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Trying to reverse cuts to medical services relied on by the needy, advocates for the poor are embracing tax increases that they acknowledge would hurt low-income people.
The groups are pushing an increase in the state sales tax and a 75-cent increase in the tax on cigarettes. In return, they want Gov. Bob Taft and lawmakers to use the extra money to pay for state-funded medical services for more poor families and children.
Acknowledging that tax increases will hurt the poor more than middle- or upper-income Ohioans, these advocates say the pain is worth the good that will come of it.
''We're talking about vital services to low-income people,'' said Cathy Levine, executive director of the University Health Care Action Network.
Republican Sen. Robert Spada raised the issue last week as advocates testified before the Senate Finance Committee.
''Aren't you hurting the very people you're trying to help?'' he asked Col Owens, co-chairman of the Ohio Family Coverage Coalition, a consumer-health advocacy group.
In addition to the cigarette tax, Owens and others want lawmakers to increase the sales tax by a quarter of a percent above the current budget proposal of 5.5 percent.
So far, Taft and lawmakers have stuck with a 45-cent cigarette tax increase and have refused to budge on the sales tax.
''Yes, this hurts our people,'' Owens said. ''But the services they can gain with the revenue outweighs by far the harm that the tax does. There's just no question in my mind that that is true.''
Taft, a Republican, wants to reduce the number of people eligible for Medicaid, the state-federal program that provides health care to the poor. While saving about $37 million, it would also reduce benefits for about 25,000 poor Ohioans.
Another proposal, to eliminate adult dental coverage, would save about $47 million but also affect more than 200,000 adults who receive some form of dental care under Medicaid.
A third plan, to eliminate a program that provides medical insurance for destitute, chronically ill Ohioans, saves about $73 million a year but also ends the coverage for about 15,000 residents.
When debating the trade-off between taxes and services, it's important to remember that the poor often have a double handicap, their low income and their lack of affordable health care, said Dennis Sullivan, a Miami University economist who studies poverty.
Any increase in taxes will generally hurt the poor more because it takes a bigger chunk out of their available dollars, Sullivan said. At the same time, the poor may not buy the kind of pricey goods that a higher sales tax would affect.
''Most of the pain that is associated with a higher sales tax falls on things that low-income people don't buy much of anyway, which are big-ticket consumer durables,'' Sullivan said.
At the same time, higher taxes also affect poor people who aren't on Medicaid, said Tod Porter, chairman of Youngstown State University's Economics Department.
''If you're one of the people who's on Medicaid and would benefit from the increased services, you'd be a net winner,'' Porter said. ''If you're individual who's just above the income level where you'd get Medicaid, you'd be a net loser.''
The House agreed to restore some funding for dental care, but Senate GOP lawmakers aren't showing a lot of enthusiasm for extra spending yet, said Spada, a suburban Cleveland Republican.
''As people continue to offer testimony, we are seeing some of our members speak up a little bit more about some of the options the advocates are talking about,'' he said.
Andrew Welsh-Huggins is the statehouse correspondent for the Ohio Associated Press.