Federal Priorities for the 118th Congress: Tobacco

Here are key actions the Centers for Disease Control and Prevention, the Food and Drug Administration, the Centers for Medicare and Medicaid Services, U.S. Congress and other federal leaders must take to prevent tobacco use and help all tobacco users get the help they need to end their addiction:

Increase Federal Investments in Tobacco Prevention and Help Tobacco Users Quit

Tobacco use remains the leading cause of preventable death and disease in this country. With youth tobacco use near all-time highs, the federal government needs to increase its investment in efforts to prevent future addiction and help current users quit.

The CDC Office on Smoking and Health (OSH) must receive robust funding to help combat the tobacco-caused diseases that are burdening the nation. Public health interventions supported by CDC OSH, such as the funding provided to state tobacco control programs and “Tips from Former Smokers” media campaign, are proven to reduce tobacco use. Congress should appropriate $310 million to OSH.

The “Tips From Former Smokers” campaign is a highly effective media campaign that features stories of people living with smoking-related diseases, but limited funding permits it to air less than half the year. From 2012-2018, “Tips” resulted in over 1 million people quitting, saved an estimated 129,000 lives and prevented $7.3 billion in smoking healthcare costs. Congress should increase funding for CDC OSH so that “Tips” can air year-round.

The Food and Drug Administration should continue its investments in “The Real Cost” campaign, a youth prevention mass media campaign which is proven effective at reducing youth tobacco use.  “The Real Cost” campaign is a proven cost-effective campaign that prevents youth use of cigarettes, smokeless tobacco products and e-cigarettes.

Strengthen Restrictions on the Manufacture, Sale and Marketing of Tobacco Products

Tobacco products are the deadliest consumer products on the market today, ultimately killing up to half of its users.  The Administration and Congress must take steps to restrict the manufacture, sales and marketing of tobacco products.

Following the removal of almost all flavored cigarettes from the marketplace, cigarette smoking rates among youth dropped to historically low levels. However, the remaining flavored tobacco products, including menthol cigarettes, cigars and e-cigarettes, on the market are attracting and addicting another generation. FDA must finalize rules by April 2023 to eliminate all flavored tobacco products from the marketplace, including menthol cigarettes, flavored cigars and e-cigarettes.

Since 2009, FDA has failed to use the comprehensive authority it has from the Tobacco Control Act to put meaningful restrictions on tobacco products, including e-cigarettes and products with synthetic nicotine, in place. Most tobacco products, including all e-cigarettes, were required to submit a product application to FDA by September 9, 2020 to determine whether they should be permitted to stay on the market. Consistent with principles established by the Lung Association and our partners, the FDA must follow the public health standard required by law in reviewing these applications and require the removal of all tobacco products that came onto the market illegally after August 8, 2016. FDA must remove all products that failed to file an application.

Nicotine is the addictive drug in tobacco products. Reducing nicotine in tobacco products to below levels that sustain addiction will make it easier for smokers to quit and harder for youth to become addicted. FDA must not limit its focus solely to cigarettes; FDA must propose and finalize regulations to reduce nicotine levels in all tobacco products, including cigars, smokeless tobacco and e-cigarettes.

The 2009 Tobacco Control Act requires FDA to issue a rule requiring all cigarette packs have graphic warning labels on the 50% of the front and back of all cigarette packs. A 2020 ruling in a federal lawsuit brought by the American Lung Association and public health partners resulted in FDA releasing final graphic warnings by March 15, 2020. Tobacco industry lawsuits have delayed this requirement and in December 2022, a federal judge in Texas sided with the tobacco industry. FDA and the Department of Justice must strongly defend graphic warning labels in the federal courts.

The 2009 Tobacco Control Act calls for the FDA to create a comprehensive track and trace system to counter the threat of illicit markets and maximize the public health benefits of strong oversight, which the agency has failed to do thus far. The tobacco industry has a history of being complicit in supplying illicit markets, repeatedly opposing taxation proposals to protect public health and financially benefitting from the illicit diversion of their own products. FDA must propose and finalize regulations in 2023 to implement “track and trace” technology on all tobacco products to prevent black market, counterfeit and smuggling activities.

Help People End Their Addiction

Quitting smoking is the single best thing a person can do for their health. As more people quit smoking, the financial burden for the healthcare system and society at large is also decreased. Congress, the Administration and states can take important steps to help tobacco users end their addiction.

Standard Medicaid is required to cover all tobacco cessation medications, however there is no requirement for counseling coverage for non-pregnant adults. State Medicaid programs may impose barriers on the non-pregnant standard Medicaid population. Congress should pass legislation to expand coverage to a comprehensive tobacco cessation benefit for all traditional Medicaid plans.

Beyond counseling, there is very little research on what is effective in helping youth quit tobacco products. Federal research investments by NIH looking into youth cessation interventions, including pharmacotherapies, must be prioritized.

Increase and Equalize Tobacco Taxes

Increasing the price of tobacco products is one of the most effective ways to reduce tobacco use, especially among youth. Every 10% increase in the price of cigarettes reduces consumption by 4% among adults and 7% among kids.

The federal government has not increased taxes on cigarettes and other tobacco products since 2009 and a significant increase is long overdue. Increasing tobacco taxes is one of the most important actions Congress could take to reduce youth initiation and incentivize tobacco users to quit for good. Congress should pass legislation that would double the federal tax rate on cigarettes and equalize the federal tax rate for all other tobacco products.

Page last updated: January 4, 2023

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