COLUMBIA — As Election Day draws near, a bitter battle over cigarette tax proposals has multiple interest groups hurling accusations at one another and Missouri voters wrestling with a confusing choice.

Amendment 3 and Proposition A are both measures on the Nov. 8 ballot to raise Missouri’s cigarette tax.

The proposals seem simple enough, but like so many issues during this divisive election season, they're anything but.

Traditional opponents of cigarette tax increases — tobacco companies and the retailers that sell cigarettes — are backing rival proposals.

Health-focused organizations that typically support cigarette tax increases oppose the measures.

Meanwhile, two contentious but seemingly unrelated issues, abortion and stem cell research, are also in the mix.

So what is a voter to do?

Two choices

Missouri’s cigarette tax is currently the lowest in the nation at only 17 cents per pack of 20. By comparison, neighboring states Illinois and Kansas have per pack taxes of $1.98 and $1.29 respectively. New York’s cigarette tax is the highest at $4.35, and the national average is $1.65.

According to data gathered by the Campaign for Tobacco-Free Kids, Missouri has one of the highest adult smoking rates in the country at 20.6 percent. Annually, Missouri has about 11,000 deaths related to smoking.

Research has shown that for every 10 percent that the price of a pack of cigarettes is raised, overall cigarette consumption decreases 3 to 5 percent, which is why many groups support a tax on cigarettes as a means of reducing smoking.

Amendment 3 would change the Missouri Constitution to increase its cigarette tax by 60 cents. The increase would be phased in over four years, bringing the tax to 77 cents in 2020. An additional 67-cent fee would be added to certain cigarettes as well.

Proposition A would introduce a tax increase of 23 cents through a statute. The increases would be phased in at 13 cents in 2017, 5 cents in 2019 and 5 cents in 2021 to a total of 40 cents.

The revenue generated from Amendment 3 would go to a proposed Early Childhood Health and Education Trust Fund, which would distribute money to programs related to early childhood education, health care and smoking cessation.

The revenue generated from Proposition A would go to transportation infrastructure projects around the state.

If neither amendment passes, Missouri will keep its cigarette tax at 17 cents. If both were to pass, both the Missouri Secretary of State and the Attorney General have told The Associated Press that the measures will likely end up in court.

Amendment 3 and Proposition A are not the first efforts to pass a higher cigarette tax in Missouri, which has had its 17-cent tax since 1993.

Four failed attempts have been made in the past 14 years.

Dueling interests

This year, groups across the state have voiced their opposition to both proposals.

Suspicions about the motives of those involved have dominated much of the public debate about the measures, and critics have pointed to the campaign funding provided by companies that profit from tobacco on both sides.

Data from followthemoney.org shows that the largest contributor to Amendment 3 is R.J. Reynolds Tobacco Co., the nation’s second-largest tobacco company. Meanwhile, Proposition A is being supported by the Missouri Petroleum Marketers and Convenience Store Association, which has received funding from smaller tobacco companies. 

This may be the real conflict behind the debate — between big and small tobacco.

In addition to Amendment 3’s increase on the cigarette tax, it adds a fee of 67 cents per pack on certain cigarettes, most sold by smaller tobacco companies.

That fee is tied to an old legal settlement. In the 1990s, several states sued the major tobacco companies, including R.J. Reynolds, to recover the money they spent on Medicaid benefits and other costs associated with treating smoking-related illnesses.

Those tobacco companies settled with 46 states, the District of Columbia and five territories in 1998, agreeing to make annual payments to the states in perpetuity to recoup these costs.

However, tobacco companies that did not exist at the time of the settlement, including many smaller companies, do not have to make these payments.

The 67-cent fee impacts only those companies exempt from those payments, and as a result, Amendment 3 raises the cost of doing business for competitors of the major tobacco companies.

Linda Rallo, executive director of Raise Your Hand for Kids, the group that crafted Amendment 3, said the amendment "levels the playing field in the tobacco industry." 

Ronald Leone, executive director of the Missouri Petroleum Marketers and Convenience Store Association, which opposes Amendment 3 and supports Proposition A, said making tobacco companies that didn’t exist during the time of the master settlement agreement pay a fee is unfair.

Leone said that while his group supports Proposition A, it is putting the majority of its efforts behind the defeat of the amendment.

"My main goal is to defeat Amendment 3, and because there’s two tobacco taxes on the ballot, we’re essentially leaving Proposition A up to the fate of the gods," he said.

Leone said the MPCA’s position is that 23 cents is a reasonable and substantial increase, but the amount was chosen largely because it would keep Missouri’s cigarette prices competitive with those in bordering states.

“It’s irrelevant to me what the tax is on a national average,” Leone said. “The only relevant fact from our perspective is, can we continue to compete with our eight border states.” 

Strange bedfellows

Critics have also pointed to language within the proposals they find objectionable.

Dena Ladd, executive director of Missouri Cures, a medical research advocacy organization, said her group is opposed to Amendment 3 because of language stipulating that none of the funding may be used for embryonic stem cell research.

Ladd said members of her group were surprised to find out the language appeared in the amendment and felt that it would "chip away at the safeguards that we’ve put around stem cell research." 

Alison Dreith, executive director of NARAL Pro-Choice Missouri, said her group opposes the amendment because of its language restricting the use of funds from the tax for abortion services.

Dreith said that adding this language to the Missouri Constitution could open the door to challenges to abortion access in the future.

"We would have supported this measure three years ago when it was first being drafted," Dreith said. "It’s gone through several changes since then, and it’s really a shame that folks think that because it failed in the past, that it would stand to do better with adding language about abortion and stem cell research to pander to more conservative voters."

When asked why the amendment contained mentions of stem cell research and abortion, Rallo said that Raise Your Hand for Kids had analyzed previous failed efforts to introduce cigarette taxes in Missouri and come to the conclusion that such provisions are what Missouri voters want.

"We used the lessons from past attempts (to determine) how to best craft language that would be successful, and so that’s where we got the idea," said Rallo.

She seemed frustrated by opposition to this part of the amendment, citing similar provisions on abortion services in the 2012 attempt to raise the state cigarette tax. 

Some anti-abortion groups also oppose the bill, however. Concerned Women for America, a national conservative group’s Missouri chapter, recommended voting against Amendment 3 in its 2016 voting guide.

The group cites the amendment’s exception for medical emergencies in its prohibition on funding for abortion services.

Ladd additionally criticized a section of the amendment prohibiting the tax's funds from being used on research into the harmful effects of tobacco.

Further opposition to Amendment 3 comes from some educational organizations in Missouri, including the Missouri National Education Association.

Mark Jones, the MNEA political director, said his organization was concerned about two aspects of the amendment.

One is that the Early Childhood Health and Education Trust Fund will be staffed by unelected members that his organization fears may not have enough background in education to make the best decisions about where the money should go.

"They can pick pet projects that they prefer, rather than focusing on what students actually need," Jones said.

The group’s other objection stems from language in the amendment that allows funding from the tax to go to private and religious schools.

Amendment 3 supporters say this language is important because some areas in Missouri have no public pre-K options, but Jones said that if more funding were available, the options might exist in the future.

Proposition A also has opponents. 

Language in the measure stipulates that the tax would be automatically repealed if a measure to increase any tax or fee on cigarettes or other tobacco products were certified to appear on any local or statewide ballot in the future.

Critics of Proposition A call that section of the proposal a "poison pill." 

Making the call

So, how do voters make sense of all this?

Here are a few general guides that might help.

• If voters want to pick the option with the highest taxes and fees, that's Amendment 3. The money goes for early childhood education, health care and smoking cessation. Just remember that some critics worry about wording that restricts funding from being used for abortion services, stem cell research and future tobacco research. They also have concerns about who would control the fund.

• If voters want to support a more modest tax increase, that's Proposition A. The money goes to transportation infrastructure projects. Just remember that some critics argue that the "poison pill" clause means that the tax could be easily repealed.

• If neither option is palatable, voters can reject both. 

Supervising editor is Mark Horvit.

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