Colorado Case Study
Tobacco Excise Tax Constitutional Amendment Referendum Campaign in Colorado
Was a needs assessment completed?
Science-based best practices, including The Guide to Community Preventive Services, identify increasing the price of tobacco products as a highly effective strategy to reduce both youth and adult tobacco use prevalence and consumption. Since 1986, Colorado's cigarette excise tax was $0.20. An unsuccessful effort to increase the tax by $0.50 had been made during 1994. Following several years of budget reductions, during fiscal year (FY) 2003 the legislature cut the MSA-funded appropriation to STEPP by 40%, and under funded or left unfunded other essential health-related programs. In response to these program cuts and to the 16 years of level tobacco excise taxes, CTEPA, during 2002, conducted an in-depth appraisal of tobacco use prevalence and what the "funding landscape" for tobacco prevention and treatment looked like in future years. Given the current climate and expected future trends, CTEPA was determined to broaden and strengthen its membership to advocate more effectively for public policies to reduce tobacco use in Colorado and to ensure adequate funding for a comprehensive tobacco prevention and treatment program. CTEPA applied to the Robert Wood Johnson Foundation (RWJF), SmokeLess States Program for a Special Opportunity grant to assist its efforts. The application served as a de facto needs assessment.
Planning Models Used
No one specific model was used. Rather, the campaign plan was developed by people who were aware of and had received specific training in several planning models.
The Colorado constitution has unique requirements for raising and appropriating revenues, including a Taxpayers Bill of Rights that strictly controls spending on state programs. Before the current initiative, the last attempt to increase tobacco excise taxes occurred 8 years earlier during the 1994 general election. Due to insufficient planning, few partners from outside the traditional tobacco control advocacy community, and millions of dollars spent by the tobacco industry on a campaign opposing the tax increase, the effort to raise the cigarette excise tax by $0.50 not only failed by a 39%-61% margin but also left tobacco control advocates dispirited, disheartened, and distrustful of each other for several years.
During 1998, 4 years after the defeat, and coinciding with the signing of the MSA, CTEPA began a focused rebuilding effort. During 1999–2002, the Colorado legislature provided limited MSA revenues to the Colorado Department of Public Health STEPP to fund a tobacco use prevention and control program. Unresolved negative feelings among legislators toward the tobacco control community, however, remained from the 1994 campaign. The more active that tobacco control advocates were in raising grassroots support for increased STEPP funding, the less financial support the program received from the legislature. No champions for tobacco control were in the state legislature; in fact, Philip Morris considered Colorado a "friendly" venue. Although the chief medical officer of the Colorado Department of Public Health supported tobacco prevention and treatment efforts, other leadership had little expertise in tobacco issues. Funding for tobacco prevention and control in STEPP was cut 40% (from $12.7 million in FY 2002 to $7.6 million in FY 2003), and then cut in half to $3.8 million during FY 2004. The tobacco control community's positive experience of working together advocating for MSA funding for STEPP for a comprehensive tobacco prevention and control program at the CDC-recommended minimum level, coupled with the adverse conditions in which advocates found themselves, strengthened the tobacco control community's resolve to rebuild the tobacco control movement in Colorado.
During 1994–2002 period, some attempts were made to test the waters for public support for increasing tobacco excise taxes, but those efforts came to a dead end. By fall 2002, CTEPA was ready to assess the feasibility of a campaign to pass a constitutional amendment to increase tobacco excise taxes. CTEPA leadership, however, recognized that the residual dislike for tobacco control issues in general, and tobacco control advocates in particular, needed to be addressed before embarking on a statewide campaign. CTEPA applied for and was awarded in December 2002 a $100,000 Special Opportunity grant from the RWJF SmokeLess States Program to continue efforts to expand and strengthen the coalition. Broadening the tobacco control base and enlarging the tobacco control constituency to include groups interested in health care issues was essential for rebuilding the momentum for tobacco prevention and treatment issues as well as for the coalition's survival as a respected leader in the state's tobacco control community.
With the RWJF SmokeLess States Program Special Opportunity grant in hand, CTEPA used unrestricted dollars to initiate the "title setting" process required to put a constitutional amendment on Colorado's ballot. CTEPA submitted language to the Title Board to increase tobacco excise taxes and to dedicate the revenues to health-related programs. Concurrently, CTEPA began working with health care advocates to develop a proposal to earmark revenues raised by the tax increases for health care programs and for tobacco prevention and treatment. The decision to begin the title process during 2003 was strategic—in effect, a rehearsal for 2004. CTEPA sought to determine whether and how the tobacco industry and its allies would challenge the amendment's language. Philip Morris, RJ Reynolds, and Brown & Williamson challenged whether the language of the title was clear and accurate and whether the initiative addressed a single subject as constitutionally mandated. The Title Board approved the amendment language, the tobacco companies appealed, and in the spring of 2003, the Colorado Supreme Court ruled in favor of CTEPA. With the knowledge that the amendment language met constitutional standards, CTEPA withdrew the amendment for voter consideration during 2003.
During late spring 2003, CTEPA hired a public relations firm with close and trusted ties to both tobacco control organizations and health care organizations in order to improve their strained relations and identify potential new partners. While this work was ongoing, CTEPA contracted with a facilitator in July 2003 specifically to bring to the table the state's top health care and tobacco control leaders to discuss joining forces to increase tobacco excise taxes and dedicate revenues to health-related programs. This group emerged as the Steering Committee for CHC, the new coalition of tobacco control and health care advocates. The group agreed to support a campaign to increase tobacco excise taxes that focused on the science-based Guide to Community Preventive Services, which recommends that increasing the price of tobacco products is a highly effective strategy to prevent youth from smoking and to promote quitting among current smokers. The Steering Committee continued its discussion on how much to propose raising the tobacco excise taxes and on how to allocate the revenues from excise tax increases. A poll was conducted that summer showing strong public support for increasing tobacco excise taxes.
Throughout the summer and fall of 2003, the Steering Committee worked to determine (1) how much to increase the taxes; (2) how to earmark the revenues raised by the increased taxes; and (3) whether to collect signatures to place the amendment directly on the ballot or seek a legislative vote to place it on the ballot. Ongoing discussions were held among CHC and the Steering Committee on whether to establish a new foundation to administer the tobacco education and cessation program that would be funded with the revenues generated by the tobacco excise tax increases or to designate STEPP as the administrator. Although there was strong support for STEPP's efforts and effectiveness during the past decade, some key leaders expressed concern about the Colorado Department of Public Health's commitment to tobacco prevention and control, and argued that a foundation could more effectively administer an enhanced tobacco education and cessation program. During October 2003 several CTEPA members participated in CDC-sponsored training on sustaining state tobacco prevention and control programs. At that time, the participating CTEPA members expressed their commitment to (1) oppose further cuts in MSA funding for STEPP; (2) oppose legislative efforts to securitize future MSA payments; (3) work with CHC to further refine the elements for inclusion in a constitutional amendment to increase tobacco excise taxes, including earmarking revenue generated by the increased taxes to STEPP for a comprehensive tobacco prevention and control program funded at the CDC-recommended minimum ($24 million) or higher with the remaining funds allocated to health-related programs; and (4) prevent the legislature from placing any other tobacco excise tax initiative on the November 2004 ballot. Following the CDC-sponsored training, the group met with the CHC Steering Committee, which endorsed designating STEPP as the program administrator for Colorado's tobacco prevention and control efforts.
The Steering Committee evolved into the Executive Committee of the campaign. By early winter, CHC reached a consensus (1) to increase the cigarette excise tax by $0.64, from $0.20 to $0.84; (2) to double the excise tax on other tobacco products from 20% to 40% of the wholesale price; and (3) to earmark the revenues raised by the tax increases for tobacco prevention and treatment and other health-related programs, i.e., 46% for expanded health coverage for low-income children and adults, 19% to boost primary care, 16% for tobacco education and cessation, 16% for preventing and treating cancer and heart and lung diseases, and 3% to bolster the Old Age Pension Fund and compensate counties for lower sales tax revenues from tobacco.
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