TOBACCO & HEALTHCARE: BUILDING EFFECTIVE COALITIONS TO IMPACT POLICY CHANGE HANDOUT A – SAMPLE MEETING RECAP FORM Meeting Recap Form Date: Organization: Contact Information: Participants: Potential Partner? Concerns: Follow Up? SONDERMANN/E-SQUARED PARTNERS, DENVER, CO TOBACCO & HEALTHCARE: BUILDING EFFECTIVE COALITIONS TO IMPACT POLICY CHANGE HANDOUT B – PURPOSE OF STEERING COMMITTEE Steering Committee Purpose / Objectives Determine if there is the interest / will to go through with the initiative Determine the amount of the tax increase Determine how to divide the revenue Determine if this should be a constitutional amendment or statutory law Determine how to run and fund the campaign SONDERMANN/E-SQUARED PARTNERS, DENVER, CO TOBACCO & HEALTHCARE: BUILDING EFFECTIVE COALITIONS TO IMPACT POLICY CHANGE HANDOUT C – STEERING COMMITTEE GROUND RULES Proposed Ground Rules Group will make decisions based on consensus: Everyone understand and live with the decisions (Fallback: Agree to disagree or organization/individual can choose to leave) One person talk at a time No Shaggy Dog Stories = be concise, do not dominate No personal or institutional attacks SONDERMANN/E-SQUARED PARTNERS, DENVER, CO TOBACCO & HEALTHCARE: BUILDING EFFECTIVE COALITIONS TO IMPACT POLICY CHANGE HANDOUT D – STEERING PRINCIPLES / CORE VALUES Guiding Principles for Determining Tobacco Tax Revenue Allocations 1. Fund sound programs that benefit the health of Coloradans. Funded programs must: a. Be cost effective. b. Have evaluation and accountability mechanisms. c. Have a proven track record. 2. Build a politically viable package. The package must be: a. Supported by the public. b. Able to attract the necessary resources to support the campaign. c. Clear and concise, limited to 3 or 4 areas of funding. 3. Favor programs that leverage money from governmental or non- governmental agencies. 4. Do not duplicate or supplant existing funding. SONDERMANN/E-SQUARED PARTNERS, DENVER, CO TOBACCO & HEALTHCARE: BUILDING EFFECTIVE COALITIONS TO IMPACT POLICY CHANGE HANDOUT E – WAYS TO ALLOCATE TOBACCO TAX REVENUE Proposed Ways to Allocate the New Tobacco Tax Revenue 1. Fund tobacco prevention/cessation services at levels recommended by Centers for Disease Control 2. Fund program(s) to provide prescription drugs to needy seniors 3. Increase prescription drug coverage in ways designed to reduce emergency room visits 4. Expand eligibility for CHP+ and/or Medicaid 5. Increase the network of providers – by expanding existing facilities or creating new facilities – for prenatal and pediatric care, emphasizing underserved populations 6. Improve or stabilize Medicaid and/or CHP+ reimbursement rates for providers 7. Create fund for hospitals to provide health care for the indigent/uninsured 8. Reduce the number of uninsured/underserved in Colorado by expanding and strengthening the private health insurance market 9. Create a statewide, comprehensive cancer prevention, screening and treatment program 10. Provide funding for emergency trauma care and/or development of a statewide trauma system 11. Provide resources for local health facilities to respond to trauma and disasters, including terrorism 12. Expand Cover Colorado, which offers health insurance for those who cannot purchase it from the private sector because of medical conditions 13. Provide funds to counties and local governments for health care programs 14. Provide funding to local non-profit health clinics for uninsured patients 15. Fund tobacco-related researchExpand access to behavioral (i.e. mental) health care to the underserved through the creation of more efficient delivery mechanisms 16. Provide guidance, education and ongoing career support to add health professionals in understaffed fields SONDERMANN/E-SQUARED PARTNERS, DENVER, CO TOBACCO & HEALTHCARE: BUILDING EFFECTIVE COALITIONS TO IMPACT POLICY CHANGE HANDOUT F – SAMPLE POLICY PAPER (Created policy paper for each of the revenue allocation areas under consideration and presented to Steering Committee in order to assist in their decision-making process) INCREASED FUNDING FOR THE STATE TOBACCO EDUCATION AND PREVENTION PARTNERSHIP THE PROBLEM: Tobacco Takes a Devastating Toll on Colorado Tobacco use is the leading cause of preventable death and disease in Colorado, with more than 4,200 Coloradans dying every year from tobacco-related diseases. Tobacco also takes an economic toll in Colorado, producing more than $1 billion in annual health care costs – costs that impact businesses, consumers, health insurers, health care providers and state and local government. Of those total costs, about $250 million are Medicaid dollars. The total tax burden to every Colorado household due to state and federal government tobacco- related expenditures is $501 per year. In the 2000 legislative session, the legislature allocated 15 percent, up to $15 million annually, of the tobacco settlement funds to a tobacco education, prevention, and cessation program administered by the State tobacco Education and Prevention Partnership (STEPP) at the Colorado Department of Public Health and Environment. In the 2003 session, however, the legislature cut funding to just $3.8 million. THE SOLUTION: Fund Comprehensive Tobacco Control Programs Programs Must Follow Best Practices: STEPP programs are designed in accordance with the Centers for Disease Control (CDC) “Best Practices” guidelines for effective tobacco control programs. The programs address three primary areas: 1) Preventing the initiation of tobacco use by youth, 2) Helping current tobacco users to quit and 3) Reducing exposure to secondhand smoke. Programs have been established in local communities throughout the state. Additionally, statewide programs have been established, such as the Colorado Quitline. Comprehensive Programs are Highly Effective: In just the first two years of implementation (2000–2002), STEPP contributed to a 10% decline in tobacco consumption in Colorado. A study published in the December 5, 2001 issue of the Journal of the American Medical Association found that the four states with the nation’s longest running tobacco prevention programs had reduced adult smoking rates at more than three times the rate of other states. Numerous other studies have proven that comprehensive tobacco control programs are effective. SONDERMANN/E-SQUARED PARTNERS, DENVER, CO POLITICAL VIABILITY: According to the Fairbank tobacco tax poll, 72% of the public supports (48% strongly, 24% somewhat) using tobacco tax revenue to increase funding for tobacco education and prevention programs in Colorado. It is expected that several state and national tobacco control organizations will contribute substantial resources to the campaign if tobacco control is a funding recipient. REVENUE ALLOCATION: In order for tobacco control programs to be effective, they must be well-funded and maintained over time. The CDC recommends a minimum spending level for tobacco control of $24.5 million per year for Colorado with an optimum spending level of $63 million. The middle point of this range is $44 million. Providing $35 million annually (80% of mid-level CDC funding) from the tobacco tax would make Colorado’s tobacco control program more effective and protect against further cuts in the tobacco settlement funding. $35 million would make Colorado the leader among all states for tobacco control funding, allowing the state to make a dramatic impact on tobacco use rates. Funding at the CDC minimum of $24.5 million would make Colorado the fifth in the nation in tobacco control funding. Following CDC and current STEPP guidelines, the funding would likely be broken out as follows: 1/3 to youth prevention programs 1/3 to cessation activities for youth and adults 1/3 to secondhand smoke education It is important to look at the level of funding needed for effective tobacco control programs in relation to the amount of money the tobacco industry spends marketing its products every year in Colorado, as illustrated by this graph: Tobacco Industry Marketing vs Prevention Funding in Colorado (Annual Expenditures) $200,000,000 $150,000,000 Tobacco Industry $100,000,000 Marketing Prevention Funding $50,000,000 $0 1997 1999 2001 Source for Industry Marketing: Federal Trade Commission SONDERMANN/E-SQUARED PARTNERS, DENVER, CO LEVERAGING FEDERAL FUNDS: Funding tobacco control minimally leverages Federal dollars. Currently, Colorado tobacco prevention programs leverage about $4 million in federal funding. About $2 million of this is secure funding for the future (CDC funds). EVALUATION: According to the CDC, STEPP in Colorado has one of the strongest evaluation protocols in the nation. Evaluation for the program includes: The Colorado Tobacco Attitudes and Behaviors Survey, which tracks data on adult and adolescent smoking, secondhand smoke exposure, and youth access to tobacco. Other systems to track tobacco use rates, such as the Youth Tobacco Survey and the Behavioral Risk Factor Surveillance System. Extensive internal evaluation protocols to measure qualitative successes. SONDERMANN/E-SQUARED PARTNERS, DENVER, CO TOBACCO & HEALTHCARE: BUILDING EFFECTIVE COALITIONS TO IMPACT POLICY CHANGE HANDOUT G – PROGRAM / PRINCIPLE MATRIX Program / Principle Matrix *This does not include program descriptions. For descriptions of the need and solution please refer to the 1-page policy proposal. Comprehensive Expansion of Federally Qual. CoverColorado Rx Drugs for Needy Tobacco Control & Trauma/ Cancer Control CHP+/Medicaid Health Centers Seniors, Disabled Prevention Disaster Prog. Political 74% Support 78% Support 73% Support 79% Support 80% Support 72% Support 72% Support Viability (48% strongly; (56% strongly; (44% strongly; (49% strongly; (59% strongly; 21% (48% strongly; 24% (42% strongly; 26% somewhat) 22%somewhat) 29% somewhat) 30% somewhat) somewhat) somewhat) 30% somewhat) Revenue $50 Million $40 - $60 M, $10 - $20 M, $5 - $10 M $40 - $100 M, $35 Million $5 - $10 M Allocation depending on depending on depending on level of level of coverage level of coverage coverage Evaluation Ongoing eval. thru CHP+/Medicaid Data collected by Regulated by To be run by existing STEPP already tracks Mock disaster cancer surveillance already have data HHS; local Div.of Insurance; agency with tracking data on tobacco- exercises and and need and cost collection and quality assurance submits annual and evaluation related matters and subsequent analysis reporting program with fiscal audits to systems in place has internal evaluation to processes in data reporting Insurance evaluation protocols assess multi- place systems exists Commissioner agency response Existing Partially Yes Yes Yes No in CO; yes in 28 Yes No Program? other states Leverage Yes Yes Yes No Potentially Yes Unknown Federal $? Campaign Board of CO. Important to FQHCs would Could bring AARP would provide Brings national Unknown Resources Cancer Center Hospital provide fiscal health insurers to in-kind support tobacco control could help Association support the table organizations Fairbank, Maslin, TOBACCO & HEALTHCARE: BUILDING EFFECTIVE COALITIONS TO IMPACT Maullin & POLICY CHANGE Associates HANDOUT H – FMM&A POLLING MEMO ON AUG. ’04 POLL TO: Interested Parties FROM: Fairbank, Maslin, Maullin & Associates RE: Results of Tracking Survey on Amendment 35: the Healthier Colorado Initiative DATE: September 20, 2004 Fairbank, Maslin, Maullin & Associates (FMM&A) recently completed a tracking survey of Colorado voters to evaluate their support for Amendment 35: the Healthier Colorado Initiative.1 The survey measured shifts in public opinion that have taken place since the baseline survey was conducted in June 2003. The recent survey reveals that, after voters heard the full ballot language, a 59 percent majority said they would vote Yes in favor of the initiative. This overall level of support has decreased slightly over time, by five percentage points. The strong support for the measure (or those who say they will “definitely” vote Yes) continues to be at 36-37 percent and one-third (33%) are still opposed to the measure. The proportion of voters who are undecided on the measure has increased to 8 percent. Figure 1 below illustrates these findings. FIGURE 1: The Vote on 35: The Healthier Colorado Initiative May 2003 August 2004 Definitely yes 37% Total 36% Total Probably yes 25% Yes 22% Yes 64% 59% Undecided, lean yes 2% 1% Undecided, lean no 1% 1% Total Total Probably no 10% 8% No No Definitely no 22% 33% 24% 33% NMI/DK/NA 3% 8% 0% 10% 20% 30% 40% 50% 0% 10% 20% 30% 40% 50% While the survey results reveal that support has weakened somewhat, they also clearly show that once voters learn more about the measure, the level of support increases significantly. With a relatively soft “definite” yes vote, the campaign cannot continue to lose support. Therefore, it is critical that the campaign communicate the importance of the initiative to Colorado voters, highlighting what the measure does and its benefits to Colorado residents. This effort will prove to be extremely effective throughout the rest of the campaign. At this point, the base of support for the tobacco tax initiative comes from Democrats (particularly those under 50), highly educated voters, voters under age 50, women (particularly those under 50), and those who reside in the Pueblo/Colorado Springs media market. However, the level of support - across the electorate - can be increased substantially once voters hear arguments in favor of the initiative. Indeed, support increases among men, women, voters of all races, political parties, and geographic areas. When voters understand that tobacco tax funds will be provided for cancer prevention and treatment programs, and for tobacco education and cessation programs that reduce the risk of heart and lung disease, their support for the initiative increases. Those messages that were particularly persuasive include: Some of the top causes of death in Colorado are cancer, heart disease, lung disease and stroke. This measure will help to prevent, detect, and treat these deadly diseases and save lives in Colorado. More than one-third of Colorado high-schoolers use tobacco. This measure will increase the tax on tobacco and fund tobacco education and prevention programs—two proven ways to stop teenagers from beginning to smoke. And for every three kids who are prevented from smoking, there is one less smoking death in the future. The state tax on cigarettes in Colorado is 20 cents, less than one third of the national average. Colorado ranks 49th out of 50 states in the tax on cigarettes. The only state in the U.S. that has cheaper taxes on cigarettes is Kentucky, a tobacco producing state. This measure will bring Colorado’s tobacco tax in line with the national average. This initiative includes strict accountability measures including guaranteed financial and performance audits, regular spending reports listed on the Internet and in local libraries across the state, and a blue ribbon panel of experts to ensure that the money is spent efficiently, effectively and as promised. Once voters heard these various statements in favor of the measure, the level of support increased 5 points from 59 percent to 64 percent. Even more striking, the “definite yes” increased 8 points from 33 percent to 41 percent. Clearly, voters are more likely to vote in favor of the initiative once they learn more about it. In sum, the results suggest that this is a winnable initiative, but the campaign must continue to put forth a comprehensive and well funded effort that communicates the benefits of the Healthier Colorado Initiative to the voters. 1 Methodology: From August 15-18, 2004, Fairbank, Maslin, Maullin & Associates (FMM&A), conducted 600 telephone interviews among likely voters in the State of Colorado. The margin of sampling error for the full sample is +/-4.0%; margins of sampling error among the subgroups within the sample will be higher. This survey tracks the results from a previous poll of 600 Colorado voters conducted May 29- June 5, 2003.
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