The numbers are staggering. In the CNMI -- 1 in 4 adults smoke cigarettes. More than 87% of adults who chew betel nut add tobacco. Thirty-five percent of all CHamorus, Carolinians, and other Pacific Islanders were cigarette smokers.

"This is a public health emergency and we should treat it like that," CNMI House Rep. Tina Sablan said.

A House bill she authored is making its way through the Senate with public hearings on Saipan, Tinian, and Rota this week to address the issue by raising the tobacco tax.

"Tobacco taxation is proven, evidence-based strategy for reducing the rate of tobacco use, and then 2, directing revenues to better support health-care and public health infrastructure. We need to do both," Sablan said.

The House bill would raise the tax from $3.75 to $4 per 20 cigarettes. It would then increase by 50 cents every following year and after 6th year the price would be tied to inflation. The tax for other products that contain nicotine would increase to 70% from the current 60% as recommended by local health officials in line with the W.H.O. and C.D.C.

At a time when more than 80% of the NMI is on Medicaid, Sablan says the cost of not doing anything is more detrimental to the public's health.

"Tobacco is not an essential commodity," she said. "It is not like food, it is not like medicine. We know that this is something that is killing our people. And we are seeing our people die at younger and younger ages."

But not everyone is on board with the measure. One lawmaker says it might not be the right time for any increased taxes.

"How far can the dollar go in the two smaller islands? Maybe the power of the dollar is just 25 cents, just 50 cents to that compared to Saipan," Sen. Jude Hofschneider said. "Because there are other elements affecting the bottom line or the price on the shelves right now. Irrespective if we pass this or not it is already very expensive. I do know on the island of Tinian the cost of 20-pack of cigarettes is over $10 now."

Other senators in opposition say it will only burden residents even more. Both sides seem to be asking the same question: at what cost?