Tobacco Use Reduction: Policy Wins In Kentucky
by Ben Chandler
Published in Health Affairs Blog, November 6, 2019
In 2016, Healthy Kentucky began a transition to doing most of its own advocacy work and using grants to fund contracts with partners to support specific policy campaigns at both the local and state levels. Our tax status has always allowed us to lobby as long as we spend only a de minimus amount of our annual expenditures on contacting elected officials to discuss specific legislation.
Healthy Kentucky’s board of directors and I agreed that our work could improve opportunities for better health for more Kentuckians and at a lower cost per person by using our limited funding—about $2 million annually—to adopt evidence-based policies already shown to improve health.
In its first two lobbying forays into the Kentucky General Assembly, Healthy Kentucky has racked up two significant policy wins for Kentuckians’ health, although they were not without challenges. The work started with the 2017 launch of the Coalition for a Smoke-Free Tomorrow, which today comprises a cross-sector membership of more than 210 organizations including health care providers and payers, health advocacy groups, educational associations, large and small businesses, and the faith community. I chair the coalition, which is led by a steering committee of 20 representative organization officials. The coalition is staffed by two Healthy Kentucky employees, who spend about half of their time on this work.
36 Million Fewer Packs Of Cigarettes Sold
In its first campaign, the Coalition for a Smoke-Free Tomorrow advocated for a $1 per pack increase in Kentucky’s excise tax on cigarettes, a tall order in a state with a longstanding tobacco culture. Research shows that raising the price of tobacco products through tax increases is among the most effective measures to reduce use, particularly use by youth.
Healthy Kentucky started by providing grants to groups to conduct regional educational sessions around the state for legislators and civic leaders about the health benefits and expected revenues associated with that $1 per pack cigarette tax increase. We followed with a major media event in the state’s capitol located in Frankfort to launch the coalition and announce our single policy agenda item—the $1 increase. Thereafter, we used traditional policy advocacy, lobbying, and media relations tactics designed to educate legislators and win support. Foundation grants funded the training of youth advocates as well as two nonprofit organizations that conducted grassroots outreach and education.
Healthy Kentucky also raised more than $175,000 to pay for advertising and campaign materials. How did we do this? We met with the leaders of a variety of organizations that could benefit from a healthier workforce or client base and asked them to donate money to the foundation to be used specifically for the Coalition for a Smoke-Free Tomorrow’s work to reduce tobacco use in Kentucky.
Ultimately, the increase included in the tax bill was reduced to 50 cents per pack and, at the last minute, following strong lobbying by the tobacco industry—which outspent the coalition four to one—a provision to increase the tax on e-cigarettes and other tobacco products was eliminated. Disappointed, Healthy Kentucky decided that a partial increase was better than none and maintained its support for the bill. About a third of the coalition’s steering committee members opposed the bill. However, Healthy Kentucky and those groups that were still on board continued to urge final passage. The 50-cent increase passed in March 2018.
Key data now show that the increase likely has had a substantial impact on reducing smoking in Kentucky. During the first 12 months (see pages 38 and 39) that the tax was in effect, 36 million fewer packs of cigarettes were sold in Kentucky, a decline of 10.1 percent from fiscal year (FY) 2018 to FY 2019 (compared to a 3.5 percent decline the year before). Also, cigarette sales nationwide dropped only 6.1 percent during the 2019 FY.
Moreover, Healthy Kentucky’s annual Kentucky Health Issues Poll (2018), which is cofunded by Interact for Health, found that, of adult respondents who smoked, half of them changed their thinking or behavior in at least one of the following ways because of the tax increase. Thirty-nine percent smoked fewer cigarettes; 33 percent considered quitting; and 26 percent actually made the attempt to, or did, quit.
More Than Doubling Tobacco-Free Schools
In 2019 the coalition advocated for a bill to require all Kentucky K-12 public schools to adopt a policy that prohibits use of all tobacco products at all times on campus and in school-owned or -operated vehicles. Our bill sped through the Kentucky House Committee on Health and Family Services early in the legislative session with a unanimous vote, but then the bill stalled on the House floor for five weeks, thanks to opposition from a few Western Kentucky legislators. We had enough votes, but House leadership wouldn’t bring the bill to the floor without a change to it.
Ultimately, the bill sponsor agreed to add a three-year opt-out provision. This means that for the first three years, a school district would have the right to opt out. Again, Healthy Kentucky was disappointed but decided to continue backing the amended bill, although some coalition members chose not to support it. The bill became effective June 27, 2019, and it sets a July 1, 2020, deadline for districts to pass a tobacco-free policy unless they choose to opt out. (To date, only Union County’s school district has chosen to opt out.)
Before the bill became law, 42 percent of Kentucky school districts had voluntarily passed tobacco-free campus policies. Less than three months after the law became effective, 90 percent of school districts had passed the model policy, and most of the remaining districts are working toward adoption of it.
As an incentive for early adoption of the policy, Healthy Kentucky entered into a partnership with the Kentucky Medical Association (KMA) to provide tobacco-free signage at no cost to all Kentucky school districts that newly passed the model policy. We’re offering the free signage—which includes the Foundation for a Healthy Kentucky and KMA logos—on a first-come, first-served basis. We will offer any remaining supplies in January 2020 to districts that had gone tobacco-free voluntarily before the new law.
Healthy Kentucky is grateful to all of our legislative champions on these two bills—in particular, Rep. Kim Moser (R) and Sen. Ralph Alvarado (R).
Next Steps—Tackling Youth E-Cigarette Use
In 2020 the Coalition for a Smoke-Free Tomorrow will seek an excise tax on e-cigarettes, or “vapes,” that is equivalent to the current cigarette tax in Kentucky. Currently, e-cigs are the only tobacco product not subject to a state excise tax. Given the lung illness crisis, the youth e-cig epidemic, and the need for new revenues in Kentucky, we are planning our strategy with the hope of another Kentucky health policy win.
About the Author:
Named President and CEO of the Foundation for a Healthy Kentucky in 2016, Ben Chandler leads the Foundation he helped bring about. As Kentucky Attorney General, Ben won a $45 million settlement from one of Kentucky’s largest insurance companies; that funding was used to create the Foundation in 2001.