Health programs lose $7.4M
By Robbie Dingeman
Advertiser Health Writer
State officials continued to chip away at the Tobacco Settlement Fund at the Legislature this year, diverting more than a third of the money that had been designated for anti-smoking campaigns, children's health insurance, and programs to prevent diabetes and other chronic diseases.
Facing a tight budget year, the Lingle administration and lawmakers cut $7.4 million from $20.7 million in tobacco money set aside for disease-prevention programs.
"We repeatedly cut prevention programs thinking that we're saving money," said Clifford Chang, director of the Coalition for a Tobacco Free Hawai'i. Meanwhile, he said, states such as California and Massachusetts have saved as much as $3 in healthcare costs for each dollar spent on prevention.
Legislative leaders have said that while they wanted to avoid tapping the tobacco fund, steep budget shortfalls made it a tempting target.
The money comes from a 1998 legal settlement in which tobacco companies agreed to pay $206 billion over 25 years to 46 states. Hawai'i's share is $1.2 billion.
Susan Jackson, state tobacco settlement manager, said Hawai'i received $48.6 million in fiscal 2000, $36.1 million in 2001, $45.3 million in 2002 and $45.3 million this year.
Not all of it goes to healthcare programs.
Right off the top, 28 percent is taken to pay for construction of the University of Hawai'i's new medical school; another 24.5 percent goes to the state "rainy day" fund for emergencies.
That left $20.7 million in fiscal year 2003 for healthcare programs, mostly of a preventive nature: the Tobacco Control and Prevention Trust Fund, the Children's Health Insurance Program and the Health Promotion Program.
But three actions at the 2003 legislative session took away $7.4 million from those programs:
• Gov. Linda Lingle shifted the $5.3 million cost of the Healthy Start home-visit service, a child-abuse prevention program, from the general fund to the tobacco fund's Health Promotion Program.
That cut more than half of the $10 million that was supposed to go to the "Start Living Healthy" ad campaign and programs to prevent chronic diseases such as diabetes, high blood pressure and obesity.
• Senate Bill 1311 repealed the exemption for several special funds from having to pay certain administrative and service fees. Healthcare programs took a $1.2 million hit (out of a total of $2.5 million taken from the tobacco fund).
• House Bill 1152 transferred interest earned this year by the tobacco fund to the general treasury. Through that action, healthcare programs took a $900,000 hit (out of a total of $1.9 million taken from the tobacco fund).
State deputy health director Jane Kadohiro said her department was pleased that lawmakers left unchanged the basic distribution of the tobacco fund money.
Despite the cuts, Kadohiro said, the Health Department will continue to support health prevention programs.
Kadohiro acknowledged that the department is "not comfortable that there had to be some of these cuts." But she said she understands the state's financial problems and "needing to have good fiscal discipline," a primary theme of the Lingle administration.
She said the programs will continue to focus on improving nutrition and physical activity and on reducing tobacco use. Kadohiro said the department will cope by seeking federal dollars, developing partnerships in the community and re-evaluating all programs.
Jackson said Hawai'i is one of only a handful of states that dedicate a set percentage to ongoing tobacco-prevention education, rather than deciding each legislative session how much to earmark for such programs and using the bulk of the money to balance the budget.
Chang said one state used the money to build a morgue.
The Health Department estimates the state now pays $328 million annually to subsidize medical care for people with tobacco-related illnesses, a figure that Chang said could be reduced if people stopped smoking, improved eating habits and exercised more.
Chang said that less money spent on programs such as the Health Department's aggressive anti-smoking campaign — which includes movie theater and TV ads — will translate to more people starting to smoke, fewer smokers quitting and healthcare costs rising.
Reach Robbie Dingeman at rdingeman@honoluluadvertiser.com or 535-2429.
