ONE PLACE TO USE TOBACCO MONEY

THE Senate Appropriations Committee was determined to keep the federal
government's greedy hands off the states' $246 billion tobacco
settlement. It seemed outrageous that the feds, who failed to make
their own deal with Big Tobacco, would expect to share in the state
governments' hard-won success, even if the feds do have a claim to a
portion of the money under federal law.

But in its zeal to protect the states, the committee did a serious
disservice to the health advocates and anti-smoking forces who have
fought so hard to see the tobacco industry held accountable for its
sins. The measure hastily approved by the committee last week allows
states to spend the settlement money on anything they want -- from
roads to schools to tax cuts. If the measure becomes law, there would
be no guarantee that any of the state money would be spent on
anti-smoking campaigns or even on health care.

The settlement announced last November, and eventually ratified by 46
states, did not specify how states could spend the money. But health
advocates assumed that since the states sued to recover
tobacco-related Medicaid costs, a portion of the settlement would go
toward health care.

The White House sought to reinforce that message. President Clinton
said the federal government, which is entitled to a share in the
proceeds of Medicaid suits, would drop its claim if the states would
agree to spend at least 25 percent of their money on health care or
smoking-related programs.

The states insist that the feds have no claim because the settlement
agreement explicitly states that the payments are not a reimbursement
for Medicaid expenses. However, considering that the basis for the
state suits was Medicaid expenses, the feds have a good case.

The states should have taken the White House's deal. Considering the
vast unmet need for health care in every state in the union, it's hard
to imagine that states couldn't find a way to spend a quarter of this
windfall on some health-related program. Some suggestions: expand
Medicaid, provide health insurance for more children and pregnant
women, offer smoking-cessation programs and anti-smoking advertising
campaigns, provide drug and alcohol treatment.

California, which is supposed to get an initial payment of $153
million and a total of $25 billion by 2025, would have no trouble
spending a quarter of that money on health care. Right now the money
is destined for the general fund, and the Legislature will have to
decide how to spend it. So far several bills have been introduced that
would earmark some of it for heart disease, prenatal care, smoking
cessation programs for teens and general health care concerns.

It can be argued, as Wisconsin Gov. Tommy Thompson has, that the
burden of paying for smokers' health care fell on all taxpayers -- and
so all taxpayers should share in the settlement with a tax cut. But
the taxpayers will win bigger in the long run if states take this
once-in-a-lifetime opportunity to invest in programs to improve the
future of public health.