By DIANNE C. ESPLIN, RD
Special to the Saipan Tribune
I understand the terrible issues facing the Commonwealth Health Corp. in funding and accreditation, and I applaud the Legislature's efforts to address the need for CNMI to make healthier choices, but I think House Bill 17-320, The Health Care Impact Tax Act, is not well thought out and I would like to respectfully point out several of my concerns:
1. The list of foods in House Bill 17-320 to be taxed includes foods that are healthy and necessary to some people.
a. Item 1. “Animal & Vegetable Fats.” To tax animal fats would include taxing every meat product brought into the CNMI, including chicken leg quarters and ribs, as all meats contain fat. This also would tax imported fish, fresh or canned, a source of Omega 3 fatty acids, which are actually necessary for normal brain development in children and normal brain function in adults. If families who are not used to a vegetarian diet eliminate meat and fish to reduce family food costs, they risk protein deficiency, which can result in developmental delays and growth retardation for their children. Milk contains animal fat as well. Will we be taxing whole milk as well as reduced fat, low fat, and skim milk? Milk is one of the few sources of dietary calcium we need for strong bones.
b. Item 6. “Canned and Prepared Meats.” Canned meats are often the only meat option for some families who do not have access to refrigeration, and we have many families who cannot afford the power or equipment costs of refrigeration. Healthy canned meats are available, such as tuna, salmon, sardines, canned chicken, etc. The healthy choice is often actually cheaper per ounce of protein than the less healthy choices of canned luncheon meats and canned corned beef.
c. Item 9. “Chocolate & other food products containing chocolate.” There are pediatric enteral formulas, such as Pediasure and Bright Beginnings, that contain chocolate. Currently, Vanilla Pediasure is more expensive than the Chocolate Pediasure at the distributors. Although this change could potentially increase CHC's dietary costs, please be aware that not all tube-fed children are hospitalized. PSS Food and Nutrition Services serves quite a few tube-fed PSS students. With this tax on products containing chocolate, this lower price option for caretakers of children requiring tube feeding at home would disappear.
d. Item 12. “Cocoa butter, fat, and oil.” Cocoa butter is often used in cosmetics and skin care. Would this tax affect those cocoa butter products that are not intended for consumption?
e. Item 20. “Oil Salad and Cooking.” There are some vegetable fats that have been shown to reduce the risk of non-communicable diseases. Olive oil and canola oil contain mono and poly-unsaturated fats that have been shown to reduce the risks of heart disease when they replace foods containing saturated fat. Although overused, fats still remain essential to the diet. Taxing all fats may cause an increase in the consumption of carbohydrates, especially refined carbohydrates, which is a concern for a population such as ours with such rampant diabetes.
f. Item 22. “Peanut Butter and Paste.” Peanut butter is a vegetarian protein source that is a rich source of calories that is exceptionally helpful for children who are underweight. The WIC program, a nutrition program funded by the USDA Food and Nutrition Services, distributes peanut butter to its participants as a healthy food. Peanut oil contains a large portion of mono and poly-unsaturated fats, which are the heart-healthy fats. Taxing peanut butter makes it harder for families facing food insecurity and hunger to provide healthy calorie-dense foods to their underweight children. This also will put an unnecessary burden on the WIC program, which serves low income families, and may necessitate a reduction in services based on their increased food costs.
2. A tax on food is hardest on the poor. The CNMI's poverty level is extremely high. We have a high incidence of food insecurity and hunger, especially among those families who cannot receive food stamp benefits. Here in the CNMI, we've had several recent occasions where parents try to take uneaten food off of student trays to take home for family to prevent it from going to the “pig food” bin, and for that reason, some schools have had to adopt policies of no parents in the cafeteria. So, in my opinion, to put a tax on food where the people are already experiencing hunger, poverty, and food insecurity is downright mean.
3. It is vague and unclear how foods containing “animal or vegetable fat” will be determined. Will all animal products containing fat now be taxed equally? For example, will pork belly and turkey tail be taxed the same as boneless skinless chicken breast and tilapia? Will whole fat milk be taxed the same as 1 percent milk? All of these foods contain animal fats, although they vary a great deal in their percentage of fat content.
4. The bill makes no provision for the funding of its enforcement. Will the Division of Customs be solely responsible for the additional costs and administration of this tax? Is this an unfunded mandate? Has the Legislature conferred with the Division of Customs to determine what sort of additional costs in manpower, training, or administration this change would cause?
5. The rule making authority for this law lies with an agency without expertise in food, nutrition, and health. The Department of Finance is well equipped to handle things financial, but do they have the expertise to determine which foods contain fat if there are no labels? For example, avocados are usually imported without a label, but avocados are high in fat.
I have no qualms about taxing non-food items that are harming the health of CNMI residents, such as alcohol, tobacco, and betel nut but, as a nutrition professional, I respectfully oppose House Bill 17-320 as it is written.
Dianne C. Esplin, RD holds a bachelor's degree in Foods and Nutrition (Medical Dietetics) from Brigham Young University, is a Registered Dietitian, (licensed as a dietitian by the Idaho Board of Medicine), and a member of the Academy of Nutrition and Dietetics.