For decades, lawmakers and regulators in the United States have attempted to reduce smoking rates using taxes, smoking bans, and regulations. Despite these heavy-handed policies, the decline in smoking has leveled off over the past few years. Electronic cigarettes, meanwhile, have quickly become one of the most popular nicotine replacement products, with the total market expected to reach $1.7 billion in 2015.
According to many in the public health community, e-cigarettes are far safer than combustible cigarettes. Several studies have found e-cigarettes to be an effective way to help smokers reduce their cigarette use or quit altogether, and thus are expected to result in significant public health and financial benefits for states and the nation.
Many elected officials are trying to undermine these efforts by treating e-cigarettes the same as traditional cigarettes even though they are completely different products. Banning the use of e-cigarettes in private establishments, in addition to excessive regulation and taxation of these products, is a shortsighted decision that ignores the benefits of e-cigarettes as a nicotine replacement.
In a new report from State Budget Solutions, J. Scott Moody writes, “45 states and D.C. stand to gain more from potential Medicaid savings than through lost cigarette tax collections and tobacco settlement payments.”
Fifty-one percent of Medicaid recipients smoke, whereas only 21 percent of the general public smokes. Reducing the use of traditional cigarettes among the Medicaid population could save states billions of dollars in health care costs from tobacco-smoking-related illnesses.
Moody cites a 2009 study by the Centers for Disease Control and Prevention that found, “[T]he potential savings of e-cig adoption, and the resulting tobacco smoking cessation and harm reduction, could have been up to $48 billion in Fiscal Year (FY) 2012.”
The total amount of money the states could have saved is higher than all state cigarette tax collections and tobacco settlement money ($24.4 billion) collected by the states in 2012.
E-cigarettes simulate the physical and psychological act of smoking while eliminating most of the harmful chemicals and smoke found in conventional cigarettes. They work by vaporizing a solution of either propylene glycol or glycerin, flavoring, and usually some low concentration of nicotine. This allows e-cigarette users to take in less nicotine while eliminating smoke and the health hazards associated with smoking.
The American Association of Public Health Physicians has concluded e-cigarettes “could save the lives of 4 million of the 8 million current adult American smokers who will otherwise die of a tobacco-related illness over the next 20 years.” A 2013 clinical trial in New Zealand showed e-cigarettes are as effective as nicotine patches in helping smokers quit. A study by the French Monitoring Centre for Drugs and Drug Addiction found about 1 percent of France’s total population had quit smoking using an e-vapor product.
Many opponents of e-cigarette use claim they act as a “gateway” product to cigarettes, especially for younger users. The evidence shows the opposite. According to HealthDay, in 2013 Theodore Wagener, an assistant professor of general and community pediatrics at the University of Oklahoma Health Sciences Center, studied 1,300 college students with an average age of 19. Only 43 told researchers their first nicotine product was an e-cigarette, and only one of those 43 later switched to traditional cigarettes. In a follow-up survey of these students, most were not using nicotine or tobacco at all.
Certain rules pertaining to youth access and product safety are appropriate, such as banning the sale of e-cigarettes to minors. However, imposing overall bans, undue regulations, and burdensome excise taxes on a product many anti-smoking public health advocates endorse as a way to greatly reduce the toll of smoking is neither sound tax policy nor a wise health policy. Lawmakers can improve their constituents’ health and save their states millions of dollars in Medicaid costs by avoiding policies that discourage the adoption and use of e-cigarette products as an alternative to smoking.