AUGUSTA — A battle is brewing between the LePage administration and public health advocates over the administration’s plan to cut $20 million over two years from a public health fund that pays for anti-smoking programs.

The administration says the funding reduction will allow the state to maintain reimbursement rates for primary care doctors who work with MaineCare patients and for other health initiatives. Public health advocates, however, say the move could decimate the Fund for a Healthy Maine, a program that allocates money from the 1998 State Tobacco Settlement to smoking prevention and cessation.

The proposal is embedded in Gov. Paul LePage’s $6.3 billion budget, a two-year spending plan that contains a broad set of policy initiatives. LePage has previously made a number of cuts to the Fund for a Healthy Maine, which has received high marks from anti-smoking advocates because it specifically directs a portion of Maine’s annual share of tobacco settlement funds toward prevention and cessation.

On Monday, the Maine Department of Health and Human Services issued a detailed explanation of the proposal, arguing that Maine’s investment in the Fund for a Healthy Maine duplicated federal initiatives and that the $215 million the state has spent on prevention and cessation since 1993 has not produced a corresponding reduction in smoking rates.

The DHHS policy brief also argued that diverting $20 million into other health programs would produce better outcomes because the money would be used to maintain reimbursement rates for primary care doctors and another initiative that connects MaineCare recipients with doctors. MaineCare is the state’s version of the Medicaid health insurance program for low-income residents.

DHHS Commissioner Mary Mayhew told lawmakers last week that the tobacco settlement funds must be evaluated. She said the governor’s proposal is designed to invest in primary care, which studies have shown is an effective deterrent in convincing people to quit smoking.

Ed Miller, public policy director at the American Lung Association for the Northeast, said health advocates completely supported the administration’s goal of funding primary care doctors, but pitting smoking cessation programs against funding for prevention is a “false choice.”

“We totally agree with the administration that we need to do more in primary care,” Miller said. “It’s on the front lines of treating disease and helping prevent it. In many cases, the physician is a prime motivator to help somebody quit smoking and to refer them to where they can get treatment.”

However, he said, helping people quit is only half the battle against smoking.

“We need to have a strong public health structure within this state to prevent chronic diseases, including tobacco-related diseases – not just treat them after they occur,” Miller said. “We need to have a system out there that’s discovering them early.”

HIGH RANK IN CESSATION SPENDING

Advocates say that’s the benefit of the Fund for a Healthy Maine. The program was created to ensure that some settlement fund money was funneled into anti-smoking programs and treatment. The 1998 tobacco settlement gave states complete discretion over the funds received. Maine has been a national leader in putting the money into prevention programs.

Maine will spend $8.2 million in settlement and tobacco taxes on cessation programs during the current fiscal year, according to an annual report by the Campaign for Tobacco-Free Kids. The allocation is only 51 percent of the level recommended by the federal Centers for Disease Control and Prevention, yet Maine ranks seventh in the country in overall spending on cessation. Only North Dakota and Alaska met the CDC funding recommendations in 2014. Many other states are plowing settlement dollars into other initiatives or to balance state budgets.

In 2014, states budgeted $490.4 million in tobacco-use prevention, 14.8 percent of the $3.3 billion recommended by the CDC, according to the Campaign for Tobacco-Free Kids report.

Miller said that diverting money from the Fund for a Healthy Maine and its Healthy Maine Partnerships – which organize tobacco prevention programs at the school and community level – is shortsighted. He said the Fund for a Healthy Maine had reduced cigarette smoking rates among high school students by 67 percent since 1997.

CALL TO RAISE CIGARETTE EXCISE TAX

The administration could maintain reimbursement rates for physicians while protecting the Fund for a Healthy Maine by raising the state excise tax on cigarettes, Miller said. Research has shown that the prevalence of youth smoking decreases with the price of a pack of cigarettes.

Maine currently assesses a $2 tax on a pack of cigarettes, tying it with four other states for the 11th-highest rate in the country. The state has the second-lowest cigarette excise tax in New England. It last raised its excise tax in 2005.

The governor has proposed an array of tax changes and increases in his budget, but the cigarette excise tax is not among them.

“We were once the leaders in excise taxes, now we’re right down there with New Hampshire with one of the lowest rates in the Northeast,” Miller said.

The administration countered Monday that by maintaining MaineCare reimbursement rates, its plan will bolster programs designed to link recipients with doctors. It cited state data showing that MaineCare recipients are twice as likely to smoke as the general population. MaineCare spending on smoking cessation is $1.9 million, including $734,533 in state money.

Additionally, the administration said Maine doesn’t need to duplicate federal anti-smoking campaigns. According to the DHHS policy brief, the federal CDC distributes about $1 million to the state for cessation and prevention activity.