Tobacco Documents Online

NEXT MEET i `iG CATE : Monday, auaust 18, 1980 1:00 - 4:00 p.M. Baker-01in West Ccmplex Rcom 1C Michigan Department of Public Health 3500 North Logan Street Lansing, MI 48909 I CITIZENS' PANEL ON SMOKING AND HEALTH MINUTES Northend Modular Unit Michigan Department of Public Health July 17, 1980 1:00-4:00 p.m. I I i i I I MEMBERS PRESENT: Ben Barker, O.D.S. Walter Manner III Donald Breckon, Ph.D. Norbert Reinstein Terry Gerald (representing Rep. Raymond Hood) Senator William Sederburg Virginia Kjolhede Douglas Vilnius Margaret Lee MEMBERS ABSENT: Eleanor Barber Scott Simonds, Dr. P.H. James Howard Gregory Smith Janice Meadowcroft James Terrian, M.D. Charles Mitchner George Watts Michael Mortimore Arthur Weaver, M.D. STAFF PRESENT: Theodore Ervin, Deputy Director, Michigan Department of Public Health Kenneth Warner, Ph.D., Project Director, Univ. of Mich., School of Public Health Sunny Sun Nai Fong, Chief, Office of Health Education Rhonda Runner, Student Assistant, Office of Health Education John Insel, Bureau of Environmental & Occupational Health Russell Holmes, M.D., Bureau of Disease Control & Laboratory Services Maxwell Alderson, Bureau of Personal Health Services GUESTS: Dennis Schornack, Legislative Aide Michael Spaniolo, Legislative Counsel, Michigan Tobacco & Candy Vendors Assoc. Rick Davenport, American Lung Association Wanda Jubb, Department of Education Abdullah Al Ruwais, Student, Central Michigan University Betil Abri, Student, Central Michigan University -35- ~

! ~ I. Call to Order , The meeting was called to order at 1:15 p.m. by Ted Ervin, Deputy Director of the Michigan Department of Public Health. Xr. Ervin chaired _r,e meeting 4 in the absence of William Clexton, Chairman Pro Tern. A round of introcuctions was conducted. II. Aooroval of Minutes The minutes of the June 19 meeting were unanimously approved III. Statement of Panel's Overall Objectives ~ The proposed objectives of the Panel were outlined and distributed to Panel members for discussion. The objectives were not outlined according to priority but reflected the fact that the Governor, in his mandate to the Panel, emphasized preventing initiation of a smoking habit, especially in teenagers and younger children. A panel member noted that the stated objectives were not measurable. Possibly in future subcommittee meetings, measurable objectives can be identified. Another member pointed out the difficulty of designing measurable objectives with the scarce resources of the Panel. Evaluation mechanisms and methodo- logies might be established by the Panel whereas operational agencies can quantify objectives from the stated goals. A question pertaining to clarification of the Panel's charge was raised. It was indicated by Michigan Department of Public Health staff that the Panel is to make recomrnendations to the Governor. If adopted, the recommendations will then be used as a base for program planning. An agency responsible for developing the program plan could'define measurable objectives. The Panel accepted the proposed objectives as a working statement of ooals. IV. Economic and Leoal Subcommittee Reoort The Project Director reported the Economic,and Legal Subcommittee's proposed recomnendatrons to the Panel. He indicated that, due to time ccnstraints, the subcommittee dealt with the legal alternatives in a general manner while the economic alternatives were discussed in greater depth. V. Discussion on Economic Approaches 1. There was a discussion on the proposed five-cent per pack excise tax increase which is also being recommended by the Public Health Advisory Council (PHAC). Concerning the bootlegging issue, a question was raised as to whether or not consideration was given to relative excise taxes of the various states. A point was made that there have been few tax increases and bootlegging has decreased nationwide. It was suggested that the Michigan Treasury Department be contacted for their impressions of the cigarette tax and its impact on bootlegging. Even with an increase in bootlegging and a subsequent loss in revenue, there will be clear tax revenue increase to QD the State. ~ ~ Cil m -3s- O I I . i I I ~ I L L L

I I i p ~ ~ i With a 5c tax, there should be approximately a two-percent reduction in ciaarette consumption, considering the price elasticity of demand. A point was made that the data base does not separately take into account different population groups which include the relatively price- sensitive younger groups. A Panel member asked for clarification of the PHAC's intent in recommending a tax increase. The PHAC is trying to create an alternative source of funding for public health programs. A discussion about earmarking the revenues of the cigarette excise tax ensued. The Economic and Legal Subcommittee proposed to earmark one-half to one-cent of a five-cent excise tax for smoking and health activities. It was noted that without resources, programs cannot be c-reated or expanded. An earmarked five-cent excise tax is not inconsistent with alcohol and other tax programs where the revenue is used to benefit health programs. A suggestion was made for all revenue to be earmarked for substance abuse programs with a percentage for smoking and health activities. The rationale for this is that a strong lobby for substance abuse exists. Therefore, such a tax may be more saleable. A point was made that the General Fund is a form of earmarking since it is used for all public health programs. It was felt by a Panel member that earmarking revenue for a specific program made it easier to obtain public support as the public than under- stands how their tax dollars are being spent. A point was made that even though the revenue might be going into the General Fund, it would be possible to define for public information which programs will use the revenue. It was felt by another Panel member that specifically earmarking revenue for a single purpose would decrease its chances for passage in the legislative system as revenue in the General Fund is needed. A Panel member stated that to support the PHAC's recommendation is exceeding the charge of the Panel. The Panel decided to separate its prooosed five-cent excise tax increase rather than suo ort the tax increase as reccmrnended by the PHAC. The inten ed purpose of t e tax is to decrease consumption with increased revenue being a side issue. Further the Panel recommends that one-half to one-percent be earmarked for smoking and ea th activities. A question was raised as to how it is that we know enough revenue will be generated to support smoking and health activities. The response was that in order to more appropriately earmark for such activities a work group could be convened to decide on a more realistic percentage or to develop an incremental percentage. A point was made that the wording of the recommendations will come back before the Panel for further discussion and decision. Also, that the consensus of the Panel to accept a proposal at this time is not to be mistaken for adoption. Adoption of recommendations will occur when the Panel reviews and accepts the final report. -37- %

i 2. The next proposed alternative was discussed. This requests the Governor and Michigan's congressional delegation to lobby the federal eovernment for a substantial increase in the federal cicarette excise tax. The subcemmittee felt the state, by itself, could not achieve this goal. Possibly the Governor could recommend or advocate a uniform tax on cigarettes by all states. A Panel member pointed out that in order to achieve uniformity, Michigan would have to lower its tax. If there is a federal tax increase then =1 proposal could be reduced to an excise tax of 1t. The Panel decided to seoarate both orooosal as a substantial federal tax increase seems remote at tnis time. A suggestion was made to earmark tax revenue nationally. The Panel aareed to amend this recommendation with an additional statement or earmarxinq fo r smokina and health activities. 3. There was general approval of the Governor and congressional deleoation working for inclusion of costs of smoking cessation as allowable itemized deduction i•n the federal personal income tax, either as medical deductions or miscellaneous. A Panel member noted that the Internal Revenue Service presently gives tax deductions for participation in smoking cessation programs if requested by a physician's prescription. A member asked why this recommendation is not proposed on a state level. It was reported that the subcommittee felt that the present state fiscal situation precluded this alternative for the State. The federal govern- ment would be better equipped to adopt the recom-,rendation. A Panel member sueaested that educational deductions be listed with medical and miscellaneous. The consensus of the Panel is to amen the proposa as such. The Panel agreed to consider this particular proposal at a later date. A point was made that people need additional financial incentives to quit smoking. The Panel agreed to table discussion or adootion on the orooosal. 4. A discussion followed on the next proposal that the Insurance Commissioner and Director of Public Health convene a meeting of representatives of in- surance companies in the State. There was general agreement that this is an important recommendation. A Panel member pointed out that Blue Cross/ Blue Shield is presently proposing a bill that will require differential insurance rates. It was suggested that the legal ramifications of the proposal be explored. A Panel member pointed out that it is difficult to implement differential premiums on an actuarial basis. The suggestion was made to combine recomrrendation #1 and T4 to use the tax as an off-set to the premiums. Further, it was recommended to include a provision that indepth research begin in the area. m The suggestion was made to include smoking cessation programs as insurance ~ reimbursable items. It was noted that insurance companies reimburse an ~ insurer for medical smoking cessation programs which may be the least ~ effective programs. CID N -38- I I , j I ( j I I t I i L

I I ! ~ I I i I i i A panel member stated that nonsmokers shculd not have to pay for someone else's lung cancer caused by smoking through a higher insurance premium. A suggestion was made to separate smoking-related cases from all others to be reimbursed through a separate funding source. It was noted that it is difficult to ascertain if the cause of an illness is due to smoking. There was general agreement that the Insurance Commissioner and Director of Public Health should do more than convene a meeting. Exploration into the feasibility and possibility of developing differentials should be undertaken. The Michigan Department of Public Health offered its services to obtain information from the Insurance Commissioner by the September Panel meeting for preliminary review by the Panel. It was recognized that if informa- tion is obtained, the Panel may be able to make a more significant recommendation. 5. The proposal concerning grants to organized groups for demonstration projects on smoking prevention or cessation was discussed. A panel member questioned whether or not the Panel should propose a recommenda- tion having fiscal implications at this time of constrained resources. Another member responded that this recommendation could be one that will be implemented in two or three years. A panel member suggested the addition of demonstration projects or programs to the statement. Another suggestion was to add the term "well-evaluated" demonstration project or program. Program effectiveness should be proven in order to receive grant funds. It was noted that the statistics of evaluated programs are not reliable. It is not known how many people complete two or t~hree programs before they quit smoking. A Panel member stated smoking cessation programs are cost-effective; studies show for every program dollar spent, two dollars are saved. The suggestion was made that grants should be given to educational institutions which will evaluate program results. However, this may eliminate small organizations which cannot evaluate because of limited resources. The Panel agreed that the Education/ Media Subcommittee should explore this recommendation urt er. VI. Discussion on Legal Approaches 1. In discussion of more comprehensive protection of the rights of nonsmokers, panel members requested a copy of the Minnesota Clean Indoor Act from the staff. Also, they will receive a copy of the article on the effects of side stream smoke on nonsmokers from the New Enoland Journal of Medicine. A panel member further requested that the s-taff analyze the laws so there is an understanding of how a more comprehensive protection of the rights of nonsmokers can be achieved. This orooosal will be discussed at a later date when the legal subcommittee can be more soecific about its recommendation. 2. The prohibition of vending machine cigarettes sold in State buildings was discussed. It was noted that employees will go elsewhere to buy cigarettes; therefore, this is not an effective strategy to decrease consumption. A Panel member stated that by allowing cigarette vendors in State buildings, we are endorsing smoking. It is inconsistent policy to fund activities that will decrease smoking and then sell cigarettes. The state should X conduct itself as a role model. C11 Cn ~A- W -39- L.

A panel member stated that there have been orevious attempts to ban the selling of cigarettes from hospitals; however, they have been un- successful. There is some support to ban the selling of vending machine cigarettes because this is where teenaeers obtain them. There is strong opposition from the Teamsters who service the vending machines. A panel member noted that the Michigan Services for the Blind supply employees for State government snack bars. A portion of their volume of business stems from the sale of vending machine cigarette sales. There was consensus of the oanel to retain this recommendation for further discussion. 3. Compliance of the no-smoking restriction in restaurants was discussed. An MDPH representative from the Division of Food Service explained that the Public Health Code does not state the percentage of seating area that must be reserved for nonsmokers. There is no legal recourse for non- compliance, as the court system will not revoke a restaurant's license for breaking the nonsmoking law. The representative noted that com- pliance with the no smoking restriction is included on the inspection report form but no penalty points are given because of the national standardization of points. Employees, while in training, are instructed to check compliance with the law. A suggestion was made to have a toll free number where complaints about noncompliance in stores, restaurants, and State offices could be directed. The complaints would then be funneled to the appropriate State agency responsible for enforcing that law. It was a reed that the recommendation of assessing penalty points for noncemo lance shou d be taken to the Division of Food Service in the Michigan Department of Pu ic Hea th and the Environmenta Hea th Advisory Committee. It was noted that this is only one strategy out of many to improve compliance with the Public Health Code. 4. With respect to the fourth proposal of opposition to legislation which places reliance on criminal sanctions to achieve smoking and health objectives and opposition to earmarking legislative revenues for cate- gorical purposes, it was agreed that this may be used as a preamble in the final reoort. VII. Public Comments There were none who wished to speak to the Panel at this time. VIII. New Business The next Citizens' Panel meeting will be Monday, August 18. The Noverrber 6 meeting will be held at the Capitol Building since there are no available rooms in MDP4. Staff will contact members of the Education/Media Subcorrmittee -40- I I , I I I E I I L

I I I to arrange a meetina. The Leaal Subccrrmitt2e will -ee= Tuesday, July 22 at 1:00 - 3:30 in Ann Arbor. _ IX. "'.djournment The meeting adjourned at 4:00 p.m. I I I I L -41- 1-_