Testimony before the Washington Senate Health & Long Term Care Committee
Lindsey Stroud, State Government Relations Manager
The Heartland Institute
January 18, 2019
Chairwoman Cleveland and members of the Committee, thank you for taking the time today to discuss the issue of increasing the age to possess and purchase tobacco and vaping products. The Heartland Institute is a 34-year-old independent, national, nonprofit organization whose mission is to discover, develop, and promote free-market solutions to social and economic problems. Heartland is headquartered in Illinois and focuses on providing national, state, and local elected officials with reliable and timely research and analyses on important policy issues. Heartland would like to submit the following testimony regarding raising the legal age of sale of tobacco and vapor products.
Many states have proposed legislation raising the age required to purchase tobacco products. Often, this legislation classifies e-cigarettes and vaping devices, also called tobacco harm reduction products, in a manner similar or identical to products that contain tobacco.
Such proposals limit individual freedom, fail to curb consumption, ignore potential health gains, and cost millions of dollars in lost revenue. Rather than restricting adults’ choices, legislators should make use of revenues already received through tobacco taxes and settlements to promote cessation efforts.
Increasing the age required to smoke and purchase tobacco and vaping products limits individual freedom and grossly undermines the responsibility governments place upon individuals aged 18. 18-year-olds can serve in war; are tried as adults in courts; and can amass tremendous amounts of debt in contractual loans, such as student loans, which averaged around $30,000 in 2016. Why then should lawmakers require so much responsibility from these individuals, but are intent on banning 18 to 20-year-olds from purchasing tobacco or vaping products?
While one can make a reasonable argument that adults shouldn’t use tobacco products, raising the age for consumption of cigarettes does not necessarily provide the public health benefits officials aim for. For instance, in the 2018 Monitoring the Future Study: Trends in Prevalence of Various Drugs, the National Institute on Drug Abuse noted more than 53 percent of 12th graders and more than 37 percent of 10th graders reported consuming alcohol in the past year. The legal age for purchasing and consuming alcohol in Washington state is 21. In fact, current law permits a $500 fine for persons under 21 found guilty of being “in a public place or in a vehicle while exhibiting the effects of having consumed alcohol.” If persons under 21 attempt to purchase alcohol, the penalty can be as much as $1,000. In direct face to such deterrents used to curb youth alcohol use, the legislation proposed today will not enforce a penalty on individuals aged 18-20, creating an inconsistency in this legislation. If you must be 21 to possess and/or purchase tobacco and vaping products, why are only individuals 18 and younger being punished while other individuals younger than 21, are not?
Moreover, Washington state currently uses very little funding from taxes and settlement moneys to promote cessation and tobacco control education programs. The American Cancer Society gave Washington state a “big fat ‘F’ [ranking] on [preventing] tobacco-related cancers.” To understand, Washington received $151 million in tobacco settlement payouts in 2017 as well as $377.9 million in cigarette tax revenue. The state distributed only $640,000, or less than two percent of the funding received, into the Youth Tobacco Prevention Account in the same year. To truly understand the state’s efforts to combat tobacco use, Washington spent $15 million on tobacco control programs in 2000. In 2018 the state spent $1.4 million. For fiscal year 2019, Washington state will spend $1.5 million on state tobacco control programs, or 2.4 percent of the Centers for Disease Control and Prevention’s recommendation.
It’s important to note that all tax revenue received from the sale of tobacco products is automatically earmarked into Washington state’s general fund, which is overwhelmingly distributed to education expenses. Prior to July 1, 2009, Washington state’s “health services account received one-half of [tobacco] tax revenues,” and after that date, all revenues are to be distributed to the general fund. Tobacco settlement moneys received are also deposited into the state’s general fund and none is earmarked for cessation and prevention efforts despite the 1998 settlement’s intention “to help reimburse the states for Medicaid costs caused by tobacco.”
The legislation fails to address how youths are able to procure tobacco products. A U.S. Food and Drug Administration study found that 86 percent of youths aged “15 to 17 years old obtained cigarettes by asking someone else,” and 89 percent relied on these sources for e-cigarettes. These so-called social sources include siblings, friends, parents, and even strangers. As indicated in the aforementioned numbers on youth alcohol consumption, youth are able to find social sources to help provide them with products restricted to persons 21 years and older and will merely rely upon these same sources to procure tobacco products.
Perhaps most troublesome with this legislation is the inclusion of vaping devices and electronic cigarettes, and even smokeless tobacco, otherwise known as tobacco harm reduction (THR products). Today’s proposal treats THR products in the same fashion and legislation, especially legislation intended to promote public health, should refrain from such synchronization. Research increasingly shows tobacco products exist on a continuum of harm, and THR products are significantly less harmful than combustible cigarettes. Policies regulating their use should not only address that continuum but validate products that deliver nicotine with a reduced harm as well as promote their use.
For example, studies on the use of smokeless tobacco increasingly indicate a reduction of harms associated with nicotine used apart from combustible cigarettes. The Swedish experience with snus is a wonderful example. Swedish men have the highest rate of smokeless tobacco use in Europe and the lowest smoking rate. Men in Sweden “also have the lowest rates of lung cancer and other smoking-related diseases in Europe.”
Research on electronic cigarettes and vaping devices finds similar reduced harms. In 2015, Public Health England found e-cigarettes to be less harmful than combustible cigarettes, noting that “the current best estimate [shows] using e-cigarettes is around 95% safer than smoking.” A 2016 report from the Tobacco Advisory Group of the Royal College of Physicians concluded that hazards from e-cigarettes were “unlikely to exceed 5% of the harm from smoking tobacco,” and these products have created “a massive opportunity for a consumer – as well as healthcare – led revolution in the way nicotine is used in society.” In 2018, the National Academies of Sciences, Engineering, and Medicine released a report that found “substantial evidence that completely switching from regular use of combustible cigarettes to e-cigarettes results in reduced short-term adverse health outcomes in several organ systems.”
Most importantly, public officials should recognize the public health gains these products provide. A 2015 policy analysis by State Budget Solutions examined electronic cigarettes’ effect on Medicaid spending. The author estimated Medicaid savings could have amounted to $48 billion in 2012 if e-cigarettes had been adopted in place of combustible cigarettes by all Medicaid recipients who currently consume tobacco products. A 2017 study by R Street examined the financial impact to Medicaid costs, should a number of current Medicaid recipients switch from combustible cigarettes to e-cigarettes and vaping devices. The author used a sample size of “1% of smokers [within] demographic groups permanently” switching. In this analysis, the author estimates that Medicaid savings “will be approximately $2.8 billion per 1 percent of enrollees,” over the next 25 years.
Rather than limiting adults from personal choice, Washington state should reform how it currently uses tobacco funds and provide more funding for education and cessation efforts. Policymakers should also examine the role of THR products and recognize the potential health gains these products provide and move to regulate these products among a continuum of harm.
Thank you for your time today.
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 J. Scott Moody, “E-Cigarettes Poised to Save Medicaid Billions,” State Budget Solutions, March 31, 2015, https://heartland.org/wp-content/uploads/documents/20150331_sbsmediciadecigarettes033115.pdf.
 Edward Anselm, “Tobacco Harm Reduction Potential for ‘Heat Not Burn,'” R Street Institute, February 2017, https://www.rstreet.org/wp-content/uploads/2017/02/85.