Funding Health and Long-Term Care: A Survey on Increasing Kentucky’s Cigarette Tax Published October 2003 Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax Data Collected by Woelfel Research, Inc. Report Prepared by Susan L. Silberman, Ph.D. Copyright © 2003 AARP Knowledge Management 601 E Street NW Washington, DC 20049 http://research.aarp.org Reprinting with Permission AARP is a nonprofit, nonpartisan membership organization dedicated to making life better for people 50 and over. We provide information and resources; engage in legislative, regulatory and legal advocacy; assist members in serving their communities; and offer a wide range of unique benefits, special products, and services for our members. These include AARP The Magazine, published bimonthly; AARP Bulletin, our monthly newspaper; AARP Segunda Juventud, our quarterly newspaper in Spanish; NRTA Live & Learn, our quarterly newsletter for National Retired Teachers Association members; and our Web site, www.aarp.org. We have staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Acknowledgements AARP staff from the Kentucky State Office, State Affairs, and Knowledge Management contributed to the design and implementation of this study. Special thanks go to AARP staff including Phil Peters, Kentucky State Office; Cathy Allgood-Murphy, Kentucky State Office; Hal Stopfel, Kentucky State Office; John Luehrs, State Affairs; Clare Hushbeck, State Affairs; Jen Beltz, State Affairs; Gretchen Straw, Knowledge Management; Rachelle Cummins, Knowledge Management, Erica Dinger, Knowledge Management; Darlene Matthews, Knowledge Management; and Cheryl Barnes, Knowledge Management. John Woelfel of Woelfel Research, Inc. insured a timely and high quality survey. Susan L. Silberman, AARP Knowledge Management, managed all aspects of the project and wrote the report. For more information, contact Susan L. Silberman at (202) 434-6339. Background Kentucky, like most states across the nation, is in the midst of an economic downturn. State tax revenues have fallen sharply, while costs are mounting, especially for health care. In 2003, Kentucky had a $400 million dollar budget shortfall. To address this problem, state officials responded by making across the board budget cuts. Health and long-term care services under Medicaid were cut by $250 million. These cuts disproportionately affect the state’s most vulnerable citizens: children, people with disabilities, and the elderly. More cuts are expected in 2004. As Kentucky considers how to meet its obligations as well as balance its budget in the coming years, AARP is examining ways the state might increase its revenues. Kentucky could generate money for health and long-term care services by increasing its state cigarette tax. Currently, there is a 3-cent tax on a pack of cigarettes in Kentucky. This tax is the second lowest in the country and was last increased in 1970. Moreover, the states surrounding Kentucky have cigarette taxes that average approximately 43-cents per pack. This survey examines the opinions of Kentucky residents 18 and older and explores under what circumstances they would consider increasing the state’s cigarette tax to generate money for health and long-term care services. Two different proposals are discussed in the survey: a 25-cent per pack increase and a 75-cent per pack increase. By increasing the cigarette tax from 3 cents to 28 cents, Kentucky could generate about $100 million annually and bring in $233 million dollars annually in federal money. Alternatively, a 75-cent increase could generate $300 million annually as well as $699 million in federal money. In Kentucky, where 31 percent of adults and 40 percent of high school students smoke, $1.17 billion in annual health care costs are directly related to tobacco use.1 Revenues generated from a cigarette tax increase could be dedicated to the health and long-term care services under Medicaid used by children, people with disabilities, and the elderly. 1 Special Reports: State Tobacco Settlement: The Toll of Tobacco in Kentucky. (2003). http://tobaccofreekids.org/reports/settlements/TobaccoToll.php3?StateID=KY. Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax 1 Highlights Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax is a telephone survey of randomly selected state residents 18 and older. A total of 815 interviews were completed; the survey has a sampling error of plus or minus 3.4 percent. The survey findings include: • Almost six in ten Kentucky respondents think there is not enough money in the state budget to meet the need for health and long-term care services and ensure quality. • More than nine in ten residents say it is important for Kentucky to restore money that was cut from health and long-term care services under Medicaid used by children, people with disabilities, and the elderly. • Seven in ten respondents support increasing Kentucky's cigarette tax from 3 cents to 28 cents per pack to generate money for health and long-term care services. Survey respondents are evenly divided in their support for increasing the state cigarette tax to 78 cents per pack to generate money for these services. • At least four in eleven residents would be more likely to vote for a candidate for state office who supports increasing Kentucky's cigarette tax to generate money for health and long-term care services. Conversely, one in ten state residents would be less likely to vote for a candidate taking this position. Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax 2 Findings Six in ten Kentucky residents 18 and older believe there is not enough money in the state budget to meet the needs for human services and ensure quality. Survey respondents were Is There Enough Money in the State Budget to asked to describe Kentucky’s Meet the Need for Health and Long-Term Care current funding for health and Services and Ensure Quality? long-term care services. A (n=815) majority (59%) of respondents say there is not enough money Enough More than in the state budget to meet the 15% enough 4% need for health and long-term care services and ensure quality. Another 15 percent Don't know believe that currently there is 22% enough money to meet needs. Less than a quarter (22%) of Kentucky respondents said don’t know to the question; and only four percent think Not enough there is more than enough 59% money in the state budget to meet the need for service and ensure quality. Respondents age 18 to 59, those who have incomes between $20,000 and $75,000, and those who always or sometimes vote are more likely than others to say there is not enough money in the state budget to meet the need for health and long-term care service and ensure quality. Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax 3 More than nine in ten state residents say it is important for Kentucky to restore money that was cut from health and long-term care services under Medicaid. Restoring money cut from health and long-term care services under Medicaid used by children, people with disabilities, and the elderly is important to almost all Kentucky residents. Eight in ten respondents think it is very important (80%) while another 15 percent think it is somewhat important. Importance of Restoring Money Cut From Health and Long-term Care Services (n=815) 100% 80% 75% 50% 25% 15% 2% 1% 0% Very Important Somewhat Not Very Important Not At All Important Important Respondents who have high school educations or less, have incomes of $75,000 or less, and smoke are more likely then others to say it is important for Kentucky to restore the money cut from health and long-term care services. Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax 4 Kentucky residents are more supportive of increasing the state cigarette tax from three cents to 28 cents per pack than increasing it to 78 cents per pack. Survey respondents were asked two separate questions about raising the cigarette tax from its current rate of three cents per pack. In the first question, an increase to 28-cents per pack was considered. In the second question, an increase to 78-cents per pack was considered. The different levels of support for the increases are striking. Seven in ten respondents support the 25-cent increase in the state cigarette tax, with over half strongly supporting it. In contrast, slightly less than half (47%) of the Kentucky respondents support the 75-cent per pack increase, and about a third strongly support it. It is worth noting that strong opposition to the cigarette tax doubles at the higher tax increase level; 36 percent of those 18 and older strongly oppose the 75-cent per pack increase in the cigarette tax, while only 19 percent strongly oppose it at the lower level. Support for Increasing the State’s Support for Increasing the State’s Cigarette Cigarette Tax to 28 Cents Per Pack to Tax to 78 Cents Per Pack to Generate Money Generate Money for Health and Long-term for Health and Long-term Care Services Care Services (n=815) (n=815) Don't Don't Know/ Know/ Refused Refused 3% 3% Strongly Strongly Oppose Support 19% Strongly 34% Oppose 36% Somewhat Oppose 8% Strongly Somewhat Support Somewhat Support 55% Support Somewhat 15% 13% Oppose 14% Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax 5 As might be expected, non-smokers are more likely to strongly support an increase to 28 cents per pack (66%) as well an increase to 78 cents per pack (43%) in the cigarette tax. However, some smokers also support a cigarette tax increase: over four in ten smokers (43%) at least somewhat support an increase to 28 cents per pack. Five times as many Kentucky residents say they are more likely to vote for a candidate who supports maintaining the delivery of health and long-term care services, even if it means generating additional state revenue, than are less likely to vote for that candidate. Forty-five percent of Vote for Candidate Who Supports Increasing the Kentucky residents 18 and Cigarette Tax to Generate Money for Health and Long- older would be more likely Term Care Services to vote for a candidate who (n=815) supports increasing the More likely state's cigarette tax to 45% generate money for health and long-term care services. Only 10 percent would be less likely to vote for a candidate who supports the increase. Don't know 9% Less likely 9% Makes no difference 36% Respondents with incomes between $20,000 and $40,000, who have at least a college education, those who always or sometimes vote, and non-smokers are more likely than others to say they would vote for a candidate who supports maintaining the delivery of health and long-term care services, even if it means generating additional state revenues. Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax 6 A Profile of Kentucky Respondents Eight hundred and fifteen Kentucky residents 18 and older participated in the survey. Eight in ten respondents (79%) say they have voted regularly in state elections for Kentucky Governor and Legislators over the last ten years. Which of the Following Best Describes Your Voting Behavior Over the Last 10 Years in State Elections for Kentucky Governor and Legislators? (n=815) Always vote 52% Never vote 12% Sometimes miss one 27% Rarely vote 9% The majority of respondents are women (66%). Respondents vary in age: 17 percent are 34 or younger, 30 percent are between 35 and 49, and 52 percent are 50 or older. Six in ten (62%) Kentucky respondents are married; yet, a large number are widowed (13%) or divorced (11%). Most respondents hold high school diplomas or the equivalent (34%) or have some college or technical training beyond high school (24%). Half (50%) are employed either full-or part-time. Another 25 percent of residents are retired. One third (34%) of Kentucky respondents (35%) have an annual household income of $30,000 or less. One quarter of respondents (25%) say they currently smoke on a regular basis. About a quarter of survey respondents (25%) are members of AARP. Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax 7 Conclusions Almost six in ten Kentucky residents think there is not enough money in the state budget to meet the need for health and long-term care services and ensure quality. Over nine in ten Kentucky respondents say it is important for the state to restore money cut from health and long-term care services under Medicaid used by children, people with disabilities, and the elderly. As Kentucky state officials grapple with how to pay for health and long- term care services, increasing the cigarette tax is an option supported by over half of state residents. Specifically, a sizable majority (70%) of Kentucky residents, 18 and over, support a 25-cent per pack cigarette tax and almost half (47%) support an increase of 75-cent per pack. Moreover, generating additional state revenue to support maintaining the delivery of health and long-term care services is an issue that could influence voting behavior. Five times as many Kentucky residents (45%) are more likely to vote for a candidate who supports maintaining health and long-term care services, even if it means generating additional state revenues compared to those (9%) who are less likely to vote for such a candidate. Methodology AARP commissioned Woelfel Research, Inc. a national survey research firm, to conduct a Kentucky random digit dial (RDD) telephone survey of state residents who are age 18 and older. A total of 815 interviews were completed between October 1, 2003 and October 7, 2003.2 The survey has a sampling error of plus or minus 3.4 percent. This means that in 95 out of 100 samples of this size, the results obtained in the sample would fall in a range of 3.4 percentage points of what would have been obtained if every state resident age 18 or older had been surveyed. Responses to all survey questions are in the attached annotated questionnaire. 2 The response rate is 24 percent and the cooperation rate is 94 percent. The response rate is Response Rate 3 and the cooperation rate is Cooperation Rate 3 from the following publication: The American Association for Public Opinion Research. 2000. Standard Definitions: Final Dispositions of Case Codes and Outcome Rates for Surveys. Ann Arbor, Michigan: AAPOR. Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax 8 Annotated Questionnaire Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax 9 Funding State Programs: A Survey on Increasing Kentucky’s Cigarette Tax WEIGHTED N = 815, RESPONSE RATE =24%, SAMPLING ERROR = +/- 3.4% (Percentages may not add to 100% due to rounding or multiple responses. A “*” means less than 1%.) Introduction Hello, this is _______________ from Woelfel Research, a national opinion research company. We’re conducting a study among Kentucky residents about paying for state services such as health and long-term care. This is not a sales call and you will not be asked to buy anything either now or later. We would really like to include your opinions in our study and assure you that all of your answers will remain completely confidential. The survey should take only about 7 minutes to complete. Are you a Kentucky resident who is 18 years old or older? 1 Yes 2 No [ASK TO SPEAK TO SOMEONE IN HH WHO IS A KENTUCKY RESIDENT AGE 18 OR OLDER] Screening Hello, this is _______________ from Woelfel Research, a national opinion research company. We’re conducting a study among Kentucky residents about paying for state services such as health and long-term care. This is not a sales call and you will not be asked to buy anything either now or later. We would really like to include your opinions in our study and assure you that all of your answers will remain completely confidential. The survey should take only about 7 minutes to complete. 1 CONTINUE 2 REFUSED RECORD GENDER OF RESPONDENT: % 34 Male 66 Female What is your age as of your last birthday? [RECORD IN YEARS] % 4 18-24 13 25-34 30 35-49 22 50-59 22 60-74 8 75+ 1 Refused Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax 10 Main Questionnaire Q1. Which of the following best describes Kentucky's current funding for health and long- term care services under Medicaid used by children, people with disabilities, and the elderly? Do you think….(READ LIST. ENTER ONLY ONE RESPONSE.) % 4 There is more than enough money in the state budget to meet the need for health and long-term care services and ensure quality? 15 There is enough money in the state budget to meet the need for health and long- term care services and ensure quality? 59 There is not enough money in the state budget to meet the need for health and long-term care services and ensure quality? 22 Don't know * Refused Q2. This year, Kentucky had a $400 million shortfall in the budget. This resulted in large budget cuts across the board. $250 million was cut from health and long-term care services under Medicaid used by children, people with disabilities, and the elderly. More cuts are expected in 2004. How important is it to you for Kentucky to restore money that was cut from health and long-term care services under Medicaid used by children, people with disabilities, and the elderly? % 80 Very Important 15 Somewhat Important 2 Not Very Important 1 Not At All Important 3 Don't know - Refused Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax 11 Q3. Currently, there are proposals to generate money to replace funding cut this year and prevent cuts in 2004 for health and long-term care services under Medicaid used by children, people with disabilities, and the elderly. Now I would like to get your opinion on some of these proposals. At three-cents per pack, Kentucky’s cigarette tax is the second lowest cigarette tax in the country. It was last increased in 1970. The states surrounding Kentucky have cigarette taxes that average approximately $.43 cents per pack. One proposal to generate money for health and long-term care services calls for an increase in the cigarette tax by $.25 cents per pack, which would generate $100 million dollars annually and bring in $233 million dollars annually in federal money. Do you support or oppose increasing Kentucky’s cigarette tax from $.03 cents per pack to $.28 cents per pack to generate money for health and long-term care services for children, people with disabilities, and the elderly? [READ EACH OPTION] % 55 Strongly Support 15 Somewhat Support 8 Somewhat Oppose 19 Strongly Oppose 3 Don’t know * Refused Q4. Another proposal to increase the cigarette tax calls for an increase of $.75 cents per pack. This proposal would generate about $300 million annually and bring in $699 million dollars annually in federal money. Do you support or oppose increasing Kentucky’s cigarette tax from $.03 cents per pack to $.78 cents per pack to generate money for health and long-term care services for children, people with disabilities, and the elderly? [READ EACH OPTION] % 34 Strongly Support 13 Somewhat Support 14 Somewhat Oppose 36 Strongly Oppose 3 Don’t know * Refused Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax 12 Q5. If a candidate for state legislative office in Kentucky supported maintaining the delivery of health and long-term care services even if it means generating additional state revenues, would you be more likely to vote for that candidate, less likely to vote for them, or would it not make any difference? % 45 More likely 9 Less likely 36 Would Not Make a Difference 9 Don't know * Refused Demographics D1. What is your marital status? Are you currently….. % 62 Married, 1 Living with partner 11 Divorced, 1 Separated, 13 Widowed, 11 Or have you never been married? * Refused (DO NOT READ) D2. Are you or your spouse a member of A-A-R-P formerly known as the American Association of Retired Persons? [IF NOT “MARRIED” ASK, “Are you a member…”] % 25 Yes 74 No 1 Don’t know (DO NOT READ) D3. Thinking about your state elections for Kentucky Governor and Legislators in the last ten years, which of the following best describes your voting behavior? Would you say you always vote, sometimes miss one, rarely vote, or never vote? % 52 Always vote 27 Sometimes miss one 9 Rarely vote 12 Never vote * Don’t know (DO NOT READ) * Refused (DO NOT READ) * Depends (VOLUNTEERED) Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax 13 D4. What is the highest level of education you have completed? (READ ANSWER CATEGORIES) % 15 Less than high school 34 High school graduate or equivalent 24 Some college or technical training beyond high school 16 College graduate 10 Post-graduate or professional degree? * Refused (DO NOT READ) D5. Which of the following best describes your current employment status? Are you currently…. % 42 Employed full-time 8 Employed part-time 25 Retired and not working 4 Unemployed and looking for work 9 Homemaker * Or something else? [Specify: ___________] 9 Disabled 1 Student 2 Self-employed * Don’t know (DO NOT READ) * Refused (DO NOT READ) D6. Now, for statistical purposes only, please stop me when I get to the category that includes your household’s income before taxes in 2002. Was it… (READ ANSWER CATEGORIES) % 10 Less than $10,000 10 $10,000 but less than $20,000 13 $20,000 but less than $30,000 12 $30,000 but less than $40,000 9 $40,000 but less than $50,000 14 $50,000 but less than $75,000 7 $75,000 but less than $100,000 6 100,000 or more 4 Don't know (DO NOT READ) 15 Refused (DO NOT READ) Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax 14 D7. Do you currently smoke cigarettes on a regular basis? % 25 Yes 74 No * Don’t know * Refused D8. What is your 5-digit zip code? __ __ __ __ __ D9. And, finally, may I verify that I reached you at: (_____)_________________________ Thank you for participating! Your Opinion Counts. Respondent gender: Male Female [SKIP TO INTERVIEWER NAME] Funding Health and Long-Term Care: A Survey on Increasing Kentucky's Cigarette Tax 15