ACS CAN Maine and Partners Send Letter to Governor Mills On Tobacco Control Funding and COVID-19

September 25, 2020
Dear Governor Mills, Legislative Leaders and Members of the Joint Standing Committees on Appropriations and Financial Affairs, Health and Human Services, and Taxation:
As organizations that represent public health professionals, health care providers and patients, including those with serious health conditions like cancer, heart and lung disease, which place them at greater risk for serious illness due to COVID-19, we commend the efforts to-date that have prevented and reduced the spread of COVID-19 across our state. Thank you.
We recognize that the economic downturn presents challenges including reduced state revenue and has a wide-reaching and negative impact on programs and services that are supported through state funding, especially at a time when non-governmental resources are also strained. As Maine policymakers examine the economic impact of COVID-19 and budget and spending priorities, it is critical that efforts be made to both protect Mainers from COVID-19-specific health and economic consequences, and also to protect and promote health in other areas. As you consider supplemental budget proposals and the development of the next biennial budget, we ask that you prioritize investments in Maine’s public health prevention programs and infrastructure, and health care access, particularly for people in Maine experiencing health disparities. These investments will help to ensure Mainers are getting recommended disease screenings, seeing a health care provider when they are unwell, and avoiding delays in care.
Specifically, our organizations recommend the following budget priorities:
  • Maintaining current funding levels for the Maine CDC’s tobacco prevention and control program at $13.9 million per year.
  • Maximizing federal funding and maintaining current levels of state funding for chronic disease prevention and early detection programs, including maintaining funding to ensure Mainers have access to recommended cancer and heart disease screening tests
  • Continuing to support efforts to ensure Mainers have access to affordable, quality health coverage, including adequate funding for MaineCare and subsidized coverage through the health care exchange
As policymakers consider revenue generating opportunities, our organizations recommend increasing the cigarette excise tax by at least $1.50 per pack, a policy proposal strongly supported by a large majority of Mainers,i which will generate much needed revenue and provides well-documented public health benefits, including protecting and improving respiratory health. Increasing Maine’s cigarette excise tax by $1.50 per pack is estimated to generate more than $37 million per year in  revenue, while also reducing youth smoking rates by more than 15 percent, preventing 4,000 Maine kids under the age of 18 from becoming adult smokers, helping 8,700 adult smokers to quit, and reducing long-term health care costs by more than $250 million, including a 5-year savings in the MaineCare program of nearly $3
According to the United States Centers for Disease Control and Prevention (US CDC) and World Health Organization, older adults and people of any age who have serious underlying medical conditions, including being immunocompromised, are at greater risk for severe illness from COVID-19 than persons without underlying medical conditions. While cancer, heart and lung disease are widely recognized as underlying health conditions that place individuals at higher risk, it is important to note that the US CDC lists smoking among conditions that can compromise the immune system. Smoking is also a risk factor for chronic obstructive pulmonary disease (COPD), heart disease and cancer. Preserving funding for chronic disease prevention and control programs, including the state’s tobacco prevention and control
program, is important for the long-term fight against these expensive and deadly illnesses, and for the state’s immediate response to addressing the health and economic costs of COVID-19. 
In Maine, nearly 18% of adults smoke cigarettesiii and 30% of high school students use tobacco products,iv driven in large part by the explosion of e-cigarette use among high school students.v Only two Maine counties – Cumberland and Sagadahoc – have adult smoking rates at or below the national Smoking is estimated to cost Maine $811 million in direct health care costs, including $262 million in annual Medicaid costs,vii and an estimated 2,400 deaths each year.viii Given Maine’s projected budget deficit, evidence-based programs that reduce tobacco use and the financial burden on taxpayerfunded healthcare costs must be fully funded. Currently, Maine invests $13.9 million in tobacco prevention and treatment programs, which is 87% of the $15.9 million the US CDC recommends spending to combat the health and economic consequences of tobacco use. Maintaining funding for Maine’s tobacco prevention and control program at $13.9 million annually is crucial to prevent kids from starting to use tobacco and to help people already addicted to tobacco quit.
For some people who use tobacco products, the COVID-19 crisis may provide motivation to quit; for others, trying to quit during a time of stress might be even harder. Research shows that quitting smoking has immediate short-term benefits, including improved circulation and lung function improvements between 2 weeks and 3 months after quitting. From 1 month to 9 months after quitting, risk of lung infection decreases and the risk of heart attack decreases dramatically one year after quitting.ix While the benefits to the individual are clear, these health improvements translate into real health care system cost savings. Improvements in lung health and keeping Mainers healthy and out of the emergency room are especially important as the state and nation battle the COVID-19 pandemic. Maine should do everything possible to encourage and support those who choose to quit.
In recent years, there have been times when funding for health care coverage has been pitted against funding for essential public health and prevention programs. While our organizations believe this scenario always creates a false choice that is unwise to pursue, the COVID-19 pandemic has shone a spotlight on the interdependency of public health and health care access. During this unprecedented public health crisis, choosing one over the other would be short-sighted, and result in greater health and economic challenges. At a time when many Mainers have lost job-based health coverage and are struggling to make ends meet, they are also delaying needed preventive care and/or delays in treatment for serious health conditions. x As such, it is imperative that policymakers take action to protect the health of Mainers by investing in disease prevention and control.
A model developed by the National Cancer Institute estimates that months of deferred screenings or delayed treatments due to COVID-19 could result in almost 10,000 excess deaths over the next ten years from breast and colorectal cancer alone.xi According to the Director of the National Institutes of Health, Dr. Norman Sharpless, “ignoring life-threatening non–COVID-19 conditions such as cancer for too long may turn one public health crisis into many others.” Similar concerns have been reported in the media related to cardiac care. While medical experts agree that decisions to preserve hospital and clinical capacity were necessary and important, many believe they will come at a cost in terms of health outcomes. In order to minimize the anticipated negative impact on health outcomes, it is critically important for policymakers to take action to ensure Mainers have access to recommended health screenings, support systems to promote the importance and availability of such screenings, and preserve access to adequate, affordable health coverage.
Our organizations recognize that reconciling the budget shortfall and the next biennial budget is challenging. We stand ready to work with you to provide information and evidence-based recommendations that will support you in these deliberations. Thank you for your leadership and public service.
Lance Boucher, Senior Eastern Division Director of State Public Policy, American Lung Association
Becca Boulos, Executive Director, Maine Public Health Association
Chace Jackson, State Government Relations Director, American Heart Association
Dee Kerry, Executive Director, American Academy of Pediatrics Maine Chapter
Hilary Schneider, Maine Government Relations Director, American Cancer Society Cancer Action Network
iIn 2019, Maine Public Health Association received funding from the Maine Cancer Foundation to conduct a poll of Maine voters about
a range of tobacco-related issues. The Association contracted with Critical Insights to conduct 450 web-based surveys between April 4
and 15, 2019, among a representative sample of voters statewide in Maine. Findings showed more than 60% of respondents support a
$1.50 per pack increase in the state cigarette tax.
ii American Cancer Society Cancer Action Network, Campaign for Tobacco-Free Kids, and Tobacconomics, New Revenues, Public Health
Benefits & Cost Savings from a $1.50 Cigarette Tax Increase in Maine, January 15, 2020.
iii Centers for Disease Control and Prevention. 2018 BRFSS Prevalence and Trends Data.
iv Maine Centers for Disease Control and Prevention. 2019. Maine Integrated Youth Healthy Survey,
v The percent of Maine high school students that use e-cigarettes nearly doubled in two years from 15% in 2017 to 29% in 2019 (2019
Maine Integrated Youth Health Survey,
vi Robert Wood Johnson Foundation, 2019 County Health Rankings,
vii Campaign for Tobacco-Free Kids . The Toll of Tobacco in Maine. Updated January 31, 2020,
viii Ibid.
ix American Cancer Society, “Benefits of Quitting Smoking Over Time,”, accessed on August 25, 2020.
xi Sharpless, Norman, “COVID-19 and Cancer,” Science, June 19, 2020,