ANNAPOLIS, Md. -- Maryland's General Assembly is reconsidering a bill to tax tobacco, with backers touting public health benefits, and health equity for people of color.

Gov. Larry Hogan vetoed House Bill 732 last year, balking at raising cigarette taxes by $1.75 per pack, even though the funds would go to smoking cessation and health programs.

Jocelyn Collins, Maryland and Washington, D.C. director of government relations for the American Cancer Society, thinks lawmakers will override the veto this session.

She said the tax is also a social-justice issue, as the tobacco industry has aggressively marketed to Black communities, and smoking is a risk factor for COVID-19, which has disproportionately hit the same group.

"In Baltimore, we do know that there are five times more tobacco retailers per square mile in the lowest-income neighborhoods than high-income neighborhoods, as defined by data from the U.S. Census," Collins observed. "We have to look at the health impact of this."

The override vote is expected Feb. 8.

The Mackinac Center for Public Policy opposes the tax hike, saying it would only increase cigarette smuggling.

Michael LaFaive, director of the Morey Fiscal Policy Initiative at the Center, estimated up to 85% of after-tax-hike changes in legal cigarette sales may be the result of tax evasion, not people smoking less.

Collins disagreed, and added the last time Maryland increased its tobacco tax more than a decade ago, retail cigarette sales dropped 30%. She also noted research showed the increased tax saved almost 13,000 lives and prevented more than 15,000 kids from becoming smokers.

"We do know that this is a proven mechanism," Collins insisted. "We do know that it will save long-term healthcare costs of over $973.62 million. It actually saves taxpayer dollars in the long run, as well."

She argued a higher cigarette tax would generate about $95 million in new revenue by also taxing e-cigarettes at 12% and vaping liquid at 60%. Part of that revenue would help pay for the Maryland Historically Black Colleges and Universities Settlement to compensate for past discrimination.


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Nonprofits across Texas are coming together to address disparities in health care for the Latinx community. A report by the Commonwealth Fund shows some factors that lead to the differences in health care include high poverty rates, elevated levels of pollution and crime and a lack of green spaces.

Paulina Sosa, Latinx Voces founder, said many in the Latinx community lack access to vital resources that could improve their overall health.

"Lack of physical access to a clinic or a doctor, the lack of information on how to go about accessing those health care services, and of course, it could be related to the lack of linguistics, otherwise known as information in Spanish," she said.

She added health disparities that had been in existence for years were brought to light during the COVID-19 pandemic when Hispanics experienced some of the highest death rates.

Edgar Carmona, president of the nonprofit Alliance for Progress in Dallas, which works to reduce health-care disparities among vulnerable populations, said some in the Latinx community don't seek medical care because they don't trust caregivers from other races.

"We just don't see the medical community being able to represent the community that it serves. We, as a society, are perhaps not creating the opportunities needed, or the encouragement for our youth to go into this field," he continued.

Both Sosa and Carmona said collaborations can help improve health outcomes for the Latinx community. Sosa added that during and after the pandemic, community partners, small businesses and faith-based organizations worked together to improve the lives of those most vulnerable.

"How do we ensure that the momentum, around addressing these disparities - particularly for Latino and Spanish-speaking communities - how do we ensure that the momentum continues? That is one of the biggest questions we're trying to tackle. We really believe that partnership is at the center of that solution," Sosa said.


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By Jackie Fortiér for KFF Health News.
Broadcast version by Suzanne Potter for California News Service reporting for the KFF Health News-Public News Service Collaboration

When pediatrician Eric Ball opened a refrigerator full of childhood vaccines, all the expected shots were there — DTaP, polio, pneumococcal vaccine — except one.

“This is where we usually store our covid vaccines, but we don’t have any right now because they all expired at the end of last year and we had to dispose of them,” said Ball, who is part of a pediatric practice in Orange County, California.

“We thought demand would be way higher than it was.”

Pediatricians across the country are pre-ordering the updated and reformulated covid-19 vaccine for the fall and winter respiratory virus season, but some doctors said they’re struggling to predict whether parents will be interested. Providers like Ball don’t want to waste money ordering doses that won’t be used, but they need enough on hand to vaccinate vulnerable children.

The Centers for Disease Control and Prevention recommends that anyone 6 months or older get the updated covid vaccination, but in the 2023-24 vaccination season only about 15% of eligible children in the U.S. got a shot.

Ball said it was difficult to let vaccines go to waste last year. It was the first time the federal government was no longer picking up the tab for the shots, and providers had to pay upfront for the vaccines. Parents would often skip the covid shot, which can have a very short shelf life compared with other vaccines.

“Watching it sitting on our shelves expiring every 30 days, that’s like throwing away $150 repeatedly every day, multiple times a month,” Ball said.

This year, Ball slashed his fall vaccine order to the bare minimum to avoid another costly mistake.

“We took the number of flu vaccines that we order, and then we ordered 5% of that in covid vaccines,” Ball said. “It’s a guess.”

That small vaccine order cost more than $63,000, he said.

Pharmacists, pharmacy interns, and techs are allowed to give covid vaccines only to children age 3 and up, meaning babies and toddlers would need to visit a doctor’s office for inoculation.

It’s difficult to predict how parents will feel about the shots this fall, said Chicago pediatrician Scott Goldstein. Unlike other vaccinations, covid shots aren’t required for kids to attend school, and parental interest seems to wane with each new formulation, he said. For a physician-owned practice such as Goldstein’s, the upfront cost of the vaccine can be a gamble.

“The cost of vaccines, that’s far and away our biggest expense. But it’s also the most important thing we do, you could argue, is vaccinating kids,” Goldstein said.

Insurance doesn’t necessarily cover vaccine storage accidents, which can put the practice at risk of financial ruin.

“We’ve had things happen like a refrigerator gets unplugged. And then we’re all of a sudden out $80,000 overnight,” Goldstein said.

South Carolina pediatrician Deborah Greenhouse said she would order more covid vaccines for older children if the pharmaceutical companies that she buys from had a more forgiving return policy.

“Pfizer is creating that situation. If you’re only going to let us return 30%, we’re not going to buy much,” she said. “We can’t.”

Greenhouse owns her practice, so the remaining 70% of leftover shots would come out of her pocket.

Vaccine maker Pfizer will take back all unused covid shots for young children, but only 30% of doses for people 12 and older.

Pfizer said in an Aug. 20 emailed statement, “The return policy was instituted as we recognize both the importance and the complexity of pediatric vaccination and wanted to ensure that pediatric offices did not have hurdles to providing vaccine to their young patients.”

Pfizer’s return policy is similar to policies from other drugmakers for pediatric flu vaccines, also recommended during the fall season. Physicians who are worried about unwanted covid vaccines expiring on the shelves said flu shots cost them about $20 per dose, while covid shots cost around $150 per dose.

“We run on a very thin margin. If we get stuck holding a ton of vaccine that we cannot return, we can’t absorb that kind of cost,” Greenhouse said.

Vaccine maker Moderna will accept covid vaccine returns, but the amount depends on the individual contract with a provider. Novavax will accept the return of only unopened vaccines and doesn’t specify the amount they’ll accept.

Greenhouse wants to vaccinate as many children as possible but said she can’t afford to stock shots with a short shelf life. Once she runs out of the doses she’s ordered, Greenhouse said, she plans to tell families to go to a pharmacy to get older children vaccinated. If pediatricians around the country are making the same calculations, doses for very small children could be harder to find at doctors’ offices.

“Frankly, it’s not an ideal situation, but it’s what we have to do to stay in business,” she said.

Ball, the California pediatrician, worries that parents’ limited interest has caused pediatricians to minimize their vaccine orders, in turn making the newest covid shots difficult to find once they become available.

“I think there’s just a misperception that it’s less of a big deal to get covid, but I’m still sending babies to the hospital with covid,” Ball said. “We’re still seeing kids with long covid. This is with us forever.”


Jackie Fortiér wrote this story for KFF Health News.


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A program in Georgetown, in Williamson County, is working to improve health outcomes for low-income residents by helping them gain access to community and social services.

Community Health Connect works with food banks, social service and health care providers to assist clients with beneficial wraparound services.

Dorothy Light, Community Health Connect director at the United Way for Greater Austin, said the program started almost two years ago.

"The first thing we did was launch what's called the Pathway Community Hub," Light recounted. "It allows us to build a network of community health workers. We're starting with pregnant and postpartum moms."

Light emphasized they hope to eventually expand services to include residents with chronic health conditions or chronic social needs. The program is one of six community sites across the state, funded by the Episcopal Health Foundation, finding local solutions to address nonmedical drivers of health inequity.

The community health workers are the eyes and ears of the HUB and report back valuable information. Light was surprised to learn a majority of the 100 postpartum moms they are working with are food insecure. She noted most of their clients are afraid to take advantage of help from food pantries or other nonprofits.

"They heard from their neighbor that the guy down the street went and got turned away, so they're not even going to try," Light explained. "Or some of our families that have emigrated from other countries are really fearful to use any type of social support."

Light added they recently completed the county's first community needs assessment focusing on food access in Williamson County.


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