E-cigarette Legislation to Get Make Over

Published in Pawtucket Times, May 3, 2013

Just weeks ago, health advocacy organizations found themselves in an awkward, uncomfortable situation at the Rhode Island General Assembly. Although they supported the stated intent of House and Senate bills (H 5876 and S 622) that blocked the sale of electronic cigarettes (or e-cigarettes) to minors, they were forced to oppose these legislative proposals because of troubling provisions they believe were embedded within these bills.

When introducing his Senate proposal, e-cigarettes, says Senate Majority Leader Dominick J. Ruggerio, are proof that not all technological advances are good things. This led the Senator, representing Providence and North Providence, to become the Senate’s lead sponsor. House Finance Committee Chair Helio Melo, whose legislative district covers East Providence, jumped in as prime sponsor in his chamber, because of his desire to get the debate started on this relatively new public health issue.

E-cigarettes contain nicotine, a highly addictive substance. According to the U.S. Federal Drug Administration, the safety and efficacy of e-cigarettes have not been fully studied, consumers of e-cigarette products currently have no way of knowing whether e-cigarettes are safe for their intended use, how much nicotine or other potentially harmful chemicals are being inhaled during use, or if there are any benefits associated with using these products.

Additionally, it is not known if e-cigarettes may lead young people to try other tobacco products, including conventional cigarettes, which are known to cause disease and lead to premature death.

The FDA warns that more research needs to be done on the health risks of inhaling liquid nicotine, and has announced its intent to assert regulatory authority over electronic cigarettes.

New Technology in Smoking

Although the first patent on e-cigarettes was filed in 1963, the smoking device became readily available in the United States by 2007. E-cigarettes are electronic nicotine delivery systems. Often shaped like cigarettes or cigars, they deliver nicotine to a user in the form of vapor. E-cigarettes ordinarily consist of battery-operated heating elements and replaceable cartridges that contain nicotine or other substances, and an atomizer that, when heated, converts the contents of the cartridge into a vapor that a user inhales. The nicotine in these products is derived from tobacco, but unlike cigarettes and cigars, there is no tobacco in e-cigarettes, and hence no smoke.

Ruggerio noted that his legislative proposal would prohibit the sale of e-cigarettes to minors, along with expanding the statutory definition of “tobacco products” to include “tobacco-derived products” and “vapor products.” “Vapor products,” as included in these bills, would refer to any non-combustible tobacco-derived product containing nicotine, such as an electronic cigarette, that employs a mechanical heating element, battery or electronic circuit, regardless of shape or size that can be used to heat a liquid nicotine solution contained in a vapor cartridge. The term would not include any product regulated by the U.S. Food and Drug Administration under the Food, Drug and Cosmetic Act.

“Those who say these products are designed for adults who want to quit smoking real tobacco products are ignoring the fact they are marketed to be appealing to youngsters, offered in flavors such as bubblegum and chocolate,” observed Ruggerio. “Kids may see these as fun things, but as adults, we should know better and take action to keep our children safe.”

Health Advocates Rally to Oppose E-cigarette Proposal

At a first read, Director Karina Holyoak Wood, of the Rhode Island Tobacco Control Network (RITCN), saw the e-cigarette legislation proposal as positive step toward keeping the new smoking technology out of the hands of minors. However, once Wood, whose anti-smoking network includes 55 groups (including the American Lung Association, American Cancer Society, American Heart Association and the Campaign for Tobacco Free Kids), looked over the bills she found it embedded with provisions that could potentially undermine future regulation of e-cigarettes and create regulatory loopholes.

Wood and colleagues discovered that the e-cigarette bill was being promoted by RJ Reynolds, a major tobacco company. She believed that while the legislative sponsors’ intent was to prohibit youth access to e-cigarettes, a laudable goal, she feared that RJ Reynolds might be utilizing the bill as “a Trojan horse to establish their own business agenda for this emerging and currently unregulated smoking device.”

Suspicions were confirmed, says Wood, when a lobbyist from R.J. Reynolds Tobacco company came to the Ocean State to support Ruggerio’s and Melo’s e-cigarette bills at the Senate and House Finance Committee hearings on April 9 and April 23, respectively. She also became aware that similar legislative proposals were popping up all over the country, with the Winston-Salem, North Carolina tobacco company lobbying for their passage.

Wood, and 17 health advocacy organizations gave the bills the thumbs down at both panel hearings, while the tobacco industry endorsed the measure wholeheartedly.

In her written statement, Dr. Patricia Nolan, former director for the RI Health Department, who now co-chairs the RITCN’s Policy Committee, warned the Senate Finance Committee members that the bill would define “a ‘new’ tobacco product and exempt it from some of the controls that currently apply to all tobacco products. She charged that it would define these products in ways that actually might undermine Rhode Island’s ability to effectively regulate and control them.

According to Nolan, the bill’s definition of tobacco products may not include all e-cigarette and vapor products, leading to confusion. The new products regulated by laws concerning indoor air pollution and worker safety, she charged. “The safety of e-cigarettes and vapor devices for users or for indoor air quality is not known,” she said.

With the State scrambling for tax revenue, S 622 and H 5876 are silent on the issue of taxation of the e-cigarette product. “Having the definition in the tax section of the law could facilitate either taxing or exempting these ‘new’ products,” she told the House panel.

Nolan also noted that the bills create obstacles to enforcing penalties against merchants which violate the Youth Access Law by eliminating the requirement for courts to maintain records of penalties and fines imposed for violations not requiring that the Division of Taxation be notified about the disposition of the violation.

Other opponents and critics included the RI Department of Health’s Tobacco Control Program, the City of Providence and East Providence Prevention Coalition, and several local retailers, including Barrington-based, Ecig Shed came and Cigotine, LLC, in Providence, who came to share their concerns, both owners threatening to leave the Ocean State if the measure was enacted. Melo’s e-cigarette bill would greatly reduce their sales by restricting online sales of nicotine-containing products by treating the smoking device the same as traditional tobacco products, noted the business owners..

Specifically, e-cigarette bills would require a retailer conducting an online sale to obtain a copy of the buyer’s driver’s license along with a statement from the buyer affirming that they are the person pictured. The purchased product must be sent through a service that checks the ID of the buyer at delivery. Retailers would be required to perform this check every time a consumer places an order.

Finally, e-cigarette retailers in Rhode Island would be required to obtain a tobacco license and only buy their e-cigarettes from licensed wholesalers or distributors.

At the hearing, Lobbyist Jack Hogan, of R.J. Reynolds’s Tobacco Company, noted that his company’s support of the General Assembly’s cigarette legislation, and proposals being considered by other state legislatures, was to keep tobacco, including e-cigarette products out of the hands of minors under age 18. In countering the concerns of the health advocates, “there is no hidden agenda [in supporting the e-cigarette legislation]. It is the right thing to do,” he said.

Voices Heard

With the effective mobilization of health advocacy organizations to oppose H 5678 at the April 23 House Finance Committee, Wood and some of her network partners and the Health Department would meet one week later with Melo to discuss their strong opposition to his e-cigarette bill. As a result, he offered to withdraw his bill for further study, effectively killing it. He invited the health advocates to work with him on a new bill, comprehensively defining e-cigarettes and vapor products and prohibiting their sale to minors, will be reintroduced next year, he says.

The saga of the e-cigarette legislative proposal is a good example that participating in the legislative process can go a long way especially for those who put the energy and effort into it. Sound testimony combined with bringing in your supporters to the table will most certainly get the attention of lawmakers. Yes, that’s Democracy in action.

Herb Weiss, LRI ’12, is a Pawtucket-based freelance writer who covers aging, health care and medical issues. He can be reached at hweissri@aol.com.

Sen. Nesselbush’s Big Legislative Adventure

Published in the Pawtucket Times, April 26, 2013 

            As a young student at BrownUniversity in the early 80s, Donna Nesselbush discovered she was a lesbian.  However, it never occurred to this College coed that 30 years later, she would be a Rhode Island Senator fighting “tooth and nail” for marriage equality, and issue she calls “the greatest civil rights issue of our time.”  Nesselbush has advocated for marriage equality alongside many local businesses and some of the state’s top political officials, in addition to Rhode Islanders United for Marriage, as well as some Catholics, too, hoping to change Rhode Island’s marriage law to allow gay and lesbian couples to marry.  

             Throughout the legislative session Rev. Thomas J. Tobin, Bishop of the Roman Catholic Diocese of Providence, issued statements calling on Rhode Island lawmakers to stand firm against changing the traditional definition of the word, “marriage.”  Before the Senate Judiciary vote, he urged them to “stand strong in resisting this immoral and unnecessary proposition” and to “defend marriage and family as traditionally defined.”   Throughout the legislative debate the National Organization for Marriage Rhode Island, would also stand by the side of the Catholic Church calling for the rejection of the same-sex marriage legislative proposals being considered by the Rhode Island General Assembly.  

 A Long-time Waiting

              For almost 20 years, state lawmakers had grappled with the religiously charged issue of same-sex marriage.  Nesselbush attended many of the legislative hearings to testify in support of allowing same-sex marriage, and other times just to watch, only to see bills “held for further study.”  As a Senator, Nesselbush now clearly understands that legislative code phrase to mean the bill is being “put out to legislative pasture,” or killed, she says.

             During last year’s legislative session, Nesselbush watched as the House, eyed the conservatively-leaning Senate. House pragmatists pushed Speaker Gordon Fox to endorse civil union legislation rather than push for full-marriage equality. Much to the dismay of Fox, the first openly gay Speaker of the House, his members exhorted “Why ask House members to make a difficult vote if the Senate was all but certain to take no action?”

              “The House chamber came to a very pragmatic, political and painful conclusion that passing the civil union bill was better than nothing,” said the Pawtucket senator.

             In 2010, being a new Senator, Nesselbush learned the legislative procedural ropes, and more importantly the fine art of vote counting in order to walk a political tight rope.  She scrambled to count votes to ensure that the civil unions legislation would pass in order to extend much needed rights to gay people, but she wanted to “take the high road,” voting against this less than desirable vehicle, “and standing for the proposition that separate is never equal; gay and lesbian couples deserve full marriage equality,” said Nesselbush.

 Taking the Torch

             Although the marriage equity bill was ultimately shot down in 2010, in 2013 Nesselbush was asked to carry the torch from former Senator Rhoda Perry to champion Senate passage of a marriage equality bill.  For over 15 years the former Providence Senator, advocating many liberal causes, had pushed for passage without success. Senator Sue Sosnowski of South Kingston, a long time civil rights advocate, the second co-sponsor on the marriage equality legislation, stepped aside and asked Nesselbush, the only openly gay Senator, to take the lead.  Senate Majority Whip, Maryellen Goodwin, of Providence, helped massage the customary seniority system to give Nesselbush the thumbs up to become the lead sponsor. “I’m forever grateful to Senators Goodwin and Sosnowski for entrusting me with this important civil rights legislation.

 Legislative History in the Making   

             Last Tuesday, the Senate Judiciary Committee on a 7-4 vote passed Nesselbush’s same sex marriage bill along with the House companion measure (H 5015B).  The legislative proposal, which would take effect Aug.1, removes gender-specific language from the section of the general laws that governs eligibility for marriage.  It inserts language that allows any person to marry any other person.

 

            Furthermore, it contains a provision that allows couples who have entered into civil unions in Rhode Island since they were established in July 2011, to convert those unions into marriages by applying to the clerk in the municipality where it was recorded to have it recorded as a marriage, without having to apply for anything else or pay a fee.  If they would prefer, they would be eligible to apply for a marriage license and have the marriage solemnized.

             Bowing to the powerful Catholic lobby, the bill contains language reiterating the constitutionally guaranteed freedom for religious institutions to set their own guidelines for marriage eligibility within their faith, and stipulates that under no circumstances will clergy or others authorized to perform marriages be obligated by law to officiate at any particular civil marriage or religious rite of marriage.

             One day after the vote of the Senate Judiciary Committee, the full Senate passed the marriage equality bills on Wednesday, April 24, 2013.  Both bills, because they were amended by the Senate, still have to clear an additional House vote before they can be sent to the governor. The full House vote is tentatively scheduled for Thursday, May 2, following a likely Judiciary Committee vote on Tuesday. 

             When Governor Lincoln D. Chafee signs the same-sex marriage bills into law, Rhode Island joins its New England neighbors and becomes the 10th state in the nation to enact marriage equality.  Nesselbush says, “I have never been prouder to be a Senator, and I have never been prouder of the full Senate Chamber.”

             The intensely public debate on the marriage equity issue has put real faces to this religiously-charged issue, notes Nesselbush. Now, it seems that “everyone knows someone who is gay, and the conversation now almost always begins or ends with, “yes, I know, so and so, who is gay and has a great partner.” 

 

Personal Journey

             Looking back, Nesselbush remembers her devote Catholic parents giving her a strong religious upbringing, as well as this religious tradition being reinforced at Our Lady of the Sacred Heart, the school she attended for eight years.

             But her strong religious faith would be tested during her undergraduate years at Brown when she came out and accepted that she was gay.  “To thine own self be true; you cannot change innately who you are.”

             “My sexuality was the single biggest reason I did not return to my family in Buffalo, New York after graduating from BrownUniversity,” says Nesselbush.  Like many others, Nesselbush would choose not to share this realization upon first meeting people, but only when a friendship “reached a depth” of  honesty and respect.

                   Accepting her sexual orientation but afraid back then of her family’s reaction, Nesselbush decided not to return to her very Catholic family in New YorkState.  She quietly left her the Catholic Church of her childhood because of its position on the gay issue.  “I love my church too much to cause it or my family any shame or pain,” she said.

             While not regularly attending Catholic Church services, her religious upbringing and Catholic education “set the foundation of my life and the standard for service to others,” admits Nesselbush, noting that “Catholicism simply imbues my bones and runs in my blood.” I am still a very religious person who believes strongly in the love of God and the power of prayer; Christ is still central to my life.”

             According to Nesselbush, her parents and 3 siblings, her extended family and classmates, friends, and “even my Portuguese friends who immigrated to the OceanState from the old country,” have all found  ways to love and accept her, even though the “gay” concept was initially very foreign to them. “Today, says Nesselbush, it’s not even an issue.”

 Finding the One…

              Nesselbush also serves as the Chief Judge of the City of Pawtucket and is a partner at the law firm of Marasco & Nesselbush.  Her life partner, Kelly Carse, 53, is a coach at CrossFit Providence. They have been a couple since 2011 when various mutual friends  became matchmakers knowing that Nesselbush and Carse were single.. With their first meeting, the attraction was both mutual and instantaneous,” quipped the Pawtucket Senator.  “She was cute, funny, philanthropic, high minded, and well travelled. I loved that she had served in the Peace Corps, and she corrected my African geography on the first date!,” noted Nesselbush.

             Nesselbush has always viewed Smith Hill’s denial of same sex marriage as discrimination, enforced by legal statute  As a Municipal Court judge, she always found it oddly ironic that she was somehow qualified to officiate wedding ceremonies (which she loves to do) but she was somehow not herself qualified to marry. “Yesterday, all that changed.”

             “The love between two people is often palpable and never stronger than the moment the two are committing their lives to one another [through marriage].  With the passage of the Senate’s same-sex marriage legislation, both Nesselbush and Carse will now be able to experience this, too, like many heterosexual couples. 

             Herb Weiss, LRI ’12, is a Pawtucket-based freelance writer covering, aging, health care and medical issues.  He can be reached at hweissri@aol.com.

Aging Groups Consider Obama’s Fiscal 2014 Budget Proposal a “Mixed Bag”

Published in Woonsocket Call, April 21, 2013

President Barack Obama, missing the federal mandated budget submission deadline by over two month, finally unveils his fiscal blueprint on April 10, giving Capitol Hill a peek as to how he would fund the nation’s federal agencies, programs and services.

The President proposed a $3.8 trillion budget plan for fiscal 2014, that seeks to slash the huge federal deficit by a net $600 billion over 10 years, raises taxes on the wealthy, and puts the breaks to rising costs of two very popular senior programs, Social Security and Medicare.

Senior groups call President Obama’s the first budget proposal of his second presidential term, a “mixed bag.” His fiscal blueprint would eliminate the draconian cuts of the sequester, that is the arbitrary, across the board cuts Congress imposed this year. However, Obama seeks to reduce the federal deficit by calling for another $200 billion in cuts to discretionary programs – half from defense programs and half from domestic programs.

Braking the Rising Costs of Social Security Despite the Social Security Trustee’s 2012 Annual Report that the entitlement program has the financial resources to pay all benefits through 2033 (see my June 1, 2012 Commentary in Pawtucket Times), Social Security benefits are targeted in the recently released budget plan for substantial cuts by adopting the “chained” consumer price index (CPI) for the purpose of calculating Social Security cost-of-living adjustments, or COLAs.

According to the Washington, D.C.-based, National Committee to Preserve Social Security and Medicare (NCPSSM), the Obama Administration sees this switch as “a technical adjustment.” Aging group warn that using the “chained” CPI will substantially reduce the Social Security benefits of current and future beneficiaries. “If it is adopted, a typical 65 year-old would see an immediate decrease of about $130 per year in Social Security benefits. At age 95, the same senior would face a 9.2 percent reduction—almost $1,400 per year,” notes NCPSSM.

While all beneficiaries will feel the impact of this change, its effect will be greatest on those who draw benefits at earlier ages (e.g., military retirees, disabled veterans and workers) and those who live the longest, says NCPSSM, especially “women who have outlived their other sources of income, have depleted their assets, and rely on Social Security as their only lifeline to financial stability.”.

With Republican Congressional lawmakers generally supportive of Obama’s push to rein in Social Security costs, through the use of the “chained” CPI, liberal Democratic lawmakers, including Rep. David Cicilline, representing Rhode Island’s 2nd Congressional District, strongly oppose the President or any Congressional efforts to cut Social Security to lower the nation’s federal deficit.

Rep. Cicilline calls for reforming the nation’s tax code by ending subsidies for “Big Oil,” along with “making responsible target spending cuts,” to slash the nation’s huge federal deficit .

AARP Poll Says, Keep Your Hands Off Social Security
In a statement, AARP Executive Vice President Nancy A. LeaMond, quickly reacted to the Democratic President’s efforts to use the “chained” CPI to control rising Social Security program costs.

While AARP recognizes the need for the President and Congress to confront budget challenges facing the nation, the nation’s largest aging advocacy group calls for “responsible solutions, not harmful proposals” that would hurt older beneficiaries or threaten the retirement security of the generations that follow, says LeaMond.

LeaMond said, “AARP is deeply dismayed that President Obama would propose cutting the benefits of current and future Social Security recipients, including children, widows, veterans and people with disabilities, to reduce the deficit. Social Security is a self-financed program that doesn’t contribute to the deficit, so it shouldn’t be cut to reduce it.”

AARP’s polls indicated that older Americans, across the political spectrum, agree with nonprofit group’s opposition to the “chained” CPI. LeaMond, notes. The recently released national survey found that “fully 84% of voters age 50 and over oppose cutting Social Security benefits to reduce the deficit.”

“Instead of making harmful cuts to Medicare or shifting additional costs onto beneficiaries, we need to look for savings throughout the health care system, including Medicare,” suggests LeaMond. She says that also “lowering the costs of prescription drugs, innovations that promote better care, reward improved outcomes and make health care programs more efficient and less wasteful have the potential to hold down systemic high health care costs, including costs in Medicare.”

Finally, LeaMond adds, “We know that prescription drugs are one of the key drivers of escalating health care costs, so we appreciate the President’s inclusion of proposals to find savings in lower drug costs. And we applaud his plan to accelerate closure of the ‘donut hole’ in Medicare Part D by 2015, which would reduce seniors’ often burdensome out-of-pocket health care expenses.”

A Snap Shot of Other Aging Budget Issues
Howard Bedlin, Vice President for Public Policy and Advocacy at the National Council on Aging (NCOA), in a written statement calls Obama’s budget proposal a “mixed-bag” when it comes to seniors.”

Bedlin acknowledges that the recently released Obama budget eliminates the sequester cuts to critical programs like Meals on Wheels and other Older Americans Act services, elderly housing, and other vital senior services. “It is unfortunate that cuts are proposed for low-income energy assistance and senior job training and placement programs,” he says.
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According to Bedlin, the President’s budget also protects SNAP (Food Stamps) and Medicaid, in sharp contrast to the drastic cuts approved in the Republican-controlled House budget proposal. “Cuts in Medicaid would be devastating to the millions of vulnerable seniors who rely on the program for long-term care and Medicare low-income protections,” he says.
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Meanwhile, a major concern for NCOA with the President’s budget surrounds Medicare and Social Security. While the organization supports some of the Medicare reductions, the proposed $370 billion in additional cuts are “excessive and several will harm” beneficiaries (more than half having incomes below 200 percent of the poverty line), says Bedlin, these cuts in addition to the $716 billion in Medicare cuts under health reform and significant reductions in spending growth over the past three years.

Also, the proposed new home health co-payment will fall primarily on lower-income older women with multiple chronic health conditions, and lead to premature nursing home placement, predicts Bedlin. “The proposed increase in the Medicare Part B deductible would be especially harmful and unaffordable to millions of seniors with incomes just above the federal poverty line ($958 per month),” he says.

Finally, Bedlin notes that the proposed Medigap surcharge would penalize seniors for decisions made by their doctors, cause major market disruption, and seriously confuse many current policy holders. The proposal to further increase Medicare premiums based on income could result in those with incomes of about $47,000 being forced to pay more.

NCOA joined AARP and NCPSSM and virtually every other national aging organization in opposing the President’s proposal to cut the Social Security Cost of Living Adjustment (COLA) through the use of a “chained” CPI.

A Final Note… With Obama’s proposed budget now thrown in the ring with the House and Senate budgets already drafted and voted on, will Congressional gridlock keep the Democratic President, the GOP-Controlled House and Democratic Senate from working together to hammer out a consensus, bipartisan compromise? Only time will tell if elected lawmakers clearly get the message from the American people, “put the people first and not your political party.”

Herb Weiss, LRI ’12, is a Pawtucket-based freelance writer covering aging, health care and medical issues. He can be reached at hweissri@aol.com.