News
October 2012 Monthly Advocacy Update
CANCER VOTES
Presidential Voter Guide
President Obama and Governor Romney responded to ACS CAN's presidential questionnaire. Read the voter guide. Chris Hansen recently promoted the guides and other Cancer Votes activities in a series of local radio and television interviews aired across the country. Read the ACS CAN press release.
Presidential Debates
Cancer Votes volunteers in Colorado, New York, and Florida were on the ground and in the crowd outside the sites of all three the presidential debates to call on the presidential candidates to lead that fight against cancer. Media coverage included Colorado State Lead Ambassador Martha Cox appeared on MSNBC's Hardball and asked a question about cancer on live TV while wearing her Cancer Votes shirt and holding a Cancer Votes sign.
Debates and Forums
Over the past month Cancer Votes has cosponsored candidate debates and forums for US House and Senate candidates in Delaware, Maine, North Dakota, and New Mexico. During the Maine debate, the moderator asked every question from the Cancer Votes palm card and added several more on tobacco control. Also of note, ABC News' Sam Donaldson moderated several congressional debates in New Mexico and joined our volunteers and supporters at the tail end of their debate watch party and the ACS CAN fundraising dinner that followed. Cancer Votes has also partnered with New Mexico PBS to cosponsor the network affiliate's national election coverage.
Volunteers are also taking advantage of debates sponsored by other organizations to talk to candidates about cancer-related issues:
- In California, 23 year old brain cancer survivor Cassie Nguyen told candidates for the state's 41st congressional district about the federally funded research that made her treatment possible.
- Massachusetts volunteers talked to supporters of both candidates for the state's US Senate seat as crowds gathered before candidate debates in Lowell and Springfield.
- Cancer Votes was out in force in Ohio outside of the hall where the US Senate candidates were debating. Volunteers passed out more than 300 palm cards, stickers and presidential voter guides and three volunteers attended the debate itself.
- Mary Bryner, a Cancer Votes volunteer in Pennsylvania, spoke with candidates for the 12th congressional district while attending one of their debates.
Van Tours
Cancer Votes vans modeled after the Fight Back Express bus toured Massachusetts, New Mexico, New Jersey, and New York this month. Thousands of signatures have been collected as the vans travel to campaign and community events. The stops have generated media interest and provided opportunities to talk to candidates.
Florida
Volunteers in Florida made sure voters understood why cancer issues must be part of the political discussion during a statewide Cancer Votes Day on October 12. They organized events, talked to the media, and reached out to the public in Daytona Beach, Gainesville, Key West, Miami, Tallahassee, and Tampa.
Texas
Cancer Votes held "Eat and Greet" events throughout Texas' 23rd Congressional district to educate candidates and voters about ACS CAN's legislative priorities. Democratic challenger Pete Gallego attended several of the events, including one in Del Rio where he was joined by the incumbent, Republican Representative Quico Canseco. Candidates took questions after talking about their personal connection to the disease. In addition, Green Party challenger Ed Scharf spoke with volunteers at the Eat and Greet held in San Antonio.
The outcome of the election will also have a big impact on the future of many key provisions of the Affordable Care Act that impact cancer patients. Regardless of who wins the election, ACS CAN will work to retain these and other protections, and to sustain the emphasis on disease prevention. Read the Kaiser Health News story: "How the Health Law Might Be Changed by the Next President."
Essential Health Benefits
As of October 22, 26 states have submitted a benchmark essential health benefits (EHB) plan to the Department of Health and Human Services (HHS). Several other states have had work groups make recommendations to the governor or the state department of insurance, but nothing formal has been submitted to HHS. Read the Kaiser Health News story.
After the election, HHS is expected to release multiple proposed regulations, including those for EHB and cost sharing. It is unclear at this time how much discretion states or insurers will have to make changes to the benchmark plan, such as how and under what circumstance a state or plan could change the benefits within or among the 10 required EHB categories. HHS has suggested that some flexibility will be permitted, but we have to await the regulations to know the process and the degree to which changes can be made. In the meantime, ACS CAN has reviewed benchmark plan options in more than a dozen states to identify benefit gaps and other hurdles that could impede cancer care.
Medicaid Expansion
ACS CAN efforts to educate state policy makers on the benefits of enrolling low income, working adults up to 133 percent the federal poverty level in Medicaid are ongoing. Despite the declaration of several governors that their states intend to opt out of expansion, ACS CAN anticipates a significant number of state legislatures will debate, discuss and vote on the issue in 2013. To prepare, education, outreach and coalition work is underway and ACS CAN has submitted written and oral comments to legislative committees, signed on to coalition letters, and engaged national and state stakeholders to campaign actively for expansion. In addition, ACS CAN is actively studying specific proposals and monitoring activity such as waiver requests, state plan amendments and legal challenges.
Exchanges
In a little over two weeks, on November 16, states must notify HHS of their intent to establish a state health insurance exchange, be it state-run or a state-federal partnership. States that decline to establish an exchange or fail to receive federal certification will default to a federally facilitated exchange in 2014.
To date, 13 states have chosen to operate their own exchange. PricewaterhouseCoopers (PwC) predicted in a recent report that a majority of the remaining states will have the federal government directly involved in running their exchanges. Eight states already have chosen to have the federal government facilitate their exchange, and three have decided to go with a state/federal "partnership" exchange. PwC also said that 88 percent the 12 million Americans expected to enroll in the new exchanges next year will be in relatively good health. At the same time, however, they are also less likely to be familiar with the health system. More extensive outreach, information, and customer assistance will be required to support the newly insurance population.
A Kaiser Family Foundation report examines the effect of government efforts focused on guaranteeing that insurance premium increases are justified and provide value to consumers and small businesses. Rate review programs require insurers in small group and individual markets to submit planned rate increase requests to state or federal regulators, who determine if the requests are reasonable. The report finds that one out of every five requests submitted in 2011 resulted in a lower rate increase or no increase at all. On average, approved rate increases were 1.4 percent lower than insurers first requested -- a reduction of about one-fifth.
The Affordable Care Act requires all insurers submitting rate increases of 10 percent or more to be subject to rate reviews. The federal government conducts reviews if a state does not have an effective rate review program, but it cannot prevent insurers from implementing "unreasonable" rates. ACS CAN believes the rate review provision helps ensure that consumers receive value for their premium dollars and that significant premium increases in all states are justified and transparent. Evidence suggests that insurers have made fewer requests to raise rates by 10 percent or more after the rate review provisions went into effect.
Pre-Existing Conditions
Enrollment in pre-existing condition plans (PCIPs) reportedly climbed to 82,000 as of July 31. Enrollment is still below original expectations, but it has grown steadily. PCIPs were created in 2010 under the Affordable Care Act to be a "bridge" to the sweeping insurance reforms in 2014, when insurers will no longer be able to deny coverage or charge someone more because of a pre-existing condition. Twenty-seven states are administering PCIPs for their citizens. The remaining states and the District of Columbia have federally administered PCIPs.
ACS CAN believes the PCIP program is a vast improvement over state options that pre-dated the Affordable Care Act, which were often unaffordable and inadequate to meet the needs of cancer patients The program is saving thousands of lives by providing a coverage option to people who were previously without options and hope because insurers could refuse to cover them simply because of their pre-existing condition.
Medicare
HHS announced that more than 20.7 million Medicare beneficiaries received at least one preventive service at no cost to them so far this year as provided for in the Affordable Care Act. The figure includes 2.13 million who took advantage of the law's annual wellness visit. HHS also reports that the 5.6 million seniors saved $4.8 billion as result of the law's provision to close the Medicare prescription drug coverage gap, better known as the "donut" hole.
Employer-Sponsored Insurance
A report released by the Urban Institute shows that if all provisions of the Affordable Care Act were implemented this year, the number of Americans covered by employer-sponsored insurance would increase by 2.7 percent and costs-per-person for small businesses (fewer than 50 workers) would decrease by 7.3 percent. For small businesses with less than 100 employees, total health insurance spending would be reduced by 1.4 percent, a reduction that stems from various provisions in the law that help small businesses, including tax credits, premium rating reforms, and administrative simplification. (The impact of the essential health benefits package on cost could not be estimated because too little information is available at this time.)
CANCER RESEARCH, PREVENTION, AND EARLY DETECTION
Lawmakers are set return to Washington after the election for a lame duck session to address the "fiscal cliff" -- the looming expiration of tax cuts and deep across-the-board spending cuts, known as sequestration. Lawmakers may act, or they may leave the heavy lifting to the next Congress. Either way, if nothing changes, priority cancer programs could be cut by nearly eight percent.
Sequestration was set in motion under the Budget Control Act of 2011 are scheduled to be implemented beginning on January 2, 2013. They would include a $2.5 billion cut in medical research at the National Institutes of Health (NIH), including more than $450 million in cancer research. By some estimates, the NIH cut could lead to 2,300 fewer research grants funded next year, 33,000 fewer jobs nationwide, and a $4.5 billion decrease in economic activity.
In addition, the Centers for Disease Control and Prevention would be cut $464 million. It is unclear how the cut would be applied to the centers, divisions, and programs, but if applied proportionately more than 50,000 fewer women would have access to breast and cervical cancer screenings.
ACS CAN is making a show of force on Capitol Hill the week after the election with our partners in the One Voice Against Cancer coalition (OVAC) and at Research!America. The primary purpose of this lobby day is to ensure that OVAC is able to meet with Congressional leadership and member offices involved in the budget negotiations. OVAC also sent a letter to leaders in Congress urging them to work together to avoid budget cuts, whether through sequestration or any other process, that would harm efforts to improve how we prevent, detect, and treat cancer.
ACS CAN's Minnesota State Lead Ambassador, Robianne Schultz, was the closing speaker on a conference call hosted by Dr. Jill Biden and HHS Secretary Kathleen Sebelius in honor of Breast Cancer Awareness Month. Discussion centered on the importance of early detection and Affordable Care Act patient protections for breast cancer patients and survivors.
TOBACCO TAXES
ACS CAN is hopeful of a victory on election night in a ballot initiative to raise Missouri's 17-cent cigarette tax --- the nation's lowest -- to 90 cents per pack. ACS CAN has been leading a broad coalition of health groups, educators, and business and community leaders, in support of the measure. Its passage would save thousands of lives. The new revenue would go toward public education, tobacco prevention programs, and quitline services.
October 2 was an historic day for ACS CAN in Alaska as they work to ensure everyone in the state enjoys their right to breathe clean air with passage of Proposition 3 in the city of Palmer with 61.5 percent of the vote. When the law takes effect on January 2, 2013, smoking will be prohibited in places of employment and public venues, and, for the first time in Alaska, hookahs and electronic cigarettes.
DEPARTMENT OF JUSTICE TOBACCO SUIT
US District Court Judge Gladys Kessler heard oral arguments from public health intervenors in the Department of Justice (DOJ) case against the tobacco industry regarding corrective statements that tobacco companies must make to explain their decades of dishonesty. The corrective statements stem from Judge Kessler's historic 2006 decision, which found the major cigarette manufacturers guilty of violating civil provisions of the Racketeer Influenced and Corrupt Organizations Act (RICO). The US Court of Appeals for the DC Circuit recently reiterated the importance of the statements because the tobacco industry is likely to commit similar offenses in the future. Read the ACS CAN press release.
The hearing enabled the public health community to emphasize the importance of strong corrective statements that reflect the industry's repeated efforts to deceive the public about the dangers of its products. The tobacco industry argued that the corrective statements should simply mirror the textual warnings, which say nothing about past wrongdoing, required under the Family Smoking Prevention and Tobacco Control Act, the 2009 law giving the Food and Drug Administration authority over tobacco products.
The American Cancer Society and five other public health groups - Americans for Nonsmokers' Rights,
American Heart Association, American Lung Association, the Campaign for Tobacco-Free Kids Action Fund and National African American Tobacco Prevention Network - are intervenors in the federal case, which DOJ filed in 1999 to hold Big Tobacco accountable for more than 50 years of fraudulent and deceptive marketing practices.
TOBACCO ATLAS
The American Cancer Society and World Lung Foundation (WLF) released a video about the global tobacco burden and tactics the tobacco industry employs to addict new users. The production highlights data from the Tobacco Atlas published by the Society and WLF. The video and a new mobile application were unveiled during a global tobacco panel discussion held at the National Press Club on October 15. Society, WLF, and the World Bank hosted the event with support from ACS CAN.
Chris Hansen | President
ACS Cancer Action Network | American Cancer Society Cancer Action Network, Inc.