Oregonians face a difficult decision this November when they decide the fate of ballot measure 50. Measure 50 is a bill which started in the Oregon Legislature but was later relegated to a vote due to intense debate. If passed it would fund the Healthy Kids Program with tax revenues on tobacco. An estimated $152.7 Million would be raised for 117,000 uninsured Oregon children.
On the surface, this bill brings a valued program to Oregon citizens. Kids in Oregon should be guaranteed some sort of health benefit. With health insurance in its present state of flux and a diminishing number of adults receiving such care, kids are the most vulnerable to lapses in care. They also stand to gain the most from preventative and maintenance care.
This being said, the way the bill was written makes this a very challenging vote. The funding for the Healthy Kids Program is derived from an increase in tobacco tax which is written directly into the Oregon constitution. Further, it pins the escalating cost of health care on a declining trend of adult smoking thus providing a poor long term platform for children's health care.
A constitution exists to define a government. Federal, state or local, constitutions set the balance of power among branches of government and define the legal framework for which that government will operate. A constitution is a strange place for a health care platform. More appropriate for this bill would have been a law written by the legislature or, strange but possible, an executive order from the governor. I can't say exactly why the constitution was chosen for this law but this maneuver raises serious flags.
But on to more pressing matters. According to the text of the ballot measure, 117,000 kids would receive a distribution of $152.7 million dollars secondary to a $0.845 raise in the cost of a pack of cigarettes (other tobacco taxes apply as well). Doing the math, this provides each kid $1305.12 per year. I look at this as an insurance premium cost; kids in Oregon make up the risk pool while only a small percentage of those kids will likely use the insurance.
Allow me to put this into context: the average premium price for a single insurance policy in Oregon is $4,051. When you divide total health expenditures by each citizen you get a cost of $4,880 per capita. Stated another way, the going rate to cover a single person for their health needs is around $4,500. Covering children at an expected rate of about one third that rate will create a program where children have health insurance but can't use it. This will necessitate some other funding source (another tobacco tax?) to make the program truly effective. Further, between 1991 and 2004 health expenditures increased an average of 8% per year. The tax will provide a margin of the average cost to cover one Oregonian the first year and then decline rapidly after that.
Now lets look at how many people smoke in Oregon. In order to assure continued funding for the Healthy Kids Program, a critical mass of Oregonians must continue buying tobacco products. The Oregon Quit Line is a state funded tobacco prevention and cessation program. It must be effective because 18% of Oregonians smoke compared with the national average of 21%. Further, roughly half of all smokers attempt to quit in any given year. Smoking is no longer fabulous, it's addictive and fewer people are buying tobacco products this year than the year before. Healthy Kids pits one program's funding against another state agency's mission; as long as neither entity works too hard, both programs will continue to exist.
In sum, while I agree with the notion that kids should be covered by a health plan I can't get over the fact that the policy was written poorly and is unsustainable. The only way the measure could be effective is if all the kids covered by Health Kids took up smoking and raised money for their own insurance.
sources:
Healthy Kids Oregon
http://www.reject50.com/
Oregon Tobacco Quit Line
Kaiser State Health Facts
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