Proponents say it will stop people from smoking and save lives, drum up money for hospital emergency rooms, community clinics and expand health insurance for children statewide.

It's also been endorsed by the California Medical Association, the California Hospital Association, the American Cancer Society, the American Lung Association, the American Association of Pediatricians and others.

But the multibillion dollar Proposition 86 on the Nov. 7 ballot has received lots of criticism -- and not just from big tobacco companies and taxpayer groups.

Some doctors, law enforcement officials and even teachers have lambasted the initiative that would make the new tax part of California's constitution.

Opponents say it would spend too little money on anti-smoking programs and give too much money -- nearly 40 percent of all the cash the proposition would create -- to big hospital corporations. They argue it will increase black-market trade in tobacco; threaten education funding and constitutionalize exemptions for hospitals from federal anti-trust laws.

The proposition, if approved by voters, is expected to generate $2.1 billion in its first year by slapping a new $2.60 tax on every pack of cigarettes sold in California, catapulting average prices for name-brands to around $7 a pack.

Proponents backing Prop. 86 argue that the increased cost will persuade teens not to smoke, force current smokers to quit, and save tens of millions of dollars spent on medical treatment for smokers.

Of all the criticisms of Prop. 86, the loudest complaint is that private hospitals are using the banner of fighting smoking to convince the public to give them a guaranteed slice of public tax money -- every year for perpetuity -- to help pay emergency-room costs.

"This is just a money-grab by the hospitals," said Dr. James Knight, a San Diego urologist and former president of the San Diego County Medical Society.

Others disagree. Peter Warren, spokesman for the California Medical Association, which represents 35,000 doctors statewide, said the association has voted to support Prop. 86, even though doctors did not like everything they saw in the complicated, 15-page ballot measure.

"We're backing the proposition," Warren said. "On balance, there's so much good in here that the vote (to support) was overwhelming."

And Tracy Ream, executive director of Escondido's nonprofit Neighborhood Healthcare -- which runs four community clinics in Escondido and one in Pauma Valley -- said clinic leaders solidly support Prop. 86 because clinics desperately need new funding, and would share $58 million from the $2.1 billion, first-year bounty.

"This is going to create money going to health care in this county," she said, "and that's what we need."

Money, money, money

According to the Legislative Analyst's Office, a nonpartisan state fiscal and policy adviser, Prop. 86 would slap a $2.60 tax on every pack of cigarettes sold legally in the state, or 13 cents per cigarette.

In the initiative's first year, it would generate roughly $2.1 billion that would be spent on 26 different sets of programs, broken down into four general categories.

First, about $180 million from Prop. 86 would be spent to "backfill" the tax revenue that is already being created by another cigarette tax -- 1998's Proposition 10, which taxed cigarettes to generate money for childhood development programs. Because Prop. 86 is expected to decrease overall cigarette sales by jacking up their price to smokers, it will also decrease the amount of money that voters said should be created by Prop. 10. Consequently, Prop. 86 revenues will have to cover that loss.

After backfilling Prop. 10, Prop. 86 would split its billions up into three accounts:

- "Health Treatment Services" would get 52.75 percent of what's left. Nearly 75 percent of this money would be given to hospitals to cover emergency room costs. Hospitals say that money is badly needed mainly because federal law requires emergency rooms to treat everyone, and uninsured patients can not pay for treatment.

The rest of this account would be spent on, among other things, nursing education programs, tobacco cessation services, and some college-loan repayment programs to entice doctors to serve in low-income areas.

- "Health Maintenance and Disease Prevention" would get 42.25 percent of Prop. 86 funding. Of this money, 45.5 percent would be spent to expand children's health coverage statewide. The rest would be spent on cancer programs, tobacco control media campaigns, asthma programs, heart disease and stroke programs, and several other areas.

- "Health Disease and Research" would get the smallest amount of funding, just 5 percent. That money would be spent on breast and lung cancer, research, general cancer research and tobacco-control research.

Easy mark?

Needless to say, officials who represent big tobacco companies are not happy about Prop. 86.

The "No on 86" campaign is identified by the California Secretary of State's office as a coalition of business, law enforcement, taxpayer groups and Philip Morris USA. The company is the maker of Marlboro brand cigarettes and accounts for about half of the cigarette market in the United States.

Carla Hass, spokeswoman for the "No on 86" campaign, which began an expensive TV campaign Aug. 14 and will continue through the election, said people were being misled.

"It's egregious that only 10 percent of the money from this would go to smoking-cessation programs," she said. "It's being marketed as an anti-smoking campaign. In reality it's a money grab for big hospital corporations."

Asked if the tobacco industry was an easy target, Hass said that smokers and big tobacco companies have been attacked and taxed for years and become increasingly socially unacceptable because of the associated health risks.

"Look, the tobacco industry and smokers have been pilloried for years," she said. "Are they an easy mark? Probably."

Hospital officials said they deserved the funding that Prop. 86 would provide.

Steve Escoboza, president of the Hospital Association of San Diego and Imperial Counties, said "lots" of patients who show up in emergency rooms do so because they have past or current histories of tobacco-related chronic diseases -- including heart and lung disease.

Hass countered by saying while it was probably true that some emergency room patients were there because they smoked, hospitals had never been able to show any statistics to back those assertions.

"We can't find that number," she said.

Other criticisms

Critics such as Dr. Knight, the former head of the San Diego County Medical Society, also sharply criticized language in Prop. 86 that would give hospitals anti-trust exemptions -- letting them talk to each other about providing emergency-room services.

Federal anti-trust laws prohibit hospitals, like other competitive businesses, from sharing business information. Doing so could allow hospitals to share wage and rate information and let them collude to fix prices or lower salaries for doctors and nurses.

Escoboza rejected the allegation that Prop. 86 would give hospitals monopolistic powers by exempting them from anti-trust laws. He said the exemptions that Prop. 86 would give hospitals was "extremely narrow" -- and would only allow hospitals to work together to find badly needed specialists to work in emergency rooms.

Law enforcement officials, meanwhile, such as Steven Remige, president of the Los Angeles County Deputy Sheriff's Association, have worried that Prop. 86 will increase crime and cigarette smuggling.

Jim Duffy, president of the San Diego Deputy Sheriff's Association, could not be reached for comment. But Knight and Hass said if regular prices for cigarettes rise to $7 a pack, it would not be hard to imagine criminals -- including gangs -- going over the border, buying up cheap cigarettes, and selling them back in California at a profit that still undercuts the legal trade.

Knight also suggested that Southern California residents could make trips to Indian casinos to stockpile cheaper cigarettes that would remain unaffected by state law. Those could also end up being resold on the black market.

And one public school teacher who signed the ballot measure opposing Prop. 86 said constitutionally guaranteeing hospitals a share of taxes could cut into the constitutionally guaranteed portion of taxes that is supposed to go each year to schools.

But others listen to the arguments and are not swayed. They say Prop. 86 still would stop people from smoking, and create money for important programs.

Peter Hasapopoulos is executive director for Escondido-based Congregations for Civic Action, a nonprofit organization representing 10 area churches and 14,000 North County families.

Hasapopoulos said his group is particularly interested in the fact that Prop. 86 would expand health care programs for children, and said that his group actually hit the streets to collect 2,600 signatures to help qualify the initiative for the ballot.

"We're going to do a lot of get-out-the-vote work on it," he said.

Contact staff writer Gig Conaughton at (760) 739-6696 or gconaughton@nctimes.com.