How to get most from tobacco tax

While Californians wait for President Trump and Republicans in Congress to decide what, if anything, to do about health care in the United States, a battle is brewing in California: How to spend the money generated by the state’s $2-a-pack increase in the tobacco tax.

The extra $1.2 billion from last fall’s Proposition 56 will be California’s largest injection of new health care funding in years. It’s desperately needed to help cover the costs of a state whose Medi-Cal system covers 14 million residents, about one-third of the population.

Rather than putting it all toward boosting MediCal’s overall budget, as Gov. Jerry Brown’s budget proposes, California should spread the money where it can get the highest return on investment. Top priorities should be:

Improve the abysmal reimbursement rates for doctors who treat MediCal patients. California’s provider rates are among the worst in the nation. It won’t do any good to enroll Californians in the MediCal system if there aren’t enough doctors who’ll accept the new patients.

The new tax won’t cover the sort of across-theboard increase the California Medical Association favors. But it could boost payments for doctors hurting from some of the worst reimbursement rates — dentists, for starters.

Restore vision, dental, podiatry and other MediCal benefits that were victims of 2009 budget cuts. These are essential for keeping low-income Californians healthy and capable of being productive workers.

Podiatry may seem less important, but foot care is one of the most overlooked aspects of diabetes management. More than 10 percent of hospital patients in the state have diabetes, and California spends an extra $1.6 billion a year on expensive care often related to foot complications.

Expand anti-smoking campaigns to further reduce the number of smokers. California spends about $9 billion a year on tobaccorelated medical care. Every smoker who quits because of the higher tax or antismoking education efforts will reduce state taxpayers’ health care bill.

Gov. Jerry Brown’s budget calls for using the bulk of the tobacco tax to boost the general, overall spending of the Medi-Cal program. Roughly 80 percent of Medi-Cal members are enrolled in managed care programs that make more efficient use of state dollars and have better reimbursement rates than doctors who go it alone and, in some cases, lose money for treating MediCal patients. California should continue to push Medi-Cal patients toward managed care program. But the state also has an obligation to give those doctors not in managed care programs fair payment for their services.

The backers of Proposition 56 made a point of not determining how every dollar of funds generated would be spent, leaving California the flexibility to make the best use possible of the revenues.

Choices that will produce measurable improvements in health, productivity and cost control are the way to go.