BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | SBX2 14|
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THIRD READING
Bill No: SBX2 14
Author: Hernandez (D)
Introduced:9/9/15
Vote: 27
SENATE HEALTH & DEV. SVCS. COMMITTEE: 9-4, 9/10/15
AYES: Hernandez, Beall, Hall, Leno, McGuire, Mitchell, Monning,
Pan, Wolk
NOES: Morrell, Anderson, Moorlach, Nielsen
SENATE APPROPRIATIONS COMMITTEE: 5-2, 9/10/15
AYES: Lara, Beall, Hill, Leyva, Mendoza
NOES: Bates, Nielsen
SUBJECT: Tobacco: electronic cigarettes: taxes: managed care
organization provider tax: in-home supportive
services
SOURCE: Author
DIGEST: This bill imposes an additional excise tax of $2 per
package of 20 cigarettes, imposes an equivalent one-time "floor
stock tax" on the cigarettes held or stored by dealers and
wholesalers, and indirectly increases the tobacco products tax.
Imposes a tax on electronic cigarettes equivalent to the $2 per
package tax imposed on cigarettes by this bill. Requires revenue
from tobacco and electronic cigarette taxes to be used for
various tobacco use prevention and research, law enforcement,
medical school education, for improved payments for Medi-Cal
funded services, and to backfill existing tobacco-tax funded
services for any revenue decline resulting from the additional
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tax. Imposes a managed care organization provider tax (MCO tax)
on health plans, with different taxing tiers based on
enrollment. Continuously appropriates funds from the MCO tax for
purposes of funding the nonfederal share of Medi-Cal managed
care rates, and transfers $230 million, to be used upon
appropriation by the Legislature, to increase the funding
provided to regional centers and to increase rates paid to
providers of service to the developmentally disabled. Repeals
the 7% reduction in hours of service to each In-Home Supportive
Services recipient of services.
ANALYSIS:
Existing law:
1)Imposes an 87 cents tax per pack of 20 cigarettes on
distributors of cigarettes and tobacco products, which funds a
variety of programs and services including: tobacco-related
health education, tobacco-related disease research, hospital
and physician services, fire prevention, environmental
conservation, breast cancer research and early detection
services, and early childhood development programs.
2)Requires the Board of Equalization (BOE), under the Cigarette
and Tobacco Products Licensing Act of 2003 (Licensing Act), to
administer a statewide program to license manufacturers,
importers, distributors, wholesalers and retailers of
cigarettes and tobacco products.
3)Establishes the county-administered In-Home Supportive
Services (IHSS) program, under which qualified aged, blind,
and disabled persons are provided with services to permit them
to remain in their own homes and avoid institutionalization.
Existing law provides for a 7% reduction in hours of service
to each IHSS recipient of services.
4)Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which health
care services are provided to qualified, low-income persons.
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Under existing law, one of the methods by which Medi-Cal
services are provided is through contracts with various types
of managed care plans.
5)Imposes a sales tax on sellers of Medi-Cal managed care
organizations (MCOs), until July 1, 2016.
6)Requires, under the Lanterman Developmental Disabilities
Services Act, the Department of Developmental Services (DDS)
to contract with regional centers to provide services and
supports to individuals with developmental disabilities. Under
existing law, the regional centers purchase needed services
for individuals with developmental disabilities through
approved service providers or arrange for those services
through other publicly funded agencies. The annual Budget Act
also appropriates funds to DDS to fund regional center
operations.
7)Establishes specified rates to be paid to certain
developmental service providers and the rates to be paid for
certain developmental services. Requires that rates to be paid
to other developmental service providers either be set by DDS
or negotiated between the regional center and the service
provider.
This bill:
1)Imposes an additional excise tax of $2 per package of 20
cigarettes, and imposes a one-time "floor stock tax" on the
cigarettes held or stored by dealers and wholesalers.
2)Imposes a tax on electronic cigarettes equivalent to the $2
per package tax
imposed on cigarettes by this bill.
3)Expands the definition of "tobacco products" to include
electronic cigarettes, as defined, for purposes of the
Licensing Act, thereby subjecting manufacturers, importers,
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distributors, wholesalers, and retailers of e-cigarettes to
the same licensing requirements imposed under the Licensing
Act applicable to tobacco products.
4)Creates the California Health Care, Developmental Services,
and Prevention Tobacco Tax Act Fund of 2015 in the State
Treasury, and requires all revenue from the $2 excise tax
increase and equivalent tax on e-cigarettes be deposited in
this fund.
5)Prohibits the cigarette and e-cigarette taxes imposed by this
bill from being considered part of the General Fund, or be
considered General Fund revenue for purposes of Proposition
98.
6)Establishes the California Health Care, Research, and
Prevention Tobacco Tax Act of 2015 in the State Treasury as a
continuously appropriated fund, to be used for the following
purposes:
a) To offset the revenue decrease resulting from the
imposition of the additional tax in this bill on the
existing tobacco-tax funded Breast Cancer Fund, Proposition
99 and Proposition 10-funded programs based on the decrease
in tobacco consumption resulting from the additional tax
imposed by this bill;
b) To reimburse the Board of Equalization (BOE) in the
administration, calculation, and collection of the tax, the
calculation and distribution of funds and in regulation
promulgation, with a 1% cap for administrative costs;
c) To reimburse the State Auditor up to $400,000 for actual
costs incurred to conduct audits required by this bill;
d) To provide $40 million in funding to the University of
California (UC) for the purpose and goal of increasing the
number of physicians trained in California;
e) To provide $48 million for the purpose of funding law
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enforcement efforts and investigative activities to reduce
illegal sales of tobacco products, illegal sales to minors,
reduce cigarette smuggling, tobacco tax evasion and
counterfeit tobacco products, to enforce licensing
requirements, to enforce tobacco-related laws, court
judgments and legal settlements, and to conduct law
enforcement training and technical assistance for
tobacco-related statutes, provided these funds are not used
to supplant existing state or local funds. Apportions these
funds in the following manner:
i) $30 million to the Department of Justice to be
distributed to local law enforcement to support and hire
front-line law enforcement peace officers;
ii) $6 million to BOE to be used to enforce laws that
regulate the distribution and retail sale of cigarettes
and other tobacco products;
iii) $6 million to the Department of Public Health (DPH)
to be used to support programs, including grants to local
law enforcement agencies to provide training and funding
for the enforcement of state and local laws related to
the illegal sales of tobacco to minors;
iv) $6 million to the Attorney General to be used for
activities including enforcing laws that regulate the
distribution and sale of cigarettes and tobacco products.
f) Requires the BOE, beginning two years after the
effective date of this bill, to determine the reduction in
revenues from a reduction in cigarette and tobacco product
consumption due to the additional taxes. Requires BOE, if
it determines there has been a reduction, to reduce the
amounts in a) through e) above proportionately.
7)Requires the Controller to allocate, after the transfers in 6)
above, the remaining moneys as follows:
a) 82% to the Health Care Treatment Fund, to be used by
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DHCS to increase funding for existing Medi-Cal health care
programs and services by providing improved payments,
including funding support for county and UC hospitals and
the governmental entities with which they are affiliated,
for the nonfederal share of payments. Requires, to the
extent possible, payments and support to be increased based
on criteria developed and updated by DHCS in consultation
with the Legislature as part of the annual state budget
process, provided these funds are used to supplant existing
state general funds for these same purposes. Requires the
criteria to include, but not be limited to, ensuring timely
access, specific geographic shortages of services or
ensuring quality care. Requires, consistent with federal
law, the funding to be used to draw down federal funds;
b) 13% for the purpose of funding comprehensive tobacco
prevention and control programs, provided that these funds
are not used to supplant existing state or local funds,
apportioned in the following manner:
i) 85% to DPH for tobacco control programs, and
requires DPH to award funds to local government and
community-based organization for the implementation,
evaluation and dissemination of evidence-based health
promotion and health communication activities in order to
monitor, evaluate and reduce tobacco use, tobacco-related
disease rates and health disparities;
ii) 15% to the Department of Education for school
programs to prevent and reduce the use of tobacco and
nicotine products by young people;
c) 5% to the UC Tobacco-Related Disease Research Program
for basic, applied and translational medical research in
California into the prevention of, early detection of,
treatments for, complementary treatments and potential
cures for all types of cancer, cardiovascular and lung
disease, oral disease and tobacco-related diseases.
8)Requires the State Auditor to define "administrative costs"
via regulation, and caps administrative costs at specified
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amounts.
9)Requires the State Auditor to conduct at least biennially an
independent financial audit of the state and local agencies
receiving tobacco tax funds. Requires the State Auditor to
prepare a report detailing its review, including any
recommendations for improvements.
10)Requires state agencies and departments receiving tobacco
tax funds under this bill to publish on an annual basis on
their internet web site an accounting of how much money was
received, and how the money was spent.
11)Repeals a provision of law that reduces by 7% the hours of
service for each IHSS recipient.
12)Establishes a new MCO tax, to be administered by DHCS, in
consultation with the Department of Managed Health Care
(DMHC).
13)Assesses the MCO tax on health plans licensed by DMHC and
managed care plans contracted with DHCS to provide Medi-Cal
services, with some exceptions, as specified.
14)Requires health plans to report to DHCS specified enrollment
information, on a quarterly basis, beginning with the 2016-17
state fiscal year.
15)Establishes applicable taxing tiers and per enrollee amounts
for the 2016-17 fiscal year. Requires, commencing with the
2017-18 fiscal year, DHCS and DMHC to determine tax tiers and
per enrollee tax amounts. Requires DHCS to request approval
from the federal Centers for Medicare and Medicaid Services
as necessary to implement these provisions.
16)Establishes the Health and Human Services Special Fund in
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the State Treasury, into which all revenues, less refunds,
derived from MCO taxes imposed by this bill would be
deposited. Requires the moneys in the fund to be allocated as
follows:
a) $230 million transferred annually from the Health and
Human Services Special Fund to the Developmental
Disabilities Fund created by this bill, to be used upon
appropriation by the Legislature, to do both of the
following:
i) Increase the funding provided to a regional center
for the regional center's operating budget by up to 10%
above the levels in effect on the effective date of this
bill; and,
ii) Increase all rates paid to service providers for
providing services to developmentally disabled
individuals by up to 10% above the levels in effect on
the effective date of this bill.
b) Continuously appropriates to DHCS for the purpose of
funding the nonfederal share of Medi-Cal managed care
rates.
Comments
1)Author's statement. According to the author, this
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comprehensive piece of legislation directly addresses the
shortage of funding for California's most vulnerable
communities. The author states this legislation guarantees
funding to improve quality and expand access to health care
for those on Medi-Cal, as well as restores funding for our
developmentally disabled community, and clearly demonstrates
California's commitment to help those that need it most,
including seniors, children, families, and individuals with
special needs. This bill would increase the cigarette tax by
$2 a pack, and would impose an equivalent increase on
e-cigarette products, which is preliminarily estimated to
generate nearly $1.3 billion annually. The revenue would go
towards increasing Medi-Cal reimbursement rates to help
improve access to quality providers for Medi-Cal recipients,
and to ensure a robust tobacco prevention program by providing
increased funding for existing tobacco-funded programs
including law enforcement and smoking prevention efforts. In
addition, the legislation also would enact the Governor's most
recent proposed tax on MCO and allocates the funding directly
to Med-Cal managed care rates and to increase rates to
providers of services to individuals served by the
developmental disabilities system and regional center
operations budgets by up to 10%. The author concludes that
this bill is a win-win for Californians as it will not only
generate much needed revenue for health care and developmental
services, but it will also help reduce smoking rates and deter
teenagers from getting hooked on a deadly habit. The revenue
generated by enacting this bill will help provide care for the
most underserved and neediest communities in California.
2)Cigarette and tobacco products tax law. State law imposes an
87 cent excise tax on a package of cigarettes. Federal law
imposes a tax of $1.01 per pack of 20 cigarettes with the
majority of the funds being used to fund children's health
programs, under federal law. Since 1998, the Legislature and
voters have adopted three tobacco tax measures which have
raised the cigarette tax by 77 cents. Current state taxes and
surtaxes are allocated in the following manner: 10 cents to
the state General Fund; 25 cents to the Cigarette and Tobacco
Products Surtax Fund (Proposition 99, 1988); 2 cents to the
Breast Cancer Fund; and 50 cents to the California Children
and Families Trust Fund (Proposition 10, 1998). In November
1998, state attorney generals and tobacco companies entered
into the Master Settlement Agreement, whereby, tobacco
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companies, agreed to change the way tobacco products were
marketed and agreed to pay, in perpetuity, various annual
payments to compensate for medical costs for caring for
persons with smoking-related illnesses. In 2012, California
received a Master Settlement Payment of around $735.7 million,
which adds an additional 50 cents tax per pack.
Current law provides that increasing the cigarette tax
triggers an automatic tobacco products tax increase.
Specifically, a provision of Proposition 99 requires the BOE
to annually determine the tobacco products tax rate at a rate
equivalent to the combined rate of all taxes imposed on
cigarettes. Additionally, because the cigarette tax increase
and indirect tobacco products tax will be included in the
total sales price, the bill will increased sales tax revenues.
3)The Lanterman Act. The Lanterman Developmental Disabilities
Services Act establishes an entitlement to services and
supports for Californians with developmental disabilities,
defined as a disability originating before the age of 18, that
can be expected to continue, indefinitely, and constitutes a
substantial disability. Approximately 290,000 children and
adults with developmental disabilities are served in
community-based programs and supported by state- and federally
funded services that are coordinated by 21 local, nonprofit
regional centers. An additional 1,100 individuals are served
in four state-run institutions, including three Developmental
Centers. Approximately 45,000 agencies provide services in
more than 150 service category types including residential
care, day programs, behavioral therapies, independent and
supported living, supported employment, respite,
transportation and many others.
Since 2009, the state has reduced costs to community-based
developmental services programs by more than $1 billion (GF)
including restrictions on payments for specific services, caps
on costs provided for other services, across-the-board
reductions, mandated holidays and other cuts. Prior to the
2009 cost-containment measures, the state had frozen rates to
providers in order to contain costs. Regional centers also
have struggled with heavy caseloads and low salary
reimbursements during this time period.
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4)In-Home Supportive Services. The IHSS program provides
personal care services to approximately 420,000 qualified
low-income individuals who are aged (over 65), blind, or who
have disabilities. Services include tasks like feeding,
bathing, bowel and bladder care, meal preparation and
clean-up, laundry, and paramedical care. These services
frequently help program recipients to avoid or delay placement
in institutional care settings. The average annual cost of
services per IHSS client is estimated to be around $14,217
($1,185 per client per month) for 2015-16.
In December 2011, as a part of the Governor's budget trigger
package that took effect as a result of lower than anticipated
state revenues, a 20% across-the-board reduction of IHSS hours
was imposed. A federal district court prevented the reduction
from taking effect, pending the outcome of litigation. In
March 2013, the Administration and plaintiffs (labor unions
and disability rights advocates) announced a settlement
agreement from an 8% across-the-board reduction to authorized
service hours, effective July 1, 2013, and a 7%
across-the-board reduction to service hours July 1, 2014. The
settlement agreement includes a provision to "trigger off" the
ongoing reduction of up to 7%-in whole or in part-as a result
of enhanced federal funding received pursuant to an
"assessment" (a provider tax under Medicaid law) on home
health care services, including IHSS.
DHCS was required by statute to submit a proposal for its
implementation to the federal government by October 2014, but
the Administration instead submitted a letter to the
Legislature in August 2014, indicating that it had worked in
good-faith to develop a federally-compliant proposal but,
given the new federal guidance on health care related taxes,
it was unable to meet the deadline. The letter indicated that
the Administration would work with all parties on viable
legislation early in the 2015-16 session. Instead, the
Governor's budget included a proposal to create a new MCO tax,
which is projected to raise for 2015-16 an additional $215.6
million GF in revenues (to be matched with federal funds) to
fully restore the 7% reduction in IHSS hours.
5)MCO tax. California's existing MCO tax imposes a 3.9% tax on
the total revenue received by MCOs through their Medi-Cal
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managed care plans. This existing tax holds the MCOs harmless
and generates funding to offset other GF costs. According to
the Senate Budget Subcommittee on Health and Human Services,
for 2015-16, the current MCO tax is projected to generate
$1.13 billion in non-federal funding for the Medi-Cal program.
The revenues are deposited into the Children's Health and
Human Services Special Fund. Half of the MCO tax revenues are
used to draw down federal Medi-Cal funds and then used to pay
back Medi-Cal managed care plans in order to "make them
whole." The other half of these funds is used to offset GF
expenditures for Medi-Cal managed care rates for children,
seniors and persons with disabilities, and dual eligibles.
California's current MCO tax sunsets on July 1, 2016.
In a July 2014 letter to State Medicaid Directors, the federal
Centers for Medicare and Medicaid Services (CMS) indicates
that taxes structured like California's current MCO tax will
likely be considered health care-related taxes that would have
to meet Medicaid requirements. This means the tax must:
a) Be applied to all providers in a class (meaning the
tax must be applied to all MCOs and not just MCOs
providing services to Medi-Cal beneficiaries, unless a
waiver is obtained);
b) Applied at the same rate for all payers of the tax
(unless a federal waiver is obtained); and,
c) Cannot directly or indirectly guarantee that
providers receive their tax back.
The federal deadline for states to reform tax structures that
are out of compliance is the end of the states' legislative
session, which is August 31, 2016 for California.
The Administration revised its MCO proposal in early September
2015. This revised tax continues to use enrollment ranges with
tax tiers for enrollment in each range, but it taxes Medi-Cal
enrollees at a higher amount than non-Medi-Cal enrollees. The
revised proposal continues to generate roughly the same amount
of revenue ($1.3 billion GF net to the state), but reduces the
net impact to managed care plans from the Administration's
prior proposal of $669 million, to $317 million. A more recent
proposal further reduces the net impact to the plans to $114
million by selectively reducing corporate, gross premiums and
corporate tax rates for plans paying the MCO tax, and by
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increasing some of the MCO taxing tier amounts and by
exempting three plans from the MCO tax entirely. In addition,
the revised proposal reduces the net impact to every plan,
significantly reduces tax rates for non-Medi-Cal lives and
reduces the differential between tiers for non-Medi-Cal
enrollees from the previous proposal, particularly for those
middle tiers that had the burden of the highest rates under
the Administration's prior proposal.
FISCAL EFFECT: Appropriation: Yes Fiscal
Com.:YesLocal: Yes
According to the Senate Appropriations Committee:
Tobacco Tax Revenues. Estimated total annual revenue increase
of $1.3 billion per year from taxes paid on cigarettes and
other tobacco products ($1.2 billion per year) and electronic
cigarettes ($100 million per year ) (General Fund).
Tobacco Tax Expenditures. The bill specifies that revenues
resulting from the increased tobacco tax will be spent as
follows:
o Ongoing costs of about $100 million per year to
backfill existing programs supported with tobacco tax
revenues (General Fund). Under current law, existing
tobacco tax revenues are used to support Breast Cancer
Research, programs supported by Proposition 99 (including
public health and environmental protection programs), and
programs supported by Proposition 10 (for early childhood
education). The bill requires that reductions in existing
tobacco tax revenues for those programs (due to declining
tobacco use resulting from higher overall taxes) would be
backfilled with revenue from the additional tobacco tax
imposed by the bill. (Note that the bill does not require
new tobacco tax revenues to be used to backfill the
portion of the tobacco tax that is deposited in the
General Fund.)
o Ongoing costs up to $12 million per year for
administration and enforcement by the Board of
Equalization (General Fund). The bill authorizes the
Board of Equalization to use up to 1% of new tax revenues
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(after backfilling existing programs) for administration
and enforcement.
o Annual costs of $400,000 per year for required
audits of tobacco tax revenues by the Bureau of State
Audits (General Fund).
o Annual costs of $40 million per year to support
physician training programs within the University of
California System (General Fund).
o Annual costs of $48 million per year for enforcement
programs at the local level, the Board of Equalization,
the Department of Public Health, and the Attorney
General's Office (General Fund).
o Annual costs up to about $900 million per year for
increased payments to Medi-Cal providers (General Fund).
The bill provides that 82% new tobacco tax revenues
(after accounting for the above expenditures) shall be
used by the Department of Health Care Services to augment
payments to Medi-Cal providers. The General Fund monies
allocated in the bill would be augmented with federal
matching funds, more than doubling the actual amount of
payments made to Medi-Cal providers.
o Annual costs up to about $140 million per year for
tobacco prevention and control programs by the Department
of Public Health and the Department of Education (General
Fund).
o Annual costs up to about $55 million per year for
research on tobacco-related diseases by the University of
California (General Fund). Similar to the increase in
Medi-Cal provider payments, the actual amount of funding
that would be available will be reduced by any backfill
of existing programs.
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Managed Care Organization Tax Revenues. Annual revenues of
$1.939 billion per year in tax revenues paid by managed care
organizations, including those providing services under the
Medi-Cal program and those managed care plans that do not
contract with the Medi-Cal program (General Fund).
Managed Care Organization Tax Expenditures. The bill would
allocate the resulting revenues as follows:
o Annual costs of $1.645 billion to provide increased
capitation payments to Medi-Cal managed care plans ($576
million from the Managed Care Organization Tax revenues
and $1.069 billion in matching federal funds).
o Annual costs of $230 million per year to increase
provider rates in the regional center system for services
provided to individuals with developmental disabilities
and increases in regional center operational budgets.
o Annual General Fund revenues of $1.133 billion used
to offset current expenditures in the Medi-Cal program
(General Fund).
Other state costs. In addition to the dedication of new
revenues for specific expenditures, the may impose other
direct costs on the state.
Potential increased Proposition 98 funding obligation. The
bill may result in additional state funding obligations for
education (General Fund). The state constitution generally
requires the state to make payments for K-14 education equal
to about 50% of annual General Fund revenues. (The actual
funding formulas for Proposition 98 are complex and vary from
year to year based on economic conditions and state
budgeting.) Historically, the state has not counted revenues
from the existing Managed Care Organization Tax towards the
Proposition 98 funding requirement. However, because this
measure imposes new taxes, the resulting revenues may be
subject to the requirements of Proposition 98. The state could
therefore be obligated to increase payments for education on
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average by about 50% of the resulting revenues - in this case
about $650 million per year due to the increased tobacco tax
and $970 million per year due to the Managed Care Organization
Tax.
o IHHS restoration. Ongoing annual costs of $275
million (General Fund only) to restore an existing 7%
reduction in In-Home Supportive Services hours.
o Cost to the state through CalPERS managed care
plans. Annual costs to the state of about $11 million per
year, due to the cost of the Managed Care Organization
Tax on CalPERS plans (General Fund and special funds).
CalPERS health care plans would be subject to the tax as
commercial managed care plans. Presumably those
contracting managed care plans would pass along the
increased tax cost to the state through higher premiums.
o Ongoing reduction in General Fund tobacco tax
revenue. By increasing tobacco taxes, the bill will
reduce overall consumption of tobacco products, reducing
revenues from the existing tobacco taxes. Based on the
projected reduction in consumption, the bill will result
in an annual reduction of about $14 million per year in
tobacco tax revenue that is deposited in the General
Fund. Unlike the other programs supported by existing
tobacco tax revenues, the reduced General Fund revenue
would not be backfilled with new tobacco tax revenue.
SUPPORT: (Verified9/11/15)
American Federation of State, County and Municipal Employees,
AFL-CIO
American Lung Association in California
OPPOSITION: (Verified9/11/15)
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Bay Area Council
California Business Roundtable
California Chamber of Commerce
California Manufacturing & Technology Association
California Taxpayers Association
Greater San Fernando Valley Chamber of Commerce
Los Angeles Area Chamber of Commerce
Pacific Business Group on Health
Simi Valley Chamber of Commerce
ARGUMENTS IN SUPPORT: The American Federation of State,
County and Municipal Employees (AFSCME) writes in support of
this measure that without a permanent funding source, the state
will reinstate the 7% cut in IHSS hours on July 1, 2016, which
would be a terrible injustice to the hundreds of thousands of
Californians who rely on the IHSS program to live independently
and safely in their homes. AFSCME states these cuts were
devastating to all IHSS recipients but particularly so to
families with developmental disabled loved ones who rely heavily
on the IHSS program.
ARGUMENTS IN OPPOSITION: The California Taxpayers
Association (CalTax) writes in opposition to the $2 per pack
cigarette tax and the equivalent rate imposed on other tobacco
products and e cigarettes. CalTax writes that relying on a
declining revenue source to fund important programs creates
long-term funding shortfalls that can be paid for only through
siphoning revenue from other budgetary needs or through
additional tax increases. In addition, CalTax argues this tax is
a regressive tax that has a greater burden on lower- and
middle-income taxpayers, and this bill will provide a financial
windfall for criminals as higher taxes create an increased
incentive for the black market and this problem would worsen
should the tax increase by $2 a pack.
Prepared by:Scott Bain / HEALTH /
9/11/15 12:39:20
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