Depending on how the current struggles and compromises over the Maine budget come out, one of the big losers can be the Fund for a Healthy Maine, which receives the state’s annual share of a 1998 multibillion-dollar lawsuit settlement with the four largest cigarette companies.

Maine gets about $50 million a year “in perpetuity” from the tobacco settlement as reimbursement for past tobacco-related health costs. The settlement allowed the states to use the payments for any purpose. Some have used the payments chiefly to balance their state budgets.

Maine has been a leader in restricting its use to health-related programs. In a 1999 law, Maine created the Fund for a Healthy Maine to receive the tobacco payments and specifies that “allocations are limited to the following health-related purposes.” It then lists eight programs starting with smoking prevention and winding up with school health and nutrition programs.

The drafters chose to use a statute rather than a constitutional amendment to safeguard the fund, since they wanted to impose it without delay. But that left open the possibility that future legislatures would modify the terms. One provision, which Gov. Paul LePage has ignored (and which the Legislature also can ignore) mandated that allocations from the fund “must be used to supplement, not supplant, appropriations from the General Fund.”

The raid on the Fund for a Healthy Maine, as proposed by the governor, involves scooping around $30 million from categories of the fund into the medical care account. That money would then be used for MaineCare, freeing up General Fund dollars to go to the MaineCare program, thus “supplanting” appropriations from the General Fund.

The Fund for a Healthy Maine accounts that thus would be wiped out in the next fiscal year include drugs for the elderly and disabled, community school grants including obesity prevention, home visitation, Head Start, support for child care and immunization. These programs serve mainly as disease prevention. That means the present economizing measures will result in costly future disease and disability — and not only in the distant future but also in the next years of Gov. LePage’s administration.

Tobacco use remains the top cause of preventable death in the United States and around the world. Yet Maine spends only a little over half of the $18.5 million a year needed for an effective, comprehensive tobacco prevention program, according to the U.S. Centers for Disease Control and Prevention.

Ed Miller, senior vice president of the American Lung Association of New England, notes that the attraction for lawmakers is that for every $1 of fund money they put into MaineCare they get $2 of federal matching money. He adds that “no one wants to talk about any kind of tax increase.” He points out that raising the tobacco tax from $2 to $3.50, as it is in Rhode Island, would both generate money and reduce smoking rates.

Becky Smith, a consultant to the Maine Public Health Association, says the governor’s proposal “rips the heart out of the fund.” She said, “These cuts will guarantee a future of fewer healthy families, higher health costs for all and an economic recovery that can only limp along because we continue to avoid dealing with the elephant in the room — the incredible cost of preventable chronic disease.”

It is up to the Legislature to save the Fund for a Healthy Maine and avoid short-sighted measures that would bring future trouble and expense.