State eyes supervision of tobacco fund boost

AUGUSTA, Maine — With tobacco settlement payments on the rise and the state budget in tatters, lawmakers are looking to strengthen oversight of spending in the so-called Fund for a Healthy Maine. Each year for the past 10 years, about $50 million has flowed into Maine as a result of the 1999 settlement between 46 states and major manufacturers of tobacco products.

This year, in keeping with the terms of the settlement, the amount increased by about $10 million for Maine and some other states that played a significant role in reaching the original agreement. The increased annual payments will continue until 2018, then drop back to the original level, adjusted for inflation and other factors, in perpetuity.

In accordance with Maine law, the money from the tobacco companies does not flow into the taxpayer-funded General Fund as it does in some other states, but instead is directed into the separate account. Over the years, a large majority of the money in the fund has been spent on a broad slate of public health measures, but in recent years it increasingly has been eyed by some lawmakers and policymakers as a resource for filling gaps in the state budget and funding projects that don’t fall neatly under the public health umbrella.

On Tuesday, lawmakers on the Legislature’s Health and Human Services Committee met with state officials to learn more about the Fund for Healthy Maine, concerned that without structured oversight, the progress Maine has made in improving the health of its people will be undone. Lawmakers and policymakers also are being pressed to demonstrate that the programs the fund pays for are effectively improving public health.

“There’s never been any real oversight,” said the committee’s House chairwoman, Rep. Anne Perry, D-Calais. “Right now, there is nobody in state government that has oversight over this fund.”

Perry said the state’s constrained finances caused the Fund for a Healthy Maine to come under increased pressure during the last legislative session as lawmakers and policymakers struggled to make ends meet. Legislation passed at the end of the session mandated the review and charged the committee with recommending an oversight structure.

Dr. Dora Anne Mills, director of the Maine Center for Disease Control and Prevention, told committee members that the Fund for a Healthy Maine comprises about 25 percent of her annual budget and pays for “extraordinarily critical” public health programs.

Mills said that in combination with state and federal taxpayer dollars, the fund has been used to reduce teen smoking rates, establish school-based health centers, increase enrollment in Head Start preschool programs, expand access to prenatal care and help low-income seniors afford their prescriptions. More recently, she said, the Fund for a Healthy Maine has enabled the development of a statewide network of public health centers charged with improving the management of chronic diseases, helping prevent substance abuse and improving Mainers’ nutrition and physical activity.

In a recent comparison of states’ per capita public health spending, Mills said, Maine’s ranking rose from 48th to 35th thanks to the Fund for a Healthy Maine.

Attorney General Steven Rowe, who helped push through the tobacco settlement in 1999, provided a historical overview and told committee members that the Fund for a Healthy Maine must have more formal oversight if it is to continue to fulfill its mission of preventing disease, promoting good health and reducing health care spending in Maine.

Every dollar spent on public health prevention programs saves $9 in costs associated with medical care, special education, substance abuse treatment, law enforcement and other associated costs, he said.

To date, the only organized effort to monitor spending from the special fund has come from a disparate group of lobbyists and public health advocates calling themselves the Friends of the Fund for a Healthy Maine. Member organizations include Maine chapters of the American Cancer Society and the American Lung Association as well as Anthem Blue Cross and Blue Shield, Aroostook Mental Health Services, and the nonprofit Consumers for Affordable Health Care.

Becky Smith, executive director of the organization, told the committee that the Friends have strong opinions about how the money should be spent but have no actual authority over allocations. The fund is a “once in a lifetime opportunity to fund public health in Maine,” she said.

Committee members also heard from State Treasurer David Lemoine and other state financial analysts.

Rep. Patricia Jones, a member of the committee, said she hopes any oversight group will protect the Fund for a Healthy Maine from being tapped for purposes other than public health. “I don’t feel $50 million is a lot to spend for public health funding,” she said.

Sen. Kevin Raye, R-Perry, said it would be a mistake to empower any oversight group with substantive decision-making powers without also strengthening accountability requirements for the programs they fund.

The committee will meet again on Sept. 24 to draft preliminary recommendations and report them to the Appropriations Committee the next day.