Cigarette taxes wanted to fund health centers

The State Health Department recommends using cigarette tax money instead of state general funds to fund the Hawaii’s 14 community health centers, but the proposal has raised questions. The centers cared for 110,000 residents in 2007.

The Hawaii Primary Care Association, which represents the health centers, says cigarette tax revenues to be collected in 2009-10 are desperately needed for capital, infrastructure, emergency preparedness and growth. Beth Giesting, the association's CEO adds, "We're trying to get people to quit smoking." Every dollar spent on care for the uninsured in the community centers saves the state's health-care system $10, she said.

A portion of the cigarette tax is already allocated to the community health centers, beginning last September. After two months, the fund already took in $399,000 and by 2009 or 2010 it is expected to grow to about $8 million, according to state Health Director Chiyome Fukino.

Fukino says she’ll recommend capping the amount given to the health centers, which now also receive $5.6 million from the state for the uninsured. However, state agencies are now giving notice of grant reductions as they wrestle with a $75 million state budget shortfall this fiscal year. Funding cuts could remove the safety net for thousands of poor, uninsured and homeless residents, according to the health centers.

The Big Island’s Bay Clinic system, for example, reports a 10 to 15 percent increase in clients in the past year, about 26 percent of whom are uninsured. "We're very concerned about the increasing demand for primary care in East Hawaii due to the shortfall of physician and provider resources and our volumes,” said Paul Strauss, Bay Clinic CEO. “We were relying on the cigarette tax to address capitalization of buildings and equipment that we don't have to support expansion," he told the Honolulu Star-Bulletin.

Senator Suzanne Chun Oakland, Human Services chair, said the cigarette tax money was intended to supplement general funding for the centers, not replace it. She questions whether the change would be legal. Fukino said it might not have been the Legislature's intent to support the health centers with the cigarette tax fund, but there is "nothing that says you can't supplant general funds," she said.

The Hawaii Primary Care Association's legislative agenda for 2009 includes requests:

• To maintain state general funding for health care for a growing number of uninsured residents, low-income patients not covered by QUEST, recent immigrants, the homeless and seniors. The 14 centers expect to have 45,000 uninsured visits next year.
• To give prescriptive authority to psychologists who complete rigorous training and testing to practice with a doctor at a community health center.
• To amend dental licensing laws so temporary licenses can be granted to dentists in a pediatric specialty training program based in community health centers.