* My weekly syndicated newspaper column was due before the House vote on the cigarette tax hike. So while there is no House vote total in the piece, the prediction was solid…

As state legislative support for a cigarette tax hike grew in late May, anti-tax crusader Grover Norquist and other conservatives stepped into the Illinois fray.

A top House Republican said over a week ago that the roll call in favor of a dollar a pack cigarette tax hike was in the double digits within his caucus. The tax would raise $700 million, including the federal match, to help close the Medicaid program’s gaping $2.7 billion budget hole.

In return, Republicans won concessions from the Democrats, particularly when it came to sparing doctors from Gov. Pat Quinn’s proposed Medicaid provider rate cuts.

For the past several decades, the House Republicans’ most reliable campaign supporter has been the Illinois State Medical Society. The House GOP always sticks with the docs, no matter what. The Medical Society was against last year’s workers’ compensation reform agreement that the Senate Republicans, including former gubernatorial candidate Bill Brady, supported. The House Republicans sided with the doctors and took a hard line against it. The decision not to cut physicians’ Medicaid payment rates was a huge win for the House Republicans, so they agreed to put votes on the cigarette tax.

Norquist is probably best known for his anti-tax pledge that most Republican members of Congress have signed, and that he aggressively holds them to whenever they start thinking about revenue enhancements. Norquist first allied himself with tobacco companies in the 1990s as part of the national Republican effort to defeat President Bill Clinton’s health care proposal, which was funded in part by a cigarette tax hike. He has since fought against cigarette tax hikes in numerous states.

Cigarette tax hikes are by far the most popular tax increases with the public. A poll of southern Illinois voters taken by the Paul Simon Public Policy Institute last year found that 60 percent of them backed a dollar a pack tax hike. A statewide poll taken in 2010 found that 74 percent of Illinoisans - including 71 percent of Republicans - supported a dollar per pack tax increase.

But Joshua Culling, the state-affairs manager for Norquist’s group, wrote that Cross’ caucus could “ruin the GOP brand in the state for a generation” if it backed the cigarette tax increase. “Tom Cross seems content to cut a deal that will further imperil Illinois’s economic outlook while simultaneously eroding the national party’s messaging on the toxicity of Obamacare,” Culling wrote.

Since April, Cross has done several public events outside Springfield and Chicago to urge that President Obama’s health care reform bill be repealed and said he was adamantly opposed to any moves in Illinois to implement the federal law. That refusal led directly to the death of a bipartisan effort by Democratic state Rep. Frank Mautino to set up a health insurance exchange in Illinois.

But Cross’ attempts at appeasing his party’s right wing apparently didn’t go far enough. In a letter sent to supporters, the Illinois Policy Institute’s director singled out Leader Cross for criticism, saying the Medicaid proposal “destroys the credibility of leaders who talk about economic freedom only to vote in favor of more heavy-handed government.”

And the United Republican Fund, one of the oldest and most conservative GOP organizations in the state, also sent out a press release about the Medicaid compromise and the cigarette tax hike. “The time has come for legislators to stop being the unwitting (or intentional) co-conspirators in the slow demise of our great state. The time has come for leadership and courage. For statesmen instead of politicians. For competence instead of compromise.”

The Republican Party’s more pragmatic, governing wing has been in full retreat for the past few years as national politics has invaded state government as part of the GOP’s messaging against the President from Illinois. That aggressive national push has resulted in far more Illinois Statehouse partisanship, so legislators who supported cigarette tax increases in the past, like Senate Republican Leader Chris Radogno, are now vocally against any tax hike of any sort. Her caucus is even against a proposal to close a loophole that allows commercial roll your own cigarette operations to avoid most state sales taxes.

But, in Illinois, some things still trump national party interests. The Medical Society is one of those things. Sorry, Grover. You may have all the Washington, DC Republicans scared out of their wits, but things are a little different here.

* Related…

* The Medicaid money trail?: Roughly 16 percent of the state’s 47,000 doctors aren’t signed up for the program. Even among those who are, the overwhelming majority infrequently see patients, leaving the care concentrated in the hands of a few, according to a Crain’s analysis of payment records. About 25 percent of Medicaid doctors account for just 0.4 percent of the $2.8 billion paid from 2009 through 2011 and make less than $1,400 a year in the program, Crain’s finds. At the other end, the top 10 percent of Medicaid earners received more than 55 percent of the total payments, making at least $70,000 a year, the analysis shows. The shortage of doctors, particularly specialists, is likely to get worse, experts say. In 2014, an estimated 611,000 additional residents will be eligible for Medicaid, a 22 percent increase over the 2.7 million people with full benefits under the Illinois program. Meanwhile, the rising number of aging baby boomers already is increasing demand for doctors.

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* House approves cigarette tax increase

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