News
June 2011 Monthly Advocacy Update
CANCER RESEARCH AND PROGRAM FUNDING
ACS CAN volunteers joined cancer patients, survivors, caregivers, physicians, and researchers in Washington, DC, last week for the One Voice Against Cancer (OVAC) coalition’s annual Lobby Day. Nearly 100 advocates from 33 states came together to urge Congress to support federal funding for cancer research and prevention programs and met with almost 150 members of Congress and their staff. The meetings were timely and important, as Congress begins to take up next year's spending bills. Read the ACS CAN press release.
High Risk Pools
The Department of Health and Human Services (HHS) announced several important changes to the Pre-Existing Condition Insurance Plan (PCIP) recently. Among the 23 states (and DC) covered by the federally run PCIP, 18 will have lower premiums beginning July 1, 2011. Reductions are as much as 40 percent in several states. These changes are a result of redeterminations of what the "standard rate" is in each state. HHS is communicating the new measures to states that operate their own PCIP and encouraging them to make similar adjustments.
HHS also simplified the process for determining eligibility for PCIP. Until now, applicants had to show evidence that they had been rejected for coverage or had received a premium quote that was unaffordable before they could be enrolled in PCIP. Beginning July 1, an applicant will instead be able to use a letter from their physician stating that they had a pre-existing condition in the past 12 months. This change could make the enrollment process much faster for many applicants. HHS will also step up its outreach efforts to increase enrollment further. The federal and state programs have been operating for nearly a year now and have identified some best practices that are being shared among all the states.
Hearing on Interstate Sales of Health Insurance
On May 25, Stephen Finan, ACS CAN’s senior director of policy, gave testimony before the House Energy and Commerce Health Subcommittee on the sale of health insurance across state lines. Interstate sales could theoretically increase competition to the benefit of consumers, but only if there are strong, uniform rules for insurers and adequate consumer protections. Only three states – Georgia, Maine, and Wyoming – now have such laws. Unfortunately, a House bill to broaden the practice would repeal consumer protections provided through the Affordable Care Act. Without these protections, there would be a "race to the bottom" among insurers, which could ultimately result in a system in which the relatively healthy could buy insurance at low rates, but higher risk people, including cancer patients, would be offered coverage with premiums that are unaffordable for most.
In the States
Six states -- California, Colorado, Maryland, Washington State, Vermont, and West Virginia – have enacted health exchange laws. Governors in Georgia, Indiana, and Mississippi bypassed their legislatures and established exchanges via executive order. Bills passed in Hawaii and Illinois are awaiting their governors’ signature. With state sessions winding down, several other states are expected to pass legislation in the next few weeks. ACS CAN and Society Divisions continue to work with state lawmakers and insurance commissioners to ensure the new exchanges meet the needs of cancer patients and their families.
Medicaid
Some recent news reports have incorrectly concluded that Medicaid offers substandard care because of evidence showing that survival rates for cancer patients in Medicaid can be poorer than for those outside the program. This conclusion is seriously misleading. Going unreported is that cancer patients more often enroll in Medicaid with a late-stage cancer because of eligibility rules—i.e., they become eligible for Medicaid only because they have developed cancer and have no other treatment options. Patients in Medicaid actually have higher rates of cancer screening than those uninsured and almost the same rate of cancer screening as those in private insurance.
The Affordable Care Act removes many of the obstacles to receiving timely access to coverage in Medicaid, such as the elimination of eligibility restrictions for uninsured adults and increased provider payments to ensure that doctors and hospitals accept Medicaid patients when the Medicaid expansion takes effect in 2014. The attached fact sheet provides information on how the program helps save lives from cancer.
Rate Reviews
HHS recently issued its final rule governing provisions in the Affordable Care Act on health insurance premium rate increases. Starting on September 1, 2011, insurance companies will face greater state, federal, and public scrutiny for premium hikes of 10 percent or more. Insurers would also have to provide information on where the money is going, including a breakdown of medical services, profits, and administrative expenses. Prior to the federal law, many insurance companies were able to increase their premiums without justification. The new rule helps ensure that consumers receive value for their premium dollars and that significant premium increases in all states are justified and transparent. HHS will conduct reviews in many states, because only a handful of states have such authority.
Litigation
A three-judge panel from the US Court of Appeals for the 11th Circuit will hear oral arguments on the multi-state lawsuit starting tomorrow. In that case, the US government is appealing District Court Judge Roger Vinson’s ruling that the Affordable Care Act is, in its entirety, unconstitutional.
The Fourth Circuit, which was the first federal appeals court to hear oral arguments in the Affordable Care Act lawsuits, took the rare step of ordering the parties to submit briefs on questions that neither side raised in their main briefs. Specifically, the court asked whether and how the Anti-Injunction Act, which forbids anyone from maintaining a lawsuit for the purpose of restraining assessment or collection of any tax, would apply to the Affordable Care Act. How this order will affect the resolution of the cases or the timing of a decision is unclear.
The Sixth Circuit Court of Appeals heard oral arguments on June 1, but the three judge panel hearing the case must first rule on the motion to dismiss that the Obama administration filed last week. The Administration filed the brief because one of the plaintiffs recently purchased health insurance through an employer and can no longer claim injury from the individual mandate to purchase insurance.
Oral arguments are scheduled for September 23 in the US Court of Appeals for the District of Columbia. In that case, the plaintiffs are appealing Judge Gladys Kessler’s decision upholding the law.
Prevention
HHS has made $100 million available from the Prevention and Public Health Fund for up to 75 Community Transformation Grants are aimed at promoting healthy lifestyles and communities. The grants are specially focused on reducing chronic diseases, disparities, and health care costs, with five priority areas: tobacco, nutrition and physical activity, evidence based prevention services, mental health, and safe environments. Local and state government agencies, tribal organizations, and nonprofits are eligible for the funds.
The City Council in Nome, Alaska, passed a comprehensive smoke-free ordinance covering all workplaces, including bars and restaurants, by a vote of four to one. When it takes effect on September 23, 2011, the city will have Alaska’s strongest smoke-free law. ACS CAN volunteers, staff, and coalition partners worked extremely hard over several years to build public support for the law and ensure its passage. Congratulations!
Congratulations also to the Illinois Division, where volunteers and staff defeated an attempt to weaken the state’s strong smoke-free law with an exemption for casinos. The victory is especially significant given a new law that expands gaming in the state. ACS CAN was proud to assist the Division in its campaign with strategic counsel and tactical support.
Thanks to the hard work of ACS CAN volunteers and staff, the legislature voted down a bill that would have weakened Washington States’ strong smoke-free law and allowed special licenses or smoking permits for 100 cigar lounges and 500 retail tobacconist shops.
Christopher W. Hansen
President
American Cancer Society Cancer Action Network (ACS CAN)