WASHINGTON -- In the mid 1980s, Massachusetts Department of Public Health official Gregory Connolly began a seemingly hopeless campaign to end smoking in his state. He had no full-time staff and a piecemeal budget. More people complained about his smoking cessation clinics than attended them. If he wanted to check his effectiveness with his own colleagues, he just had to get up from his desk and inhale.
"My building was filled with smoke," he told The Huffington Post. "Doctors, nurses smoked."
It was hard to see a public policy solution. At the time, nearly one-third of the state's residents smoked, with little hope of kicking the habit. The U.S. Surgeon General affirmed in 1988 that cigarettes were as addictive as heroin.
Still, Connolly, who worked out of the dental health division, kept chipping away, speaking out at community forums, organizing with other health groups and buttonholing any member of the state Legislature who would listen. In 1992, with a push from the American Cancer Society, Massachusetts residents passed a ballot initiative to fund his smoking-prevention work through an increase in taxes on cigarette sales. The tax generated $123 million that first year, of which Connolly's program received $56 million.
Connolly invested the money in community programs, municipal grants to enforce laws against selling cigarettes to minors, and lobbying to pass local bans on smoking indoors. If a resident wanted to quit, the program offered free nicotine patches, counseling and a quitters hotline. New initiatives were geared toward youth smokers and pregnant women. And the program alarmed every Massachusetts resident, smoker and nonsmoker alike, with its ad campaign.
One ad featured a man showering with a hole in his throat. In another, a mother spoke just before her death about what it might be like to say goodbye to her children and how she struggled to breathe with her emphysema-wrecked lungs. In a third ad, a doctor squeezed a deceased 32-year-old smoker's aorta like a tube of toothpaste until a mass of fatty deposits squirted out.
In a short time, Connolly started to see dramatic reductions in smoking rates in Massachusetts that far outpaced the rest of the country. The Massachusetts program was so successful that the Centers for Disease Control (CDC) used it as a national model. Dozens of other states put Connolly's ads on TV. Even other countries latched onto the campaign, beaming the ads into television sets as far away as Crete and Australia. They continue to serve as a model for public service ads today.
"We had the cure for cancer," Connolly said. "It was the most exciting thing anyone could ever experience. We achieved the impossible."
But 10 years into his crusade, Connolly met a tougher opponent than Big Tobacco: Mitt Romney.
While Romney's signature achievement as governor was reforming Massachusetts' health insurance system, axing cheap prevention in favor of pricey treatment was also a hallmark of his tenure. Romney attempted to eliminate or gut programs providing hearing tests for newborns, screenings for prostate and breast cancer, counseling for young parents, support for people living with severe physical disabilities, and suicide prevention services. The Democratic-controlled Legislature ultimately overruled him.
But before taking office in January 2003, Romney had promised the state's anti-smoking advocates that he would increase funding to the tobacco-control program. Instead, he cut its budget from $5.8 million to $2.5 million, far below what it needed to be effective. Romney ignored the warnings of public health experts, while working to secure a tax cut for some of the state's richest residents.
His efforts all but killed the program and serve as one of the most dramatic examples of his preference for short-term political gains over long-term health care solutions. Romney has continued this approach as the Republican nominee for president, vowing to repeal President Barack Obama's health care reform law while insisting that emergency rooms provide effective treatment for the uninsured.
"We expected Mr. Romney to come in and restore the tobacco program to its level for the past 10 years and make himself a national hero," said Connolly, now a professor at the Harvard School of Public Health, where he directs the Center for Global Tobacco Control. "But he did the opposite. ... We got the Marlboro Man."
SLASH AND BURN
The post-9/11 recession had hit Massachusetts hard. Connolly's anti-smoking program, with its emphasis on prevention, became a fat target. Between taxes on cigarettes and the 1998 landmark settlement with tobacco companies over their deceptive marketing, the state was raking in more than $570 million a year from Big Tobacco, some of which was intended for anti-smoking efforts. Nearly all of it, however, would be siphoned off to other programs. Romney's predecessor as governor, Jane Swift, slashed the smoking-prevention program, from $33 million in 2002 to $5.8 million in 2003.
Tobacco-control advocates went looking for a savior and believed the 2002 governor's race would produce one. A coalition of groups, including the American Cancer Society, Children's Hospital, the Massachusetts Nurses Association and the Campaign for Tobacco-Free Kids, put pressure on Romney and his Democratic opponent, Shannon O'Brien, to pledge to restore the program's budget.
"Despite $800 million in tobacco revenues, the governor has destroyed the state's tobacco prevention program," the group wrote in a full-page ad in The Boston Globe. "To save our kids, the next governor must restore it."
O'Brien agreed to restore funding to the anti-smoking program, and Romney appeared to do so as well. In an Oct. 30, 2002, letter obtained by HuffPost, Romney campaign manager Ben Coes sent the Campaign for Tobacco-Free Kids an explanation of his candidate's position.
"It is our view that it is a shame our state leaders mismanaged the budget so that worthwhile programs have been cut," Coes wrote. "Mitt Romney's goal as governor will be to fundamentally restructure government so we can restore funding for worthwhile programs, including the tobacco control program."
At the time, anti-smoking activists did not know about Romney's close ties to the tobacco industry. As HuffPost reported in October, after Romney took over as CEO of Bain & Co. in the early 1990s, the consulting firm performed key research for Philip Morris that formed the basis for a price cut on which researchers blame a dramatic rise in teen smoking. The firm also worked with two cigarette companies to expand the Russian smoking market, making millions of dollars in the process.
L. Scott Harshbarger, who labored over the tobacco settlement as Massachusetts attorney general, said that Bain & Co.'s work with Philip Morris and British American Tobacco during Romney's tenure as CEO would have been a major red flag for public health advocates, who would have mobilized many of the state's political institutions against Romney.
"In Massachusetts in 2002, if you were in any way tainted as a tobacco advocate, it would have been a major negative as a candidate," Harshbarger said. "It would have been a very tough sell."
The advocates believed Romney was on their side. After he was elected governor in November, the Campaign for Tobacco-Free Kids Action Fund announced that Romney's victory was "a win for Massachusetts kids" and that the "outlook is optimistic" that the governor-elect would reinvest in the anti-tobacco campaign.
After all, this government program, with its mix of civic engagement and cutting-edge methods, actually worked. From 1992 to 2003, per capita cigarette consumption declined by more than 47 percent in Massachusetts, compared to 28 percent nationally, according to the Campaign for Tobacco-Free Kids. The Boston Globe reported that between 1990 and 2002, the smoking rate for pregnant women dropped 52 percent. The anti-smoking program also reduced lung cancer death rates in the state by 9.5 percent and was responsible for a 31 percent plunge in heart disease deaths, according to studies co-authored by Connolly that isolated the program's direct effect on those conditions.
The program saved the state money, as well. A Massachusetts Institute of Technology study in 2000 found that the program reduced health care costs by $85 million per year. For every dollar the state spent on Connolly's effort, it saved two dollars in treatment.
Despite the smoking-prevention program's benefits, however, it became one of Romney's top targets as he worked to close the state's $1.2 billion budget deficit.
In his first year in office, Romney attempted to slash the program's budget further, to just $1.8 million. Democrats in the state Legislature balked, overriding the governor and preserving $2.5 million in funding -- which still represented a 57 percent cut. Connolly felt that the program had been singled out: Its cut was deeper than others within the health department.
Advocates like Connolly were "severely undermined," said Harshbarger. "Then-candidate Romney had been all things to all people in this ... and all that a governor had to do at that point to keep the program was to say, 'No, this is important to me,'" he explained.
Instead of restoring funds to the anti-smoking program, Romney chose to fight for a tax cut for Massachusetts' richest residents. One of his first budgetary moves as governor was a capital gains tax rebate worth $250 million -- enough to fund the tobacco-control program at the level the CDC recommended for more than seven years.
Romney played hardball with the state Legislature on the tax rebate, instructing the Massachusetts Department of Revenue to send notices to about 48,000 taxpayers who might be eligible for it, thereby generating public support for the measure. In the end, about half of the total tax payout went to just 278 wealthy taxpayers, The Boston Globe reported in 2005.
In contrast to the tax rebate, the cuts to the anti-smoking program had a minimal impact on the state's fiscal crisis, representing just 0.2 percent of its budget shortfall. But the impact on the health of Massachusetts residents was huge. With a budget of only $2.5 million, the program had to back off its support of law enforcement, and cigarette sales to minors nearly tripled, from minors buying cigarettes in a little over 8 percent of their attempts in 2002 to nearly 23 percent in 2007.
Cheryl Sbarra, senior staff attorney for the Massachusetts Association of Health Boards, told HuffPost that she and other advocates warned Romney's administration about the importance of keeping the tobacco-control program intact. She said that she pressed the case personally with then-Lt. Gov. Kerry Healey, who is now an adviser to Romney's presidential campaign. Sbarra gained the impression that Healey didn't know how effective the program had been.
"She said in no uncertain terms, 'You need to show us the facts that cutting this program the way it's been decimated has actually had negative outcomes,'" Sbarra recalled.
Sbarra organized compliance checks in 68 cities and towns that had lost funding for tobacco control. Nearly everywhere they went, they found stores willing to sell cigarettes to minors. "The rates of sale [when minors tried to buy cigarettes] were just astronomical," she said. "Some were as high as 60 percent sales-to-minors rate."
All the cigarettes they bought, they showed to the administration. "We did what Healey wanted, and it made no difference," Sbarra said. "It was like talking to a closed door whenever we talked to the administration."
Neither Healey nor the Romney campaign responded to requests for comment.
The Campaign for Tobacco-Free Kids reported that per capita cigarette sales in Massachusetts actually increased in the third year of Romney's term by more than 3 percent, while they declined nationally. And with sales to minors rising, smoking among the state's high school students plateaued, after declining by 41 percent from 1995 to 2003.
As smoking stats in Massachusetts soured, the Romney administration sought to downplay the importance of the tobacco-control program. A spokesperson for the Department of Public Health told The Boston Globe in March 2004 that the "agency could not draw a direct link between budget cuts and increased sales to minors." The spokesperson called the program a "supplemental check" on retailers. "The responsibility for cigarette sales to teenagers rests at the retailer's door," the spokesperson said.
The Globe's editorial board sharply criticized the cuts that same month. "Underfunding tobacco control programs is a textbook case of penny-wise, pound-foolish. Every analysis of the state's budget problems focuses on the accelerating increases in Medicaid," the board wrote. "But smoking-related illnesses cost Medicaid about half a billion dollars a year. Skimping on tobacco control now simply ensures that this cost will rise in coming years."
A year later, Healey admitted that the fight against youth smoking had been neglected. But she defended the Romney administration. "We in truth are investing hundreds of millions into health care for people whose health has been complicated by use of cigarettes," she said.
Public health advocates, however, portray Romney's emphasis on treatment rather than prevention as closing the barn door after the horses have left.
"It was saving people's lives," Rachel Kaprielian, who as a Democratic state representative argued for anti-smoking efforts, told HuffPost. "All the efforts were promptly reversed."
Romney's dismal tobacco-control legacy as governor is mitigated by 2004 legislation banning smoking in the workplace, including at restaurants and bars. The law made Massachusetts one of the first states, along with New York and California, to end smoking in watering holes. Dozens of states have since followed suit.
But Romney had little enthusiasm for the legislation, lawmakers and anti-smoking advocates recall. Sbarra said that his administration essentially sequestered the state's public health officials while the bill was pending. They were "hardly allowed to leave the building," she said. "They weren't allowed to testify or talk to legislators about it."
Connolly, the state's leading public health expert on smoking, had testified 12 times before Congress on the Massachusetts program before Romney assumed office. On his own time, he had also traveled across the country, testifying in 19 state legislatures to persuade them to fund their own tobacco-control programs. The vast majority of those states ended up adopting similar efforts.
When it came time to debate the smoking ban, however, Connolly said the Romney administration didn't let him testify for the bill. "He didn't want us involved in it," said Connolly.
Connolly had spent the first year or so of Romney's governorship banging on the administration's door with Sbarra and the rest of the anti-smoking advocates. He was shut out of the budget process, no matter how many memos he sent up the chain of command, he said.
"At the height of the program we felt we had defeated Big Tobacco," Connolly recalled. "When the cuts hit, it felt like Big Tobacco had defeated us." During the budget battles with Romney, he learned of the governor's connections to Philip Morris. "You couldn't help but think that the longstanding relationship of millions of dollars between Bain, Philip Morris and Romney was the reason why," he said.
Connolly's own history with tobacco was very different. In the 1970s, he learned about smoking's deadly effects firsthand while working at a hospital in the low-income section of Boston where he had grown up. He handled the late shift in the respiratory care unit, treating patients who were dying of emphysema.
"It's tough seeing someone die," he said. "They were basically drowning in that bed for two, three weeks. ... These people are not being cared for by society, except treating their end stages of addiction -- keeping them alive to suffer. ... They stayed with me my whole life. We put those images on TV."
Then under Romney, his ad campaign had to be shuttered. "What was left [in the budget] was not enough to put posters in high school gyms," Connolly said.
The final blow came in late 2004, when Connolly received yet another invitation to speak before Congress at two different hearings. The Romney administration refused to let him go.
"He sent me a clear message," Connolly said. "It was my time to leave."
Connolly could never gain an audience with Gov. Romney. But, now, if he wanted to, he might get Romney's attention with a neighborly wave. His old nemesis lives across the street from him in Belmont, Mass. He has seen Romney on his front lawn, leaving the house in the morning or walking to a car.
Once, Connolly ventured to say something to the former governor. "He walked into his house as I approached him," Connolly remembered, "probably without noticing me."