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ECONOMIC REPORT OF THE PRESIDENT

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Box 4-1: Public Health Benefits of CHIPRA<br />

In addition to extending and improving CHIP, CHIPRA also raised<br />

the Federal cigarette tax from $0.39 per pack to approximately $1.01<br />

per pack. By increasing cigarette prices, cigarette taxes substantially<br />

reduce smoking rates and generate large improvements in public health.<br />

Research examining the impact of Federal cigarette tax increases on the<br />

number of teen or young-adult smokers imply that the 2009 Federal<br />

cigarette tax increase will reduce youth smoking by between 3 and 15<br />

percentage points (van Hasselt et al. 2015; Huang and Chaloupka 2012;<br />

CBO 2012b; Carpenter and Cook 2008). Assuming that roughly a third<br />

of youth smokers die prematurely due to smoking (U.S. Surgeon General<br />

2014), these estimates suggest that the 2009 cigarette tax increase plausibly<br />

reduced the number of premature deaths due to smoking in each<br />

cohort by between 15,000 and 70,000, as illustrated in Figure 4-i.<br />

Figure 4-i<br />

Estimated Reduction in Smokers in a Cohort of 18 Year-Olds<br />

Due to the 2009 Cigarette Tax Increase<br />

Number of Premature Deaths<br />

0<br />

-25,000<br />

-50,000<br />

CBO (2012b)<br />

Carpenter and<br />

Cook (2008)<br />

-75,000<br />

Huang and<br />

Chaloupka (2012)<br />

van Hasselt et al.<br />

(2015)<br />

-100,000<br />

Lower Estimate<br />

Higher Estimate<br />

Note: Lower estimate for van Hasselt et al. (2015) based on results for 18-25 year-olds, higher based on<br />

results for 12-17 year-olds.<br />

Source: Huang and Chaloupka (2012); van Hasselt et al. (2015); CBO (2012b); Carpenter and Cook<br />

(2008); CEA calculations.<br />

rate among children.6 Consistent with this time-series evidence, research<br />

examining specific changes in state CHIP and Medicaid programs enabled<br />

by CHIPRA has concluded these changes were effective in expanding coverage<br />

for children (Blavin, Kenney, and Huntress 2014; Goldstein et al. 2014).<br />

6 Figure 4-5 uses adults ages 26-64 (rather than all non-elderly adults) as a comparison group<br />

in order to exclude any effects of the Affordable Care Act’s dependent coverage expansion,<br />

which took effect in late 2010. That coverage expansion is discussed in greater detail below.<br />

208 | Chapter 4

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