News
December 2012 Monthly Advocacy Update
CANCER CANDOR BLOG HIGHLIGHTS
See Chris' blog for a look at ACS CAN's 2012 highlights and an inspirational guest blog by Dr. Richard Deming, a member of the ACS CAN Board, about his recent experiences hiking in the Himalayas with a group of cancer survivors and care givers.
2013 PREVIEW
ACS CAN began 2013 by completing the process of integrating American Cancer Society Division advocacy into ACS CAN. As of January 1, all Division advocacy staff are legal employees of ACS CAN. This follows the September 1, 2012 transfer of Division advocacy programs to ACS CAN. The alignment of Division advocacy staff and programs will help ACS CAN be more strategic, deploy resources more effectively, and better position us to support volunteers and staff in every Division.
2013 is the first full year in which we will see the benefits of this move -- accelerated progress toward the Society and ACS CAN's lifesaving mission -- and the timing is fortuitous. State legislative sessions are getting underway, a new Congress is convening, and President Obama is starting his second term. As always, ACS CAN has an ambitious agenda that flows directly from the mission priorities set by the Society's National Board of Directors. Attached is the list of federal legislative priorities and click here for a drop down menu of individual each state's priorities.
2013 ACS CAN Legislative Agenda.pdf
The current political environment continues to pose challenges. The battle over federal spending and deficit reduction is as contentious as ever and sustained funding for key cancer programs remains vulnerable. State fiscal conditions are improving, but cuts made over the past several years mean many cancer-related programs and initiatives are severely underfunded. The pace for implementation of the Affordable Care Act at the federal and state levels will pick up as the law moves closer to taking full effect in January 2014. Tobacco industry efforts to weaken and undermine measures that protect public health show no signs of abating.
No doubt we have our work cut out for us, but ACS CAN is a nationally respected nonpartisan organization with a history of working with lawmakers from both political parties. I have great confidence we can succeed. Because every lawmaker has been affected in some way by the disease, every lawmaker is also a potential cancer policy champion. ACS CAN's policy and legislative solutions are rooted in science and enjoy broad public support. And of course ACS CAN's passionate volunteers and staff will go to great lengths to make cancer a national priority. Much hard work is ahead, but ultimately we expect to prevail.
There is much work to be done at the state and federal level leading up to the January 1, 2014 Affordable Care Act implementation deadline. ACS CAN has been the voice of people with cancer throughout the debate and will continue to work to ensure critical patient protections and initiatives to prevent disease in the law are preserved. The law is by no means perfect, but it is an important means of helping to advance the Society and ACS CAN's lifesaving missions. In the coming year, ACS CAN will continue to call upon elected officials to work together in a bipartisan effort to implement the health care law as intelligently as possible for patients and their families. For further information, see the Department of Health and Human Services' (HHS) Frequently Asked Questions document which clarifies questions about the law's exchanges, market reforms, and Medicaid provisions.
ACS CAN Comments on Proposed Regulations
ACS CAN submitted comment letters last month to the federal government on the proposed regulations for essential health benefits and the state insurance market reforms. The biggest concern in the essential health benefits regulation is ensuring cancer patients access to all medically appropriate prescription drugs. The information provided by the HHS so far suggests that most benchmark plans have good coverage, but we and many other patient groups are very concerned that some patients in critical need of certain drugs may not have complete access. There are a number of other important concerns that are raised in our comment letter, as well. Read the essential benefits letter.
The insurance market reform proposal is equally important because it lays out the specifics of how some of our highest priorities for reform, such as guaranteed issue and no pre-existing condition restrictions, will actually be implemented in the states. Our biggest focus was directed at how the premium surcharge for tobacco users will be implemented. The ACA states insurers may assess a surcharge of up to 50 percent on tobacco users, but HHS solicited comments on specific operational questions such as who should be defined as a "tobacco user" and how that status should be determined. ACS CAN drafted template language for other consumer groups to use in responding to these questions. Read the insurance market reform comments.
Network Adequacy for Health Insurance Plans
Health plans are increasingly relying on provider networks as a marketing tool for improving market share and controlling costs. Insurers are raising the rate of cost-sharing when participants go out-of-network for care, sometimes as high as 50 percent. Moreover, the networks sometimes change frequently as providers are added or dropped. The Affordable Care Act requires health plans in the exchanges to have "adequate networks," but the final regulations issued by HHS largely leave it to the exchanges and the states to determine what is adequate, in large part because needs and resources vary considerably among the states. The issue is potentially very important to cancer patients who may have to go out of network to get the best treatment. Unfortunately, consumers who go out of network currently have few protections or rights. Thus, ACS CAN will advocate for strong networks and consumer protections as states and exchanges begin to grapple with developing standards for plans. Georgetown University prepared the attached issue brief for ACS CAN to assist our staff and volunteers in gaining a better understanding of the issues that we will want to address as states begin to develop standards for network adequacy.
Network Adequacy FINAL Jan. 13.docx
Increasing Access to Medicaid
Under the Affordable Care Act, people who earn up to 133 percent of the federal poverty level will be newly eligible for health coverage through state Medicaid programs, with the federal government picking up 100 percent of the cost through 2016 and reducing it incrementally to 90 percent in 2020 and years thereafter. State participation is voluntary due to last year's Supreme Court ruling on the ACA. States that increase access to Medicaid coverage but fall short of covering people at 133 percent of the federal poverty level will not be eligible for the new federal money according to HHS.
ACS CAN believes that health outcomes regarding cancer are hugely dependent upon health coverage and access to care. For this reason, ACS CAN is urging state leaders to "opt in The federal funds have already been authorized for states to use to increase access to lifesaving cancer prevention and early detection measures, treatment, and follow up care through Medicaid so it makes good health and economic sense to provide more people with health coverage through the Medicaid program.
ACS CAN's work is starting to pay off, with 19 states and the District of Columbia indicating they will opt to increase access to Medicaid coverage. Among those states is New Mexico, where a highly focused effort led to the inclusion of the new federal funds in the governor's recently unveiled budget. Tens of thousands of residents in New Mexico will be able to obtain coverage through Medicaid as a result. The New Mexico campaign included grassroots action, media advocacy, and direct lobbying, and it sets a great precedent.
Exchanges
The White House announced earlier this week that it would waive or extend the deadline for any state that expresses an interest in creating a state based health insurance exchange. HHS had initially stated that it would determine whether states were prepared to operate their own exchange by January 1 of this year. If a state cannot meet the statutory and regulatory requirements for an exchange, HHS will oversee a federally facilitated exchange in that state. To date, HHS has given preliminary approval to 19 states and the District of Columbia to operate health insurance exchanges. Seventeen of these states and D.C. are set to run their own exchange. The remaining two will engage in a partnership exchange with the federal government. At this time, however, it is unclear how and when HHS will determine whether a state has the capacity to properly establish and operate its own exchange. ACS CAN will continue to work with HHS and other consumer groups to understand how operational decisions will be made for each state.
Medicaid, CHIP and State Based Health Exchange Coordination
Millions of Americans stand to gain access to affordable health coverage through health insurance exchanges and improvements in Medicaid and the Children's Health Insurance Program (CHIP) under the Affordable Care Act. To provide a seamless experience for the consumer, these programs should have consistent standards and systems to meet consumers' health care needs, improve quality, and lower costs. This week HHS released a proposed rule that would lay out a structure and options for coordinating Medicaid, CHIP, and exchange eligibility notices and appeals; provide additional benefits and cost-sharing flexibility for state Medicaid programs; and codify several provisions included in the health law and the law reauthorizing CHIP. ACS CAN is reviewing the proposal to determine if there are areas where we should comment from the cancer perspective.
Essential Health Benefits - Benchmark Plans
A new Kaiser Family Foundation analysis shows that 25 states and the District of Columbia have identified health plans to act as the benchmark for defining the essential health benefits (EHB). The remaining 25 states will default to the largest small-group plan in their states. The next step is for the federal government to review each benchmark plan to ensure it meets criteria specified in federal regulations governing the EHB.
As you know, ACS CAN submitted comments last month on proposed EHB regulations. The biggest concern is ensuring cancer patients access to all medically appropriate prescription drugs. The information provided by HHS so far suggests that most benchmark plans have good coverage, but ACS CAN and many other patient groups are concerned that some patients may not be able to access needed drugs.
ACS CAN strongly supports the EHB because of its potential to give patients the security of knowing that their health plan will cover proven methods to prevent and treat cancer . Ongoing efforts around the country are aimed at ensuring that the needs of cancer patients, survivors and their families are met. Activities include submitting written and/or oral testimony in multiple states. ACS CAN, on behalf of several groups representing patients, also spearheaded the collection of data on 31 different health benefits that are vital to individuals with cancer and other life-threatening chronic diseases. This major undertaking is helping to identify major coverage gaps in selected benchmarks plans so we can work at the state level to eliminate or lessen them before they become problematic for individuals fighting serious illnesses.
Rebates and Savings
The Commonwealth Fund reports that consumers saw nearly $1.5 billion in health insurer rebates and overhead cost savings in 2011 due to the ACA's medical loss ratio (MLR) provision. The MLR is a calculation health insurance companies must use to demonstrate what proportion of premiums they spend on providing health care to patients, as opposed to salaries and other administrative expenses. Insurers that fall short of the target are required to rebate the difference to policy holders.
The study examined how insurers in the individual, small-employer, and large-employer group markets in every state responded to the MLR rule between 2010, the year before it took effect, and 2011. The results showed that insurers reduced administrative costs in every market, with the majority of savings going toward the large-group market. In the individual market, savings were passed on to consumers. But the large- and small-group markets offset their decreased costs with increased profits. The study's authors conclude that stronger measures may be needed to ensure that all consumers benefit from reduced overhead costs in the group insurance markets.
The MLR provision is one of the most important consumer protections in the health law. The rebates benefit consumers whose plans provide too little value. In addition, the MLR rule puts pressure on insurers to manage costs more efficiently. Insurance premiums are rising at considerably lower rates and the MLR and rate review provisions in the Affordable Care Act are undoubtedly important contributing factors.
Coverage for Young Adults
The Affordable Care Act provision allowing children up to age 26 to remain on their parents' health insurance has helped more than 3 million young adults gain health coverage according to a study published in the January edition of Health Affairs. Coverage gains were felt across all racial and ethnic groups as well as marital and employment status. The report also attributes broader coverage to a significant decline in the number of young adults who postponed health care or declined to seek it because of the cost.
Proposed Regulation on Employer Responsibility
The Treasury Department issued a proposed regulation for the employer responsibility provisions of the Affordable Care Act (i.e., the employer mandate). Under the law, employers with more than 50 full-time workers must contribute to the cost of "affordable" health insurance and cover at least 95 percent of their workers or be subject to penalties. The proposed regulation lays out the ways in which employees will be counted, how affordability is determined, how employer penalties (if any) will be assessed, and transitional relief for certain businesses. The employer responsibility provisions take effect in January 2014.
New Provisions Take Effect
Provisions of the Affordable Care Act that took effect January 1 include two aimed at expanding access to preventive care. Specifically, the federal government will provide new funding for states that cover preventive services in Medicaid at little or no cost to patients and will increase payments to primary care physicians who treat Medicaid patients. A provision calling for a pilot program encouraging hospitals, doctors, and other providers to better coordinate and improve patient care also took effect January 1. The pilot calls for bundling service fees together and paying all providers involved in a patient's care a flat rate as opposed to the fragmented claims and billing systems typically used now.
Physician Workforce
The Institute of Medicine (IOM) convened a committee to examine the governance and financing of Graduate Medical Education (GME). As part of the committee's meeting, ACS CAN participated on a panel to provide its perspective on the changing need for physicians in cancer care. ACS CAN's comments focused on three main points: the importance of coordinated, team-based care; palliative care as a model of care that the IOM committee should explore; and the need for enhancements in residency education and training. ACS CAN emphasized that one path to achieving a strong healthcare workforce is to provide physician training in the skills required for team-based, coordinated care. ACS CAN also requested that the committee examine the need for new GME slots in primary care and new sub-specialties such as palliative care. In addition, ACS CAN stressed the need for greater physician diversity and training in skills necessary for a reformed health care delivery system. ACS CAN's statement is attached.
IOM GME Statement-Narrative Dec 12.docx
CANCER RESEARCH, PREVENTION, & EARLY DETECTION PROGRAMS
The National Cancer Institute released its proposed budget for the 2013 fiscal year (FY 2013). The budget reflects the agency's best professional judgment of the resources it needs to fight cancer to the fullest extent. Although not adopted in practice, the content is still quite relevant and extremely useful for highlighting advances being made in a variety of areas as well as work being done on the Cancer Genome Atlas.
BREAST & CERVICAL CANCER EARLY DETECTION PROGRAM
A report jointly commissioned by the American Cancer Society, ACS CAN and the Centers for Disease Control and Prevention (CDC) on the National Breast and Cervical Cancer Early Detection Program (BCCEDP) program was recently published concluding that the NBCCEDP and other government sponsored cancer screening programs will remain essential even after the Affordable Care Act is fully implemented in 2014. Although more people will have health insurance thanks to the law, not everyone will be covered. Millions of Americans will still be eligible for these programs and can benefit from them. In addition, the programs' infrastructure and community presence can provide education, outreach and navigation services to both the uninsured and newly covered individuals. ACS CAN is working aggressively at the federal and state levels to ensure these screening programs continue to provide lifesaving care in the future. See ACS CAN fact sheets on state breast and cervical programs. by-state fact sheets on
See the Cancer CANDor post celebrating smoke-free law anniversaries.
TOBACCO CONTROL
State Program Funding
A report released by ACS CAN, the Campaign for Tobacco Free Kids, the American Lung Association, the American Heart Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers' Rights shows how severely inadequate tobacco prevention and cessation funding is. The groups found that while states will collect a record $25.7 billion in revenue in 2012 from the 1998 tobacco settlement and tobacco taxes, they will spend just 1.8 percent of it on tobacco prevention and cessation programs. Total state funding for tobacco prevention this year amounts to just 12.4 percent of the $3.7 billion recommended by the CDC for all states combined. States have also failed to reverse deep budget cuts that reduced funding for tobacco prevention by 36 percent from the 2008 to 2012 fiscal years.
Rhode Island Victory
A federal judge in Rhode Island upheld two local tobacco ordinances in Providence that go beyond the Family Smoking Prevention and Tobacco Control Act regulating the sale, marketing and manufacture of tobacco products. The ruling allows the city to go forward with a law barring retailers from redeeming coupons for tobacco products as well as a law prohibiting the sale of flavored (except menthol) and candy-like smokeless products. The latter measure goes beyond federal law which only prohibits the sale of flavored cigarettes. ACS CAN and other public health groups filed friend of the court briefs in support of the ordinances and will remain engaged in the fight as the tobacco industry is all but certain to appeal the ruling.
Youth Smoking Down
The number of teens who smoke cigarettes is at a record low according to an annual government survey of middle and high school students. The drop is in good part the result of a combination of tobacco control policies ACS CAN has fought hard to put in place and implement, namely higher cigarette taxes, smoke-free workplace laws, funding for tobacco prevention and cessation programs, and federal regulation of the manufacture, sale, and marketing of tobacco products.
The news is encouraging and further shows the effectiveness of these strategies, but there is still a lot of work to do. Not only do 17 percent of high school students graduate as smokers, use of other tobacco products, such as small cigars, hookahs, and smokeless tobacco, among youth is on the rise. In the coming year, ACS CAN will continue to lead aggressive campaigns at every level of government to put policies in place that will help to reverse these disturbing trends and block the tobacco industry from undermining public health.
ORAL DRUG PARITY
Massachusetts is the latest state to enact legislation that requires insurers to provide the same level of coverage for oral chemotherapy drugs as their intravenous equivalents. Congratulations to volunteers and staff in the New England Division for their many years of hard work to enact the law, which will improve patients' access to lifesaving and life-enhancing treatments. The law was signed in late 2012 and takes effect on May 1.
TANNING
Society Deputy Chief Medical Officer Dr. Len Lichtenfeld and ACS CAN President Chris Hansen sent a letter to HHS Secretary Kathleen Sebelius calling on HHS to expedite its review of the current tanning bed classification. Tanning beds greatly increases risk of skin cancer, the nation's most common cancer, yet the federal government has them in the same medical device class as tongue depressors and bandages. Reclassifying how tanning beds are regulated is a crucial step in protecting Americans from the dangers of these deadly devices. Read coverage of the letter in The Hill. Meanwhile, tanning salons nationwide recently formed a coalition to stave off further federal regulation as well as to fight legislation ACS CAN actively supports at the state and local level that limits tanning bed usage to adults. See the Bloomberg Businessweek story.
Chris Hansen | President
ACS Cancer Action Network | American Cancer Society Cancer Action Network, Inc.