will have an understanding of whether they care what I think. I'm a physician. I trained as a physician in internal medicine. I also trained as a researcher, and my research is about the prevention of heart disease and stroke. I saw patients in the clinic up until about seven or eight years ago, and I've continued to do research and teaching about prevention of heart disease while taking on administrative responsibilities. I'm president of the local American Heart Association board, and I'm dean of the Colorado School of Public Health.
I guess I would say I know a little bit about heart disease and stroke — about the prevention of heart disease and stroke and what works, including issues around tobacco-control policy.
Why should people vote for Amendment 72? Really, the most effective way to prevent our kids from starting to smoke in the first place is to raise the price of tobacco products by raising the tax on tobacco products. We know based on evidence from all around the country that every time states raise tobacco taxes, there's a reduction in youth smoking — kids smoking cigarettes. When Initiative 35 was put in place twelve years ago, youth smoking in Colorado went down by around 15 percent. Sales of cigarettes went down immediately about 25 percent, and over the long term about 33 percent. [Initiative 35, passed in 2004, increased taxes on a pack of cigarettes sold in Colorado from 20 cents to 84 cents.]
So we know that raising taxes on cigarettes reduces youth initiation — stops our kids from starting to smoke in the first place. But it also provides an incentive for folks who currently smoke to quit. It puts more money back in their pockets.
The tobacco industry knows this. They know that the vast majority of people who get addicted to smoking cigarettes start smoking before the age of eighteen, which is the age of legal purchase of tobacco products. About 80 percent of people who become addicted to tobacco in their lifetime start smoking before the age of eighteen — typically around the age of fifteen.
I started smoking around the age of fifteen and stopped around the age of 21. I quit when I got accepted into medical school, because I thought it would be pretty stupid to show up at medical school with cigarettes.
I tell people — I need to be careful I don't get caught in a sound bite — I tell people that it's easy to quit, because I quit four times, and anything you can quit four times must be easy.
The hard part isn't quitting. It's staying quit. The cravings are really intense. The addiction is real.
I've read that some heroin addicts feel it's easier to kick heroin than it is to kick tobacco. Is that just anecdotal, or is there some clinical truth to it?
It's certainly something you read, and I'm not an addiction expert, so I don't know how you would study that. But it's certainly true that it's very hard to quit smoking for people who are addicted to nicotine. So the key is to prevent kids from smoking in the first place. The tobacco industry knows that almost nobody starts smoking after the age of 21. Well, why is that? It's probably because people's brains are more fully formed and we're able to make a more rational, adult decision about whether to use a deadly product. When you're talking about teenagers, you're talking about people whose brains aren't fully formed yet. My kids are older than that now, and I sure see a difference in them at the ages of 27 and 24 than I saw when they were fifteen. Fifteen-year-olds aren't in a position to make rational decisions about lifelong choices. They're called children, not adults, and we can put regulations in place to protect our kids from the tobacco industry. And part of that is setting an age for purchase at eighteen.
That's not fully effective. Kids are still smoking. So that's why we want to raise the price via taxes. Kids are very price-sensitive. They don't have a lot of disposable income, and when you raise the price of tobacco products, the people who are most sensitive to that are kids and low-income people, who also don't have a lot of disposable income and are more likely to quit when the tax goes up than wealthy people.
How much is the current tax on cigarettes? And how much would Amendment 72 add to the average price of a pack?
In the state of Colorado, the current state tax is 84 cents. Federal taxes are a buck and a penny. The average price of a pack of cigarettes is about $5.84. The increase in the state tax would be $1.75.
Typically what the tobacco industry does when taxes go up is, in the short term, they reduce their profit by trying to hold the prices down, so they don't go up a full $1.75. They try to take some of that out of their profits for a while in order to keep people hooked and keep attracting kids, and then they increase their prices over time. That's what they do all the time when taxes go up. It may cut into their profits for a little while, but they're a highly profitable business, because their product is addictive.
Where will the money go?
In general terms, the money goes into providing services to people who smoke and into communities that are disproportionately affected by smoking-related health problems. So some of the money goes into smoking-cessation programs. Once those funds are dedicated to smoking-cessation programs, Colorado will become the first state in the country to actually meet the CDC's recommended level of investment for expenditures on smoking-cessation programs. That would be wonderful. We'd be the very first state in the country to fund smoking-cessation programs at the level recommended by the CDC. Some of the money goes into biomedical research, health research. That health research is focused on a couple of different things. And it will be administered by a grant program, by the way. It will be focused on things like finding better ways to help smokers quit, since current smoking-cessation programs are not completely successfully. It will be devoted to research about understanding the health consequences of smoking and doing a better job of treating or preventing or curing the health consequences of smoking, like heart disease and cancer and lung disease and other problems.
Some of the money will go into providing mental-health services for veterans and kids and other people. And that's really important. It turns out that people with mental-health problems, including depression, anxiety, substance abuse, post traumatic stress disorder — these folks are much more likely to smoke cigarettes than people without mental-health problems. Schizophrenia as well, and bipolar disease: A lot of people with mental-health conditions, those populations are much more likely to smoke cigarettes. And if their mental-health condition is left untreated, it's really, really hard for them to quit smoking cigarettes. So it's very important to be able to provide mental-health services along with smoking-cessation programs to these populations.
Another place where some of the money is dedicated to go is improving health-care access in rural communities. And rural communities are places that typically have higher smoking rates and typically have less access to some of the smoking-cessation programs. So those are the major places the money's going. The money is allocated through a grant program that will be very similar to the grant program set up for Initiative 35, which means the grant programs will be competitive, reviewed on a regular basis. The amount of grant money allotted will be dictated by the amount of the revenue raised, so hopefully as smoking goes down over time, the grants will be reduced as that occurs.
Opponents of these kinds of taxes often argue that they're regressive — that a disproportionate amount of the taxes fall upon people of lower income. How do you reach those people? Is there a mechanism in the measure that will help them quit smoking, as opposed to spending higher and higher amounts of their income on cigarettes?
I'd like to hit a couple of points here. The opposition is funded by Altria, otherwise known as Philip Morris, the largest tobacco company in the country. They're putting about $10 million into the campaign. [Since this interview, the amount of money contributed by Altria has gone up to more than $17 million via an organization called No Blank Checks in the Constitution.] And they don't care about regressive taxation. They don't care about low-income people. They care about selling tobacco products. They care about hooking our kids on an addictive, deadly product. So I think the first thing to understand is where the opposition is coming from. And they fight every tobacco-tax increase across the country no matter how it's designed or what the money is to be used for. They fight them with whatever strategies they can bring to bear. That's the first thing I want to put on the record.
It is true that low-income people in the United States are more likely to smoke than high-income people. That's because low-income people are less educated, and they're targeted by the tobacco industry with advertising in their communities, with promotional programs to make cigarettes less expensive, so people get hooked. So, yes, low-income people are much more likely to smoke.
Parenthetically, it's interesting to look at low-income countries. There, wealthier people are more likely to smoke, because they're the only people with the disposable income that allows them to buy cigarettes. But in wealthy countries, low-income people are more likely to smoke, because higher-income people are more educated and grow up in areas where they're less targeted by the tobacco industry. If you ride through wealthy suburbs, you don't see convenience stores with big advertisements about tobacco products in the windows or big displays of tobacco products behind the counter. You see those in low-income neighborhoods.
So the tobacco industry targets low-income people to sell their product. And, yes, the tax is going to fall primarily on the people who are purchasing the products. The good news is, when the tax goes up, among current smokers, it's the low-income smokers who are much more likely to quit than the high-income smokers, because it makes a bigger impact on their disposable income, and they have a much larger economic benefit from quitting, relatively speaking. A high-income smoker doesn't notice the increased tax that much. A low-income smoker does, which makes them much more likely to quit. The importance of providing access to health care and smoking cessation is to help people who want to quit to do so. That's a really important component of the use of the tax. The money comes from the current users of the tobacco products, and a lot of the money goes into smoking-cessation programs and other programs that help people who smoke.
It's also true that smokers don't pay the full cost of smoking on society at present. The amount of money this tax raises in Colorado will be less than the amount of money that Colorado taxpayers spend on tobacco-related illnesses through Medicaid alone. Taxpayers in Colorado spend more money paying for care of tobacco-related illnesses than we're going to be raising through this tax. So it's clear that smokers don't pay the full societal cost of smoking through what they currently pay in tobacco taxes. Who pays that? We do. Taxpayers do. When you look at it from a societal point of view, it's not unreasonable to ask the people who use tobacco products to pay a greater share of tobacco's cost to society. Even after this tax, users of cigarettes won't be paying the full societal cost for the use of those products as [related to] the health-care costs for the health consequences of smoking.
If I'm understanding you correctly, the smoking-cessation programs that will be funded by this tax aren't known yet, because they'll be chosen through a grant process. Is that why you can't say, for example, that there'll be a program to help low-income smokers quit for free? Because the specifics of the programs are unknown at this point?
A lot of the money, as I understand it, would be allocated to the communities through grant-making processes. That's particularly true for health research programs and the expansion of mental-health services and access to care in rural communities. There are already some programs around tobacco cessation — quit lines and the like. And while these details are yet to be completely worked out because of the enabling language, it seems likely to me that some of the money for tobacco cessation will be to expand existing programs, but also to implement newer programs that show promise.
The opponents of this measure talk about how many of these programs are yet to be determined, and they argue that this is a reason to be critical of the way the amendment is written. Why do you feel that's not a valid argument?
This is much the same argument that was raised about Initiative 35 at the time, and the track record of Initiative 35 is a very strong one. The programs have been implemented with the appropriate state oversight. I have confidence that these programs will be implemented with similar oversight. The general areas of investment have been laid out and defined, and the grant-making process is a familiar one that the state and the legislature have implemented in relation to Initiative 35. I don't see that, personally, as a problem. Again, taking a step back, the biggest purpose of this amendment is to prevent kids from starting to smoke in the first place. It will generate revenue, and that revenue should be used responsibly. But the biggest goal of this program, and the biggest impact of this tax increase, will be to prevent kids from starting smoking in the first place. The money, as I see it, will be used very responsibly, targeted at communities disproportionately affected by the consequences of smoking and other appropriate areas, and it will be administered through a process that's demonstrated its ability to do this in a responsible and effective manner with Initiative 35.
And remember, the money to fund the opposition is coming from the tobacco industry. They go to any state that wants to raise their tax. It doesn't matter how they plan to use the money or how they propose to raise the tax — an amendment to the constitution or a simple bill. None of that stuff really matters to them. They fight it no matter what.
Who's funding the Yes on 72 campaign?
We have about $2 million dollars, last I heard, and one of the major funders is the American Heart Association. I don't know where all the money's coming from. [The top five donors can be found on this Ballotpedia post.] What I do know is there are over a hundred organizations across the state of Colorado that are supporting this amendment, including the Heart Association, the Lung Society, the Children's Hospital of Colorado, which obviously cares about the health of kids. I think it's wonderful that there are over one hundred organizations across the state that are supporting this tax increase and this amendment.
What percentage would smoking in Colorado have to drop in order for you to consider the amendment a success? I'm sure you'd like it to be 100 percent, but what do you see as a realistic figure?
Yes, we'd like it to be 100 percent. Twelve years ago, when the tax went up 84 cents, there was about a 15 percent reduction in youth smoking. I'd like to see at least that much this time. I'd hope we'd see at least a 20 percent reduction in youth initiation. This is a bigger increase, so hopefully it will have a bigger impact.
Is there anything else about the amendment that you'd like to add?
I think it's important for people to know that tobacco is still the leading cause of preventable death in the United States and in Colorado, and that most people who smoke start smoking before the age of eighteen. We're talking about kids, and the most effective way of stopping kids from starting smoking in the first place is by raising the price of tobacco products through taxation. We know that this works, and the tobacco industry knows this works. That's why they're throwing millions in false advertising and scare tactics at trying to prevent this amendment from passing. So if you care about the health of the children of Colorado, vote for Amendment 72.