The University of Hawaii John A. Burns School of Medicine could lose up to $4 million a year, or 4 percent of its budget, if the state Legislature does not restore tobacco settlement funding set to expire in July.

The school is fearful that if it loses the steady income for operations, it will no longer be able to enroll 90 percent of local students into its programs, instead seeking to enroll more out-of-state students who pay double the state tuition of about $27,000 per year. The school would seek to raise in-state tuition to $58,000 in 2012 if the money is redirected, said Tina Shelton, school spokeswoman.

The Legislature is considering whether to extend the July sunset date for the school’s use of a portion of the state’s Tobacco Settlement. Opponents say the money should go toward other tobacco-related prevention efforts.

The Coalition for a Tobacco-Free Hawaii said money spent on tobacco prevention has been significantly cut since 1999.

"We are deeply concerned that the long-term viability of tobacco prevention efforts is at risk," said Trisha Nakamura, the coalition’s policy and advocacy director. "The Legislature’s support of the medical school was never intended to fund operations, and the support was meant to be temporary. Our state cannot afford to have tobacco settlement monies directed away from tobacco prevention efforts."

In recent years, the group said, the portion of tobacco settlement funds used for prevention and smoking-cessation programs has been whittled down from 25 percent to 12.5 percent to 6.5 percent.

The tobacco settlement pays the state between $40 million and $60 million a year. The money is the result of an agreement between 46 states and large tobacco companies to recover costs paid by taxpayers for tobacco-related ailments.

In addition to a proposal to redirect medical school money, lawmakers are contemplating sweeping all special funds, including the tobacco settlement fund, into the general fund.

Tobacco money was used to finance construction of the medical school’s $150 million Kakaako campus in 2005 and subsequently to fund operations, with between $3 million and $4 million allotted to the school annually. The medical school also receives more than $10 million a year from the tobacco fund to pay its debt service.

The medical school uses the $3 million to $4 million in operational money for medical training programs on the neighbor islands and subsidies for local student education.

If the school cannot subsidize tuition for local students, it could mean there will be "fewer future doctors at a time when we need physicians to treat our growing aging population," Shelton said.

She added that physicians trained at the school do significant tobacco prevention outreach and treatment to residents statewide. Patients are more than 30 percent more likely to quit smoking at the advice of their physicians than other advocates, she said.