COLUMBIA - Some black leaders and Democrats want to raise South Carolina's cigarette tax to help pay for Medicaid, the state and federal health insurance program for the poor and disabled.

There has been little appetite in the legislature in recent years for raising the cigarette tax, which at 7 cents a pack is the lowest in the nation. But a new legislative season gives hope to lawmakers who favor raising the tax.

The call to raise the tax came during a rally at the State House on Tuesday, the opening day of this year's legislative session. It comes months after Republican Gov. Mark Sanford proposed sweeping changes to the Medicaid program, which helps nearly a million people in South Carolina.

"Our state is in a crisis as far as health care," said Sen. Ralph Anderson, D-Greenville. "It is imperative that we attempt to change the formula and that we generate some funds."

Sanford's proposal would create personal health accounts used to purchase private health insurance.

His plan was changed to lower or eliminate copays for some after it drew harsh criticism from advocates for the poor and disabled as well as from Democrats and black legislators. And Sanford has been sued by a group of rural health care clinics that say he doesn't have the authority to make changes without legislative approval.

Sen. Phil Leventis, D-Sumter, said raising the cigarette tax would be an investment in South Carolina. He wants the tax raised to at least the national average of 92 cents, and to have an economic impact study on the proposed changes before any take effect.

Rep. Dan Cooper said he doubts legislators will raise the cigarette tax this year. He also said that with fewer people smoking, there's less money to be raised.

"I'm not very eager to make state government dependent on something that's going to decline," said Cooper, R-Piedmont.

Jim Felder, head of the S.C. Voter Education Project, urged the about two dozen people who attended to talk with their legislators to "save the Medicaid program."

David Hoats, an advocate for the disabled, attended the rally with his wife because they don't want her to lose any services. Hoats said that while he voted for Sanford, he thinks this proposal is a little misguided.

"It doesn't sound like they're going to be there for us," said Hoats, who traveled from Charleston. "When the funding is spent, that's it -- you don't have any health care."

The S.C. Health and Human Services Department, which developed Sanford's proposal, has said that Medicaid recipients wouldn't lose any services.

Sue Berkowitz, director of the S.C. Appleseed Legal Justice Center that does advocacy work for low-income communities, said she has always supported raising the cigarette tax to fund health care.

"It's not really a tax as much as it is a user fee, and our state has had no problem increasing other user fees over the last couple of years," said Berkowitz, who has opposed Sanford's plan. "I'm always hopeful that there's a chance of doing it. We've got some new leadership, and who knows? Hopefully, nothing is totally off the table."