Legislatures around the country are deciding how to spend the impending avalanche of tobacco settlement money. This avalanche has the capacity to be a boon for tobacco control or a boondoggle. Hundreds of billions of dollars will flow into states for 25 years. Nobody knows whether this money will go for road repair, general fund bailouts, education, medical services, or tobacco control. If settlement money is not allocated to tobacco control now, it will be difficult to recapture it in future years.

Managed care organisations (MCOs) have a role to play that can be very positive or potentially negative. We are large businesses with a legitimate stake in this issue. We pay for tobacco related care, even more than the states do. We will be affected by how cessation services are provided as well.

We also have some quirky incentives. MCOs can obtain immediate direct financial gain from government spending …