South Carolina ranks among the worst states in the nation in smoking prevention efforts, according to a new report, just as lawmakers return to Columbia today with raising the state's lowest-in-the-nation cigarette tax a top issue.
According to the report by the American Lung Association, South Carolina is one of six states to score all "F's" for their efforts on tobacco prevention and control spending, smoke-free air laws and rules, taxing cigarettes and helping smokers kick the habit. The other states with all failing grades were Alabama, Mississippi, Kentucky, Virginia and West Virginia.
All of those issues have been wrapped up in the 10-year push by anti-smoking and public health care groups to raise South Carolina's 7-cent per pack cigarette tax. Last year the House passed a bill to raise the tax 50 cents a pack, but questions about where the estimated $147 million would be spent split the General Assembly.
But a new issue could change this year's debate - the potential cost of health care reform legislation under debate in Congress, which could add $1 billion to S.C. Medicaid costs in the decade after passage, according to some estimates,.
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"That's our biggest issue, what to do with the money," said Senate Majority Leader Harvey Peeler. "What is going to happen with Medicaid? You talk about a budget buster."
Votes during in the past two years have shown a majority of lawmakers in both houses agree the tax should be raised by 50 cents per pack, but Gov. Mark Sanford's veto has proved an obstacle to final passage.
Sanford has threatened to veto any cigarette tax increase that does not include an equivalent tax cut, and Peeler said the Senate likely could not reach the two-thirds majority needed to override a veto. But Sanford spokesman Ben Fox said a federal health care bill might make a difference.
Sanford will oppose the federal bill, Fox said, but "wouldn't put a blanket prohibition on (using cigarette tax revenue) without seeing how it plays out."
Some lawmakers favor passing the tax and saving the revenue until the federal bill is finished.
Opponents, such as cigarette maker Reynolds American, warn that lawmakers should not depend on a shrinking pool of smokers to pay for health care.
Cigarette sales have dropped 10 percent to 12 percent since a 62-cent federal tax increase last year, said Reynolds American spokesman Frank Lester. Earmarking that money for health care is "poor fiscal policy," Lester said.
Lester noted that states, including South Carolina, have not used the hundreds of millions won in a lawsuit against tobacco companies for health care.
The bill has also been bogged down in the past by tangential issues - such as taxes on smokeless tobacco - and advocates worry the federal health care bill could add another delay.
"It does seem like each year there is one more issue," said Kelly Davis, spokeswoman for the S.C. Tobacco Collaborative, "or one more concern or one more excuse - if you want to call it that - that clutters the debate."
The group is a coalition of anti-smoking and public health groups that favors a tax increase.
Advocates of raising the tax have tried to focus on the health benefits to the state: reducing smoking rates, preventing teens from starting and helping fund the cost of smoking-related diseases. They have pushed to include money for cessation and prevention programs.
Last year's bill would have set aside $5 million for anti-smoking efforts, a key item according to the American Lung Association.
With the price of cigarettes rising and many workplaces and restaurants restricting smoking, the American Lung Association said smokers now need more help quitting.