The National Cancer Institute and Colorado's Project ASSIST
by Dr. James T. Bennett
The July 1995 issue of Alternatives in Philanthropy ("Project
ASSIST: Image and Reality") described how the National Cancer
Institute (NCI), part of the federal government's National Institutes
of Health, has provided anti-smoking organizations with as much
as $100 million in federal tax revenues to lobby for higher tobacco
taxes at the state level. The NCI's Project ASSIST, the American
Stop Smoking Intervention Study for Cancer Prevention, is the
major funding vehicle for this campaign.
Project ASSIST was largely spearheaded by the American Cancer
Society (ACS), the nation's largest and best-known health charity.
Officially launched in 1991, ASSIST ostensibly supports grassroots
groups that organize public education campaigns to discourage
smoking. This follow-up article examines the actual operation
of ASSIST in the state of Colorado. It shows how federal funds
were illegally used to promote a ballot initiative to raise the
state's tobacco tax.
Far more is known about operations of ASSIST in Colorado than
in other states where ASSIST grants have been awarded because
a lawsuit was recently filed against the Colorado Department of
Health, the agency charged with disbursing ASSIST funds in that
state. The suit alleged the improper use of ASSIST funds and illegal
lobbying by state health department officials. Documents related
to this case provide revealing information about how ASSIST was
developed in Colorado, its activities, and the personalities involved.
What emerges is a complex and twisted tale: front groups were
created to provide a smokescreen for lobbying; state bureaucrats
used state offices to facilitate lobbying; and positions of authority
were sold, with those hoping to acquire a share of the projected
tax revenue paying "front money" to secure their positions.
Colorado's Amendment 1: Self-Interest Disguised as Public Health
Colorado was in many ways an ideal state from the perspective
of those organizing Project ASSIST. For more than a decade, anti-smoking
groups had been active, and one of their prime objectives had
been to raise tobacco taxes. Colorado's constitution also allowed
citizen-initiated referenda. Against this backdrop, the National
Cancer Institute awarded the Colorado Department of Health (CDH)
an ASSIST contract, providing $6,976,683 for the period September
20, 1991 to September 29, 1998. The CDH would in turn provide
ASSIST funds to local anti-smoking groups.
On November 19, 1993, anti-smoking activists filed an "initiative
regarding Tobacco Taxes" with the Colorado Department of
State. If the initiative passed, taxes on cigarettes would be
raised on July 1, 1995 by 50 cents per pack and taxes on cigars
and smokeless tobacco would be increased by 50 percent of the
manufacturer's list price.
Purportedly, the goal of anti-smoking activists was to reduce
smoking by 43 percent in Colorado. If improved public health were
the sole objective, however, the disincentive of higher tobacco
prices should have been sufficient. But substantial tax revenuesan
estimated $130 million per yearwere to be distributed as follows:
- $65 million to medical professionals and hospitals for health
care of the needy;
- $39 million to anti-smoking activists and health charities
for educational programs to reduce tobacco use;
- $13 million to academics and public interest groups for research
on tobacco use.
Another $13 million was to be divided among municipalities, counties,
economic development initiatives, and an 11-member citizens' commission.
This would be composed of individualsmost likely health charity
officials, medical professionals, and anti-smoking activistswho
would oversee the disbursement of revenues. While they would be
unpaid, no doubt they would take many expense-account trips to
anti-smoking meetings held at pleasant venues in the U.S. and
abroad.
The Fair Share For Health Committee and Colorado ASSIST
In March of 1993, the Fair Share for Health Committee (FSFHC),
a 501(c)(4) lobbying organization, was created to promote the
tax initiative. As shown in Table 1, its membership was essentially
a who's who of the Colorado hospital, medical, and health charity
professions. The overlap between FSFHC membership and membership
in Colorado ASSIST, a 501(c)(3) educational organization created
to receive Project ASSIST funds, is substantial. Colorado ASSIST's
executive committee included representatives of the American Cancer
Society, Colorado Department of Health, and the Coalition for
a Tobacco-Free Colorado (CTFC), a 501(c)(3) organization instrumental
in securing the ASSIST grant.
The activities of one anti-smoking activist, Arnold Levinson,
illustrate the ties between FSFHC and Colorado ASSIST. Levinson,
formerly an assistant city editor for the Colorado Springs
Gazette, served as a Colorado ASSIST consultant, helping "extensively
in the design of Colorado ASSIST." He was also executive
director of FSFHC, and was thus in charge of promoting the tobacco
tax initiative.
Colorado ASSIST paid Levinson $50 per hour for his services under
an initial contract for 930 hours. Other contracts followedone
for $46,500 during the period 1992-1993 and another for $60 per
hour for the period 1993-1998. Thus, Colorado ASSIST, a federally
funded organization, paid Levinson while he organized the tax
initiative. It also reimbursed Levinson for travel costs to Grand
Junction and Durango, where he gave "presentation[s] on tobacco
taxes."
The Coalition for a Tobacco-Free Colorado
Another anti-smoking activist, Walter F. "Snip" Young,
served as director of Prevention Programs at the Colorado Department
of Health and was also the director of Colorado ASSIST. CDH's
"Best and Final" grant proposal to the NCI noted that
Young learned in 1987 of a possible ASSIST grant in Colorado:
"[Young] informed the Coalition for a Tobacco-Free Colorado,
which includes representatives of the American Heart Association
of Colorado and the American Lung Association. . . . In Spring
1988 . . . , Mr. Young convened a series of informal discussions
with the executive directors of ALA-Colorado and AHA-Colorado
to discuss their prospective roles in the project. As national
ASSIST planners disclosed information about the Project, Mr. Young
shared this information with the voluntary health agencies through
formal discussions with an ad hoc committee of the [CTFC]. .
."
CTFC's 501(c)(3) status would seem to preclude political activity,
but this restriction was ignored in the early stages of the tax
initiative. On January 6, 1993, Young and Peter Bialick, president
of the anti-smoking group GASP of Colorado, sent a letter on CTFC
stationary to anti-smoking activists. It said that "The Coalition
for a Tobacco-Free Colorado is on its way to placing a ballot
initiative to increase the state tobacco tax before the voters
in 1994. We need your help to construct the language of the petition
[at a day-long retreat]. . . . Morning presentations will explain
the rationale for tobacco taxes and the successful experiences
of California and Massachusetts. The afternoon will be a work
session where we will discuss and agree on the principal objectives
of the petition language. . . ."
A main topic of the retreat was money. Participants approved an
organizational structure for promoting the initiative that included
a board of directors and an executive committee charged with conducting
campaign operations. Organizations that wanted to obtain a seat
on the boardand thus influence in determining what groups would
receive the projected tax revenuewere required to pay $10,000.
Significantly, more than half the organizations on CTFC's initial
board were also members of the lobbying group Fair Share for Health
Committee (see Table 1, entries marked §). Four other groups
involved in FSFHC were also affiliated with CTFC (Table 1, entries
marked ). By January 1993, CTFC had more than a dozen sponsors
or affiliated organizations who were also members of FSFHC. Thus,
for all intents and purposes, these two organizations were indistinguishable,
even though one was ostensibly a tax-deductible, tax-funded educational
group and the other a political lobbying organization.
The National Cancer Institute
NCI was aware that the objective of Colorado ASSIST was to raise
state taxes and that federal funds would be used for this purpose.
Documents that the Colorado Department of Health submitted to
NCI clearly and repeatedly emphasize the tax theme:
- Colorado should "increase economic incentives and taxation
to discourage the use of tobacco products;"
- "The price of tobacco products needs to be greatly increased
through taxes and/or sales-license fees;"
- "The Colorado ASSIST Alliance will work to increase public
knowledge of the need to increase the cigarette tax substantially;"
- "Educational presentations will be made to all [areas] regarding
the need and current efforts to increase tobacco taxes;"
- "Strategies to advocate increased tobacco taxes will be
incorporated into the ASSIST media plan;"
- "Information will be presented . . . regarding the rationaleand need for sales license fees on tobacco sales."
Other CDH materials clearly show that ASSIST funds were used for
political activity. Expense reports submitted by Connie Acott,
an ASSIST consultant and founding board member of CTFC, to the
CDH note that Colorado ASSIST meetings concerning the "tax
initiative" and the "coalition tax initiative"
were held in August and November 1992. Another Colorado ASSIST
expense report refers to a meeting of the organization's "Political
Advocacy Team," held on April 15, 1993.
Tax Dollars Down the Drain
Organizations promoting the tax initiative lost little time in
obtaining ASSIST money from the CDH. Table 2 is a partial list
of groups that received ASSIST contracts during 1993-1994. A comparison
of Tables 1 and 2 shows that substantial funds were given to organizations
involved in the Fair Share For Health's tax initiative.
How were these funds used? Recipients were required to complete
contract reimbursement forms and an "Activity Matrix,"
one of whose goals"Economic Incentive to Decrease Tobacco
Use"lists the following activities: "Educate re excise
taxes," "attend training," and "coordinate
publicity/media." Activities related to the tax initiative
were reported on this form. Reports submitted by grant recipients
requesting payment are also revealing. They show that substantial
amounts were paid for activities that apparently involved very
little effort:
- The American Lung Association received $5,000 in October 1993
for having "completed orientation and review of implementation
responsibilities for the Annual Action Plan" and for "[establishing]
recruitment and operating systems for Field Coordinator."
In November 1993, the ALA received $5,000 for exploring "preparations
for a legislative breakfast." The following month, it received
$5,000 for identifying speakers to make "presentations on
tobacco taxation," initiating "development of a list
of influential contacts," and examining "existing databases
and resource directories that identify Denver Metro tobacco youth
cessation resources;"
- Valley Wide Health Services received $2,083 in October 1993
for "papers contacted/articles written." Similar amounts
were given in November and December 1993 for identifying "community
groups" and writing articles for newsletters;
- The Weld County Health Department received $2,000 in December
1993 for having "developed Action Plans" and for attending
a CTFC meeting.
ASSIST funds were also spent freely on business amenities:
- That Personal Touch Catering company received approximately
$300-$400 per month for catering Colorado ASSIST executive committee
and Alliance board meetings;
- Nearly $5,000 was spent in 1993 to host a Colorado ASSIST
banquet;
- Throughout 1990 and 1991, an average of $1,000 per month was
spent on temporary employees;
- Ramada Inn was paid $1,055 to host a Colorado ASSIST board
meeting;
- Nancy Salas, a CDH employee who often attended ASSIST training
sessions in Washington, was reimbursed $36.70 for a letter opener.
Politicking in the PICS
Petitioners for the tax initiative were organized in twelve cities
and regions, called "Primary Intervention Communities"
or "PICs." Active in Aspen, Alamosa, Boulder, Colorado
Springs, Craig, Denver, Durango, Fort Collins, Grand Junction,
Greeley, Montrose, and Pueblo, their role was to raise funds for
the initiative and gather signatures. Additionally, 130 "community
organizations" throughout Colorado formed a coalition called
the Colorado ASSIST Alliance. Evidence of widespread lobbying
by these organizations can be found in the minutes of their meetings
and in newsletters used to communicate with and motivate the petitioners.
The Colorado ASSIST Alliance published its own newsletter using
ASSIST funds. In the March 1992 inaugural issue, it reported that
the American Cancer Society had contacted 120 individuals "concerned
with tobacco control across the state . . . with a reminder to
urge their Representatives to achieve legislative passage of House
Bill 1239 Pat Sullivan's measure to add an additional 25 cents
tax on the purchase of a pack of cigarettes. . . . We urge everyone
to let your representatives know your feelings about this measure."
In the fifth issue (July 1993), ACS-Colorado's Madelyn Parker
praised the political activism of ASSIST participants in an article
entitled "PICs Take on Policy Advocacy:" "Though
carefully nourished personal interaction at the state and local
levels, ASSIST alliance members who recently attended orientations
in the process of political advocacy are now working to educate
public policy makers about health and safety issues related to
tobacco."
The same issue carried another article by the Fair Share for Health
Committee's Arnold Levinson. Headlined "To Get Rid of Tobacco,
TAX IT!," it described how a "coalition of organizations
has now been formed to increase Colorado's tax on cigarettes .
. . and other tobacco products. Leading the effort is a broad
coalition of health organizations, including the largest voluntary
health agenciesthe American Lung Association, the American Cancer
Society, and the American Heart Association." The article
noted that more information about the initiative was available
from the FSFHC's Amanda O'Neill.
Colorado ASSIST's "Annual Action Plan" (AAP), submitted
to the National Cancer Institute in August 1993, explicitly stated
that politics was the organization's central focus. Under the
heading "Year One Objectives," Colorado ASSIST announced
that "By October 1994, a state bill will be introduced in
the Legislature to license tobacco sales, and active support for
the measure will come from businesses, labor, medical professionals,
educators, youth and the religious community. . . . By October
1994, policy advocacy will be provided to PIC representatives."
Arnold Levinson also made numerous presentations to PIC representatives
throughout the state, financed with ASSIST funds. The minutes
of a meeting of the Larimer County PIC, held June 9, 1993, note
that Levinson "gave a presentation on the campaign his organization
[FSFHC] is heading to place a cigarette sales tax initiative on
the 1994 election ballot. . . . [FSFHC] is asking for our help
in collecting signatures on petitions." According to travel
expense reports that Levinson submitted to the Colorado Department
of Health for reimbursement, similar appearances were made in
June to PICs in Boulder and Pueblo.
GASP of Colorado
One anti-smoking group which received ASSIST funds, GASP (Group
to Alleviate Smoking Pollution) of Colorado, offers insight into
how federal money was used to promote the tax initiative. As one
of the oldest and most energetic anti-smoking organizations in
the state, GASP's newsletter, The Nonsmokers' Voice, relentlessly
promoted the initiative. One issue contained the following articles:
- "Cigarette Tax Efforts Underway. GASP of Colorado
is teaming up with other pro-health groups to put on the ballot
an initiative to increase Colorado's cigarette tax . . . under
the name Fair Share For Health Committee."
- "President's Challenge to Our Members: One Completed
Petition Per Member. I would like to ask each able-bodied
GASP member to help complete at least one petition."
- "Contributions Needed. Initiatives take much time
to organize. . . . [We] will contribute some money and in-kind
support. . . . Pitch in now with your contribution."
- "Annual Meeting to Focus on Cigarette Tax Efforts.
Candace Pierce-Lavin, the coordinator of the successful Massachusetts
cigarette tax campaign, will be GASP's special guest at our annual
meeting . . . this fall."
Two Questions
Despite the efforts of ASSIST-funded organizations, the Colorado
tobacco tax initiative was defeated by voters on November 8, 1994.
The story of the political campaign for Colorado's Amendment 1raises two serious questions:
- Is it proper for the National Institutes of Health and its divisions,
including the National Cancer Institutewhose mission is to research
the causes of and to find cures for diseaseto divert millions
of dollars to advocacy group politics?
- Is it proper for health charities such as the American Cancer
Society, American Heart Association, and American Lung Association
to increasingly embrace politics while abandoning their traditional
mission of providing assistance to disease victims? Obviously,
when health charities use funds for political activities, fewer
resources are available for helping disease victims.
(A version of this article with endnotes is available from the
Capital Research Center. Please contact Daniel T. Oliver, Editor,
Alternatives in Philanthropy.)
Table 1
Membership of the Fair Share for Health Committee
*§American Cancer Society, Colorado
*§American Lung Association, Colorado
*AMC Cancer Research Center
Avista Hospital
Boulder County Health Department
Merle C. Chambers
*Coalition for a Tobacco-Free Colorado
*Colorado Public Health Association
*Colorado School Health Council
*§Colorado Society for Respiratory Care
Colorado Tobacco-Free Schools and Communities
§Denver Public Health
*Doctors Ought to Care (DOC)
El Paso County Health Department
Sam and Nancy Gary
*§GASP of Colorado
Greeley Medical Center
Gunnison Valley Hospital
Swanee Hunt
International Assoc. for the Study of Lung Cancer
*Jefferson County Dept. of Health and Environment
*Kaiser Permanente Health Care Program
Kate's at 35th Avenue
*Larimer County Department of Health
National Jewish Center for Immunology and Respiratory Medicine
North Colorado Medical Center
Parkview Episcopal Medical Center
Physicians for Social Responsibility
Platte Valley Medical Center
§Porter Memorial Hospital
*Presbyterian-St. Lukes Swedish Health Care System
Rocky Mountain Adventists Healthcare
*Rocky Mountain Center for Health Promotion
and Education
Rocky Mountain Oncology Society
Rose Health Care Systems, Inc.
Southern Colorado Clinic
Southern Colorado Health Plan
Spalding Rehabilitation Center
Sterling Regional Med Center
St. Joseph Hospital
St. Mary-Corwin Hospital
Swedish Medical Center
*The Children's Hospital
*University of Colorado Cancer Center
Weld County Health Department
West Pines Hospital
Source: See text. Notes: Member of Colorado ASSIST as of September
1991; group added to the ASSIST coalition shortly after September
1991; §member of the board of directors of the Coalition
for a Tobacco-Free Colorado; organization "affiliated with"
the Coalition for a Tobacco-Free Colorado.
Table 2
Colorado ASSIST Contractors, 1993-1994
Amount
Organization Amount
American Lung Association of Denver $60,000
Arnold Levinson, dba Levinson 25,000
and Associates
Valley Wide Health Services, Inc. 25,000
Larimer County Department of Health 35,000
and Environment
La Plata County Hospital District 25,000
Pueblo City-County Health Department 35,000
El Paso County Department of Health 45,000
and Environment
Boulder County Health Department 20,000
Weld County Health Department 20,000
Aspen Substance Awareness Project 15,000
National Council on Alcohol / Drug 15,000
Abuse-Mesa County
Source: Colorado Department of Health ASSIST contracts.