February 2016 Advocacy Update

Cancer Research, Prevention & Early Detection

Cancer Research Funding Receives Largest Increase in More than a Decade

The FY16 omnibus appropriations bill passed by Congress in mid-December included a $2 billion (6.6%) increase for medical research at the National Institutes of Health (NIH) and a $264 million increase for cancer research at the National Cancer Institute (NCI). This is the largest boost in annual appropriations for the National Institutes of Health since FY 2003 and brings NCI's total in 2016 to more than $5.2 billion. This is a significant milestone for the NIH and for all cancer research advocates. This win was made possible in large part because ACS CAN targeted efforts to build bipartisan support for the bill.

Most of the cancer programs at the Centers for Disease Control and Prevention (CDC) received level funding, with two programs receiving increases. The National Breast and Cervical Cancer Early Detection Program received a $3 million increase (1.6%) under the bill and the Ovarian Cancer program gained $500,000 (7.1%) in increased funding. It is also worth noting that none of the funding for the CDC cancer programs would come from the Prevention and Public Health Fund in FY16, reversing a practice from the past few years.

On the heels of this victory, in his last State of the Union address, President Obama informed the nation that Vice President Biden would be spearheading a new initiative to eradicate cancer. The President announced last week plans to launch the National Cancer Moonshot by calling for $1 billion in funding for specific cancer prevention and research initiatives intended to accelerate progress in FY16 and FY17. ACS CAN immediately launched an aggressive social media campaign to promote the Cancer Moonshot. By the end of January our Facebook posts and Tweets had reached more than 885,000 people.

State & Local Activity

On January 27, the Massachusetts House overwhelmingly approved a bill that would bar anyone under 18 from using tanning beds. Gov. Charlie Baker signed the bill into law on Feb. 5. This victory was the culmination of a year-long ACS CAN-led legislative campaign to prohibit the use of tanning devices by minors.

Twelve Nations Sign Trans-Pacific Partnership with Momentous Tobacco Control Provisions

On Feb. 4, World Cancer Day, representatives from 12 Pacific Rim nations, including the United States, signed the Trans-Pacific Partnership (TPP), a wide-ranging trade and investment pact that for the first time includes a provision that protects the right of participating nations to adopt public health measures to reduce tobacco use and prevents tobacco companies from using the TPP to launch legal attacks on such measures. Ahead of the signing, ACS CAN sent a letter to Congress urging members of both houses to vote in favor of the TPP when it comes up for vote.

State & Local Activity

Along with our partners, ACS CAN continues to make advances in tobacco control on the state and local level.

• The California cities of Danville, El Monte, Manhattan Beach and Santa Rosa each passed a smoke-free multi-unit housing ordinance. Santa Rosa's regulation includes all parks and city-owned properties, including garages and parking lots, and all outdoor dining and service.
• Likewise, Los Angeles enacted a smoke-free policy for the city's Housing Authority, which oversees roughly 75,000 dwellings. Los Angeles also enacted an ordinance to ban smokeless-tobacco anywhere in stadiums, sports venues and public parks.
• Monterey, California enacted an ordinance to prohibit e-cigarettes wherever smoking is prohibited and to prohibit smoking on the municipal wharf.
• El Cerrito and Manhattan Beach, California each enacted a tobacco retail licensing ordinance. The Manhattan Beach regulation includes a flavor ban, minimum pack size, buffer zones around youth sensitive areas, prohibition of free samples or discounting tobacco products and prohibits any new "significant" retailers.
• On Jan. 6, Saint Paul, Minnesota followed its sister city of Minneapolis by becoming the second municipality in the nation to ban flavored tobacco in all locations with the exception of a handful of tobacco-only retail shops.
• In late December, Red Oaks, Texas passed a comprehensive smoke-free ordinance that became effective in January. On Jan. 19, Duncanville, Texas followed suit with another comprehensive ordinance including bowling alleys and bingo halls. Both measures passed unanimously, a significant show of strength as both communities are located in the Dallas-Fort Worth region, and Fort Worth is a priority smoke-free campaign nationally.
• The Wausau, Wisconsin city council voted on Jan. 12 to include e-cigarettes in its smoke-free law, adding an important conservative voice to the campaign against statewide preemption of e-cig policy.

ACS CAN Weighs in on Draft CDC Opioid Prescribing Guideline

The CDC has developed a draft guideline for the use of opioids to treat chronic pain. ACS CAN was asked to serve on a select panel to review an earlier version of this guideline in October of last year. We submitted comments which expressed concern about the low level of evidence on which the guideline was based and the non-public process used for its development. In response to ACS CAN's comments, CDC issued a revised guideline and opened the process up to broad public input. While the revised guideline exempts cancer patients undergoing treatment, some of the recommendations still cause concern because of the lack of evidence supporting them and the likelihood of their unintentional application to cancer patients.

ACS CAN Works to Improve Patient Access to Community Providers

On Jan. 15, ACS CAN filed comments to the Centers for Medicare and Medicaid Services (CMS) on its Draft Letter to Issuers in the Federally-Facilitated Marketplace (FFM), which provides guidance to health insurance issuers that choose to offer health plans in the federally-facilitated marketplaces. ACS CAN's comments focused on strengthening the health insurance network adequacy requirements, ensuring that patients have better access to essential community health providers, and ensuring that plans do not design their benefits package in a manner that could be considered to be discriminatory.

ACS CAN Represents Consumer in Comments to Formulary Model Act

The National Association of Insurance Commissioners (NAIC) has begun the process for updating its formulary Model Act which would impose requirements on what information health plans must disclose to consumers regarding the lists of drugs that are covered under a health care plan, also known as prescription drug formularies, and how those formularies are designed. The Model Act also strengthens the requirements for how individuals can appeal their plan's formulary in order to obtain medically necessary drugs, and provides information on clinical trial coverage. Anna Howard, ACS CAN Policy Principal serves as a consumer representative to the NAIC and served as the lead consumer representative in drafting comments on the Model Act.

Senate Finance Committee Chronic Care Working Group

Last year, the Senate Finance Committee created a bipartisan working group to explore how to improve the Medicare program for beneficiaries with chronic conditions. As a result of feedback it received from stakeholders,including ACS CAN, in December 2015, the Chronic Care Working Group released a series of policy options for discussion. ACS CAN filed comments supporting the proposed new Medicare payment for physicians who coordinate care for beneficiaries with multiple chronic conditions and urged the working group to consider expanding this payment to cover palliative care services. ACS CAN expressed support for the proposed policy to cover an additional visit for clinicians to use after having diagnosed a beneficiary with a serious or life-threatening illness like Alzheimer's or dementia. We believe this additional visit will allow beneficiaries and their families the opportunity to better understand the progression of their diseases and treatment options and urged the working group to require that providers use this visit to develop a care plan. We were concerned with some of the policy proposals that sought to improve the Medicare Advantage program (from which approximately 30 percent of beneficiaries chose to receive services) without making similar improvements for beneficiaries who are enrolled in the traditional fee-for-service Medicare program.

New Dietary Guidelines Disregard Important Link Between Diet and Cancer

In early January, the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS) released the Dietary Guidelines for Americans, 2015-2020, which will serve as the basis for all federal food and nutrition policies, programs, and educational initiatives for the next five years. While the Dietary Guidelines are required by law to be based on current scientific and medical knowledge, this year's guidelines unfortunately do not acknowledge the totality of evidence available to make recommendations to reduce consumption of foods known to cause cancer. While the guidelines do, for the first time, include the evidence-based recommendation for people to limit their consumption of added sugars to 10 percent of calories, important for reducing obesity and obesity-related cancers, they omit the science-based recommendation for people to eat less red meat and processed meat. This advice has been part of the Society's nutrition and physical activity guidelines for decades and is important for reducing the risk of certain cancers.

The Society and ACS CAN had been working to influence the content of the latest Dietary Guidelines since their development process began more than two years ago. The 2015 Dietary Guidelines Advisory Committee, comprised of independent researchers and experts, for the first time ever reviewed the research linking diet and four of the most common cancer types, and recommended that Americans lower their intake of red meats and processed meats. The Society and ACS CAN applauded this and other recommendations from the Advisory Committee earlier this year, but it was not included in the official 2015-2020 Dietary Guidelines. ACS CAN will continue to advocate that federal programs and policies consistent with the Dietary Guidelines, including the National School Lunch Program and School Breakfast Program, be based on the current scientific evidence regarding diet and obesity-related cancers.