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A cigarette butt is extinguished in this April 4, 2017, file photo.

WASHINGTON — The Louisiana Legislature rejected a proposal that would have raised the smoking age from 18 to 21 during its most recent session, but it may not have a choice on the issue if some members of Congress get their way.

U.S. Senate Majority Leader Mitch McConnell, R-Kentucky, and Sen. Tim Kaine, the Virginia Democrat who was Hillary Clinton's running mate in 2016, are pushing a change to federal law that would outlaw tobacco sales to anyone younger than 21.

The remarkable bipartisan partnership between two lawmakers who hail from tobacco-producing states has given the proposal a new air of credibility at the U.S. Capitol.

"I think it's a good thing," said U.S. Sen. Bill Cassidy, a Baton Rouge Republican.

The tobacco age hike has been folded into a larger health care bill that covers several areas, including prescription drug costs, surprise medical bills and patient transparency, that Cassidy took a key role in drafting.

Senate health committee, of which Cassidy is a member, advanced the omnibus health care bill in a 20-3 bipartisan vote on Wednesday. It's expected to be brought to the floor before Congress' August recess. The bill also would have to be vetted by the U.S. House before it could become law.

Senators see the bill as a substantial piece of legislation that could provide a bipartisan win for a divided Congress, where the Democrat-controlled House has created multiple roadblocks for the GOP's priorities.

"I was proud my colleague from Virginia joined me in leading this effort, giving this cause the strong bipartisan momentum it deserves," McConnell said.

"We can come together to do this on behalf of our young people," Kaine said.

Speaking from the Senate floor in May, McConnell described himself as "an unusual candidate to lead this charge" to raise the federal minimum age to buy tobacco products, including e-cigarettes and other vaping products, from 18 to 21.

"I have consistently stood up for our Kentucky farmers, including our tobacco farmers," McConnell said, outlining past positions he has taken that benefited the tobacco industry. "Kentucky is proud of what we make, but we also take pride in the health and development of our children, and the sad reality is that Kentucky's been home to the highest rates of cancer in the country."

"Our state once grew tobacco like none other, and now we're being hit by the health consequences of tobacco use like none other,” he added.

Tobacco use is the largest preventable cause of death and disease in the United States — killing more than 480,000 peoples each year, according to the Centers for Disease Control and Prevention. That includes about 7,300 people annually in Louisiana.

The National Institute of Medicine estimates that nearly 90% of adults who are daily smokers first used tobacco before they were 19, and there has been a documented surge in e-cigarette use, or vaping, among teens. 

"We're backsliding," Kaine said. "The recent increases in youth tobacco use demonstrate we need to do more."

Louisiana already has high rates of smokers among adult and teen populations.

About 22.8% of Louisiana adults are smokers, compared to the national average of 17.1%, the CDC estimates, and 12.3% of Louisiana high school students smoked on at least one day in the past 30 days in a 2017 study, outpacing the national 8.8% rate.

Cassidy, who is a medical doctor, said restricting purchases to those 21 and older is a form of "risk reduction" because of those trends.

"Nicotine is very powerful, particularly on younger minds," he said. 

Cassidy said some naysayers may argue that increasing the age won't prevent teens from finding other ways to obtain tobacco products, but he dismissed that argument as minimal compared to the potential positive impact.

"I think it's reasonable," he said.

Sixteen states, including Louisiana's neighbors Texas and Arkansas, have already passed laws raising the minimum age to purchase tobacco products to 21.

The Louisiana House shot down a similar proposal in May, with just 22 of the chamber's 105 members voting in support after the idea attracted an odd pairing of opponents, arguing from opposite sides that the legislation would be an intrusion on personal decisions or that it didn't go far enough in restricting access to tobacco products.

McConnell and Kaine's proposal has faced a similar pushback and speculation over whether Big Tobacco has more say than is being let on.

The American Lung Association is one of several dozen health care organizations to sign on as a supporter of raising the smoking age to 21, but the ALA noted in a statement that the McConnell-Kaine measure "is an important step forward, but we urge them to include a faster implementation of the Food and Drug Administration’s enforcement of the new minimum age of sale."

"When passed, raising the minimum age of sale will reduce the number of young people who use and become addicted to tobacco products, and as a result, save hundreds of thousands of lives by reducing the disease and premature death that these products cause,"  said Harold Wimmer, national president and CEO of the American Lung Association.

The proposal also has won the support of JUUL, the leading e-cigarette brand that is owned in part by to Marlboro manufacturer Altria.

"We commend Senator McConnell for announcing this legislation as we strongly support raising the purchasing age for all tobacco products, including vapor products, to 21 and have been actively supporting legislation to do this at the federal level and in states across the country," JUUL CEO Kevin Burns said in a statement. He promised that the company will "continue to work with lawmakers across the country to enact these effective policies."

The McConnell-Kaine proposal would force states to update their own laws to maintain compliance with federal laws that regulate tobacco sales. If they don’t, they would risk losing access to federal health dollars.

Skeptics argue opening up those laws will leave states vulnerable to pressure from the tobacco industry’s powerful lobbying prowess.

"Given recent tobacco industry behavior, it is highly likely that this provision will be used by the tobacco companies to pass laws that weaken state and local efforts to reduce tobacco use," Matthew L. Myers, president of the Campaign for Tobacco-Free Kids, said in a statement. "We are concerned that requiring states to pass their own Tobacco 21 laws, especially with the threat of losing substance abuse funds, would provide the tobacco industry with both the opportunity and the leverage to add special interest provisions that harm kids and public health."

Democratic U.S. Sens. Brian Schatz, of Hawaii, and Dick Durbin, of Illinois, who have proposed their own legislation on the issue alongside Republican Sens. Todd Young, of Indiana, and Mitt Romney, of Utah, said they were encouraged to see the most powerful member of the Senate agree that the minimum age needs to be raised.

"However, his bill would force each state to pass individual laws or risk losing critical substance abuse prevention and treatment funding, in the midst of an opioid epidemic," Schatz and Durbin said in a joint statement on McConnell's proposal. "Forcing state action creates a dangerous loophole that gives the tobacco industry an opening to intensify their efforts at the state level to undermine strong anti-tobacco proposals, such as regulations on flavored tobacco products."


Email Elizabeth Crisp at ecrisp@theadvocate.com and follow on Twitter, @elizabethcrisp.