October 2000

Grant Results

SUMMARY

Brandeis University, Florence Heller Graduate School for Advanced Studies in Social Welfare held a three-day conference October 4–6, 1997, at Brandeis focused on the use of tobacco excise taxes to fund expansions in health care access for children and other groups. It also provided technical assistance to emerging coalitions of tobacco control, health care access and health advocacy groups on using this approach.

Key Results

  • One hundred people from eight states (Connecticut, Indiana, Illinois, Maine, New Jersey, New York, Pennsylvania, and West Virginia) attended the conference.
  • The Brandeis investigator conducted research and analysis on the experiences of four states (Arizona, California, Massachusetts, and Oregon) that have pioneered the use of tobacco excise taxes to fund expansions in health care access for children and other groups is approach.
  • Six months following the conference, the investigator surveyed all conference participants to gauge their interest in receiving technical assistance in the area of collaboration between advocates for children's health and those for tobacco control; and to track their progress in instituting tobacco control programs that generate tax revenues to fund expanded access to health care.

Key Findings

  • New coalitions between health access and tobacco control advocates had formed in four of the states (Maine, New Jersey, New York, Pennsylvania), while previously existing coalitions expanded and/or launched new initiatives in three other states (Indiana, West Virginia and Connecticut).
  • Maine and New Jersey increased tobacco taxes considerably, but the new revenues were not earmarked for expansion of access to health care.
  • Legislatures in four states (Connecticut, Indiana, Illinois and New York) considered, but did not pass, measures to increase tobacco taxes and direct the new revenues to health access expansion.
  • The settlement reached during this time between tobacco companies and state attorneys general, and the substantial expansion of federal funding of children's health care through SCHIP, represented valuable gains for both tobacco control and children's health advocates.

Dissemination
More than 300 copies of a report, Funding Children's Health Through State Tobacco Taxes: Building Winning Coalitions with New and Unexpected Allies, which incorporated the earlier review of efforts in four states and the postconference survey findings, were distributed to conference participants and others involved in advocacy efforts related to tobacco control and children's access to health care.

Funding
The Robert Wood Johnson Foundation (RWJF) supported the conference and technical assistance with a $145,656 grant.

 See Grant Detail & Contact Information
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THE PROBLEM

Since the collapse of the Clinton administration's drive for national health insurance, many policy experts have come to believe that efforts to expand insurance coverage will proceed incrementally. Such incremental approaches must identify both target populations for coverage and potential sources of funding.

Focusing on children's health coverage has broad popular appeal, and one possible funding source for this coverage that has been identified is increased tobacco taxes. Tobacco taxes have been a major source of revenue for expansion of health care coverage for children and families in the four states that had expanded health care coverage under RWJF's State Initiatives in Health Care Reform program (Minnesota, Washington, Vermont, and Oregon).

Efforts to fund increased health coverage for children and other populations through new tobacco taxes have often required the collaboration of advocates for children's health and advocates for tobacco control. The relationship between advocates in these two areas, however, has been mixed. While Massachusetts and several other states have demonstrated the potential for successful collaboration, other states, such as California, have exhibited considerable tension between tobacco control and children's health advocates over the most appropriate use of revenue from increased tobacco taxes.

RWJF believed that a concerted effort to bring together advocates in these two areas might foster better understanding and communication between the two groups, and could lead to greater recognition of the mutual benefits that might accrue from their collaborative efforts.

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THE PROJECT

This grant from RWJF provided funds to the Collaborative for Community Health Policy at the Florence Heller Graduate School for Advanced Studies in Social Welfare at Brandeis University to convene a three-day conference of key players in the children's health and tobacco control communities, with the goals of reviewing the past relationship between the two groups and exploring the possibilities for future collaboration in some states.

The proposal also called for (1) a written review to be prepared prior to the conference, detailing the history and current status of the relationship between the tobacco control and children's health communities, and (2) the provision of technical assistance following the conference to groups in five states that Heller School researchers would identify as promising targets for collaboration.

Heller School faculty undertook the project in conjunction with two Massachusetts-based advocacy organizations, Health Care for All and the Tobacco Control Resource Center, which had played leading roles in the successful collaboration of tobacco control and health care advocates in Massachusetts.

Preconference Activity

Prior to the conference, a team of Heller School researchers conducted an extensive review of documents and carried out 10 to 15 interviews in each of five states where organizations had participated in tobacco control and health coverage expansion initiatives.

The report that was produced focused on four of the states where the authors felt sufficient time had elapsed since the funding of expanded health coverage through tobacco taxes to allow for meaningful evaluation of the effort: Arizona, California, Massachusetts, and Oregon. The report, Funding Health Care with State Tobacco Taxes: Lessons Learned in Four States, outlined common components of successful ballot initiatives or legislative drives to fund expanded health coverage for children and families through tobacco taxes.

Also, prior to the conference, telephone, written, and in-person contact was made with advocates in about 20 states who had been identified as having the potential to develop joint tobacco control and children's health coverage expansion initiatives. This effort identified 12 states where commitment to exploring collaboration between these two groups seemed the strongest: California, Florida, Kansas, Maine, Massachusetts, Minnesota, New York, South Carolina, Tennessee, Texas, Vermont, and Washington.

The Conference

The October 1997 conference, Funding Children's Health Through State Tobacco Taxes: Building Winning Coalitions with New and Unexpected Allies, was held at Brandeis University. The conference drew more than 100 participants from these 11 states, the five states that had already adopted joint tobacco tax/health care expansion policies (Arizona and Oregon in addition to California, Massachusetts, and Washington), and representatives of national organizations concerned with these issues.

The conference included panel discussions and presentations that reviewed national developments, efforts in individual states, and strategies for successful campaigns to promote expanded health care coverage through tobacco taxes. Key addresses included presentations by Senator Edward Kennedy, Massachusetts Attorney General L. Scott Harshbarger, and legislative and advocacy group leaders of the successful Massachusetts drive to fund expanded children's health care coverage through new tobacco taxes.

The conference had originally been scheduled for May 1997, but this date was postponed five months to occur in October 1997, with the approval of RWJF, based on several factors:

  1. Conference organizers found that more advance work was necessary to identify promising target states from which to recruit attendees.
  2. Settlements between tobacco companies and state attorneys general were being negotiated, and federal legislation expanding funding for children's health coverage was nearing approval, both of which were likely to affect the potential for state-level collaborative efforts between tobacco control and children's health advocates in a significant way.
  3. An RWJF-supported conference on the development of statewide tobacco control programs using tobacco tax funds (see Grant Results on ID# 031814), which would draw many of the same attendees, was scheduled to be held at Brandeis University in October 1997.

By rescheduling the children's health/tobacco tax conference for the days immediately following the conference on tobacco control efforts, the two projects were able to share some expenses and improve the resources available for both conferences.

With savings garnered from the coordination of the two conferences, the conference organizers expanded the project to include a follow-up survey of all conference participants to identify additional technical assistance needs and to track the progress in each state in instituting tobacco taxes that help fund expansion of access to health care.

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FINDINGS OF THE SURVEY

The survey found only limited interest in technical assistance with statewide efforts:

  • New coalitions between health access and tobacco control advocates had formed in four of the states (Maine, New Jersey, New York, Pennsylvania), while previously existing coalitions expanded and/or launched new initiatives in three other states (Indiana, West Virginia, and Connecticut).
  • Maine and New Jersey increased tobacco taxes considerably, but the new revenues were not earmarked for expansion of access to health care.
  • Legislatures in four states (Connecticut, Indiana, Illinois, and New York) considered, but did not pass, measures to increase tobacco taxes and direct the new revenues to health access expansion.
  • The settlement reached during this time between tobacco companies and state attorneys general, and the substantial expansion of federal funding of children's health care through SCHIP, represented valuable gains for both tobacco control and children's health advocates. At the same time, these developments appear to have dampened the interest in, and perceived need for, collaborative efforts between advocates in the two areas to achieve their respective goals.

The Report

The project team published a 25-page final conference report, Funding Children's Health Through State Tobacco Taxes: Building Winning Coalitions with New and Unexpected Allies, which incorporated the preconference review of the history of tobacco tax/health care initiatives in four states, Funding Health Care with State Tobacco Taxes: Lessons Learned in Four States. The conference report included the survey findings. In addition to a number of articles on lessons learned about state-based collaborations between health care access and tobacco control advocates, the conference report also incorporated a revised version of the review prepared prior to the conference of the experience in four states that had successfully enacted tobacco tax/health care initiatives.

Communications

The preconference review of the history of tobacco tax/health care initiatives in four states, Funding Health Care with State Tobacco Taxes: Lessons Learned in Four States, was distributed to more than 800 individuals and organizations prior to the October 1997 conference. More than 300 copies of the final conference report, Funding Children's Health Through State Tobacco Taxes: Building Winning Coalitions with New and Unexpected Allies, which incorporated the preconference review, were distributed in the late summer and early fall of 1998 to conference participants and others in health care, tobacco control, and health care access organizations nationwide. See the Bibliography for full details.

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AFTER THE GRANT

No continuation of this project is anticipated. The project has, however, spurred further interest among Heller School faculty in tobacco-related topics, which are now the subject of several proposals to the National Institutes of Health.

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GRANT DETAILS & CONTACT INFORMATION

Project

Project to Explore Collaboration Between Advocates for Tobacco Control and Children's Health

Grantee

Brandeis University, Florence Heller Graduate School for Advanced Studies in Social Welfare (Waltham,  MA)

  • Amount: $ 145,656
    Dates: February 1997 to July 1998
    ID#:  030463

Contact

Jack P. Shonkoff, M.D.
(781) 736-3883
shonkoff@brandeis.edu

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APPENDICES


Appendix 1

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

Conference Participants

Ellen Andrews
Connecticut Association of Human Services
Hartford, Conn.

Ann Bachrach
Maternity Care Coalition
Philadelphia, Pa.

Edward Bailey
American Academy of Pediatrics
Springfield, Mass.

Joan Benso
Pennsylvania Partnerships for Children
Harrisburg, Pa.

Jennifer Berkley
MS League of Community
Boston, Mass.

Sandi Bex
Mt. State Parents CAN
Wheeling, W.Va.

Judy Blei
Match Coalition
Mansfield, Conn.

Alison Blizard
Consumer for Affordable Health Care
Thomdike, Maine

Kelly Boyles
Campaign for Tobacco-Free Kids
Austin, Texas

Blake Cady
Women and Infants Hospital
Providence, R.I.

Beth Capell
Health Access California
Sacramento, Calif.

Regina Carlson
New Jersey Gasp
Summit, N.J.

Karen Carpenter
NECARC/Northeast Action
Hartford, Conn.

Molly Clark
American Lung Association
Providence, R.I.

Sara Crickenberger
ALA West Virginia
Charleston, W.Va.

Carol Dadeo
Center for a Tobacco Free NY
Albany, N.Y.

Joe Ditre
Health Access, Consumers for Affordable Health Care
Augusta, Maine

Patty Dobroski
Coalition for a Tobacco Free PA
Rosemont, Pa.

Stan Dom
Children's Defense Fund
Washington, D.C.

William England
Consumer Health Coalition PA
Pittsburgh, Pa.

Peter Fisher
Campaign for Tobacco-Free Kids
Washington, D.C.

Maureen Forbes
Attorney General's Office
Newton Center, Mass.

Patty Freeman
Children Now
Oakland, Calif.

David Gallagher
Arizona Addiction Program
Mesa, Ariz.

Timothy Gens
Mass Hospital Association
Burlington, Mass.

Susan Girard
Arizona House of Representatives
Phoenix, Ariz.

Elinor Goldberg
Maine Children's Alliance
Augusta, Maine

Shirley Greene
American Cancer Society
Philadelphia, Pa.

Chris Hager
Community on Health Care
Boston, Mass.

Carter Hedrick
Campaign for Tobacco-Free Kids
Washington, D.C.

Kathleen Henry
CHILD Council, Inc.
Hartford, Conn.

David Holuquist
American Cancer Society
Lincoln, Neb.

Cherrille Howard
CHILD Council, Inc.
Hartford, Conn.

Kristin Hubbard
Children's Defense Fund
Washington, D.C.

Tracy Hyams
Brandeis University
Waltham, Mass.

Rich Kehoe
Match Coalition
Hartford, Conn.

Howard Koh
Boston University School of Medicine
Boston, Maine

Judith Kurland
Department of Health and Human Services
Boston, Mass.

Candace Pierce Lavin
American Cancer Society
Framingham, Mass.

Mary Leary
Massachusetts General Hospital
Revere, Mass.

Susan Longley
Maine Senate
Liberty, Maine

Marlene McGann
Meriden/Wallingford Substance Abuse Council
Wallingford, Conn.

Katherine McHale
Coalition for a Smoke-Free Valley
Bethlehem, Pa.

John Miller
Office of Senator Diane Watson
Sacramento, Calif.

Marisa Morello-Colbert
Citizen Action/Health Care For All
West Hartford, Conn.

Robert Murphy
Connecticut Education Association
Hartford, Conn.

Ami Nagle
Voices for Illinois Children
Chicago, Ill.

Tony Nejara
American Lung Association of California
Sacramento, Calif.

Jack Nicholl
Malibu, Calif.

Andy Nichols
Arizona State Legislature
Phoenix, Ariz.

Rick North
American Cancer Society
Portland, Ore.

Renata Pore
Office of Health Project
Charleston, W.Va.

John Rivers
Arizona Hospital and Health Care Association
Tempe, Ariz.

Jill Rosenthal
West Virginia Tobacco Prevention
Charleston, W.Va.

Kristin Schmidt
American Cancer Society
Chicago, Ill.

Stisan Schulthesiss
Connecticut Association for Human Resources
Hartford, Conn.

Russ Sciandra
Center for a Tobacco-Free NY
Albany, N.Y.

Paul Severance
United Senior Action of Indiana
Indianapolis, Ind.

Charlie Shaeffer
American Health Association
Rancho Mirage, Calif.

Samuel Shekar
Department of Health and Human Services
Boston, Mass.

David Simmons
Maine Medical Association
Manchester, Maine

Gordon Smith
Maine Medical Association
Manchester, Maine

Susan Smith
New York, N.Y.

Madeline Solomon
Smokeless State Program Office
Chicago, Ill.

Judy Sopenski
STAT
Springfield, Mass.

Judith Stephany
Vermont Department of Health
Burlington, Vt.

John Thibodeau
Maine Tobacco Control
Portland, Maine

Susan Vega
Campaign for Better Health in Illinois
Chicago, Ill.

Steven Weizman
American Cancer Society
Hershey, Pa.

Kathy Williams
Indiana Coalition for Human Services
Indianapolis, Ind.

Patricia Wrice
CHILD Council, Inc.
Hartford, Conn.

Ann Wright
American Cancer society
Sacramento, Calif.

Anthony Wright
New Jersey Citizen Administration
Hackensack, N.J.

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BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Books and Reports

Capitman J (ed.). Funding Children's Health Care Through State Tobacco Taxes: Building Winning Coalitions with New and Unexpected Allies. Waltham, Mass.: Heller School, Brandeis University, July 1998. 300 copies distributed to March 1999.

Sponsored Conferences

"Funding Children's Health Care Through State Tobacco Taxes: Building Winning Coalitions with New and Unexpected Allies," October 4–6, 1997, Brandeis University, Waltham, Mass. Attended by 100 participants representing state public health departments, tobacco control organizations, health care access advocacy groups, and state legislative leaders.

Presentations

  • Congressman Martin Meehan, "The Tale of Two Movements Coming Together in 1997 in Washington, D.C."
  • John Marttila, "A National Pollster's Advice After 10 Years of Analysis of the Public's Attitude on Tobacco, Public Health, and Access to Health Care for the Uninsured."
  • Senator Edward M. Kennedy, address.

Panels

  • "The Tale of Two Movements Coming Through in 1996 in Massachusetts," Robert Restuccia, Donald Gudaitis, John E. McDonough.
  • "What's Happening in the States Right Now — Trends and Themes, Latest Updates on National Developments — Global Settlement and Federal Children's Block Grant," Judy Meredith (moderator); Peter Fisher, Susan Sherry, L. Scott Harshbarger, Samuel Shaker, Stan Dorn, (panelists).
  • "Lessons Learned: The Story of Four State Tobacco Tax Campaigns," Jack P. Shonkoff (moderator), John Capitman and Candace Pierce-Lavin (discussion leaders).
  • "Identifying Gaps in State Health Access and Tobacco Control Programs Including the Need for Higher State Taxes on Tobacco Products," Jeffrey E. Harris, Andrew W. Nichols (discussion leaders).
  • "Where Do We Go From Here? Selected States' Presentations," Catherine Dunham (facilitator).

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Report prepared by: Michael Jonas
Reviewed by: Marian Bass
Reviewed by: Timothy F. Murray
Program Officer: Michael Beachler

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