We've had the highest sales rate to children of cigarettes in the State. We have brought it down much lower, it's a 117 5/24/00 PUBLIC HEALTH - RES. 000042 much bigger percentage that we've brought it down than in any other part of the State. At this point, we're lower than some of the other parts. And we have the best and the strongest law in the State. It's a model. We get calls from all over the State, we've gotten calls from outside of the State for our legislation because other people wanted to use it in trying to develop their own. So that's been a real success story, and a lot of partners have helped make that possible.
Could you kind of summarize. I mean, I think the record has been documented about the statistics and the proposes and things of that nature. Could you summarize yours?
I will be very brief. I only have two pages, and I will move through it 118 5/24/00 PUBLIC HEALTH - RES. 000042 pretty quickly. I'm Chairman of TEACH and past president and current executive committee member of the Coalition for a Tobacco-Free Pennsylvania. I appreciate the opportunity to testify here today. I appreciate the committee's courtesy in moving us up in the order. Actually, we have a press conference coming up in minutes or so. 10 I can't help but note that the 11 circumstances of today's hearings could have been 12 very different from what they are today. If 13 Philadelphia had filed suit against the tobacco 14 companies as a number of other cities had, such as 15 San Francisco, the hearing today would be on how Philadelphia should spend the money -- the millions of dollars that we would be getting directly from the tobacco companies. Now we have a settlement that not only limits Philadelphia's ability to sue the tobacco companies in the future, but also fails to earmark any money for the cities of Pennsylvania, including Philadelphia. Another unfortunate aspect of the settlement is that none of the money going to the 119 5/24/00 PUBLIC HEALTH - RES. 000042 State is earmarked for the purpose of reducing tobacco use and the billions of dollars in treatment of the diseases that it costs us. This has given license to everyone and their brother to stake their claim on the money; hence, the division that you're trying to overcome here. Now, I think the Ridge Administration did an admirable job of weeding out many of the tangential purposes and proposed allocating 11 percent of the settlement to comprehensive and 12 sustained tobacco prevention and cessation 13 programs. S. Centers for Disease Control and Prevention. We would like to see the General Assembly provide the additional funding required to bring us in line with the CDC recommendation of spending between 65 and $184 million annually so that we can reduce the scourge of tobacco-related disease in the State, with it's massive human and financial costs. Shortchanging the programs to reduce tobacco use, which have proven to be successful in California and Massachusetts, would only doom us 120 5/24/00 PUBLIC HEALTH - RES. 000042 to spend more for treating tobacco-related diseases than we receive in tobacco settlement payments. So it would ultimately be counterproductive. Now, the State Health Department is in the process of developing a plan to implement the programmatic elements recommend by the CDC to reduce tobacco use. We wholeheartedly endorse this approach. It includes counter-tobacco advertising, school-based programs, enforcement of laws against selling tobacco products to minors, smoking cessation programs, chronic disease programs, and community-based programs. It is my understanding that the State Health Department currently plans to allocate most of its tobacco control funds to county and municipal health departments and drug and alcohol prevention authorities for community-based programs. There's a very good reason for doing this. In Pennsylvania, as well as the rest of the nation, we have had the greatest success in reducing tobacco use through local initiatives. In Philadelphia, for example, we have the best law in the state for reducing illegal 121 5/24/00 PUBLIC HEALTH - RES. 000042 sale of tobacco products to minors, and the law has helped us cut these illegal sales in half. Our mass transit system was the first in the State, I believe, to accept no tobacco advertising. And if City Council adopts Councilman Nutter's proposal to curtail nonsmokers exposure to secondhand smoke, one of the CDC's four primary goals, we will once again provide leadership for the rest of the State. There are other organizations in the State, however, which are attempting to divert funding for reducing tobacco use to their coffers, I'm afraid.
Some have denigrated the effectiveness of tobacco control measures, even though research has shown tobacco control and cessation programs to be the most cost-effective way of reducing cancer deaths. Some have warned against duplication of programs coming out of the National Foundation, but this foundation was never intended to substitute for State-funded programs. Other statewide organizations have been trying to change the State Health Department's plan to allocate most of its tobacco control funding to local government agencies. 122 5/24/00 PUBLIC HEALTH - RES. 000042 I urge the City to lobby hard for full funding of tobacco control programs, in line with the CDC recommendations, as well as the State Health Department plan to fund local government agencies. The City's ability to sue the tobacco companies is curtailed by the State settlement. It is imperative that the State provide adequate funding to the City, therefore, to reduce tobacco use. Thank you.
Thank you very much. Do you have any idea why we didn't sue?
Thank you. As we have to do a lot of things. Thank you very much. We appreciate your testimony and look forward to hearing you this afternoon, I imagine.
Yes. Thank you very much. 123 5/24/00 PUBLIC HEALTH - RES. 000042
Dr. Lawrence Frame, American Heart Association. (Witnesses come forward.)
Good afternoon. I'm Dr. Lawrence Frame, a cardiologist and past president of the American Heart Association, Pennslyvania-Delaware affiliate. ) from the American Lung Association. I'm here representing a coalition of these three statewide organizations: the American Heart Association, the American Cancer Society, and the American Lung Association. We have joined together to help ensure the well-being of Pennsylvania's benefits from the settlement monies by promoting effective tobacco prevention and cessation programs. You have before you our detailed plan called "A Call for Action," which is included with the statements. Our basic goals are two. First, we recommend that the entire settlement funds be directed to new health initiatives; second, we as that a substantial portion of the monies be used 124 5/24/00 PUBLIC HEALTH - RES. 000042 to fund a comprehensive tobacco control program that prevention, treatment, education, cessation, and research. Tobacco is the single largest preventable risk factor for stroke, cancer, heart disease, and lung ailments such as emphysema in our Commonwealth. Each year, over 23,000 deaths are linked to tobacco in our state. Our agencies are asking for funding for our own programs. Instead, we are advocating a comprehensive approach to tobacco control. We need a plan that will be sustained over time, use community partnerships, enforce our youth access and secondhand smoke tobacco laws, help Pennsylvania smokers quit, teach our children the dangers of tobacco use, investigate approaches to cessation and prevention through biobehavioral research, evaluate our results, and implement the best practices. Our proposal follows the Center for Disease Control guidelines in terms of what a comprehensive tobacco control settlement is. I'm not going to read the details of our proposal, but it has multifacets that are detailed in the Call 125 5/24/00 PUBLIC HEALTH - RES. 000042 to Action description. It is based on proven programs and strategies such as those that have been shown to prevent people from starting to smoke or reduce smoking consumption in the leading state such as Massachusetts, Florida, and California. We applaud the Governor's position that all of the funds should be used for health initiatives. The Governor has also outlined a proposal that includes percent of tobacco 12 settlement monies to be directed to cessation and 13 prevention programs. 14 A statewide nonpartisan task force or 15 commission consisting of the appropriate state department secretaries, private health sector experts, and voluntary health organizations should be established to oversee the distribution and use of these settlement funds. This funding should then be directed to local multi-county lead agencies across the Commonwealth, which have submitted proposals to a State board comprised of experts in the field of tobacco cessation and prevention. Local communities, such as the City of 126 5/24/00 PUBLIC HEALTH - RES. 000042 Philadelphia, should have input into these local lead agencies and be able to submit proposals for funding. Using the lead agency model, Philadelphia would able to fund local programs that follow the CDC guidelines for best practices. What could this funding do for Philadelphia and Pennsylvanians? We've already heard that in Pennsylvania, 35 percent of high school students, 63,000 kids under the age of 11 become new daily smokers each year. That means 12 today that as we speak, 150 of our Commonwealth 13 children will start using tobacco. 14 Smoking claims the lives of 23,000 15 Pennsylvanians each year, and an estimated 274,000 16 Pennsylvania children who are under the age of 18 17 will die prematurely from smoking unless we can 18 stop this trend. By acting now, these are lives that could be saved. By acting now, we are helping our children grow up tobacco-free. By acting now, we are ensuring a healthier tomorrow for Philadelphians and Pennsylvanians.
The Commonwealth has an unprecedented opportunity to invest in education, treatment, and 127 5/24/00 PUBLIC HEALTH - RES. 000042 research that will significantly improve the health of Pennsylvanians in the coming century. We all have to remember that the reason why there's a huge pool of money here, the tobacco settlement, is because of the tremendous negative impact that tobacco has on the health of our communities. Therefore, we owe it to your constituents and our fellow citizens to institute effective programs that will decrease this smoking problem; otherwise, we will see increases in tobacco addiction and continued economic effects that will arise for decades to come. Our coalition and its thousands of volunteers across the State of Pennsylvania encourage Councilmembers to join us in a call insisting that 15 percent of all tobacco settlement funds be directed toward cessation and prevention programs. We also want to see that programs follow the CDC guidelines for best practices and are comprehensive in scope and nature. Thank you for this opportunity to comment.
Thank you very 128 5/24/00 PUBLIC HEALTH - RES. 000042 much. Thank you very much for your testimony and for the documentation. That certainly will be helpful as we moved forward on this issue. Thank you.
Cheryl Weiss, 21st Century League. UNIDENTIFIED PERSON: She left.
Okay. Evonne Tisdale, Richard Weishaupt, Stepheni Trott-Batipps, Jacqueline Rigney. (Witnesses come forward.)
Good afternoon. State your name for the record, please.
My name is Evonne Tisdale, and I am the Assistant Director of the Philadelphia Unemployment Project. I am also here representing the Consumer Health Coalition, which is a broad-based statewide coalition of groups who came together in an effort to ensure that these tobacco dollars were being used for health care; more specifically, for uninsured adults in Pennsylvania.
You may testify, 129 5/24/00 PUBLIC HEALTH - RES. 000042 go ahead.
I'm going to try to be brief 'cause I know we're running behind time, but I'd like to thank you for inviting me to testify here this morning on this very important subject. As I mentioned, I am here representing the Consumer Health Coalition and the Philadelphia Unemployment Project. And basically what I do is I do run a health rights hotline for the Philadelphia Unemployment Project where Philadelphia citizens call in, trying to access health care. And my job is basically to try and get them any available resource that is possible here in Philadelphia. More and more recently, the resources for the uninsured has been shrinking, while the number of uninsured have been increasing. More than 75 to 80 percent of calls that I receive are from uninsured adults who are working here in Philadelphia, who either cannot afford to purchase insurance through their employers, or they are either not able to afford them. When we heard about the tobacco settlement funds, basically we saw this as a 130 5/24/00 PUBLIC HEALTH - RES. 000042 window of opportunity for us to really try and make an impact on the severity of the uninsured not being able to get the needed health care. We came together -- or I basically contacted groups in the Philadelphia are and throughout Pennsylvania who I know are advocates for the uninsured, for them to come together to work on putting -- really ensuring that the State legislature put these dollars into the means of health care. All of the funds received by the State -- we came up with several principles, and I'll just briefly go over them. That all of the funds received by the State should be spent on health care. Claims against the tobacco industry were based on the fact that the state and local governments had spend billions of dollars over the years treating tobacco- related illnesses, so we see that proceeds from the settlements, therefore, should be funneled back into health care. We felt also that funds should be provided to health care for the uninsured because the poor and uninsured have less access to health care and a lack of health insurance. It is a 131 5/24/00 PUBLIC HEALTH - RES. 000042 major barrier for them getting the care for the illnesses that they have. In Philadelphia, we have approximately 100,000 people who are uninsured. Over percent 6 of that population are adults who are between the 7 ages of 18 and 64. Seventy percent of those 8 uninsured are working adults who are working in 9 house households, as I mentioned, where they do 10 not have health insurance because they can't 11 afford it or their employers don't basically offer 12 it to them. In addition to that, more than 21,000 13 families within last year, between '98 and '99, 14 who left the welfare rolls fell into this pool of 15 uninsured. 16 The political climate of today suggests 17 that everyone should be working and that our 18 citizens should become self-sufficient, pay their 19 taxes, and do what we consider to be the right 20 thing, but we must also ensure that they are healthy. And the uninsured only depend on the provisions of uncompensated care and charity care from our city health centers and hospitals to get the care that they need. Currently, 63 percent of the people now 132 5/24/00 PUBLIC HEALTH - RES. 000042 serviced by our city health centers are uninsured. They are receiving free care because they have no health insurance, and the financial burden on our city and its health centers will eventually erode their ability to provide services, and we will continue to see the decline and elimination of health-care services, jobs, and institutions here in Philadelphia. As I mentioned earlier, the tobacco settlement funds was an opportunity for us to see ways of stabilizing the resources for the uninsured. This tobacco money is free money, and Governor Ridge has already proposed that these funds be used for health care.
He wants to allocate 40 percent, which is approximately $160 million a year for the next years, to a 18 State-funded health insurance plan for uninsured 19 adults. 20 There are some concerns with the 21 specific, which Richard will address, I guess, 22 with the Governor's health insurance plan, and 23 I've also included that in a packet that I gave 24 with my testimony. But overall, the Governor has 25 basically put together a good plan. It is a good 133 5/24/00 PUBLIC HEALTH - RES. 000042 start. But, unfortunately, arguments are being made by State legislators to reduce the 40 percent for the uninsured. It is being said that this program will be underutilized by uninsured Pennsylvanians, and in all likelihood, for the first year or so, this may be true. We understand it will take time to put together a new health program, to get it up and running, and for the citizens to become aware of the plan. But this money should remain available and accessible for use in programs for the uninsured. The Governor has also indicated that he would use -- that any unused funds would have to go into what they call "a rainy day fund," where it would take two-thirds of the legislature to release it and, therefore, after its release, it could be used for whatever means necessary that they deem necessary. If this money, the 40 percent, is reduced and the number of uninsured are allowed to continue to rise, we will continue to see the further decline of health care resources here in Philadelphia. We are a part of, as I said, the 134 5/24/00 PUBLIC HEALTH - RES. 000042 statewide coalition who has been lobbying in Harrisburg for the past several months to ensure that the funds for the uninsured stay at 40 percent. Part of our message to legislators has been that any unused funds by the uninsured health plan should go to facilities that actually basically use or have a high disproportionate share of uninsured, such as City health centers or rural health centers and our hospitals. Health centers are first points of contact in the health care system for many of the uninsured. People can be enrolled into the health centers -- excuse me, can be enrolled through the health centers into the new health insurance plans. And also, the health centers, thereby, would be paid for their services. When we go to the State legislators, time and time again, they have responded to us by saying, We haven't heard anything from the City regarding funding for the health centers. Unfortunately, we cannot respond to them as to the reason why. It is surely not because there is not a need. There a window of opportunity for Philadelphia to make an impact on these decisions, 135 5/24/00 PUBLIC HEALTH - RES. 000042 and we're here asking you to do so now. We encourage City Council and the Mayor to make every effort to influence the debate publicly and behind closed doors with those key legislators that will decide the outcome of this debate. Philadelphia's uninsured cannot afford for you to watch the tobacco settlement parade go by. And as I said, the groups that are in this coalition are statewide. We have about 75 groups that meet or that are interested in really taking this debate to the legislators. And I want to pass this on to Richard so that you can get a detailed explanation as to why the Governor's plan needs some work, but we do need the City Council at this point to really make an impact.
Before we move to the next witness, your name is Mr. -- help me out.
Weishaupt. In your visits to Harrisburg, have you met with both sides of the aisle, both the Rs and the Ds?
Okay. And the coalition you're referring to is what Henry Nicholas spoke to earlier in his testimony?
Thank you. And in the interest of time, I'll be very brief. We're concerned that the 40 percent that's earmarked for insurance be used for health care of the uninsured. And we all know that it will take a while to sign people up, it will take a particularly long while if the Governor's plan to have a $30 premium stays in effect, because experience in other states suggests that if the amount is that high, no one will sign up for the insurance. Because for people at or below the poverty level, $30 a month just doesn't seem like a wise choice of where to use their money. The first reaction that we have when we talk to people in the Health Department about this 137 5/24/00 PUBLIC HEALTH - RES. 000042 was, Could we pay the $30 insurance premiums for them? because we're going to be the ones that are left holding the bag if people don't have the insurance when they come through. It would make much more sense to put the insurance premiums on a sliding scale so that people could afford them and make them basically free for people below the poverty level. The CHIP Program charges a premium for families above 200 percent of poverty, and that part of the CHIP Program is extremely underutilized. Even the modest premiums that the CHIP Program charges, and even given the fact that most families and most adults will sacrifice so that their children can get health care, even that program is way under-subscribed. And if we put a $30 premium on this, people aren't going to take it. Assuming we get over that hurdle, the question is, Well, it's going to take some time to get people signed up, what should the money be used for in the meantime? We don't have a problem going with it going to legitimate health care agencies that provide services to the uninsured. 138 5/24/00 PUBLIC HEALTH - RES. 000042 We are concerned, though, that the money will be spread too thin to every hospital and every health-care provider in the Commonwealth who comes forth with a tale of woe. The money needs to be earmarked for the hospitals and institutions that provide some degree of accountability and some degree of access to people without insurance. It can't be going to every hospital merely because they are a hospital. There isn't enough money to go around to make this into a broad-based grant program to every health care agency in the entire Commonwealth. It needs to be earmarked, it needs to be identified, and there needs to be accountability so that it's simple to administer, but at the same time, it goes to the institutions that are closest to the brink of disaster. Mr. Nicholas talked about that earlier. It needs to go to those institutions so that they can remain open and serve the communities where large numbers of the uninsured are found. That basically is it. I could talk a lot longer, but it's late and I know there are other people behind us that want to testify. 139 5/24/00 PUBLIC HEALTH - RES. 000042
Again, with regards to the CHIP Program, and always recognizing that there's several sides to one story, one point of view, or one fact, even, what's your view on why the CHIP Program is underutilized?
Well, I don't think it's any one thing. And I would say that I spend a lot of my time trying to work on getting more kids into the Medicaid program and into CHIP. One study that we have seen from California suggests that a good way to sign up more families in CHIP Programs is to offer insurance for the entire family, because at least for some families, it may be that the children are older and they're not in that age where they need to see the doctor all that often. I mean, they should see the doctor every two years or so, but, you know, teenagers don't need to see the doctor all that often for checkups, and a lot of them are resistent to that. The way to reach those families, or at least some of them, is to offer comprehensive insurance both for the children and for their 140 5/24/00 PUBLIC HEALTH - RES. 000042 parents, 'cause some of the parents have health problems, and if you could offer one package that would bring the whole family in and say, Here, we can provide some level of coverage for everybody in your family, we could insure a lot more people. And there are suggestions that states that have gone that route have had better success in signing people up for CHIP. And so one of the suggestions we have is for people with families is to run this program in conjunction with the CHIP Program so that one stop, one application gets people -- everybody in the family access to health insurance.
My name is Stepheni Trott-Batipps, and I am a member of the 141 5/24/00 PUBLIC HEALTH - RES. 000042 Philadelphia Unemployment Project, the Pennsylvania Consumer Health Coalition, but most important of all, I am a member of the 1.2 uninsured. And as I sat here listening -- and I had something prepared and I'm going to make this part brief too -- I couldn't help but notice that no one was talking about the uninsured. I couldn't help but notice that you look at it as most of the uninsured at certain income levels and certain things that are happening to them. But there are a lot of factors for many people to be uninsured, there are a lot of factors why it's most critical to have some health coverage. Many of your uninsureds (sic) are working uninsureds, and they themselves cannot afford it. I myself, through a divorced, could not afford COBRA because $570 a month is way too much when I am a single parent taking care of a child who's 6-foot-1-1/2 and wears a 13-1/2 shoe and is only 13 years old. So, therefore I could not afford it. The only thing I was able to do was to get CHIP for him. However, it was a lot of red 142 5/24/00 PUBLIC HEALTH - RES. 000042 type, a lot of running around. The information was not easily accessible. I would like to see, as Richard has mentioned, as Evonne has mentioned, an adult-like program where I, too, can take benefits for myself as well as my child. Because within one year's time, we're going to be in a Catch 22. My child will no longer be eligible for CHIP, he will be out of insurance, I will be out of insurance, we will not be able to afford the premiums, they will be still higher. And yet and still, I have a rare enzyme disease which causes me to go into what they call "Steven Johnson syndrome." I break out in hives, I go into respiratory failure, and sometimes, I have seizures. As I live here in a glass bubble, I have to say, Well, I still have to go on, I have a family to support, a child to raise. I make sure that he gets the best treatment, and he has a heart murmur and asthma. So you see, the uninsured is looked at in a different light. And while we lobby and we argue for a lot of other points, let's talk about lobbying for who needs it. I'm glad that Governor Ridge proposed 40 percent of the money to go to 143 5/24/00 PUBLIC HEALTH - RES. 000042 the uninsured, I'm glad to see that there are advocacies like with the Pennsylvania Consumer Health Coalition thinking about the uninsured, thinking about what we really need, and not just saying, Well, this is another agency to pass it on to. Smoking cessation, all of those I agree with. I agree that there's a lot of health problems, but I don't hear anyone agreeing about what to do with the uninsured. And as I said, I'd make this short, so please think about the City becoming involved. I use your facilities, I use the City health centers, I use the emergency rooms at hospitals, but that's not enough if the funds dry up, so please think about that. And thank you.
You're welcome. The beauty of this type of forum, public hearings, is that it allows all who care about an issue to register where you are with that issue. And you've spoken to the next step, which is to reach through a strategy, that Councilwoman Tasco has already spoken to, trying to come to 144 5/24/00 PUBLIC HEALTH - RES. 000042 grips with priority consensus, if there's such a possibility, as we move to submit a formal set of recommendations to Governor Ridge. But be encouraged, because that's the beauty of this kind of forum, so that we, on this side of the table, don't miss any possibilities of what should be in that ultimate document. Okay? Thank you very much.
Thank you very much for your testimony. Bill Godshall and Marcia Hinnershitz. (Witness comes forward.)
Bill, I believe, is across the hall at a press conference.
And he'll be back with us. My name is Marcia Hinnershitz. I'm President of the Coalition for Tobacco-Free Pennsylvania. And I know in our discussions this morning and this afternoon, we talked about the importance of who supports you. 145 5/24/00 PUBLIC HEALTH - RES. 000042 Our coalition is representative of over 50 organizations, diverse organizations across Pennsylvania, who came together to look at the issues that tobacco brings to our state, and we are concerned. I also serve as a child advocate and I work as a prevention specialist with the Single County Authority in Berks County. And one of our concerns has always been, how do we promote the health of our children? And what we have found in looking at the issue of smoking -- and I know you've heard this already -- is that smoking really is one of the major causes or health concerns for our children. And if you look at issues around drugs, murders, violence, AIDS, all major health concerns, and you put them all together, it doesn't really amount to what smoking really brings to the health care costs of our country. Unfortunately, none of these problems have easy solutions, and tobacco prevention doesn't either. We are confronted with billions of dollars being spent by the tobacco industry to be able to encourage our youth to smoke. We have 146 5/24/00 PUBLIC HEALTH - RES. 000042 a formidable obstacle. And in Pennsylvania at this point, we do not have a single consistent source of funding for tobacco prevention or smoking sensation. We really need to address the significant gap in health care services. The Master Settlement Agreement, of course, offers an opportunity. The goal of the settlement was clear and direct: to reduce the burden of illness and disease caused by past and future tobacco use. When the Master Settlement Agreement became a reality in Pennsylvania, the Coalition for a Tobacco-Free Pennsylvania developed a proposal following the guidelines of the Center for Disease Control, basically requesting that percent of the tobacco 17 settlement dollars be directed to tobacco control 18 programs. We wanted to model those programs over 19 what we know has been successful in other states. 20 We know that we don't need to reinvent the wheel. 21 In January, Governor Ridge presented 22 his health investment proposal. And, again, he 23 presented an emphasis on tobacco prevention, but 24 unfortunately, only a 15 percent designation for 25 tobacco prevention, including smoking cessation. 147 5/24/00 PUBLIC HEALTH - RES. 000042 What Governor Ridge's administration was able to recognize, though, is that we do have an infrastructure in place in Pennsylvania that can effectively administer the tobacco control programs. The Department of Health and our single county authorities have already set in place experience with contract management, data collection, and quality assurance, and have been recognized by the Governor to serve as lead agencies. What I think is important to understand about both the Department of Health and our single county authorities is, we have experience in reaching out to community organizations to engage in diversity. We know that if you're going to implement effective programs, it can't be a cookie-cutter approach, that each community's going to be different. What works in Philadelphia may not work in a rural area of Altoona, okay? So we see this as being the most effective approach, which is really to look at what communities need and designing those programs to work effectively within each community. We also know that prevention does work. 148 5/24/00 PUBLIC HEALTH - RES. 000042 Unfortunately, in the dialogues that have gone on recently, we've heard people say, Well, prevention doesn't work. We only need to look to other states that have had well funded programs. In Florida, amazingly, a 54 percent drop in use of tobacco by middle school youth because they were able to have a comprehensive program.
We become concerned if funding is not consistently directed to tobacco prevention, we may lose out on an opportunity to really impact on the health care. When we talk about unfunded health care, if we're able to be successful in prevention, we might down the line not be able to be as concerned about the health care cost because they indeed will be reduced. One of the things in coming to Philadelphia -- and I really feel honored sitting here in the City Council. It was one of my dreams as a social worker when I attended Temple University to be speaking to City Council. " We can't forget that because that's real, and we can make a difference in prevention. 149 5/24/00 PUBLIC HEALTH - RES. 000042 I've included in my presentation some suggestions for effectiveness in prevention programming. One thing we do know is that school-based programs, as has been stated earlier, curriculum can be effective. We've seen that in drug and alcohol prevention. We need to build on those models, but we need to make sure there's a consistent, discrete source of funding for tobacco prevention programs, or we're just going to continue to spin our wheels and generate more health care costs rather than reducing the health burden on both this city and on Pennsylvania. I thank you.
Thank you very much for your testimony. Thank you very much. Joe Minott, Clean Air Council. Could we have Shelah Harper, Chairwoman of Board of Citizens Public Health Centers. We'll make this sort of like a panel since you all represent similar interests. (Witness comes forward.)
Good afternoon. Please state your name for the record.
My name is Joseph Minott. 150 5/24/00 PUBLIC HEALTH - RES. 000042 Shall I start?
Good afternoon. I am Joseph Minott, and I'm the Executive Director of the Clean Air Council of Philadelphia. I am an attorney, an environmentalist, a soccer coach, and a community activist. I am the full-time Executive Director of the Clean Air Council, but my most important role is that of father. My son, Christopher, is an active ten-year-old. He loves to play soccer and basketball. He also an asthmatic. I do not know how many of you in this room today have had to deal with a child that has had to be rushed to the hospital because he could not breathe, or even had to explain to a child that he needs to skip a soccer game air because of air pollution, indoor or outdoor, is making him wheeze. If you have asthmatic member of your family, you will understand the urgency I feel on this topic. The Clean Air Council is a member- supported nonprofit organization that was formed in 1967. The Council is involved in secondhand smoke as part of its work on indoor air quality. 151 5/24/00 PUBLIC HEALTH - RES. 000042 The health impact from indoor air quality is the Council's interest in smoking-related issues. We commend City Council for creating this opportunity for the community to respond to the Governor's proposal on allocation of the tobacco settlement funds. The Council's first and strongest point is to emphasize the need for maximum local involvement in the allocation process. Local health departments must deal with the negative impact of smoking on smokers and nonsmokers alike on a daily basis. The Clean Air Council supports the position of the Philadelphia Health Department, that dedicated funding be provided for public health departments through the venture capital or insurance pool components of the Governor's and Senator Hugh's proposals. The Council supports City's effort to assure that local health departments are recipients of tobacco settlement funds. It is very important that however the money is allocated to local health departments, that a portion is dedicated to prevention and cessation. The local health departments are best 152 5/24/00 PUBLIC HEALTH - RES. 000042 qualified to determine how to administer these funds through program recommendations submitted by organizations in their jurisdiction. The other important issue to keep in mind, as local health departments make allocation determinations and create mechanisms for distribution, is the overall importance of indoor quality and the negative health impact of secondhand smoke. The Clean Air Council gets more phone calls each month on secondhand smoke than any other air pollution issue. Indoor air pollution creates more health problems than outdoor pollution, and most indoor pollution is from secondhand smoke. The Clean Air Council operates the region's only indoor air pollution information center and handles over 2,000 calls per year. I'm going to skip the rest of my testimony and just conclude that the Clean Air Council urges the Commonwealth to allocate funds through the local health departments. The Council urges the City and the Commonwealth to assure that funding for smoking cessation and prevention is protected. The Clean Air Council strongly 153 5/24/00 PUBLIC HEALTH - RES. 000042 recommends that education programs funded through the tobacco settlement money have indoor air quality is one of the priorities. This includes the health impact of secondhand smoke. Thank you very much for the opportunity to come to testify before you today.
Thank you very much for your testimony. Would you state your name for the record.
Yes. Good afternoon. My name is Shelah Harper. I am Chair of the Board of Citizens for Health Care Center No. 9, and I'm here today representing a group of public health centers. I, first of all, am a smoker. I have been smoking since I was 16 years old. I'm also uninsured. I am very much interested in making certain that these funds go towards what it was originally intended for: which is those who are addicted to nicotine. I've heard a lot of things today about the uninsured. I feel as though -- of course, that's a major issue that must be dealt with. 154 5/24/00 PUBLIC HEALTH - RES. 000042 However, we have we have we have to focus those funds on those that are uninsured that have diseases as a result nicotine addiction -- whether it's lung, heart, respiratory, whatever. It can't be an endless pot of money that just goes to cover the uninsured; it has to be focused on what it was originally dedicated for. Now, as a member of the Board of Citizens for Health Center No. 9, I'm also concerned about the cutback of federal funding that's going to be coming down the pike as of the year 2003. We are federally qualified health centers, which is how our boards came into existence. As of the year 2003, that funding will be stopped. What will happen after that is a study, with no guarantee of additional funds. That FQHC funding cutback, without specific as to what's going to replace it, along with the demise of the Allegheny Health Systems -- Allegheny Health Systems, over the last ten years, received a major part of something called "hospital disproportionate share dollars," which is to cover the uninsured. Back when all of that happened back in March, we sent a letter to the 155 5/24/00 PUBLIC HEALTH - RES. 000042 Attorney General to request specifics of how those funds were spent in the community. We wanted to make certain that those funds, whatever was earmarked for the uninsured, was spent in that community as opposed to being swept under the rug with whatever else happened with those public funds through Medicaid and Medicare. 3 billion represents a lot of money, for which our public health centers, with the exception of the smoking cessation programs -- when the Governor's budget plan says 10 percent towards hospitals and clinics, he does not mean public health clinics; he means hospital clinics. Therefore, it's going to have to be amended to specify public health ambulatory health clinics, because we have, of course, a number of people, like myself, who will, eventually, 10, years from now, have cancer or 20 whatever, who might possibly be uninsured, that are seen at those public health centers. Our public health centers see -- now this is some statistics that I saw recently. Seventy-five percent of all of our patients that we see throughout the entire city have no 156 5/24/00 PUBLIC HEALTH - RES. 000042 insurance. And at Public Health Center No. 9, it is 86 percent of all the people that we see have no insurance. And that's because we have a larger proportion of people that just slipped through the cracks. They are not eligible for medical assistance, they are not eligible for anything else. One other thing that I'd like to really have us take a look at. While CHIP is a wonderful, wonderful program, when people get insurance, they leave our public health system, they go to private physicians. A CHIPS-like adult program, unless something is specifically earmarked towards the public health centers, almost spells a death sentence for the public health centers, because, again, once get insurance, they will go elsewhere. " We are not free by no means, as you guys well know. It costs quite a bit of money to operate those centers. So, again, I'm just here today to plead to Council and to whoever citizens are here to make certain that those funds are not just 157 5/24/00 PUBLIC HEALTH - RES. 000042 earmarked to go into an endless pot of uncompensated care for mismanaged possibly hospitals, okay?
And the reason I say that is because, you know, if you don't get your bill out, you don't get paid. And, of course, that's uncompensated. That is not what we are talking about. We are talking about people who specifically do not have insurance -- not that the hospital did not bill and they're not managed properly. We're talking about the people without insurance, we're talking about the people that are suffering from tobacco-related illnesses. 3 billion forever. So what we are doing, as boards of citizens, we have a little campaign going on where what we're trying to do is to contact our State elected officials, representatives. We are also a member of the Consumer Health Coalition, and we have been meeting. We have petitions that we are signing and we're asking people to call their State elected officials and local elected officials, and also to keep in mind that the 158 5/24/00 PUBLIC HEALTH - RES. 000042 uninsured that smoke should be our focus. Thank you very much.
Thank you. Could we have the mental health association of Southeastern Pennsylvania -- Donna Preston, Frezell Campbell, Patricia Romano, Richard Askew, III. (Witnesses come forward.)
Is William Dunn here? You'll be next, Mr. Dunn. And then Mr. Sklaroff, is Mr. Sklaroff here? All right after this panel. Thank you.
Hi. My name is Holly Bennett. And just for the record, as you've been asking, we're from the Mental Health Association of Southeastern Pennsylvania. All of our comments are very brief but I think, more importantly, very personal.
Identify yourself 159 5/24/00 PUBLIC HEALTH - RES. 000042 for the record, okay.
Thank you very much for the chance to speak to you today. My name is Pat Romano, and I am an advocate with the Friends Connection, a peer support program that helps people in their recovery from mental illness and substance abuse disorders. I am here to urge that you encourage the Governor to expand his proposal to provide health insurance for the uninsured so that the insurance covers not just physical health but behavioral health care and prescription medications. Unless insurance covers people's behavior health needs, it is only doing half the job. Untreated, mental illness has a proven and often disastrous impact on physical health. This is even more obvious in the case of untreated substance-abuse disorders. I have mental illness as well as a substance-disorder and am here to tell you that my life would be unmanageable without insurance. I was 34 when I finally realized I had a substance- abuse disorder. Although I had been drinking 160 5/24/00 PUBLIC HEALTH - RES. 000042 since I was years old, my mother died when I was 12, and I became so withdrawn, that they put me on tranquilizers. But at 14, I picked up a drink. A few years later, I married a man who was an active alcoholic. I sought help from AL-ANON and soon realized that I had a drinking problem also. I started going to Alcoholics Anonymous and though I would be able to save my ex-husband, but it didn't work out that way. My home life was insane, and I went downhill to the point of becoming suicidal. Although Alcoholics Anonymous was helpful, I needed more help than I found there. Finally, in 1987, I called the Living (unintelligible) Foundation, a residential substance-abuse treatment center in Bensalem. I was there for 28 days, followed by a 6-month stay in a halfway house for women. When I got out, I was sober a year, I didn't want to drink, and I also didn't want to live, but I didn't want to die, I was in some kind of limbo. I went back to the halfway house, and they suggested I get a psychiatric evaluation. I went into the hospital for five days and I was diagnosed with 161 5/24/00 PUBLIC HEALTH - RES. 000042 post-traumatic stress disorder and anxiety disorder. I have now been on medication for about years and have been sober all that time. But 6 if I had not had insurance coverage, I do not know 7 what might have happened. I now see a 8 psychiatrist and my medications are covered 9 through my prescription plan. 10 I have been happily remarried for 10 11 years, I have a daughter we adopted when she was 12 16, she is now 21, and I also have a 12-year-old. Some of my family members also take medication, and without insurance, we would have to decide whether to take medication or eat. Frankly, as expensive as mental health care and medications are, I don't know how good a roof we could keep over our heads without insurance. I am hopeful that you will urge Governor Ridge to revise plan so that it includes mental health, substance abuse, and prescription covering. Thank you for your attention.
Thank you very much. You bring a whole 'nother perspective to the testimony today that we have not heard too 162 5/24/00 PUBLIC HEALTH - RES. 000042 much specifically for this area. Thank you.
Good afternoon. My name is Donna Preston, and I'm a peer advocate on the staff at the Mental Health Association of Southeastern Pennsylvania. I appreciate the opportunity to talk with you about the Governor's proposed plan to use 40 percent of the tobacco fund settlement to expand health insurance, while, at the same time, excluding mental health, substance abuse, and prescription coverage. An insurance plan for uninsured people that does not include behavioral health and prescription drug coverage will be a disaster. It is both discriminatory and extremely short-sighted. Although such services are expensive, not providing such service, they'll end up being even nor expensive. This is because without adequate behavioral health care, many people will become dependent rather than contributing members of society.
Excuse me for a moment. To those of you who are having sidebar 163 5/24/00 PUBLIC HEALTH - RES. 000042 conversations, we would appreciate it if you would take your conversations to the hall. This is a hearing on the use of the tobacco settlement money. We will begin the next hearing soon after this is completed, but it is distracting. We appreciate your cooperation. Thank you. Proceed.
A few years ago, when the Pennsylvania General Assembly considered mental health parity legislation, all of the reputable data pointed to the cost effectiveness of mental health treatment. That has not changed coverage. If for mental illnesses are excluded from the package, consumers of mental health services will remain effectively uninsured with regard to the conditions for which they most needed the coverage. As someone who has been diagnosed with bipolar disorder, I know the comprehensive services I need to get better and get healthy so that I can be productive. My treatment and recovery are a daily process. Without the services I need, I would not be able to function productively. I know what my life would be like 164 5/24/00 PUBLIC HEALTH - RES. 000042 without mental health treatment because I walked around for almost a year with undiagnosed mental illness before I went into the hospital. I had hallucinations in which memories from my past came back to haunt me in terrifying form. The most frightening came out of my Air Force experience as a weapons technician for the 26th (unintelligible) Command, which was located outside of Phoenix, Arizona in the early '80s. Years later, as I was getting sick, the computer-simulated nuclear annihilation I had seen at that time became real to me. It blocked out all the walls, the furniture, and everything else. And all I saw was a nuclear holocaust destroying the universe over and over and over again. At work, on the street, and at home, I was tortured by a separate reality. I couldn't make it stop or even slow it down. It interfered with my ability to communicate and it was extremely difficult to understand what people were saying to me, and I had to be very careful how I responded to them because I didn't want anyone to know what was going on in my mind. 165 5/24/00 PUBLIC HEALTH - RES. 000042 At that time, I was working as a concierge in an upscale Philadelphia residential complex and I had to deal with staff, residents, and guests who included celebrities such as Bill 6 Cosby, Will Smith, Sylvester Stallone, and Randall Cunningham. I was working the graveyard shift, and I was always seeing or hearing something that wasn't there. I would call security, and they would check it out and say there was nothing there, so I had to back down because I couldn't trust my own perceptions. My thoughts were racing and I couldn't shut my mind off long enough to get a decent night's sleep, which made everything even worse. People complained to management that my behavior was strange and inappropriate, and I was finally let go. Then I had no benefits, I couldn't afford COBRA, and I couldn't look for another job because the racing thoughts and hallucinations were becoming more intense. I would see snakes crawling on the ground that would make me freeze in the middle of the block, and I couldn't step off the curb to cross the street because it seemed 166 5/24/00 PUBLIC HEALTH - RES. 000042 likes cars were trying to run me over. Today, because I have mental health coverage, I am a productive taxpaying member of the community. Without such coverage, I guarantee that I wouldn't be here before you today. I certainly wouldn't be able to afford the medications I need. Without a prescription plan, these drugs would cost me around $325 a month. I hope you will urge the Governor to include mental health, substance abuse, and prescription coverage in his plan for health insurance for the uninsured. Thank you.
Thank you very much for your testimony. We appreciate you sharing it.
Good afternoon, ladies and gentlemen, committee members, and other distinguished guests, my name is Mr. Richard Askew, III, and I am with the Mental Health Association of Southeastern Pennsylvania. I am a 38-year-old young man, and I am a health consumer. I know that time is running out for us to speak, but I will be succinct, and what saying 167 5/24/00 PUBLIC HEALTH - RES. 000042 to you, although I have something written, I'm going to speak to you extemporaneously, but I will be brief. First of all, I have been diagnosed as mentally ill ever since I was a little boy, and what I want to say is that I consider this a honor and a privilege to be here before you today to speak. I speak on only on my own behalf but also for those who cannot speak for themselves, those who are too ill or those who just couldn't do it. Each day I awake, I go to a mental health program in the Northeast. This costs my insurance on a monthly basis $4,600, and my expenses of my medicine are $160 a month. One medication alone is $70 a month. And I come on behalf to ask you all for the government's plan on the tobacco fund settlement to please seek out mental health. People are dying. Without medicine, where would I be? I was once so terribly disillusioned and sick that I saw Satan the devil. I heard voices, I became afraid of people. I was afraid to even go outside, I was afraid of my family. I stayed locked up inside of my own house, with bars on the 168 5/24/00 PUBLIC HEALTH - RES. 000042 door. To some of you, it may seem, Well, this has no bearing on my life. But let me tell you all something right now. Mental illness could happen to any one of you. I don't care what your status is, I don't care how much money you have or whatever. A blow to the head, a accident, you too can become mentally ill. I lost my sister Carol at the age of 18, which was years ago. I loved her dearly. 12 She too, like I am, was bipolar. Carol took her 13 life in one of her low spells when she jumped in 14 the river. I cried and I cried and I cried. The 15 one person that really loved me was taken away 16 from me. I was angry at God, I was angry at the 17 world. Why did you take my sister. 18 Today, my life is a struggle. Some of 19 you have jobs to go to. You know, everything 20 comes easy for you. But each day of my life is a struggle. For people when they find out you got that stigma of being mentally ill, they talk down to you. They say mean little things, patronizing you. I am not a stupid person by no means. I've been to four colleges, two schools, and I'll let 169 5/24/00 PUBLIC HEALTH - RES. 000042 you know, I have finished top student in most of my classes, but I still am mentally ill. If you're wondering, what I'm trying to say to you today is that, suppose I didn't have any insurance, suppose I could not get a job, what would happen to me? I would be dead. No more program, no more medication. Please, please, I ask you earnestly, on my behalf, on behalf of millions of other people that I know who suffer from mental illness, please consider in the Governor's proposed plan tobacco funds, make some allotment, allocations for us who are mentally ill. We are not asking for a handout; we are asking for a hand up. Please consider that. I thank you all very much for giving me this opportunity. Thank you all and God bless you.
Thank you very much for your testimony. Certainly Councilwoman Blondell Reynolds Brown, in preparing her report on this session, will make that a top priority of her report.
Good afternoon, 170 5/24/00 PUBLIC HEALTH - RES. 000042 Councilwomen.
And guests, friends. My name is Frenzell Campbell, and I'm a recovering substance abuser. I've been clean for ten years now. I now work for the Friends Connection, where I help other people with substance-substance abuse disorders and mental-health issues. I have been working in the mental health field for ten years now. I'm glad I can be here to talk about the importance of substance- abuse treatment. I am sure it won't surprise you when I say that drugs can kill. I don't know where I would be today if I hadn't gotten clean. As a matter of fact, I do know: dead. I have been in my addiction since I was 17 at the time I had gotten involved with some negative people who weren't good for me. I started out smoking marijuana, which led to drinking, which led to cocaine, which led to heroin. Time passed and I had four children. My kids' father was very abusive, and my life was chaos. As a result of my addiction and being left 171 5/24/00 PUBLIC HEALTH - RES. 000042 alone by children's father, I attempted suicide. I landed in a hospital, but I could not get the treatment I felt that would have helped me because I was on public assistance. I was in the hospital for a week and was then released. They stated I was fine. Of course, my benefits had ran out. I had heard about a good rehab program in Chester called "Keystone," but you needed real good insurance to get into Keystone. I ended up back in the psych ward at St. Joe's. I never attended a substance-abuse treatment facility because it just wasn't covered. Finally, I moved to Narcotics Anonymous. That didn't help me in the beginning. I managed to get my act together for a while, but then I started using again, to the point that I believed that this was the last time that I was -- this was the last time and I was going to die. I worried about losing my kids, I was afraid to face my parents, I was derelict. Finally, my sister helped me. She took my hand and she guided me. My kids are doing well now, but my 12-year-old son who was born during my addition 172 5/24/00 PUBLIC HEALTH - RES. 000042 had withdrawal symptoms when he was born. He has been through JFK and Children's Psychiatric Center. Luckily at that point, I had a job with insurance coverage. That's why I'm here today, 'cause I strongly believe that had I been able to go into a facility and get the help I need, I would have gotten cleaner sooner. But as I was saying, I'm here today to tell you people that substance-abuse treatment should be able to be covered through this tobacco proposal plan -- just as if it was a physical problem like heart disease or cancer. People's lives are at stake just the same. Thank you very much.
Thank you very much for your testimony. Are there any questions of the panelists?
I do have a comment. It is incredible that the Governor's proposal, as we know it to be currently crafted, does not have a provision to assist and provide help to those of us who are struggling with mental health, so that's the downside. The upside is 173 5/24/00 PUBLIC HEALTH - RES. 000042 that we have now until September to provide recommendations, suggestions through a collective coalition and enlighten the Governor to the value of having this particular constituency included as well.
And we are a part of many of the coalitions that have been here today. The group that spoke earlier, the Pennsylvania Health Care Coalition, we are a member of. We also do a fair amount of letter-writing at our drop-in centers, at our clubhouses, so we are taking action both individually, as well as in a collaborative effort.
Yes. We're a part of that whole big group as well and attended a rally day, a lobby day, yes.
Thank you very much for your testimony. We appreciate it and good luck. 174 5/24/00 PUBLIC HEALTH - RES. 000042
Could we have Mr. William Mr. Bill Godshall, and Dr. Robert Sklaroff. Is there anyone else here to testify on this resolution? (No response.) (Witnesses come forward.)
Good afternoon. My name is William Dunn. I'm here today because I am concerned about the tobacco settlements. I know about the damage that tobacco can do. I started smoking at the age of 12, and by 1986, I was smoking 3 packs a day. In August of '86, I was diagnosed with throat cancer because of smoking, at the age of 40. I had a total laryngectomy September the 8th of 1986. I had to relearn to talk. Some of the things that I couldn't do anymore was to smell. I could no longer sing, I could not go swimming. I started smoking at the age of 12 because I thought it was cool. Since my 175 5/24/00 PUBLIC HEALTH - RES. 000042 laryngectomy, I kind of changed, and I started talking to young people, trying to get them not to end up like me. The tobacco settlement money, 6 percent of that money is needed to be used to help 7 young people realize the effects of tobacco. The 8 smoker cessation programs -- prevention, 9 prevention, prevention. The programs that are out 10 there are all good, and they're all needed, but we 11 need to encourage them to spend 25 percent of that 12 money on tobacco education and prevention. If we 13 can prevent our kids today from ending up like me, 14 it will be well worthwhile, and I'm not going to 15 say anything more on it. 16 Thank you. 17
Thank you very 18 much for your testimony and thank you so much for 19 your patience. 20 Mr. Godshall, why don't you go next, 21 and we'll end up with Dr. Sklaroff. 22
Hello and thank you for 23 permitting me to testify today. 24
You may have left, 25 and I notice you're from the Smoke-Free 176 5/24/00 PUBLIC HEALTH - RES. 000042 Pennsylvania. We have recorded on our record all the statistics, so if you could give the other point of your message, it would be helpful.
Okay. My name is Bill 6 Godshall, and I founded Smoke-Free Pennsylvania in 1989 and have served as the Executive Director ever since. We're a grassroots organization with 500 members across the State, whose goals are to protect people from secondhand smoke, to protect youth from tobacco, and to help nicotine addicts with recovery. In 1994, '95, and '96, we were the first organization to urge Attorneys General Preate, then Corbett, then Fisher to file a lawsuit against the tobacco industry. On the day Attorney General Fisher filed the lawsuit against the tobacco industry, he said, "This is a fight about protecting the public health and safety of the young people of our Commonwealth." We think that goal is extremely important for all Pennsylvanians to remember. Following the settlement in November 1998, our organization, in alliance with 50 other health advocacy groups, as the Coalition for a 177 5/24/00 PUBLIC HEALTH - RES. 000042 Tobacco-Free Pennsylvania, developed a comprehensive statewide tobacco-control program proposal that is consistent with the Centers for Disease Controls Best Practice Guidelines and prevention and cessation programs that have reduced smoking by 35 percent in California and Massachusetts this past decade. Throughout the last year, we've testified at numerous public hearings and met with many State officials, urging them to appropriate $120 million annually, or 30 percent of the settlement for our comprehensive tobacco-control proposal, much of which would fund local health departments, including Philadelphia's. In January this year, Governor Ridge unveiled his proposal for the comprehensive tobacco-control programs that very closely resembled our proposal, although the Governor's proposal provided just half of the money that we had requested, and the lower estimate of the CDC's recommended budget. And the CDC's guidelines is attached to the back of my testimony. (Mr. Godshall's testimony not provided to stenographer for attachment hereto.) 178 5/24/00 PUBLIC HEALTH - RES. 000042
Since the Governor's proposal was announced, Smoke-Free Pennsylvania has been urging the State legislature to support the Governor's proposed plan for tobacco-control programs, which is also attached to the back of my testimony, but to expand the tobacco-control appropriation from percent to percent of the 9 settlement funds. 10 And just to put this in context, this 11 year in Pennsylvania, about $5.7 billion will be 12 spent treating tobacco diseases, 5.7 billion. The 13 settlement will be about 350 to 400 annually in 14 the State, of which the Governor's proposed 55 to 15 60 million for tobacco-control programs. Now, 16 that means for every hundred dollars that is 17 currently spent treating tobacco diseases, the 18 settlement only brings in $7 of that 100. And of 19 the $7 that come in from the settlement, only one 20 of those dollars will be appropriated under the 21 Governor's plan for prevention and control 22 programs, so that's 1/100th of the money the 23 State is currently spending to treat tobacco 24 diseases. 25 Under the State Department of Health 179 1 5/24/00 PUBLIC HEALTH - RES. 000042 plan, much of the money would go to local health departments, as has been previously stated. And if the Governor's proposal is adopted by the legislature, Philadelphia's health department can expect to receive 4 to $5 million annually to implement various components of the State Health Department's comprehensive program. And I'm not going to go through the components of the CDC's Best Practices. I think many of the other speakers before me have already addressed this issue. But we are confident that the Philadelphia Health Department, under Dr. Walter Tsou's leadership, is best suited to implement and administer these programs within the City of Philadelphia. Not only are tobacco-control programs effective, but they are also supported by the public. In March, a statewide survey of registered voters found that 75 percent of those questioned favored spending percent of the 22 settlement funds for tobacco prevention and 23 cessation programs. 24 In closing, I urge the Philadelphia 25 City Council to request the State legislature to 180 5/24/00 PUBLIC HEALTH - RES. 000042 support Governor Ridge's and the State Health Department's tobacco-control program proposal. I also urge this Council to request that the State legislature increase the funding for these tobacco-control and prevention and cessation programs from the percent proposed by the 8 Governor to 25 percent of the total settlement 9 funds. Of all the proposals for spending 10 settlement funds, only tobacco-control programs 11 can achieve the original goals in the State's 12 lawsuit, and tobacco-control programs have also 13 been found to be the most cost-effective health 14 services in terms of years of lives saved for each 15 dollar spent. Thank you, and I'll be pleased to answer any questions.
One question. Are you a member of the coalition that Henry Nicholas or Sharmain Matlock-Turner spoke about, where your priorities parallel or at least mirror their priorities with regards to how the dollars can be spent?
Was that the Consumer Health Coalition? 181 5/24/00 PUBLIC HEALTH - RES. 000042
Thank you very much. To those of you waiting for the second hearing, we are going to open the balcony, so maybe you can have a seat. It's going to be a long day, so we'll open it for your convenience. Thank you very much, gentlemen, and you don't have to stay if you don't want to. I just called you up together so we could sort of conclude this. Dr. Sklaroff, you have a lengthy testimony. We'd appreciate it if you would summarize it.
Yes. You can convert what you have typed to written testimony, and you also have appended to it about 70 pieces of paper, which you don't have before you, but staff already has filed, okay? Okay, what I'm going to do is I'm going 182 5/24/00 PUBLIC HEALTH - RES. 000042 this into one third of its length, and then add about two paragraphs of oral comments summarizing what I heard today, and then leading into two key-action items that might formulate your thinking as opposed to simply viewing this as everybody preaching to the converted. I am Robert B. , a Philadelphia physician and taxpayer. I speak on behalf of the Federation of Physicians and Dentists, a constituent organization of the National Association of Hospital Health Care Employees. NUHHCE, as you heard from Henry Nichols earlier, is a part of AFSCME, which is part of the AFL-CIO. FPD was indeed part of the coalition to which he referred, and I attended a number of its meetings. At the triennial NUHHCE convention in California, a resolution that I helped write was adopted, and that called for one quarter of the money from MSA (Master Settlement Agreement) to go to tobacco control (unintelligible) went to CDC guidelines, you heard, and the other 75 percent to go to Medicaid. And you already heard from Henry Nicholas, and he explained why if you put it in 183 5/24/00 PUBLIC HEALTH - RES. 000042 Medicaid, you get the matching funds. All the other ideas of Ridge do not max out on the total dollars. And I also attended a couple of meetings with Senator Hughes, and I believe also he encouraged a lot of these ideas, particularly through his PACT Program, and a lot of these ideas are independent of whether or not do you or do not get the concomitant tax increase, of course, which would be desirable. I'm speaking on behalf of FPD, which is 6500 members strong, and I've testified to this effect in the State House, Senate, and the Administration last year. I didn't elaborate in the written testimony this time on how to spend the money because, quite frankly, your body does not have control over those issues, although I do support urgently whatever coalition-building you can achieve in order to make sure the monies are divvied up as previously suggested. What I want to do so is skip , skip , and only cite the fact that Dr. Ronald Herberman's testimony, which I was provided two days ago, which was critiqued by 184 5/24/00 PUBLIC HEALTH - RES. 000042 Mr. Godshall in great depth, including in the media yesterday, a follow-up article in the Post Gazette, illustrates the problem that you must make sure you follow, and that is, with all due respect to the academic centers, the jury is not out. Tobacco control works and is cost-effective. I am now going to skip to what is my major concern. I'm now on . At the top of the page, I state the legal issues. I have to read this paragraph so that you understand exactly the context of what I'm trying to achieve. I only have three weeks before the deadline for an amicus brief that could be filed by the City of Philadelphia regarding my Writ of Certiorari to the United States Supreme Court, and I want to explain a couple key details, and then what you will see in rest of the testimony will be bold-print and underlined, and I will not go into the rest of text. I will now focus upon the legal issues you must now confront regarding the MSA, and if you want to be able to ensure the money goes properly, then the City should try to attain standing through the Court of Common Pleas. And 185 5/24/00 PUBLIC HEALTH - RES. 000042 then by that mechanism, you will be able to achieve the interpleader status that the City supposedly was going to be seeking a year-plus ago. And then by that mechanism, the Court controls divying up the money, and since the lawsuit was filed for Medicaid recipients, that's where the money would be directed by court order to go. So that's the priority of the implementation mechanism I'm trying to describe to you.
You need not be concerned about the fact that I've sued Philip Morris, Incorporated for having financed the billboards sponsored by Wawa Food Markets that got some press last year, in April and in December. You need only know that I sued the Attorney General for having allowed this pattern of behavior to occur, plus having allowed youth marketing to go unchallenged in Pennsylvania. The latter was identified last year and dutifully reported by myself to General Fisher. J. Reynolds for comparable mail-order activities, and even as the parent 186 5/24/00 PUBLIC HEALTH - RES. 000042 organization of General Fisher, the National Association of Attorneys General (NAAG) last week announced it is pursuing the tobacco industry for having expanding advertising in magazines read by youth, particularly Sports Illustrated, the February issue, the swimsuits. Both of these behaviors were predicted by myself, and you heard from Messrs. Barg and Godshall. We wrote an essay that was published in the Post Gazette and in the Inquirer a year and a half ago, only weeks after the (unintelligible) of the MSA. That the Attorney General's colleagues are now belatedly discovering the disingenuous behavior of Big Tobacco was somewhat reassuring, but that he has forced me to prod him to enjoin such reprehensible conduct is quite sad. So with all due respect, I'm going to skip now the bottom of and describe some of your handouts, and I'm going to skip the top of and I'm going to go right to the four action items that were in the brief that was filed in the court on June the 12th of 1999 by Michael Eichert, representing the City and coauthored by Steve Scheller, a private attorney. 187 5/24/00 PUBLIC HEALTH - RES. 000042 He said, number one, the participation of City of Philadelphia as amicus curiae herein was proper. I have no problem with that. Number 2. Intervention, he said, was unnecessary only because they anticipated an interpleading would be filed. It was not filed. Therefore, intervention is necessary by the City of Philadelphia. And the mechanism is to join into the appeal that was filed initially by the Allegheny County people, which subsequently got cost by the wayside, which is another story I can skip. Number 3. " That has not been stipulated. Verbal comments notwithstanding by the Attorney General, the bottom-line point is, House Bill 445 has a "whereas" section which would empower the Attorney General potentially by interpretation to block lawsuits filed by the City and/or by other tobacco-related activists such as myself. So, therefore, I would want to see that stipulated as opposed to a verbal comment that could be superseded by a contractual finding. And Part A was, the Attorney General does not have the 188 5/24/00 PUBLIC HEALTH - RES. 000042 authority to release claims on behalf of the City. Fine, please stipulate it. Number 2 (sic). The MSA has already contemplated the position of the City of Philadelphia. Fine, stipulate it. Point 4. The Court should require the parties hereto to clarify their position on the scope of release. There's some great quotes in here, I'll just read one of them. " This point was supported in the minority opinion of the Commonwealth Court by James Kelly and, therefore, since it was ignored, however, it's incumbent upon the City as soon as possible to pass a resolution in City Council to state we need an amicus curiae brief filed on my litigation, I'm a sole litigant, and this is the last pathway that you're going to have, but all the other lawsuits at the State level are not dealing with nonseparable clauses and/or are only related to the fiscal issues. Mine is the only one dealing with whether or not there could be immunity 189 5/24/00 PUBLIC HEALTH - RES. 000042 granted to the tobacco industry for future misconduct and also whether or not the illegal, etc.
offset clause, which is in my writ, is going to be validated, by which means, that if I sue the tobacco industry and win, you lose that amount of money that they would pay me because they would deduct that dollar for dollar to it from the annual allocated payments. This is stuff that has not gotten press, unfortunately, and which had better get to the public consciousness before it's too late. So I close with the request, number one, whatever you can do to formulate a coalition to the State government, percent tobacco 16 control, 75 percent Medicaid recipients, as 17 intended by the filing of the lawsuit, which was a 18 class action lawsuit, per all the various quotes 19 in the beginning preamble thereof, all available 20 on the Internet upon request. 21 And, number two, please ASAP, pass a 22 resolution so -- and I only have three weeks 23 before the deadline runs -- to support my 24 litigation to the United States Supreme Court 25 through an amicus curiae brief. 190 5/24/00 PUBLIC HEALTH - RES. 000042 And I'll answer any questions you have.
Well, thank you very much. Certainly, this is an issue that's a legal issue, and we just received this testimony, so we can't tell intelligently ask you any questions at this point in time with the limited amount of time that we have.
Thank you very 12 much. 13 Is there anyone else to testify on this 14 resolution. 15 (No response.) 16
There being no 17 further testimony on this resolution, this 18 committee will recess to the call of the Chair. 19 I will state that the hearing on Bill 20 No. 000314 will begin at 3:15. We have to allow 21 for our court stenographer to take a break. She 22 has been here since 10:30. 23 (Adjourned at 2:55 p.m.) 24 - - - 25 191 C E R T I F I C A T E I HEREBY CERTIFY that the foregoing proceedings of the Council of the City of Philadelphia of Wednesday, May 24, 2000, were reported fully and accurately by me, and that this is a correct transcript of same. RE: COMMITTEE ON PUBLIC HEALTH AND HUMAN SERVICES BILL NO. 000042 __________________________________, JOSEPHINE CARDILLO, Registered Professional Reporter