Columns » John Brummett

Cigarettes and trauma — how and why



It begins with the fact that Arkansas is the only state in the country without a system of advanced trauma care in emergency rooms as verified by the American College of Surgeons.

It may end with a relatively major statewide health care program.

The political will is strong for a trauma system in the legislative session that began Monday. We lean heavily toward finding $28 million to set up two Level 1 trauma centers in Little Rock, one at Children's Hospital and the other at the University Hospital or Baptist Health Medical Center. Among other things, Level 1 centers have neurosurgeons and orthopedic surgeons always on hand.

We also intend to set up a system of reimbursement for the existing Level 1 center in Memphis that handles many of our East Arkansas cases, often by absorbing costs.

We'll pick up rural political support by spending some of that $28 million to improve emergency room care throughout the state, with four Level 2 centers and several Level 3s and 4s.

Most people seem to have settled on raising the cigarette tax to generate this $28 million. The cigarette tax has nothing to do with traumatic injury, but everything to do with general health. We'd need to put a $7 tax on a pack of cigarettes to cover all the costs that cigarette smoking imposes on our health care system, Gov. Mike Beebe was saying last week that he had been told.

Public health advocates like raising the cigarette tax because it generates money for their programs and it has a bit of deterring effect on smoking.

To be safe and avoid litigation, legislative leaders think we need to assume that raising the cigarette tax requires a three-fourths vote. Raising taxes existing at the time of the Futtrell Amendment in the 1930s requires a three-fourths. Raising taxes on new levies coming after that requires only a majority. We had a retail cigarette tax at the time of the Futtrell Amendment. We now impose the cigarette tax at the wholesale level.

Is that new or existing? That's anybody's guess, and guessing isn't good enough.

To forge the political census for a three-fourths majority, Beebe, House Speaker Robbie Wills and others want to tap rural and regional interest in more than trauma centers, but general community health advancement.

There is support for community health centers, community mental health programs for children, in-home health care and a satellite campus in Northwest Arkansas of the University of Arkansas for Medical Sciences.

Here, then, is the plan: Raise the cigarette tax by 50 cents a pack or maybe more, raising from $70 million to $100 million, and use the amount in excess of the $28 million on these other popular and helpful health initiatives.

Beyond that, much of this cigarette manna could be spent on Medicare and get quadrupled by the federal 3-to-1 match on our Medicaid spending. And even beyond that, the Obama stimulus plan calls for shipping extra Medicaid money to states for the next two years, both to plug Medicaid deficits in several states and encourage states to increase their own Medicaid coverage to extend health care to the growing number of working poor in this dire economy.

Medicaid money is an especially productive public expenditure in Arkansas. Federal matching rates are determined by the poverty rate of a state. Our poverty rate, sadly, is the third-highest in the country.

Now to the opposition: Some Northwest Arkansas Republican legislators, ever anti-tax, have been talking about eschewing the cigarette tax and paying for the trauma system with increased court fines for reckless and drunken driving.

But the traffic judges say they need any flexibility in those fines to pay for their own strapped court costs. Plus, those fees probably wouldn't pay for a general health program, or, more to the point, for a satellite medical school in Northwest Arkansas.

Look for an emerging coalition of public health advocates and rural legislators, spanning the anti-smoking forces, the Little Rock medical community, Northwest Arkansas boosters and the small community hospitals and health clinics. It'll take this group's intense lobbying for most of the session to cement the three-fourths majorities. But it'll probably get there.

If it can't quite get three-fourths, we could always pass the program by a simple majority vote on a cigarette tax, rather easily attainable, and see what the courts say before actually implementing anything.


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