Indiana health care providers urge Governor Holcomb to support $2 cigarette tax increase

January 13, 2021

The Honorable Governor Eric Holcomb Indiana Statehouse, 2nd floor Indianapolis, Indiana 46204

Dear Governor Holcomb,

As Indiana health care providers, we have witnessed the unprecedented burdens the COVID-19 pandemic has placed on the physical and emotional health of Hoosiers, and we are committed to working with your administration to safely guide Hoosiers through this crisis. But the pandemic has also magnified the quieter and equally pervasive challenges that have long plagued the health of our state. In areas including heart disease, cancer, diabetes, maternal and infant mortality, and a host of other morbidities, Indiana draws national distinction for its poor health. These lingering maladies not only make the risks of COVID-19 more acute for Hoosiers, but fixing them will demand a long-term commitment that extends well beyond any response to the current crisis.

The causes of Indiana’s health challenges are varied, but many of our chronic ailments can be linked to the state’s high tobacco use rate and low investments in proven public health interventions. Fortunately, there are science-driven policies that can guide our path toward a healthier Indiana and, on behalf of the patients we serve, we write with urgency to request your support for these proven solutions to reduce smoking rates and improve Hoosier health.

One-in-five Hoosier adults smoke, placing Indiana among the ten worst states for our smoking rate, and an equal number of youth use tobacco products. Consequently, more than 11,000 of our friends, family members and neighbors will die from a tobacco related illness in 2021. Commendably, your administration has taken steps to curtail vaping among Hoosier youth and has made cessation services more accessible to Indiana Medicaid members. These important steps should be complemented by increasing Indiana’s low cigarette tax rate. Just as wearing a mask and social distancing can save lives, so too can raising the state’s low cigarette tax.

Projections show that a $2 increase in the cigarette tax would save nearly 30,000 lives and help more than 100,000 Hoosiers stay or become tobacco free. Importantly, reduced smoking rates can also reduce Indiana’s health care costs. As policymakers continue to look for cost-savings in our health care system, they must not overlook evidence-based public health solutions, like raising the cigarette tax, that can produce significant savings for all Hoosiers.

Raising the cigarette tax by $2 per pack will also produce up to $350 million in new revenue in the first year that can shore up Indiana’s underfunded health programs. At just $55 per person, Indiana has the third lowest share of public health investment in the country, meaning we spend less on things like disease prevention, substance abuse prevention, and healthcare access than all but two other states. The consequences of this disinvestment are not abstract; we see them every day in our offices, emergency departments and operating rooms. We also recognize that poor health can have more than physical manifestations. Poor health leads to higher health care costs, for instance, that not only affect our patients, but can hamper Indiana’s economic development efforts. Taking steps to improve the health of all Hoosiers can transform outcomes for Indiana’s physical and economic health.

The burdens of poor health are carried by all Hoosiers, but we do not share those burdens equally. Children, under-resourced communities and Black Hoosiers often bear a disproportionate burden of Indiana’s health policy failures. That is especially clear with issues like infant mortality which disproportionately affects Indiana’s Black community. We applaud you for recognizing this problem and for prioritizing evidence-based solutions to this infant mortality crisis. Though much work remains before we solve this problem, the early results of your administration’s investments are very promising and should give us the confidence to make similar investments in other proven health programs.

Even as we battle this pandemic, it must not fatigue our commitment to fixing other urgent and deadly health crises that will outlast the threat of COVID-19. In fact, we know that individuals who smoke and people with chronic lung diseases are at much higher risk for poor outcomes if infected with COVID -19. Certainly, the pandemic has reminded us of an old truth – that our physical health is foundational to our quality of life. Without a renewed and serious commitment to evidence-based health policies, poor physical health will hamper Indiana’s full potential.

The year ahead will pose many difficulties for our state, and we recognize the unique leadership role you will continue to play in protecting the health of Hoosiers. As you consider policies that can take Indiana to the Next Level, we urge you to prioritize public health issues that reach beyond the scope of the pandemic. Raising the cigarette tax by $2 and using the revenue to enhance investments in proven health programs are the most impactful things we can do for Hoosier health in the year ahead, and Indiana’s health care providers offer you our full partnership in improving the health of our state.

Thank you for your consideration of these matters and thank you for your service to our great state.


Emily Scott, M.D. President, Indiana Chapter, American Academy of Pediatrics

Nykki Boersma, M.D., FAAFP President, Indiana Academy of Family Physicians

Emily Sego, DNP, RN, NEA-BC President, Indiana State Nurses Association

Donald R. Westerhausen, Jr., M.D., FACC President, Indiana Chapter of the American College of Cardiology

Mark A. Henderson, M.D. President, Indiana Oncology Society

Roberto Darroca, M.D. President, Indiana State Medical Association

Brian H. Black, D.O., FAAFP, HMDC, President, Indiana Osteopathic Association

Lynn Thoma, PharmD, BCACP, BC-ADM, CDCES, LDE, LDIF President, Indiana Pharmacists Association

Leonard Henry, M.D., President, Indiana Chapter, American College of Surgeons

Lauren Stanley, M.D., FACEP, President, Indiana Chapter, American College of Emergency Physicians

Andrew Chastain, MSAPS, PA-C, President, Indiana Academy of Physician Assistants

John Stephens, M.D, President, Indiana Academy of Dermatology

Sarah Bauer, M.D., Indiana Chapter, American Thoracic Society

David H. Wolf, D.D.S., President, Indiana Dental Association

Millicent Moye, M.D., President, Aesculapian Medical Society

Sheli R. Taulbee, LDH, President, Indiana Dental Hygienists’Association

Linda Feiwell Abels, M.D., President, Indianapolis Medical Society

Brownsyne Tucker Edmonds, M.D., MPH, MS, Chair, Indiana Section of the American College of Obstetricians and Gynecologists

Joy Sunday, BSN, RN, President, Indiana School Nurses Association

Angela Thompson, DNP, FNP-C, BC-ADM, FAANP, President, Coalition of Advance Practice Registered Nurses of Indiana

Steve Greubel, BS, RRT, NPS, C-NPT, AE-C, President, Indiana Society for Respiratory Care

Rachel Shockley, D.O., President, Indiana Chapter, American College of Osteopathic Family Physicians