The Indiana Chamber of Commerce wants to raise Indiana’s smoking age from 18 to 21 as part of a four-part proposal in its 2018 legislative agenda.
The other three arms of the proposal include increasing the tobacco tax on cigarettes by $1.50 to be $2.50 a pack, increasing funding for cessation programs to quit smoking and repealing the Smoker’s Bill of Rights.
The Smoker's Bill of Rights is a 1991 law that keeps employers from screening for smokers before hiring.
Julie Halbig, Indiana Hospital Association vice president of legislative relations, said the plan is in response to state smoking rates that fall far above the national average.
The smoking rate for Indiana was 21.1 percent in 2015, putting Indiana six percentage points above the national average for the year, according to the Center for Disease Control and Prevention. The numbers put Indiana at 10th place in terms of states with the highest smoking rates.
“Unfortunately, we’re just a generally unhealthy state,” Halbig said. “We could be doing a lot better.”
The Indiana Hospital Association is a founding member of the Alliance for a Healthier Indiana, an organization centered on bringing up Indiana’s health rankings.
The alliance’s 2025 vision includes bringing state smoking rates down to 15 percent.
Halbig said one step toward that goal would involve following in the footsteps of five states — Hawaii, California, New Jersey, Maine and Oregon — that have already increased their smoking ages to 21.
Michael Ripley, Chamber of Commerce vice president of health care policy and employment law, said people under 21 who already smoke would also not be able to buy tobacco products in Indiana. They would have to quit or shop elsewhere.
Many states and counties that have adopted increased smoking ages have included grandfather clauses so those under 21 who smoked before the law passed could continue to buy tobacco products in-state.
A 2015 study by the Truth Initiative, an anti-smoking public health organization, suggests 11.2 percent of Indiana high school students smoke,
Ripley these students get tobacco products from their 18-year-old classmates.
If the smoking age is changed to 21, the people smoking will be out of high school and unable to give teenagers cigarettes.
“Just increasing the age of legal consumption a bit can do a lot to reduce illegal consumption as well,” Ripley said.
Halbig said the smoking-age increase would be effective because 95 percent of smokers start before age 21, according to the U.S. Department of Health and Human Services.
Mike Fisher, owner of The Briar & The Burley, a Bloomington business that sells cigars, pipes and other tobacco products, does not think the smoking age increase would do much.
He said people under 21 still get their hands on alcohol even though the drinking age was increased to 21.
“If someone under 21 wants to smoke, they’re going to get it,” he said.
He said people could order tobacco products online or drive across state lines to stock up, which would do little to bring down smoking rates. Instead, he said it would help larger companies and out-of-state businesses while harming small Hoosier tobacco businesses.
Fisher said IU students buy his products. They grab cigars on weekends. Fraternities have cigar parties.
As a result, he said about a quarter of his sales are students under 21.
“If we lose a 25 percent of our tobacco sales, that would really hurt,” he said. “Sometimes we don’t net 20 percent.”
He said the increasing tobacco tax has already hurt sales.
“How are we supposed to make up the revenue if this continues?” he said.
Fisher said one option would be to add other kinds of merchandise, which would have a steep initial cost. With a store that already has merchandise in many different categories, he said bringing in a new product wouldn’t make up the difference.
Raising prices is also not an option because it would drop demand, he said.
“It’s difficult to try to fill that void,” Fisher said.
Fisher said he is confused as to why the Chamber of Commerce would opt for a plan that would hurt small businesses.
Halbig said much of their opposition has come from businesses that sell tobacco products.
She said these business owners have the same statistics that they do and expect bringing the age up to 21 would drop sales.
But she pointed to CVS, which stopped selling tobacco products in 2014. She said they likely lost money at first, but they are still going strong.
“Businesses think they will be hurt, that the sky is going to fall, and they won’t be able to make a profit,” she said. “I call it the bogeyman syndrome. But they later realize that they end up doing better or the same.”
CVS estimated a $2 billion loss of annual revenue after eliminating tobacco products.
Fisher said it’s difficult to see the plan helping his business do better.
Ripley said bringing down smoking rates would make Indiana a more attractive business climate for out-of-state companies that can see Indiana’s low health metrics and high health care costs.
If companies expand, they will choose healthier states than Indiana, Ripley said.
Indiana health care costs directly caused by smoking amount to $2.93 billion annually, according to a 2015 study by the Truth Initiative. The same study estimates the cost of lost productivity due to smoking, which comes to $3.17 billion.
Ripley said these health care costs and productivity losses cost employers.
He pointed to Jasper Engines & Transmissions, where he said half of its 500 new hires in 2016 were smokers.
“It’s companies like that that this is really hurting,” he said.
Ripley said the fair thing to do would be to allow employers to screen for smokers before hiring.
He said some may choose not to hire smokers, but most need the skilled labor to fill their workspaces. As a result, they will try to work hand-in-hand with employees in cessation programs to help them quit smoking.
Some companies may opt for cessation contracts that would allow employees a certain span of time to quit, he said. If employees break that contract, they can be fired.
“Employers will be able to say, ‘OK, alright we know you smoke, but we want to help you, and we’re going to require you to be in a cessation program,'” he said.
Fisher said smoking may raise health care costs but so does obesity. However, obesity is not something that would or should ever be screened before hiring.
He said obesity and smoking fall in the same category, but smokers are being unfairly singled out.
“Are you going to let people not hire people who are overweight?” he said. “People will scream, holler and carry on if anything like that gets passed.”
Fisher said employers should instead encourage people to smoke less, not require them to quit altogether.
But Ripley said encouraging people to smoke less doesn’t work. He said those who want to quit will participate in cessation programs, but it is people who do not want to quit who need an extra push.
“It’s not incentivizing people who aren’t trying to quit, and those are the people who drive up costs when they come through the door,” he said.
Halbig said smokers are now a protected class of employees, even though those protections are usually meant for inherent characteristics, not chosen behaviors.
“We don’t think smoking should be given the same class as race, religion, sex,” she said. “You have the right to smoke, but it is often employers that have to pay the price.”
A 2008 clinical practice guideline by the U.S. Department of Health and Human Services referred to smoking as an addiction caused by a dependence on nicotine, rather than a choice. It also indicated little correlation between desire to quit and successful withdrawal from dependence.
The guideline was based on a meta-analysis of research on nicotine dependence.
Halbig said the repeal, increased tobacco taxes, more funding for cessation programs and a smoking-age increase would have a significant effect of reducing smoking when used together.
“The goal is to get people to take care of themselves,” she said. “It’s not just ‘Do this, and see the results.’ It’s not just one silver bullet. It’s the combination that really moves the needle.”