Voters were closely divided on whether Missouri's tobacco taxes should be raised to boost spending on health care programs, according to Tuesday's incomplete election returns.
With nearly two-thirds of precincts reporting statewide, Proposition A was failing by 52 percent of the vote.
The proposal seeks to quadruple Missouri's cigarette tax to 72 cents a pack, up from the current 17 cents. Taxes on other tobacco products would rise by 20 percent.
The measure was defeated soundly in Cape Girardeau County. With 100 percent of the votes cast, it failed 12,290 to 9,761.
Sue Roussel of Cape Girardeau, who voted at the Arena Building, said she voted no on Proposition A to preserve personal choice.
"If people want to smoke, let them smoke," she said. "If they get sick, then let them pay for it."
Lynn Hicks, who also cast her ballot at the Arena Building, said it was a hard decision, but she decided to vote yes.
"I thought it was a good idea," she said. "If it does indeed help out paying for health care, then it's a good thing. There's no doubt that smokers are more prone to illness and cigarettes are bad for you."
But Ken Keesee disagreed.
"Once all these programs get started, what if the money from the tax doesn't pay for them?" Keesee said. "We'll end up paying more for those programs. It will end up costing us more."
In St. Louis County, where nearly one quarter of precincts were reporting results, Proposition A was passing with 57 percent of the vote. But it was failing in early returns in many rural counties. Few precincts had reported results in Jackson County or St. Louis city -- two of the state's larger voting blocks.
Under the tax proposal, 43 percent of the new money would go to health care treatment, including prescription drugs for seniors and initiatives for the poor, women, minorities and children. Twenty-nine percent would go to hospital trauma care; 14 percent to life sciences research; 7 percent to smoking prevention efforts; and 7 percent to early childhood programs.
The tax increase was estimated to raise $342.6 million annually, according to the official ballot estimate. But Gov. Bob Holden's budget office was projecting $311.8 million for next fiscal year, with revenues declining thereafter because of an expected decrease in tobacco use.
Staff writer Scott Moyers contributed to this report.