Until then, legislators and health advocates would be busy working on how MSA funds were to be divided by the state’s general appropriations bill, House Bill 2. It had also become clear that the Republicans preferred allocating the MSA money through HB 2, which would not lock up the funds into specific programs or purposes, thereby giving legislatures more control of the money. An April 17, 1999 Associate Press article reported that Senate Majority Leader John Harp said the general fund would be an appropriate place to put the MSA money, and that decisions on how to allocate the MSA money to CHIP and other health related programs were best left to the budget experts on the House Bill 2 conference committee.Since the MSA money had not been legislatively designated to a specific agency or purpose, the money would be placed into the general fund and allocated through House Bill 2, the General Appropriations Act of 1999 which allocated money to various agencies for the biennium .On April 19, 1999, state legislators in the House-Senate Free Conference Committee held a hearing regarding proposed amendments to House Bill 2, including the amendments that designated where money from the first MSA payment would be placed.Governor Racicot recommended $3.5 million per year for the establishment of tobacco control and prevention programs,96 which was approved by the Conference Committee,rolling shelves though specific program guidelines were not laid out in HB 2.121 Rather, funding for tobacco prevention and control programs would be decided by the Department of Health and Human Services, which would be in charge of developing programs specifics.
During the 1999 legislature session, the lack of specific tobacco control guidelines in such proposed bills was not a major concern for tobacco control advocates. Given the tax-relief oriented Republican majority in the legislature, tobacco control would have a better chance of being funded under the Department of Health, which was run by a tobacco control sympathetic administration. The House-Senate Conference Committee allocated the rest of the $67 million of MSA money over the next two years as follows: $20 million to the state general fund for government operations; $28.4 million into a reserve, or budget surplus, which could not be spent until the next biennium; $2 million for the Montana Comprehensive Health Association ; and $1.6 million to the state Department of Military Affairs for the “Youth Challenge Program” to be run by the state National Guard.Additionally, $8 million was also allocated for the Children’s Health Insurance Program under Senate Bill 81, sponsored by Senate Majority Leader John Harp at the request of Governor Racicot.SB 81, which received final legislative approval in the House on April 21, 1999 by a 79 to 20 vote, created a program to provide health care to children not eligible under the Montana medicaid program by contracting with insurance companies or other entities to provide health care through an insurance plan, a health maintenance organization, or a managed care plan.According to the minutes from the April 19, 1999 Free Conference hearing on HB 2, no proponent or opponent testimony was presented over the proposed motions concerning the MSA money allocations, with the exception of MSA funding for the Youth Challenge Program .
Supporting testimony was given for the YCP by General John E. Prendergest, head of the Montana National Guard, who explained that the program would recruit 200 unemployed high school dropouts without criminal records for a 5 month military style boot camp where they could obtain a general-equivalency high school diploma.The budget request had not been previously heard by the legislature, and some legislators not on the Conference Committee criticized the “spur of the minute” approval of the program to newspapers as unfair to those proposals that had been debated throughout the legislative session.Gen. Prendergest explained that the budget request came so late because the program had only recently received approval for federal matching funds, and members of the Conference Committee defended the program as a good application of the MSA funds for a program that had already been used in 14 other states.After the failed attempts in the 1999 legislative session to dedicate some MSA funds to health care and tobacco prevention programs through HB 131, HB 240, and SB 323, health advocates were disappointed that tobacco control funding was far below recommendations by the Center for Disease Control’s “Best Practices for Comprehensive Tobacco Control Programs – August 1999″ for Montana . However, health advocates did not see the legislative session as a total loss, and were happy that at least some money would go to tobacco prevention, especially considering the lack of such funding in other states.Also, health advocates like nurse Georgiana Gulden , believed that this initial funding would only be a starting point, and that subsequent funding would increase over time: “So my understanding is that the plan had been that [Governor Racicot] would do, you know, support the initial funding through the program and then each biennium would support increased funding until we were able to get to CDC best practices.”The state health groups did not make an organized attempt to publicly express frustration over the legislature’s MSA allocation to non-health related purposes,although the shortcomings of tobacco prevention spending was pointed out briefly in the press.
An August 25, 1999 Associated Press article reported that information from the American Heart Association and Campaign for Tobacco-Free Kids had shown that Montana fell far short of the tobacco prevention spending minimums that were recommended by the CDC.Montana’s $3.5 million tobacco prevention allocation for the year 2000 was 37.4% of the CDC’s minimum recommendation .However, because other states that participated in the MSA had dedicated little or no money to tobacco prevention for the year 2000, Montana seemed to be doing relatively well. Although Montana’s year 2000 allocation for tobacco prevention was only 37.4% of the CDC’s minimum recommendation, the tobacco prevention allocations in twenty-seven other states for that year were less than 35% of the CDC minimum recommendation.Montana State Attorney General Joe Mazurek stated to the Associated Press that “relative to some states, we did OK, but we ought to be doing better,” and that “the bulk of this money should be used for public health; that’s the bottom line… At a minimum, we should be meeting the CDC recommendations.”Tobacco control and public health advocates in the 1999 legislative session were unprepared for the heavy resistance on the part of legislators to fund tobacco use prevention and health programs with MSA money. This lack of preparedness likely resulted from an absence of any previous organized tobacco control movement on the statewide level . Tobacco control advocates and health groups did make appearances at committee hearings and lobbied the 1999 Legislature in support of tobacco prevention program funding,shelving systems but that was the extent of their efforts. Tobacco control advocates did not attempt a larger advocacy movement through public campaigning, choosing instead to focus their efforts on direct lobbying with the assistance of a Governor sympathetic to their cause. In addition, tobacco control advocates wrongly underestimated the potential for tobacco control programs to be underfunded. Cliff Christian, of the American Heart Association, said of the MSA allocation fights, “it was really a sleeper issue.” However, the 1999 MSA allocations led advocates to create a much more organized state tobacco control campaign, starting with Constitutional Amendment 35 in 2000. The second media campaign by the DPHHS and TUPP, the “Most of Us” Campaign, started to run in September 2000, and was implemented by Jeff Linkenbach, director of the Montana Social Norms Project a the Montana State University Health and Human Services Department, with funding from the Montana TUPP and the CDC .The social norms approach was created by H. Wesley Perkins, a professor of sociology at Hobart and Smith College in Geneva, N.Y., who also served as a consultant on the Montana project. The campaign would continue until May 2001, and targeted youth between the ages of 12 to 17 years old in seven counties . The primary message of the campaign was that “most of us,” meaning 70% of Montana teens, were smoke free, in the belief that teen behavior is often driven by what they think their peers are doing.Marketing methods for the campaign included television ads and radio ads , as well as print and promotional items distributed to schools.
According to the Montana Social Norms project at the Montana State University Health and Human Development Department, the “Most Of Us” Campaign showed successful results.After the 8-month campaign, only 10-percent of the teens in the pilot area reported a first time use of cigarettes in academic year 2000-2001. By contrast, data from the state outside of the pilot program area showed that 17-percent of teens reported trying cigarettes for the first time in academic year 2000-2001.The seven pilot counties, which were chosen because of their media isolation that would allow for an undiluted message, contained about 21,300 teens between the ages of 12 and 17. Phone surveys were conducted of 800 Montana teens before the campaign began, and then again in April 2001, when the campaign was over.The “Most of Us” Campaign also received public support from state tobacco control advocates such as former Montana Attorney General Joe Mazurek and the Director of the DPHHS, Gail Gray, as well as from local tobacco control advocates Charlene Hansen, tobacco education coordinator at the Lake County Health Department, and Jamie Schroeder, Project Manager at the Missoula Girls and Boys Club, who said that local teens were embracing the program.Another element of the TUPP was the Montana Tobacco Quit Line, which began taking calls on August 31, 2000. The toll free line was operated by the Group Health Cooperative of Puget Sound under a one year contract with the DPHHS at a reported cost of $694,000.The toll-free Quit Line provided a caller with an assessment of their addiction and offered consultation on how to go about quitting, as well as referrals to support services and resources across the state. The Quit Line had a goal of taking between 1,200 to 2,000 calls a year. By October 2000, the Quit Line had received 232 calls from prospective non-smokers, exceeding expectations by state health workers that the service would get approximately 150 calls by October 2000.Chris Devany, Program Manager for the Montana TUPP, distributed a press release stating that “[t]he tremendous response demonstrates that there is a real need for this type of program.”By June 2001, the Quit Line received 1, 527 calls from prospective nonsmokers.Though the Governor’s Advisory Council and the Tobacco Use Prevention Program had considerable support under Gov. Racicot’s administration, the TUPP would essentially be dismantled in the following administration under Governor Judy Martz, who took office in January 2001, leading to the end of the both media campaigns and the Montana Quit Line, which would end in July 2001. Because of the quick reduction in funding, the TUPP was unable to show any results from the initial programs, which Martz and Republican legislators then sighted as evidence that such programs did not work. However, before the end of Gov. Racicot’s tenure, health advocates, now better organized, would successfully put forward an initiative that would amend the state constitution, requiring part of the MSA money to be put into a trust fund, so that the interest could be used for health care and tobacco use prevention programs.Though state health advocacy groups did not publicly express their frustration over the MSA allocations made in the 1999 Legislative session, their disappointment did lead groups such as the Montana Hospital Association, the Montana Medical Association, the American Lung Association of the Northern Rockies, and the Montana Dental Association to start meeting in order to discuss funding for health care and tobacco disease prevention.Though this coalition of health groups were not officially organized as a joint entity at the time, they formulated a plan for a voter initiative that would put part of the MSA payments into a trust-fund for health care costs.