Friends,
Happy first day of school for our Fulton County Schools families! I know you’re all looking forward to seeing your friends and teachers again, and adults, I’m sure you’re looking forward to a little more peace and quiet during working hours. Here’s to a great start to the new school year!
Here at our legislative office we’ve been busy doing the work of the district, and while we are not in session over the summer that doesn’t mean there’s not plenty to do!
In this newsletter I’d like to take a deep dive into one area of policy on which I’ve been working for the past five years, and take you behind the scenes on a study committee evaluating the financial burden of smoking and vaping in the state of Georgia.
As a practicing physician who sees the toll of tobacco smoking every day on our patients, I’ve long been advocating for reforms in this area. As a sitting state lawmaker, I also see this area as one that presents opportunities to mitigate Georgia’s chronic disease burden, grow revenue while cutting public costs, and work across the aisle in crafting substantive legislative solutions for our state.
You ready? Let’s go.
HOUSE STUDY COMMITTEE ON THE COSTS & EFFECTS OF SMOKING
First, let’s frame the topic more broadly.
Jenny Kane / apimages.com
Tobacco smoking is the number one preventable cause of death in the country. It is responsible for more than 480,000 deaths annually, including those from secondhand smoke exposure. This accounts for roughly one in five of all deaths in the United States, with negative health consequences to every organ system in the body.
Source: The Health Consequences of Smoking – 50 Years of Progress
(Read full 2014 Surgeon General report here)
CDC data from 2022 shows that here in Georgia, approximately 12.5% of adults smoke cigarettes, while 7.7% use e-cigarettes. The rates of cigarette smoking among adolescents in Georgia is lower and falling, as it is nationally, but an alarmingly high number of teenagers smoke e-cigarettes (e.g. vapes) or use alternate nicotine delivery products (e.g. nicotine pouches like ZYN).
Graphic credit: Truth Initiative
(Read full summary of Georgia tobacco use data here)
Costs due to the health burden incurred by smoking is enormous. In 2018, smoking-related costs in the United States exceeded $600 billion. A breakdown of some of these costs:
Healthcare Spending
A significant portion of the total expenditures, over $240 billion, is attributed to healthcare costs related to smoking. This includes expenses for treating conditions like lung cancer and COPD, heart disease, vascular disease and strokes, along with many other smoking-related illnesses.
Image source: CDC, “Smoking and COPD”
Lost Productivity
Smoking leads to substantial productivity losses, with nearly $372 billion in 2018 alone. This includes costs associated with:
Photo credit: Damon Winter / The New York Times
- Absenteeism – Smokers tend to take more sick days than non-smokers.
- Reduced on-the-job performance – Smokers may experience decreased productivity due to nicotine cravings, the need to exit the workplace to smoke, or health issues.
- Premature death – Smoking-related deaths remove individuals from the workforce prematurely, leading to significant economic losses.
Other Costs
In addition to healthcare and productivity losses, there are other costs associated with smoking, such as:
Infographic source: MD Anderson Cancer Center
- Secondhand and thirdhand smoke exposure – Secondhand smoke (a mixture of air and smoke/vapor exhaled by smokers) and thirdhand smoke (the toxic residue from tobacco smoke that lingers on surfaces and in the air long after smoking has stopped) causes premature death and costs billions.
- Increased insurance costs – Smoking can lead to higher health insurance premiums for individuals and businesses, costs that are borne by everyone whether or not you yourself chose to smoke.
The economic burden of smoking represents a substantial portion of the U.S. economy. In 2020, smoking-related costs were estimated to be 4.3% of U.S. GDP. Meanwhile, the annual costs of smoking (including health expenditures and via lost productivity) is estimated to sum up to approximately $7 billion here in Georgia.
This is all data which can be extracted, calculated, and is publicly available. However, one thing I’ve noted is that Georgia’s legislature has not itself analytically examined these costs, despite the fact that it adds to our state healthcare spending and negatively affects state revenues, thus having a huge effect on the state budget we are tasked with passing. This is why I, for many years, have proposed forming a study committee to evaluate the specific state costs of smoking, because the legislature itself producing a report obligates us more to look at the results of that report and generate policy proposals in response.
After five years of work we finally managed to get this bipartisan study committee passed. House Study Committee on the Costs & Effects of Smoking has been meeting through the summer, discussing, gathering data, and hearing testimony from experts on the issue. I’m proud to serve as the Vice Chair of this committee, which is lead by my good friend Rep. Sharon Cooper, also Chair of the House Committee on Public and Community Health and a retired nurse.
All meetings of this study committee are open to the public, live-streamed, and the video archived for those who could not participate live.
(Watch intro to the first committee hearing here)
Our first meeting, held on June 12th, focused on the costs related specifically to cigarette smoking. Much of the discussion centered around not just the medical harms of cigarette smoking but its fiscal impact, particularly given that Georgia’s state cigarette tax–which we can view as a “user’s fee” for partaking in this costly and harmful behavior–is the second lowest in the nation. The national average tax for a pack of cigarettes is now up to $2.01 per pack. Georgia’s tax, which has not changed in more than 20 years, is 37 cents.
(I’m anticipating your next question, and the answer is: Missouri.)
Graphic credit: Campaign for Tobacco-Free Kids, July 25, 2025 / Ann Boonn
This issue is of particular salience given the massive federal funding cuts we’re anticipating with the passage of President Trump’s spending bill, which slashes a calculated $911 BILLION from Medicaid, the largest cuts to this vital program in history. Given that twice as many Medicaid patients smoke as patients in the general population, the costs resulting from chronic tobacco exposure are therefore largely covered by state dollars, which, when coupled with our extraordinarily low state cigarette tax creates a perverse system where the Georgia is, in effect, subsidizing people to smoke.
Here Andy Lord, representing the Georgia Society of Clinical Oncology, explains how Medicaid cuts, on top of our Republican Congress allowing the enhanced federal subsidies for patients to buy coverage via the Affordable Care Act, in the face of the high state costs of cigarette smoking, could put Georgia in an incredibly perilous situation.
(Watch an excerpt of this committee testimony here)
One reasonable concern some lawmakers have when we discuss raising the state tobacco tax is the impact this tax will have on farmers. Therefore the committee also looked at data showing that while agriculture is indeed Georgia’s top industry, tobacco itself is not considered a major commodity on the state level. (Per the University of Georgia’s 2024 Agricultural Forecast, poultry and eggs, cotton, and peanuts accounted for 74% of Georgia’s cash receipts in 2022.) Further, in 2021 (the most recent year available), no tobacco product manufacturing jobs were reported in Georgia.
Georgia Cash Receipts by Agricultural Commodity in 2022
(Graphic credit: UGA 2024 Georgia Agriculture Outlook)
We also heard from Danny Kanso, the Director of Legislative Strategy and Senior Fiscal Analyst at the Georgia Policy and Budget Institute, on the financial effect that smoking has on the state budget, and how it affects not just healthcare spending, but our state workforce and individual incomes.
One key aspect that I took away from his testimony is that the high cost of smoking is not simply borne by the individual. It is in fact borne by the entire state, including higher health insurance premiums for everyone.
(Watch an excerpt of this testimony here)
Though we still have a long way to go on tobacco policy in Georgia, generally at this point the health harms of cigarette smoking are well known. However, less is known about vaping, a newer nicotine delivery modality that is seeing its market share rise as the popularity of cigarettes has fallen. The second meeting of our study committee was held on July 17th, and focused on these products, and the state and social costs of their use.
Vaping has become increasingly popular among younger smokers, with the tobacco industry playing a familiar role in its rise. While some promote vaping as a smoking cessation tool for adults, there’s evidence suggesting the industry targets youth through marketing and appealing product designs. This includes utilizing advertising tactics and appealing flavors to attract a new generation of nicotine users in an effort to expand and addict its customer base.
Youth Appeal
E-cigarettes often come in youth-friendly flavors and designs, making them particularly attractive to young people. Studies have shown that teens are particularly drawn to fruity or dessert flavors, and some vape flavors currently on the market include “mango cake,” “strawberry tartz,” “blue razz,” “watermelon zkittles,” gummy bear, and cotton candy.
Some vapes are also disguised in a way that make them easier to conceal from parents or to use in places (e.g. classrooms) where smoking would otherwise not be allowed. One of our experts, CHOA pediatric pulmonologist Dr. Mary Ellen Fain, showed us this picture and challenged us to identify the vapes shown. We could not.
Blake McCarty / SBG San Antonio
(The two vapes are the yellow “highlighter” furthest on the left, and the blue “highlighter” standing on its end.)
Gateway Effect
While many cite the use of vapes as a smoking cessation method moving people away from traditional cigarettes, some research suggests that young people who vape are actually more likely to transition to smoking traditional cigarettes or to continue smoking as “dual users,” using both vapes and incinerated tobacco. Research has also shown vaping in youth as associated with an increased risk of illicit substance abuse in the future.
Johns Hopkins School of Medicine video, “Does Vaping Lead to Smoking?”
Public Health Concerns
One of the biggest lies pushed by the tobacco industry is that vaping is safe. And while research into vaping does not have the cumulative decades of data that tobacco smoking does, we do have a growing sense of how harmful these products really are. Health effects include:
Addiction: Nicotine, a key component of most e-cigarettes, is highly addictive and can lead to dependence. Exposure of children and adolescents to nicotine in vaping solutions can lead to long-term negative impacts on brain development. Many teenagers who vape experience poor concentration, anxiety, mood disorders and sleep disturbance.
(Read full research findings from the American Heart Association here)
Lung Damage: Vaping can cause lung irritation, coughing, wheezing, and shortness of breath. EVALI, which stands for E-cigarette or Vaping product Use-associated Lung Injury, is a serious lung condition linked to the use of e-cigarettes and vaping products. It is characterized by inflammation and injury to the lungs and can cause severe respiratory illness and even death. Additionally, some vaping liquids contain chemicals like diacetyl (once commonly used to simulate butter flavor in microwave popcorn), linked to bronchiolitis obliterans, a serious lung disease. Fittingly, the common name for this condition is “popcorn lung.”
Cardiovascular Issues: Vaping nicotine can increase heart rate and blood pressure, potentially leading to long-term cardiovascular problems. Some chemicals in e-cigarette vapor can damage blood vessels and increase the risk of heart disease.
Other Health Risks: Vaping can cause irritation of the eyes, nose, and throat. There are also reports of seizures associated with vaping, possibly due to nicotine, according to the American Cancer Society. Furthermore, some studies suggest a link between vaping and oral health issues like cavities and gum irritation.
Chemical Exposure: E-cigarette vapor contains various harmful chemicals, including nicotine, heavy metals, and volatile organic compounds (VOCs). Some flavorings, even if safe for ingestion, may be harmful when inhaled. Thankfully, in 2023 Georgia’s Smokefree Air Act was amended to include vaping in its indoor air laws, meaning vaping is prohibited anywhere where smoking is already banned (including many indoor public places). However, significant secondhand risks for non-smokers remain.
Industry Lobbying
Julio Cortez / AP
Companies like Juul have invested heavily in lobbying efforts, including hiring numerous lobbyists at both the federal and state levels to influence regulations related to vaping and alternative nicotine delivery products. Some of these include pieces of legislation that, while marketed in the mantle of noble regulatory intent, actually seek to create an industry monopoly for vape sales. (Last session’s HB 577 is one such example.)
Our final study committee meeting is set for Thursday August 21st, at which we will be discussing policy proposals in response to the information gathered in our first two meetings. This meeting will be open to the public, live-streamed and archived. We welcome any and all suggestions and testimony from Georgians interested in the issue, and six basic areas we’ve pre-emptively identified to work on include:
1: Retail Licensing
Alamy stock photo
In Georgia, the cost to be licensed to sell tobacco products like cigarettes is only $10 annually for retailers. (Yes, I said $10.) For an additional $10 fee these same retailers can add vapor products onto an existing tobacco license. The general consensus of the committee seems to be that this licensing fee is far too low given how much these products end up costing the state, and policy discussion may center around increasing or modernizing this fee.
2: Flavor restrictions
While there are challenges to passing a federal ban on flavored vapes, several states have already implemented bans on flavored e-cigarette fluids which are more appealing to young smokers. Such bans often focus on specific types of products, such as cartridge-based or disposable e-cigarettes, while exempting others like menthol-flavored products. Testimony from the American Lung Association’s Danna Thompson also noted that the well-funded tobacco lobby has thus far been less successful in winning court cases to overturn such state laws.
STATES & LOCALITIES THAT HAVE RESTRICTED
THE SALE OF FLAVORED TOBACCO PRODUCTS
(Source: Campaign for Tobacco Free Kids)
3: Tax Policy
(Watch full presentation here)
Several colleagues and I have long been pushing Georgia to raise our state tobacco tax, which is the second lowest in the nation. At the end of last session, in fact, I presented my bipartisan bill HB 83 to a House Ways and Means subcommittee, to do just that. And there are many sound fiscal reasons why.
The last time we raised the state tobacco tax was in 2002. At that time, the average cost for a pack of cigarettes in Georgia was $2.37, at which point the tax was 37 cents. Now, in 2025, the average cost for a pack of cigarettes in Georgia is between $8 and $9 (higher in the metro area), while the tax on that pack is still…37 cents.
(Source: industrydocuments.library.ucsf.edu/tobacco/docs/nxcp0124
Graphic via Truth Initiative)
Let me say first that there is nothing that scares the tobacco companies more than the possibility of raising the tobacco tax. It works to dissuade people from smoking cigarettes and they know it. A 1985 Philip Morris internal document stated, “Of all the concerns, there is one— taxation—that alarms us the most. While marketing restrictions and public and passive smoking do depress volume, in our experience taxation depresses it much more severely. Our concern for taxation is, therefore, central to our thinking about smoking and health. It has historically been the area to which we have devoted most resources and for the foreseeable future, I think things will stay that way almost everywhere.” So be aware that the tobacco lobby has no intention of allowing this bill to sail through.
That said, most other states have increased their state cigarette taxes in the past two decades. Many have done so more than once. And what we’ve seen in those other states is multifold.
(Graphic credit: Truth Initiative)
One is that when they increased their state cigarette tax, smoking numbers went down. As basic economics tells us, generally speaking when a good becomes more expensive, fewer people will buy it. This effect is seen most significantly in younger smokers, who are both more sensitive to price and are also less likely to be addicted to cigarettes.
Two, as a result, when smoking numbers go down, the chronic health burden related to smoking also goes down, leading to lower costs for the state. Recall that the Medicaid patient pool smokes at a rate twice as high as that of the general population, which means more of these costs are ultimately borne by state dollars. Therefore, raising the state tobacco tax can drive down state expenses.
Three, raising a tax increases state revenues, which can then be reinvested. So not only would we be able to increase funding for the state in a way very targeted to the areas where federal funding will be cut (read: from healthcare and Medicaid), we also have the effect of growing the state economy by mitigating the workforce effects incurred by smoking. It’s a win-win-win, and I hope that when we return for session in January we will give a fair look at HB 83, as well as my bill HB 84, which aims to raise the state vaping tax.
4: Environmental exposure restrictions
Photo credit: Lucas Jackson / Reuters
As noted, Georgia’s Smokefree Air Act was amended to include vaping in 2023 to include most enclosed public areas. However smoking and vaping is still allowed in many areas where workers or bystanders can be exposed, and presents an opportunity for a health policy.
One such modification to the current law could involve increasing the minimum distance required for smoking and vaping from buildings statewide, potentially adopting a 25-foot radius as suggested by some local ordinances or the Georgia Department of Public Health. Another could include removing exemptions that currently allow smoking in specific enclosed workplaces.
5: Funding smoking education/cessation programs
At our last study committee meeting we heard from Fonda Nash Doby, the Tobacco Cessation Program Coordinator at the Georgia Cancer Center of Augusta University. The program they run has had tremendous success in supporting smokers who aim to quit, consisting of youth and school outreach, smoke-free campus and community policies, and evidence based support with follow-up for patients. State support of more similar school-based programs would be a worthwhile investment, especially given the high state costs we might avert.
6: Disclosure of vaping product ingredients
Photo credit: Liz Doufour / The Cincinnati Inquirer
There was significant interest among members of the committee for requiring more transparent disclosure of vaping fluid contents, similar to the stated intents of HB 577 but without the tobacco industry interest in having a monopoly on their market share. The details of what such state-level legislation would look like is something I hope we can discuss at our upcoming August meeting.
This study committee has so far been an incredibly educational experience, and I look forward to bringing our findings to the full House when we return in January. I want in particular to thank our excellent staff, including Andrew Smith (our budget and policy analyst) and many of my Team Au fellows who have been with us through the committee taking notes and providing insight, particularly when it comes to vape marketing to high school and college students. We have a great team, and I’m proud to work with them!
Are you a student interested in connecting with our office, or just want to come visit us in district or at the Capitol? Email cos@auforga.com!
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It has never been more important to pay attention to the work of state legislatures. Thank you as ever for your support so that we can keep doing this most important work together.
As always, please do not hesitate to reach out to our office should you need any assistance, or if you have any concerns you’d like me to address on your behalf.
It is my honor to be your voice in the Georgia House of Representatives.
In service,
