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Tu-Uyen Tran, Forum Communications Co., Published February 01 2011

Tobacco control proponents oppose dismantling of their program to pay for UND med school expansion

BISMARCK – Proponents of North Dakota’s tobacco control program found a frosty reception Monday when they came to the Capitol to oppose the dismantling of their program to pay for another program at the University of North Dakota to increase the number of health care workers in the state.

Some lawmakers in the House Education Committee, which took up the matter, implied that the proponents may have illegally used tax dollars to lobby the Legislature. Others implied that the 2008 initiated measure creating the tobacco control program out of a portion of the state’s tobacco settlement may not have really been the true voice of the people.

Measure 3 certainly had never been popular with the Legislature, particularly Republicans. Even in 2009, months after it passed with 54 percent of the popular vote, lawmakers hesitated to give it any funding and some even wanted to ask voters if they might not change their minds. Two years later, some lawmakers want to take a stab at overturning Measure 3 themselves, and they think they can muster the two-thirds vote needed from each legislative chamber to do it.

House Bill 1353 would end the roughly $18.6 million-a-biennium tobacco control program – not just cut funding, but end the program and the agency that runs it – and use the money to expand UND’s School of Medicine and Health Sciences, which would cost $34.7 million in the initial biennium.

Many hospitals and doctors say this is needed because the state faces a major shortage of health care workers even as the state’s aging population requires more care.

Tobacco control proponents say they want the med school to expand, too, but not at the cost of their program. To do so, they said, would cause tobacco use to rise again. Some of them are proposing a more than three-fold increase in the cigarette tax, from 44 cents a pack to $2, to raise funds for the med school.

Committee members took no action on the bill.

The Education Committee meets in one of the larger meeting rooms at the Capitol, but it was completely packed Monday, mostly with proponents of the tobacco control program. Many wore red to show solidarity, and Chairwoman RaeAnn Kelsch, R-Mandan, had to clarify that she wasn’t one of them. She wore red, she said, “because it makes me happy.”

She didn’t seem happy, though, when she talked about the flood of voicemails and e-mails that she received. How is it, she said, that the wording of these messages were almost identical? When she returned the calls, she claimed, the callers “had no idea” what they were talking about. “Somebody had to orchestrate it,” she said, noting all the red shirts in the audience.

Proponents said they just got phone calls or e-mails from friends to show up Monday and that they ought to wear red.

In the audience were a handful of supporters of the med school expansion, though they were not mutually exclusive with the tobacco control proponents. Some that spoke in support of the bill said they only support the part that would get more health care workers trained, not the part that kills the tobacco control program.

Bruce Levi, executive director of the North Dakota Medical Association, called HB 1353 a “paradox.” The association wants to increase the supply of health care workers, he said, but it also believes that for supply to ever meet demand, demand has to also drop. The easiest preventable health problem, he said, is tobacco use.

Kelsch responded by asking him how many doctors in the state the NDMA represents. Levi said 70 percent.

Other med school supporters chose to avoid the tobacco control issue altogether.

Joshua Wynne, the med school dean, said something along the same lines as Levi – increase supply, decrease demand – but he left out the part about tobacco and about funding. How to pay for the expansion, he said, is a “value judgment” for the Legislature.

Sen. Ray Holmberg, R-Grand Forks, chairman of the Senate Appropriations Committee and a sponsor of the bill, explained that value judgment this way. It’s true that the tobacco control program came out of a vote of the people, he said. The committee ought to bear in mind, however, that voters only get a “yes” or “no” vote with these measures, he said, and it’s the Legislature that must deal with prioritizing one state need over another.

Let’s say you make up your mind to save up money for a new house, he said, but then, after you’ve been saving a bit, the furnace goes out. Do you say that you can’t touch the money for the new house, he said, or do you fix the furnace?

While supporters of the bill spoke, proponents of tobacco control passed out stickers that said “Save money, save lives, save Measure 3.” And they spoke to all three.

Between 2008 and 2025, North Dakota is expected to reap $575.5 million from the settlement that state attorneys general, including North Dakota’s, reached with the tobacco industry. Dr. James Hughes, a heart and lung doctor at St. Alexis Medical Center in Bismarck and an assistant professor at UND’s clinic there, told the committee that settlement represents the “immensity of the economic impact” to North Dakota because of tobacco-related diseases.

The true cost to society of a pack of cigarettes isn’t what’s paid at the cash register for it, he said, but $10.48. The difference is what society pays later for the loss of productivity, he said, not to mention the impact to families.

He decried the attempt to take tobacco settlement money away from tobacco control programs to pay for more doctors as counterproductive.

“If a car heads into an accident, the solution is to stop the car, not build repair shops.”

Tran writes for the Grand Forks Herald