News
Advocacy Update 11.13.2014
 This message is being sent via blind copy to, Division Senior Leadership Team (EVPs, SVPs, and VPs), Corporate Center Functional Leaders, Community Engagement and Partner Relationships Senior Directors, All Health Systems Staff, ACS CAN Field Staff and ACS CAN National Staff.
Election Outcomes Last week, elections for several federal, state, and local offices were held across the country and Republicans made huge gains at all levels. In the U.S. Senate, Republicans picked up 8 seats for a 53-46 majority. They are favored to win in Louisiana and could end up with a 54-46 seat majority. In the U.S. House of Representatives, Republicans picked up an estimated 15 seats. If current margins hold, Republicans will head into the 114th Congress with at least 248 seats, their largest margin since 1947. At the state level, Republicans netted three governorships after unseating Democratic governors in Arkansas, Illinois, Maryland and Massachusetts. Democrat Tom Wolf unseated a Republican governor in Pennsylvania. Republicans will control 31 governorships, compared to 18 for the Democrats and 1 for Independents, unless Republican Gov. Sean Parnell of Alaska loses to Bill Walker, an Independent who is currently ahead in the race. Republicans will control both state legislatures in 30 states, and completely controls both the legislative and executive branches in 24 of those states with Republican governors. Nebraska’s unicameral legislature is technically nonpartisan, but in practice, Republicans control it by a wide margin. This is the greatest number of legislatures Republicans have controlled in more than 150 years. Democrats will control both houses in 11 states, and completely control both branches in only 6 of those states. Impact on ACS CAN Issues Access to Care The Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS) will continue overseeing implementation of the Affordable Care Act (ACA). Open enrollment begins November 15 and runs through February 15, 2015. ACS CAN’s primary areas of focus will not change as it relates to the law: working to effectively implement those provisions of the law that are important to our cancer mission by expanding access to affordable, high quality care for cancer patients and their families. The House is likely to cast another vote to repeal the ACA at the start of the 114th Congress. It is possible, but less likely, that the Senate will also cast a repeal vote. These would be largely symbolic efforts, given that a repeal bill would not survive a veto by President Obama. We expect both chambers also to move to repeal smaller sections of the ACA such as the medical device tax and the Independent Payment Advisory Board (IPAB) which is tasked with achieving specified savings in Medicare without affecting coverage or quality. Also at risk of repeal is the employer mandate which requires all businesses with more than 50 full-time equivalent (FTE) employees to provide health insurance for their full-time employees. More worrisome would be a legislative effort to eliminate the individual mandate which assures all people, not only those who are ill, purchase insurance. There may also be action taken to amend the 30-hour work week requirement and other small fixes. With the exception of the mandate repeals, these bills could be enacted quite easily. Congressional committees with ACA jurisdiction will continue to hold regular oversight hearings on the ACA to focus primarily on costs, impact on employers and individuals, premium subsidy delivery, and patient access. And in the states, ongoing efforts to broaden and preserve access to health care through Medicaid will continue to be a significant challenge. The newly-elected legislators in Arkansas do not support broadening access to health care through Medicaid, or what is referred to in the state as the “Private Option.” The reelection of Maine’s governor, Paul LePage, will hamper efforts in that state. The “Doc Fix” Early in the 114th Congress, members will have to address a looming 24 percent cut in Medicare payments known as the Sustainable Growth Rate (SGR) or “doc fix.” The House and Senate committees crafted bills in the 113th Congress to eliminate the SGR, but failed to agree on a way to offset the $138 billion cost of the fix. The current fix expires on March 31, 2015. The doc fix is the legislative vehicle in which ACS CAN is working to tie legislation to remove barriers from colorectal cancer screenings for seniors, which is a barrier to achieving an 80 percent screening rate by 2018. Discretionary appropriations for cancer research at the National Institutes for Health (NIH) and screening at the Centers for Disease Control and Prevention (CDC) have little room to grow under the current budget caps. However, in FY16 NIH may fare better than other programs within the HHS umbrella because it enjoys significant bipartisan support. We will be working throughout the year to reinforce this support with help from our partners, including Stand Up to Cancer and others. By contrast, the Prevention and Public Health Fund, a mandatory program created by the ACA, will be a prime target for elimination in the Republican-led Congress. Senator Mitch McConnell (R-KY), the presumptive new Senate Majority Leader and House Speaker John Boehner (R-OH), have stated that they will work with the president to enact tax reform, which could present another opportunity to pass a federal tobacco tax increase. The tobacco tax is a significant source of revenue. Each 10 cent increase in the federal tax raises roughly one billion dollars per year. At the state level, we will need to revisit our plans for a 2015 campaign to raise Maryland’s tobacco tax and increase the state’s funding for tobacco prevention programs including cessation, as Governor-elect Larry Hogan (R) has stated that he will not support raising any taxes, including tobacco taxes. Pennsylvania Governor-elect (D) Tom Wolf is a strong supporter of raising the tobacco tax, which will be is encouraging, as the Pennsylvania legislature presents a challenge to our efforts. While Republicans will control both the House and the Senate at the federal level, they will need Democratic cooperation to pass significant legislation because they will not possess the 60 Senate votes needed to override a presidential veto. To date, Obama has vetoed only three bills, but he is very likely to veto significantly more bills during the remaining two years of his term. And we anticipate that Congress will conduct more investigations into the activities of the administration. Please be assured that ACS CAN is positioned to work well with the new Congress. Our priority issues, including NIH and CDC funding, cancer screening initiatives and our patient quality of life initiatives all enjoy strong bipartisan support. Securing sufficient funding in the current budget cap environment will be challenging, but we are pressing Congress for higher appropriations for NIH and CDC for Fiscal Year 2016. As a nonpartisan organization, ACS CAN also stands ready to work with newly elected state governors and legislators. We are assessing the impact of the new legislators and governors on our ability to move legislation in 2015. We lost some legislative champions which will require that we quickly educate incoming legislators about our issues. The sharp increase in divided state governments may lead to gridlock, but legislators and governors are more likely to seek compromise because 49 states are required to pass balanced budgets each year. Our staff and volunteers are already creating strategies and setting up meetings with the newly elected state legislators and governors.
Cancer Votes 2014 Through Cancer Votes ACS CAN’s nonpartisan voter education program, we distributed candidate questionnaires in 53 campaigns this year – 27 federal and 32 state races. We received our highest response rate ever and saw an increase in the amount of completed responses from both candidates in a given race. We also found that the information we shared with candidates was an effective means of educating them on ACS CAN’s positions and earning their support for cancer-related policies. In Florida’s race for governor, for example, both candidates affirmed their support for increased funding for Florida’s Breast and Cervical Cancer Early Detection Program. In the Colorado Senate race, both candidates, Democratic and Republican, vowed to protect NIH funding, and it was clear that the information ACS CAN provided about the impact that cuts to NIH have had on cancer research helped to shape each of the candidate’s responses. The same proved true in the case of palliative care. Each candidate’s answers on the topic mirrored ACS CAN’s own policies, which had been read and digested by both campaigns. We have seen examples of this in other races across the country – in questionnaires, at candidate forums and in candidate meetings. While campaign pledges must be put into context, the good news is that we are using Cancer Votes as a different method of educating lawmakers and potential lawmakers, and we will be able to use their own answers to help build a working partnership with them on many state and federal issues.
Status of ACA Tax Credit Litigation As mentioned in previous updates, the tax credits are vital to the workability of the law because they make the coverage affordable on a sliding scale for families who make between 133 percent and 400 percent of the poverty index. If the Supreme Court finds in favor of the plaintiffs, 4.6 million people living in the 34 states with federal exchanges could lose their credits, and as many as 12.5 million who are eligible for the credits would never have the opportunity to obtain them. Such an outcome could leave millions of cancer patients and survivors without access to lifesaving care. The Society and ACS CAN, along with the American Diabetes Association and the American Heart Association, made these points in friend-of-the-court briefs filed with the DC and Fourth Circuit appeals courts. The organizations filed a similar brief in advance of the DC Circuit’s en banc proceeding. Our brief provides the court with critical information about the scientific link between health insurance coverage and medical outcomes. Citing numerous studies involving people who have experienced cancer, diabetes, heart disease, or stroke, the brief asserts that Congress intended for the ACA to make tax credits available in all marketplaces, and that access to affordable health coverage saves lives
Quality of Life Legislation Gains New Support In addition, the Patient Quality of Life Coalition that ACS CAN established last year recently held a bipartisan briefing focused on palliative care for the staff members of the Senate Health Education Labor and Pensions (HELP) Committee, which has jurisdiction over the palliative care legislation. Leading researchers in the field of palliative care, including Sean Morrison, MD of Mt. Sinai Hospital, provided coalition staff with essential information on the medical subspecialty of palliative care. Dr. Morrison also discussed policy changes that are needed to ensure that patients have broader access to palliative care. These needed changes are addressed in the palliative care bills ACS CAN supports.
State & Local Activity The Branson, Missouri Board of Aldermen voted unanimously to adopt a comprehensive smoke-free ordinance. Billed as the “Live Entertainment Capitol of the World,” Branson claims 10,500 residents but many more visitors to its live shows and restaurants each year The ordinance also includes e-cigs and takes effect on July 1, 2015. This is a particularly impactful public health win since Taney County, which includes Branson, has the highest smoking rate in the state at almost 30 percent. Congratulations to all of the advocates who stuck with this campaign. Gov. Eddie Calvo of Guam recently signed into law a bill restricting multi-pack promotional incentives (such as buy-one-get-one-free) for tobacco products. The law is effective immediately. The new restrictions provide an important protection for Guam’s high tobacco tax rates, which the tobacco industry was seeking to thwart with deep discounts. ACS CAN helped to promote the legislation through testimony, petitions, and media advocacy.
Making Strides Against Breast Cancer Advances the Mission ACS CAN offered a 2014 Power or the Purse collectors pin at Making Strides events, an item reflecting both the Power of the Purse that Congress holds as well as the power that Making Strides participants possess. The pin is an ACS CAN $20 membership premium item and helped us recruit 4,207 new members and raise nearly $87,000. Of note, ACS CAN Arizona staff and volunteers recruited and raised 240 members and close to $5,000 at the Phoenix Making Strides event, the most of any event in 2014. ACS CAN also encouraged Making Strides participants nationwide to sign petitions urging lawmakers to “Put the Power of the Purse” behind cancer research funding and prevention to saves lives. Tens of thousands of petitions were delivered to members of Congress in October. Massachusetts staff and volunteers collected nearly 1,200 petitions at the Making Strides of Boston event, the most collected in 2014. |
