Problem/Objective: The increase in health care costs attributable to smoking are well-documented. The CDC's SAMMEC model provides a means for estimating the financial and human impact of tobacco use. Generally, these estimates are statewide. To understand the local tax burden of tobacco related health care costs, the private portion of those costs must be eliminated from the calculations.

Methods: Medicaid is a publicly financed program, the cost of which is borne by the taxpayers. In Massachusetts, surveys show that the smoking rate among the adult Medicaid population is roughly double the state average. Each year, the Centers for Medicaid and Medicare Services estimates health care costs for every state. The Centers provides separate reports for costs associated Medicaid. By using the SAMMEC model, estimates were made for smoking attributable expenditures (SAE's) of Medicaid in Massachusetts.

Results: Local tax burdens vary dramatically from community to community. Wealthier cities and towns pay higher taxes and thus pay a much larger percentage of the publicly financed portion of health care. The SAMMEC estimate of tobacco related Medicaid costs was divided in proportion to each community's tax burden. The result was a virtual mirror image of the town by town smoking prevalence estimates. High prevalence towns generally had lower tax burdens and low prevalence towns had higher tax burdens.

Conclusions: In one way or another, everyone pays a price for smoking.