Prop B was not even plan B for funding a proposed expansion of MU’s School of Medicine into Springfield, Mo., when the idea was first broached a few years ago. But it might be just what the doctor ordered to increase the number of Show-Me State physicians.
Every year, 1,400 applicants are rejected from the School of Medicine. In a state where 90 percent of counties don’t have enough health care professionals, university leaders want to see more Mizzou students in the pipeline to become Missouri doctors.
To that end, MU and Springfield health care providers Mercy and CoxHealth announced a partnership plan in spring 2012 in which Mizzou’s medical school would increase annual enrollment from 96 to 128 and open a clinical campus in Springfield.
The price tag is $33 million in one-time capital costs — $30 million for a new education building in Columbia to handle the larger enrollment and $3 million for renovations to existing facilities in Springfield. There will also be an expenditure of $10 million in annual operating costs.
The partners initially planned to raise a portion of the capital cost from private donors and go to the legislature, hat in hand, for everything else. “[We knew] that with a hurt economy it would probably take two or three years to do that,” said Weldon Webb, medical school associate dean for rural health.
Then, the proposed tobacco tax surfaced on the Missouri November ballot — Proposition B.
Prop B would increase the state tax on cigarettes by 73 cents a pack, bringing Missouri’s lowest-in-the-nation rate of 17 cents a pack up to 90 cents, which is still below the 50-state (and District of Columbia) median of $1.36.
From the tobacco tax, annual state revenue estimates range from $283 million to $423 million, with 30 percent going to public higher educaiton, 50 percent toward public schools and 20 percent toward smoking cessation programs.
Using a midpoint figure of $350 million in taxes raised, MU could see $26.3 million from the new tax, at least 25 percent of which must go toward training future health care workers. The university could borrow against future cigarette tax revenue in order to start construction work right away.
Webb hopes the school can admit its first expanded class in August 2015. That class would go to Springfield for clinical training in June 2017.
But the tax proposal is not without its detractors. Opponents say it might cause a reduction in sales tax revenue and create a $283 million excuse to replace existing state education funding with tobacco tax proceeds.
When smokers buy a carton of Marlboro’s at a Columbia gas station, they’re actually paying three taxes — a sales tax that’s divvied up among the city, county and state, a 10-cent local cigarette tax, and the current 17-cent state cigarette tax.
Increasing the state cigarette tax by 73 cents is expected to cause some smokers to quit and deter others from acquiring the habit. Fewer packs sold means less sales tax and local cigarette tax money for Missouri, said Joseph Haslag, MU Kenneth Lay Chair in Economics.
Haslag wrote a research study on the issue, paid for by the Missouri Petroleum Marketers & Convenience Store Association, the main group opposed to the measure. In it, he estimated that, statewide, $67 million in existing tax streams would be lost annually under Prop B — assuming that 157 million fewer cigarette packs a year are sold and that people won’t spend that money on anything else that is subject to sales taxes.
Whatever the decrease might be, municipalitites, counties and the state will have to either reduce services by that amount or raise the money some other way, Haslag said.
Arguing in favor of the tax, UM System President Tim Wolfe and Columbia Public Schools Superintendent Chris Belcher wrote in an Oct. 28 Columbia Daily Tribune op-ed about the social responsibility of preventing youth from smoking.
They cited national data showing a 4 percent decrease in cigarette consumption for every 10 percent increase in cigarette taxes. That translates to an estimated 40,100 fewer youngsters becoming addicted adult smokers and 33,000 adult smokers quitting if Prop B passes.
Fewer smokers mean longer lives and less health spending on tobacco-related illnesses, according to the American Cancer Society. The society estimates smoking costs Missouri $2.13 billion annually in direct health costs, and that a Missouri household pays an average of $565 a year in state and federal taxes for smoking-caused government expenditures.
Missouri voters will decide the measure’s fate Nov. 6.
— Erik Potter