There's no question that the number of Alaskans smoking has dropped dramatically in recent years, but whether or not a program that plays a big role in trying to keep tobacco out of the hands of youth and adults will continue to get the funding it needs is a major question.
This spring, lawmakers cut $746,000 from the state's tobacco prevention program out of concerns that at the current rate of spending, funds for the $10.1-million program will dry up by fiscal year 2016. But advocates for the program, and its funding, are worried that bad information and a misunderstanding of how the program works may be causing hasty decision-making.
Anti-smoking advocates argue that drastic cuts are not what's needed to secure the program in perpetuity, one goal everyone can agree on. Instead, they say, it's time to either look at different ways to increase cash flow to the program or consider gradual steps down, noting that drastic impacts to funding could have devastating consequences.
“In every other state we've looked at, when you cut the (prevention) program, you see other tobacco-use rates go up,” said Emily Nenon, Alaska Government Relations Director for the American Cancer Society Cancer Action Network. “You're not saving anything there.”
Smoking in Alaska
Earlier this week, the state announced a major shift in smoking trends among Alaskan youth. A survey conducted earlier this year showed that smoking rates among Alaska's high schoolers dropped dramatically between 2007 and 2013, from 17.8 to 10.6 percent in 2013. According to the state Department of Health and Social Services, that means only one in 10 high school students are smoking on a regular basis. It's hard to say how that decline compares nationally, though, since the most current results of a biennial national survey won't be released until spring.
Statewide, 23 percent of all Alaskans -- or one in four -- reported smoking in 2011, the most current data available. It's been a steady decline in the state according to Andrea Fenaughty, a chronic disease epidemiologist for the state. Since 1996 -- considered the state baseline based on the lack of smoking control programs at the time -- 27,000 Alaskans, or roughly the population of Juneau, are not smoking, Fenaughty noted. She said that equates to roughly 9,000 averted early deaths.
Why such a decline? Fenaughty said it may not be a “sexy silver bullet,” but she credits the state's long-standing commitment to funding a comprehensive tobacco-prevention program based on Center for Disease Control guidelines and "maps" from other states.
“We've followed that road map, funded it well, implemented it well,” she said. “It really does work as a whole package.”
The comprehensive program -- which entails outreach, education, quit lines and resources to stop tobacco use -- has “helped change social norms” related to tobacco use in the 49th state, according to recent state press release announcing the youth decline. Quit lines, commercials and other prevention programs are common in Alaska.
But some of those could go away under the current funding scheme. Nenon said the roughly $700,000 cut will impact many support positions for grantees of the program around the state, as well as some “counter-marketing” anti-smoking ads.
Nenon said there has been a misunderstanding among legislators on how the program is funded. Even during the last session, legislators were given two different sets of numbers on how much money was available in the “tobacco education use and cessation fund” -- the primary funder of the prevention program.
But Rep. Mark Neuman, R-Big Lake, chair of the House Finance Subcommittee for the Department of Health and Social Services, contends the committee did have the right information, it was just a matter of trying to make the program sustainable.
“It's a great program for what it does,” he said Thursday. “But we can't spend more money than what's going in.”
The goal for those fighting for the program's funding next session is to truly reconcile the numbers and make sure lawmakers are working with the most accurate information possible.
But finding that information is a complex prospect. The contributions that go into that fund come from a variety of fluctuating sources -- including the state's tax on tobacco -- and one big, very complicated lawsuit.
Tobacco lawsuit settled, but funds variable
In 1998, 46 states settled Medicaid-payment lawsuits against the big four tobacco companies under the Tobacco Master Settlement Agreement. The companies agreed to curtail deceptive marketing practices and pay, in perpetuity, billions of dollars to each state. So far, the companies have paid over $100 billion to the states, out of a total $246 billion under the first 25 years of the agreement.
Of that, Alaska has received $376 million since the first payments began in 1999. In that first year, then-Gov. Tony Knowles set up the Northern Tobacco Securitization Corporation, which put millions of those dollars into bonds to pay for over 200 construction projects. The projects are broad, encompassing everything from renovations in rural Alaska schools, to utility transmission interties in Southeast Alaska and repairs to airports, docks and sewer systems in almost every corner of the state.
Each year, the state gets an annual payment of roughly $30 million from the settlement, though the amount changes based on a complicated formula that takes into account a variety of national factors, including the volumes of people who smoke cigarettes. In 2012 the state received just under $30 million, a decline compared to 2009's payment of $37 million.
No matter what the payment is, where the funds go is standard per state statute: 80 percent goes to paying off the bonds, while 20 percent goes into the tobacco use education and cessation fund.
The amount of money that goes into the fund is constantly shifting, according to Kathy Allely, section chief of the state's chronic disease prevention and health promotion. The tobacco companies often try to reduce or postpone some payments as much as possible. Just under 9 percent of the state's tobacco tax is also plugged into the program, coming in monthly contributions, though the amount of money coming in can shift based on the amount of cigarettes sold.
The settlement payment also comes in April -- nine months after legislators appropriate funds for the prevention program -- making it tricky for lawmakers trying to figure out how to fund the program.
Also shifting: Exactly how much the state will continue to get from the settlement. Starting in 2008, Alaska started getting additional funds as part of the “strategic contribution fund.” That fund provides additional payments for states based on how much they contributed to fighting the original lawsuit. While Alaska gets a relatively small annual payout from the annual master settlement agreement -- only around $20 million -- it gets an additional $12 to $15 million each year from the fund according to numbers provided by the Alaska Department of Law.
But those additional millions will stop in 2017 as part of the lawsuit, taking away several million for prevention programs.
No big drops
Allely said the state is looking hard at funding to the prevention program to try to figure out a flatter way to cut the program, to avoid a big impact. She said that studies have shown that states that have made large cuts to their prevention programs often see tobacco use surge back.
“Do we continue to spend and then reach a point where were going to make a drastic cut? Or do we level out our spending and keep a strong level for the future?” she said.
This next session, Neuman hopes to get a better sense of how all the dollars that go into DHSS programs work to try to better measure the benefits from the programs. He noted that as grants for different elements of the program run out, there will be some natural attrition in the program. He said he'll be careful to take a hard look at those programs to see if they're working as intended or not.
"Cutting funds for all these programs is a difficult decision to do," he said. "But someone has to make that call."
Nenon pointed out that Alaska hasn't raised its tobacco tax since 2004. She said maybe it's time to take another look at that tax, adding that the state is nowhere near taxing tobacco products at the rate that tobacco use costs the state. She said with big successes from the program being documented, it's worth hanging on to them.
“We want to make sure we are able to hang onto those wins," she said. “We don't want any threats that are based on hasty decisions.”