President Clinton's latest budget proposes funneling billions of dollars to federal and state healthcare programs from tobacco companies. The trouble is, there's no guarantee the money will materialize.
Clinton wants tobacco companies to provide $65.5 billion in new federal revenues from 1999 to 2003 as part of a national settlement of tobacco litigation. But he hasn't written legislation to implement that plan. And many Republican leaders say his reluctance to do so will prevent major anti-tobacco legislation from passing.
Nevertheless, Congress has been hearing testimony on such bills and has set a mid-March deadline for the end of such hearings, so a bill can begin moving through Congress.
Potential beneficiaries, meanwhile, already are fighting among themselves over who is most deserving of the money.
Clinton complicated that part of the deal by suggesting that $14.8 billion of the tobacco revenues be used for child-care programs and education initiatives over the next five years, rather than defraying government costs for treating people with smoking-related illnesses.
A big chunk of the pie, roughly $24 billion, would go to anti-smoking initiatives.
Sen. Phil Gramm (R-Texas), who spoke last week for conservative GOP senators, opposes using the tobacco revenues for programs other than healthcare, saying there's no logical tie between smoking and school construction or child care.
"We believe very strongly it should go to Medicare," he said of the tobacco revenues.
Carmela Coyle, the American Hospital Association's senior vice president for advocacy and representation, agreed. "If there is a tobacco settlement, it is important that money be used to offset healthcare costs," she said.
Legislation introduced in the House last week would require that any excess tobacco revenues received by the federal government be spent solely on Medicare. A bill scheduled to be introduced in the House this week, however, would earmark that money for deficit reduction and tax cuts.
Under the Clinton budget proposal, $900 million of tobacco revenues over the next five years would be remitted to states to enroll in Medicaid more of the estimated 3 million uninsured children now eligible for the program.
Some $750 million would pay for a three-year demonstration program allowing Medicare beneficiaries to participate in federally sponsored clinical trials of cancer treatments. And $25.3 billion would be channeled to a new "Research Fund for America." The fund, which will receive other government revenues, is supposed to give $85.3 billion over five years to the National Institutes of Health for biomedical research and an additional $254 million to the Agency for Health Care Policy and Research for quality research.