The Senate voted 41-1 to approve the House's proposed increase of 50 cents a pack. South Carolina's current tax of 7 cents has been in place since 1977, when a pack cost 48 cents.
If Gov. Mark Sanford's promised veto is overridden, Missouri would then have the nation's lowest tax at 17 cents a pack, according to the Campaign for Tobacco-Free Kids, a national advocacy group that tracks cigarette taxes and trends. Rhode Island leads the nation with a $3.46 tax on each pack.
"It moves us down the road," said Sen. Thomas Alexander, a Walhalla Republican who pushed the legislation through the Senate.
The legislation generates $125 million for a Medicaid trust fund and sets aside $5 million each for cancer research and programs to reduce smoking. It also gives $1 million to marketing agriculture products.
Sanford spokesman Ben Fox said the governor stands by his long-standing belief that the tax burden on state residents shouldn't be increased.
"The governor has vetoed legislation similar to this in the past, and we'll be making a final announcement on this tax hike bill in the near future," Fox said in an e-mail.
Supporters said the more important votes lie ahead, when the House and then the Senate would have to muster two-thirds votes to override the veto.
"The real question is what the House is going to do," said John Ruoff, whose advocacy group South Carolina Fair Share backed the legislation. The House sustained Sanford's last cigarette tax veto two years ago.
"This is an absolutely essential step given the fiscal condition of this state," Ruoff said.
With federal bailout money for state budgets and health care programs disappearing next year, the $125 million trust fund the legislation sets up is needed to begin filling a projected $485 million gap in state spending on health care for the elderly, poor and disabled under Medicaid.
South Carolina's increase would tie the state with Idaho at 42nd nationally, the Campaign for Tobacco-Free Kids said. The Palmetto State tax would still be well below the $1.41 a pack national average.