美国国家公共电台 NPR Big Tobacco Spends Big To Block A Tax And Medicaid Expansion In Montana（在线收听）

LULU GARCIA-NAVARRO, HOST:

And now we're going to look at how one issue in one race is playing out. The tobacco industry is pouring money into Montana to fight a ballot initiative that would raise tobacco taxes to pay for Medicaid expansion. Montana Public Radio's Eric Whitney reports that the stakes are high for about 100,000 Montanans benefiting from the expansion.

ERIC WHITNEY, BYLINE: Montana expanded Medicaid, barely passing the state legislature in 2015. And it was with the condition that it would expire in 2019 unless lawmakers vote to reapprove it. The tobacco tax initiative is an attempt to go around the Montana legislature because lots of state lawmakers say Montana simply can't afford it. Fearing they might not renew expansion, Montana's hospitals and other expansion fans came up with a ballot measure this year to keep it going and to pay for it with the tobacco tax.

AMANDA CAHILL: We poked the bear. That's for sure.

WHITNEY: Amanda Cahill works for the American Heart Association and is a spokesperson for the initiative.

CAHILL: It's not because we were all around the table saying, hey, we want to have a huge fight. It's because it's the right thing to do.

WHITNEY: But a huge fight they got. Tobacco companies have spent more than $17 million fighting Montana's initiative so far. And that's in a state with not a lot of smokers - fewer than 200,000. According to the National Institute on Money in Politics, this is the most that cigarette maker Altria has ever spent on a state ballot issue. The company is not talking to the media about it. Ben Miller, the chief strategy officer for the nonprofit Well Being Trust, has studied tobacco and tax policy for years.

BEN MILLER: They're not afraid to spend a lot of money. And I do think that that trend plays out elsewhere.

WHITNEY: Miller says, of course, tobacco companies want to kill new taxes on their products wherever they pop up. But they also have an interest in rolling back Medicaid coverage.

MILLER: People that are covered are more likely to not smoke than people who are uninsured.

WHITNEY: Health coverage, including Medicaid, by law, has to give people access to medical help to quit smoking. And Montana's initiative to keep Medicaid expansion going with a new tax of $2 per pack would be a double whammy for tobacco companies, Miller says.

MILLER: Every time you raise cigarette taxes, price per pack results typically lead to a decrease in people smoking. So that works against their business model, which is, you need to smoke, so we can make money.

WHITNEY: A recent poll shows Montana voters evenly split for and against the proposed tobacco tax. If it fails, a leading expansion advocate in the legislature says that means state lawmakers would be more likely to repeal Medicaid expansion altogether next year. For NPR News, I'm Eric Whitney in Missoula.

GARCIA-NAVARRO: This story is part of a reporting partnership with NPR, Montana Public Radio and Kaiser Health News.