News
January 2012 Monthly Advocacy Update
CANCER RESEARCH AND PREVENTION PROGRAMS
The President's Budget
On February 13, President Obama released his budget for the 2013 fiscal year. ACS CAN was deeply disappointed to learn that the budget cuts funding for cancer research at the National Cancer Institute, especially as the President had singled out the importance of the issue during his State of the Union address last month. The cuts also contradict the president's previous commitment to increase cancer research and come just months after Congress showed bipartisan support by including an increase in the current 2012 fiscal year research budget.
Congress needs to reinstate funding for cancer research and prevention programs and truly make cancer a national priority in a way that we can capitalize on past advances. ACS CAN advocates will strongly urge them to do so throughout the year. Watch ACS CAN Vice President Dick Woodruff's comments on the impact of the budget proposal and read the ACS CAN press release.
Cancer Center Event
ACS CAN brought cancer community leaders together at the Fred Hutchinson Cancer Research Center in Seattle on February 23 to encourage lawmakers to urge Washington State's congressional delegation to commit to sustained or increased federal funding for cancer research. The event was the fourth in a series of cancer center visits ACS CAN and Society Divisions are organizing in partnership with local research facilities to highlight the benefits of federal investments in cancer research. Similar briefings were held last year in Birmingham, Houston, and San Diego and more events are planned for this year.
US Representative Jim McDermott (D-WA), a strong supporter of federal research funding was on hand and delivered eloquent remarks on the importance of federal funding. Dr. Lawrence Corey, MD, president and director of the Hutchinson Center highlighted specific breakthroughs federal funding made possible. Chuck DeGooyer, CEO of the Great West Division, spoke about the Society's role in supporting research while Chris Hansen gave an update on the status of cancer funding in Washington, DC.
Central to the program were remarks from Oliver W. Press, MD, PhD., a member of the Hutchinson Center's Clinical Research Division, who discussed his current research. Lisa Verner, a cancer survivor and patient of Dr. Press, was the final speaker. Her story provided tangible proof of the benefits of cancer research. Following the program, a tour was given to congressional staff of the Hutchinson Center's research facilities. Read Chris Hansen's blog post and the ACS CAN press release.
ACS CAN has grave concerns about a proposal in the president's budget to plug funding holes for proven cancer prevention and early detection programs, such as the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), at the Centers for Disease Control and Prevention using funds from the Prevention and Public Health Fund. The Prevention Fund is meant to refocus the nation's health care on early detection and disease prevention through innovative and integrated methods at the federal, state and local levels. Using these monies to shore up existing programs undercuts the Fund's goals and will lead to potential cuts of more than one-fifth of its overall budget by 2021. Although NBCCEDP is woefully underfunded, money for this critical program should not come from the Prevention Fund.
ACS CAN has endorsed critical legislation introduced recently in the US House of Representatives that would ensure that cost is not a barrier for Medicare beneficiaries in obtaining lifesaving colon cancer screenings. Read the ACS CAN press release.
The "Removing Barriers to Colorectal Cancer Screening Act of 2012" (H.R. 4120), sponsored by U.S. Representative Charlie Dent (R-PA), would eliminate cost sharing for Medicare beneficiaries receiving a colonoscopy, even if a polyp is removed. Colonoscopies have been shown to prevent colon cancer and under current Medicare policy, routine colonoscopies are considered a free preventive service; however, cost sharing is required if a polyp is removed during the routine colonoscopy. This cost may serve as a barrier for some people, since a patient won't find out whether a precancerous polyp or other abnormality was removed until after the procedure is complete.
In Congress
On March 2, the Senate voted on an amendment introduced by Senator Roy Blunt (R-MO) that would allow any health insurance plan or employer, with a religious affiliation or not, to exclude any service required by the Affordable Care Act if they object based on undefined "religious beliefs or moral convictions." The implications of this provision could result in coverage denials of life-saving preventive services such as mammograms or tobacco cessation based on employer discretion. For example, a tobacco manufacturer could refuse coverage of tobacco cessation benefits for its employees. The amendment failed 51-48. Read the ACS CAN press release and letter to Senators expressing ACS CAN's opposition to the amendment.
Essential Health Benefits Conference
On Tuesday, February 28, ACS CAN brought together some of the nation's leading health care experts at its first ever National Forum on the Future of Health Care to examine the essential health benefits provision in the Affordable Care Act, which requires all health plans to offer patients a minimum standard of benefits beginning in 2014.
ACS CAN believes the essential benefits provision is one of the most critical insurance reforms in the Affordable Care Act, with the potential to give patients the security of knowing that their health plan will cover proven methods to prevent and treat cancer as well as to provide necessary follow-up care. ACS CAN strongly supported its inclusion in the law to ensure that cancer patients and survivors have adequate insurance coverage to assure access to lifesaving care.
The conference provided valuable insights on how ACS CAN and the public may ensure the success of the essential health benefits package for patients nationwide.
Numerous issues were examined at the forum, including:
- What health care services will be included?
- How will essential benefits improve care while containing costs?
- What role do the states have in defining essential benefits for their citizens?
- How can all patients nationwide be assured of access to basic care and innovations that are helping to save lives?
Secretary of Health and Human Services (HHS) Kathleen Sebelius was the keynote speaker at the day-long conference. Massachusetts Governor Deval Patrick spoke from his vantage point as the leader of a state that enacted its own health reform law in 2006. Governor Patrick later wrote about his views as a guest blogger on Chris Hansen's Cancer CANdor blog. Former Utah Governor Mike Leavitt, who served as HHS Secretary under President George W. Bush, was the luncheon speaker.
In addition to the featured speakers, top officials from federal and state government, the health care industry, non-profit organizations, academia, and the media were on hand for panel discussions on the provision's wide ranging impact. For more information about the conference, including media coverage of the event and the agenda that lists all of the speakers, panelists, and panel topics, please visit fightcancer.org.
Summary of Benefits and Coverage
The administration published the final regulation for the Summary of Benefits and Coverage (SBC), which will put cancer patients, survivors and their families in a far better position to make important decisions about their health coverage. Under the Affordable Care Act, insurers are required to provide consumers a brief, straightforward summary of benefits, including real-world examples. ACS CAN views the provision as a fundamental component of the fourth "A" - administrative simplicity -- in the Society and ACS CAN's four "A's" of meaningful health coverage. Read the ACS CAN statement.
The final rule is a very good step forward for consumers. Beginning September 23, 2012, all plans-individual and group markets and self-insured plans-will be required to provide a standardized document to all plan participants and applicants for coverage. For the first time, consumers will be able to obtain basic information about health plans in concise, comprehensible language. In addition, there will be two examples that allow for direct comparisons between plans. The initial examples are for maternity and diabetes care, but more examples are expected to be included over the next few years, including one for breast cancer.
The final rule is a great victory given grave concerns just before it was published that it might be weakened considerably. ACS CAN and other consumer groups fought hard for a strong rule, sending a letter to the White House signed by the chief executive officers of ACS CAN, the American Heart Association, the American Diabetes Association, Consumers Union, and AARP. We have been told that the letter had a big impact and contributed to consumer-oriented improvements in the final regulation. ACS CAN also issued a grassroots alert that resulted in hundreds of messages being sent to the White House that made our position clear.
Prevention Fund
On February 16, Congressional negotiators announced a deal that would raid the federal Prevention and Public Health Fund to help pay for the payroll tax and to maintain Medicare physician payment at their current rates. ACS CAN sees this as a deeply regrettable funding approach that will undermine the nationwide effort to prevent death and suffering from cancer and other life-threatening diseases. (see earlier paragraph) Read the ACS CAN press release.
Last year, the Fund allocated $1 billion to communities in every state, and over the course of its first 10 years (fiscal years 2010-2019), it is supposed fund a total of $15 billion in proven effective prevention and public health approaches to keep Americans healthier. By steering funds away from prevention efforts focused on keeping people well, Congress is pulling back from its commitment to the common-sense goal of saving lives and money by preventing deadly and costly chronic disease. . ACS CAN is deeply disappointed in these developments and will work to persuade our national leaders that sacrificing disease prevention in the name of budget austerity makes no economic sense and diminishes our ability to improve public health.
In the States
HHS announced a new round of grants to help states establish insurance exchanges. A total of $229 will be allocated to 10 states - Arkansas, Colorado, Kentucky, Massachusetts, Minnesota, Nevada, New Jersey, New York, Pennsylvania, and Tennessee. In its announcement, HHS noted that the latest round of grants brings the number of states making significant progress in creating exchanges to 33.
HHS also announced a final rule for state innovation waivers this week. Under the Affordable Care Act, states can request waivers from the law's requirements if certain conditions are met. The regulation lays out the procedures states must follow to request waivers. Although the rule is final, states must wait until 2017 before they can apply, unless Congress amends the law.
Pre-Existing Condition Insurance Plan Covers Nearly 50,000
HHS released a report recently showing that Pre-Existing Condition Insurance Plans (PCIP) are providing health coverage to nearly 50,000 people with high-risk pre-existing conditions nationwide. The PCIP was created under the Affordable Care Act to provide access to quality, affordable health care to people in every state with pre-existing conditions such as cancer who have gone uninsured for six months or more. The program is temporary and unable to serve all in need, but it does serve as an important first step to unlocking the health care system for people with pre-existing conditions. In 27 states, a state or nonprofit entity elected to administer PCIP, while HHS operates the program in the remaining 23 states and the District of Columbia.
ACS CAN strongly supports the program so that uninsured people with a history of cancer have an option to get the care they need. Recently ACS CAN hosted a webinar for staff nationwide on PCIP. HHS officials led the session, explaining how the program works and what organizations like the Society and ACS CAN can do to ensure that eligible patients are aware of this option. Read the ACS CAN blog post for more on PCIP.
Litigation Update
The Supreme Court added an additional 30 minutes for oral arguments to the cases surrounding the Affordable Care Act. The additional time will be dedicated to issues surrounding the Anti-Injunction Act, which bars lawsuits from being brought before a tax is levied. Six hours of the Court's time is now dedicated to oral arguments on the case, which is unprecedented for the Court in the modern era. Arguments are scheduled for March 26-28, with a decision expected prior to the Court's adjournment for the summer.
As you know, the central issue is whether Congress exceeded its constitutional authority by requiring most Americans to purchase health insurance coverage - the so-called "individual mandate." The requirement is what makes key provisions that ACS CAN fought to include in the law sustainable, such as:
- Denying coverage to anyone with a pre-existing condition;
- Terminating coverage when a patient's care exceeds arbitrary dollar limits; or
- Raising premiums to unaffordable levels in response to a diagnosis.
ACS CAN's support for these provisions was based on American Cancer Society-peer-reviewed studies showing that the uninsured are more likely than people with private insurance to be diagnosed with cancer at its later stages, and are less likely to survive the disease. Legal challenges to the constitutionality of the individual responsibility requirement are putting these provisions at risk. That is why the Society, ACS CAN, the American Diabetes Association, and the American Heart Association filed a joint friend-of-the-court brief in support of sustaining provisions that are critical for people with cancer and their families. Read the joint press release.
While the constitutionality of the individual mandate is the main issue, the court will also consider other important questions: (1) Whether the law's other provisions can continue to be implemented even if the individual mandate is ruled unconstitutional; (2) Whether the law's expansion of Medicaid is constitutional; and, (3) whether challenges can even be brought at this time since the mandate has not yet taken effect.
Prevention Coverage
HHS recently announced that tens of millions of Americans are taking advantage of preventive services now available free of charge as a result of the Affordable Care Act. In 2011, 54 million Americans with private health insurance and an estimated 32.5 million Medicare beneficiaries reviewed their health status at an annual wellness visit (a benefit that the Society and ACS CAN helped to establish) and/or received at least one other preventive services with no deductible or cost sharing.
Deductibles, co-pays, and co-insurance for preventive services were eliminated under the Affordable Care Act. ACS CAN fought forcefully to ensure the provision was included in the final law and continues to support it strongly as a strategy to encourage more Americans to obtain preventive care and lifesaving cancer screenings.
FAMILY SMOKING PREVENTION AND TOBACCO CONTROL ACT
Bad Ruling in Cigarette Warning Label Case
In a disappointing development, a federal district court judge in Washington, DC ruled for Big Tobacco and against public health in barring the Food and Drug Administration (FDA) from implementing a provision in the Family Smoking Prevention and Tobacco Control Act (FSPTCA) that requires more graphic warning labels on cigarette packaging. The case was brought by the tobacco industry, which argues that the labels infringe on their First Amendment right to free speech. Earlier this year, the same judge issued an injunction prohibiting the FDA proceeding with its plans to implement the regulation pending the outcome of the lawsuit. Read the ACS CAN statement.
The new graphic warning labels, which would cover 50 percent of the front and back of cigarette packs starting in September 2012, are a common sense bipartisan provision in the FSPTCA, historic public health legislation signed into law in 2009 which grants the FDA the authority to regulate the manufacture, sale and marketing of tobacco products.
A similar lawsuit was filed in 2010 and the FDA's general authority to require graphic warning labels was upheld by a judge in the U.S. District Court in Kentucky. ACS CAN and its public health partners filed friend-of-the court briefs in both cases. The briefs provide scientific data on the dangers of smoking, as well as specific evidence on the efficacy of graphic warnings in other countries. The Department of Justice is expected to appeal this latest ruling and ACS CAN and its partners plan to file another friend-of-the-court-brief when the time comes.
World Trade Organization
The Society and ACS CAN, along with several health partners, recently filed a brief to support the US government's appeal of a decision of the Dispute Resolution Body (DBR) of the World Trade Organization (WTO) made to allow clove cigarettes to be sold in the US. Under the FSPTCA, clove cigarettes are banned. The DBR decision was brought about by a challenge from Indonesia, the single-largest exporter of clove cigarettes to the US. Indonesia charges that the ban on cloves restrains trade, violates an international trade agreement, and is unjust given that the law allows for the manufacture and sale of menthol cigarettes. The DBR sided with Indonesia, saying that there was not sufficient evidence of a difference between cloves and menthol to warrant the ban.
TOBACCO TAXES
Two of the most high profile tax campaigns this year are in California and Missouri, which are both seeking to increase tobacco taxes via ballot initiatives.
California's campaign to pass the California Cancer Research Act (CCRA) received a big boost recently with an announcement from ACS CAN CEO Dr. John Seffrin that ACS CAN has pledged up to $1.25 million to match coalition fundraising efforts. This is on top of approximately $1 million that ACS CAN and the Division already invested. In addition, the Lance Armstrong Foundation, also known as Livestrong, donated $1.5 million. Lance Armstrong is one of the campaign co-chairs and joined Dr. Seffrin to make the announcement.
The CCRA would increase the tax on cigarettes by $1.00 per pack and raise more than $500 million annually to support life-saving research. CCRA is on the state's June 5, 2012 ballot as Proposition 29. Sixty percent of the revenues from the increased tax would go toward research on cancer and other tobacco related diseases. The remaining revenue would go toward facilities and capital equipment for research, tobacco prevention and cessation programs, and enforcement of anti-tobacco laws. Programs funded by existing tobacco tax revenue streams will be "backfilled" so that their revenue streams remain constant and no current programs are harmed.
A $1 increase in the price of tobacco in California will result in more than 100,000 deaths averted due to smoking and nearly 230,000 children who will never become addicted.
In Missouri, a broad coalition led by the High Plains Division filed a ballot proposition on tobacco taxes to provide badly needed funding for public health and education. At 17 cents per pack, Missouri has the lowest cigarette tax of all states in the nation, costing an estimated $581 per household in public expenditures and claiming 9,500 lives per year from cancer and other smoking-related diseases.
The ballot measure asks voters to approve a 73-cent per pack cigarette tax increase and an increase in the tax on other tobacco products. The revenue would go towards local public K-12 schools, colleges and universities statewide, and tobacco use prevention and cessation programs. In addition, the initiative would close a loophole that allows certain small tobacco companies to avoid contributing to a fund that reimburses the state in part for tobacco-related costs.
ACS CAN is partnering with the Division and recently provided a $500,000 grant to support the campaign. Strategic and tactical support is ongoing.
DRUG SHORTAGES
On February 21, the Food and Drug Administration (FDA) held a press event to announce progress in the effort to address the drug shortage crisis that has affected access to treatment for cancer patients across the country. American Cancer Society Deputy Chief Medical Officer Len Lichtenfeld, MD, participated in the event. Dr. Lichtenfeld testified before the FDA about the crisis and its impact on people with cancer in September 2011.
During the event, the FDA revealed that it will allow temporary importation of Lipodox, a therapeutic equivalent for Doxil, a drug used for ovarian and other cancers. The FDA also announced the approval of a new manufacturer for a preservative-free version of Methotrexate, a drug used for the treatment of children with acute lymphoblastic leukemia. Read the ACS CAN press release.
The Society and ACS CAN are actively engaged with other stakeholder groups , and generic and name-brand pharmaceutical companies as well as with Congress and the Administration to better understand the causes of the crisis and possible solutions. ACS CAN has also endorsed a bill in Congress on addressing the problem. In addition, the Society's National Cancer Information Center in Austin is tracking calls from patients who have experienced drug shortages, and Divisions are also collecting patient stories.
Chris Hansen | President
ACS Cancer Action Network | American Cancer Society Cancer Action Network, Inc.