Hawaii could raise the legal smoking age to 100, effectively banning cigarettes for the vast majority of people in the state.
In a new bill, proposed by Democrat Richard Creagan, the smoking age would increase rapidly between 2020 and 2024.
It will need to pass through the state legislature and weather a potentially strong backlash from tobacco companies in order to become state law.
E-cigarettes, chewing tobacco and cigars are not included in the bill.
Dr Creagan, who was an emergency room physician before he was elected as state representative in 2014, calls the cigarette "the deadliest artefact in human history" in the bill.
In January 2017, Hawaii became the first US state to raise its smoking age to 21. In other US states the legal age is usually 18 or 19.
The new bill, HB 1509, suggests that the smoking age should go up to 30 in 2020, 40 in 2021, 50 in 2022, and 60 in 2023 - until finally, in 2024, people would need to be 100 years old to buy cigarettes.
He told the Hawaii Tribune-Herald that a "ridiculously bad industry" had designed the cigarette to be "highly addictive, knowing that it is highly lethal".
"We don't allow people free access to opioids, for instance, or any prescription drugs," he said.
E-cigarettes and cigars are left out of the bill because Dr Creagan believes they are significantly safer for smokers than regular cigarettes - although the National Cancer Institute warns that "all tobacco products are harmful and cause cancer".
"Regular cigar smokers and cigarette smokers have similar levels of risk for oral cavity and oesophageal cancers," it adds on its website.
The Centers for Disease Control and Prevention in the US say that cigarette smoking is the top cause of preventable disease and death in the country.
About half a million people in the US die every year from smoking-related conditions.