3-29-11 Maine Advocacy Update

Maine Government Relations & Advocacy Newsletter

March 29, 2011

 

Note that items in underlined, blue text are hyperlinks - click on them for more information.

 

State Budget - Maine Breast and Cervical Health Program

The Governor's proposed Biennial Budget for FY 2012-2013 includes a $60,000 cut to the Maine Breast and Cervical Health Program. ACS testified in opposition to this cut to the program at the public hearing held by the Appropriations and Health and Human Services Committees. The Health and Human Services Committee has been holding worksessions in order to prepare their recommendations on the budget. Last Thursday, the Committee voted to table the $60K cut to the MBCHP. They will take this up again - likely at their worksession this Friday, April 1.

 

State Budget - Fund for a Healthy Maine

The Governor's proposed Biennial Budget also includes a significant cut in the Fund for a Healthy Maine (FHM). There are more than $18 million in program cuts used to fill budget holes in the state Medicaid program. 15 programs had their FHM funding completely eliminated.  Note that the increase in funding for the Medicaid program is not an overall increase in funding - the FHM funding supplants funding for the program from the General Fund.

 

This is the first time in the Fund's history that there has been a proposal to eliminate the entire portion of FHM funding for certain programs. In addition, there is a proposed statutory language change that would make it easier for the Fund to be continually raided to fill budget holes. Recognizing the tremendous opportunity Maine's tobacco settlement presented, the Legislature designed the Fund specifically to "supplement not supplant" General Fund expenditures.  The Governor's budget eliminates this protection and uses the Fund to fill budget gaps, flying in the face of a decade of bipartisan legislative support.

 

ACS testified in opposition to these cuts to the Fund for a Healthy Maine in the public hearing held by the Appropriations and Health and Human Services Committees. While no votes have been taken yet on this portion of the budget, the discussion during the HHS Committee worksessions has been concerning. It appears likely that the FHM will see major cuts in the majority report of the Committee's recommendations. The Committee will meet to discuss this proposal on Thursday, March 31 at 1 pm.

 

TAKE ACTION: We are currently collecting signatures of Maine businesses that oppose these cuts. If you own a business or know someone who does, please ask them to sign a letter to the legislature, which can be found here: http://www.surveymonkey.com/s/wesupportthefhm

 

TAKE ACTION: Please contact members of the HHS Committee to let them know that the current FHM proposal takes Maine in the wrong direction. Ask them to do everything they can to protect the Fund for a Healthy Maine and keep it working as it was intended - creating opportunities for better health and lower costs for everyone.

 

State Budget - MaineCare Eligibility

ACS testified in opposition to proposed cuts in eligibility in the MaineCare program, as well as proposed copayment increases for certain MaineCare populations. Due to the negative impacts on access to important cancer prevention, detection, and treatment services, ACS opposes these proposals.

 

State Budget - Dirigo Health Program

The Governor's proposed Biennial Budget includes a proposal to reduce the assessment on health insurers in the state that currently fund the subsidies for Dirigo Health insurance coverage gradually between now and 2014. Essentially, this will slowly eliminate the program. This will result either in individuals being forced to leave the program or the benefits will need to restructured to provide less coverage or greater out of pocket costs. Almost 15,000 Mainers are currently covered by Dirigo Health Agency programs, including coverage through over 500 small businesses and organizations across the state. In the past year, the program has provided coverage to 142 Mainers with a cancer diagnosis and some cancer patients have credited the program with saving their life. The elimination of these subsidies will put this coverage out of reach for a large number of those individuals and businesses. Since these programs provide important coverage of prevention, detection, and treatment for cancer, ACS opposed this proposal. The Insurance Committee will meet this afternoon to discuss this proposal.

 

Public hearings and worksessions on the budget are scheduled into early April. This makes it necessary for the budget to receive a 2/3 majority vote. It is now looking like a budget will not be passed until late in the session, possibly not until May or even June.

 

Access to Affordable, Quality Health Care

Access to Clinical Trials

Last week, ACS testified in support of LD 712, sponsored by Representative Strang Burgess (R-Cumberland) at the public hearing held by the Insurance and Financial Services Committee. This bill will expand Maine's mandated benefit law for clinical trials and will require insurance companies to provide coverage for pharmaceutical clinical trials. The bill also makes it clear that insurers need to provide coverage for all phases of clinical trials.  ACS testified in support of this bill. There Committee is scheduled to vote on this proposal this Friday, April 1.

 

Private Insurance Consumer Protections

There are some legislative proposals being considered in the Maine Legislature this year that could have a significant impact on cancer patients and their families, especially with regard to access to health care coverage and services.

 

Geographic Access Standards for Health Insurance Carriers (Rule 850)

Currently, there are laws in place in Maine that limit the distance insurance companies can require patients to travel to get health care services that are covered under your health insurance policy as an "in network" service. This law requires insurance companies to have provider networks where primary care services are available within 30-minutes travel time and specialty care and hospital services are available within 60-minutes travel time. Insurance companies cannot require patients to travel farther than these limits for in-network coverage. This consumer protection is called Rule 850.

 

 LD 496, sponsored by Representative McKane (R-Newcastle), is a proposal to repeal this law. The American Cancer Society opposes this proposal because we do not want patients to be required to travel extraordinary distances in order to receive preventive and diagnostic cancer screenings (e.g., colonoscopies) or cancer treatment. In other words, while some cancer patients choose to travel to Boston for cancer treatment, we would oppose efforts by insurance carriers to require patients to do so. Similarly, we would oppose efforts by insurance companies to require someone to travel from a more rural part of Maine to a more urban part to receive a colonoscopy or other screening or diagnostic test. Moreover, while some patients choose to travel to get care, some patients are unable to do so. We do not want to set up a situation where those that are unable to travel do not have access to the care that they need closer to home. Supporters of this proposal are interested in finding more ways to provide patients with incentives to travel further to receive higher- or equal-quality care at lower costs. ACS is open to reviewing the current law and supports efforts to provide patients with more accessible information about the costs and quality of available care.

 

TAKE ACTION: There is a public hearing on LD 496 on April 6 at 1:30 pm in the Insurance and Financial Services Committee (Room 220 of the Cross State Office Building). If you are interested in sharing your story to ensure that legislators are thinking about the impacts that these proposals may have on cancer patients and their families, please contact me at 373.3707 or [email protected]. If you cannot show up in person, emails or calls to committee members are also very effective.

 

Community Rating and Guaranteed Issue

Currently, there are laws in Maine that prohibit insurance companies from denying individuals health insurance coverage because of their medical history. This is called guaranteed issue. There are also laws that prohibit insurance companies from charging individuals higher health insurance rates based on their medical history (and limits on how much rates can vary based on age, geographic location, and industry). This is called community rating. These protections apply to individuals that are buying health insurance on their own or who receive health coverage through a small employer (50 or fewer employees).

 

There are legislative proposals being considered this session to repeal or modify these consumer protections. These proposals include ones that allow individuals to purchase insurance policies from other states that do not have to comply with these Maine laws. While this proposal may sound attractive on the surface, the result is that young, healthy people would be attracted to buy these less expensive, limited benefit plans. The remaining market share would be left to cover individuals, such as cancer patients and survivors, who tend to be more expensive to health insurers. This would leave one insurance pool more heavily weighted with sicker individuals and could drive up costs for those individuals and businesses (and their employees), particularly small businesses, that remain in the traditional insurance market. In addition, young, healthy individuals buying the limited benefits packages could end up facing a cancer diagnosis and be left without the coverage that they need to help treat their disease.  

 

TAKE ACTION: There is a public hearing on six bills (LD 226 - sponsor: Sen Sullivan (D-York), LD 455 - sponsor: Rep Hogan (D-Old Orchard Beach), LD 473 - sponsor: Rep Harmon (R-Palermo), LD 645 - sponsor: Rep Parry (R-Arundel), LD 1162 - sponsor: Rep Volk (R-Scarborough), LD 1200 - sponsor: Rep McKane (R-Newcastle)) that would allow "out-of-state health insurance" to be sold in Maine without complying with the consumer protections described above. The public hearing is on April 12 at 1 pm in the Insurance and Financial Services Committee (Room 220 of the Cross State Office Building). The American Cancer Society opposes these proposals for the reasons described above. If you are interested in sharing your story to ensure that legislators are thinking about the impacts that these proposals may have on cancer patients and their families, please contact me at 373.3707 or [email protected]. If you cannot show up in person, emails or calls to committee members are also very effective.

 

National Policy Landscape

Affordable Care Act (ACA)

Last Wednesday, we celebrated the one-year anniversary of the Affordable Care Act. The American Cancer Society participated in a press event at the Portland Public Market House to celebrate the anniversary with other members of the steering committee of a new alliance ACS is part of - called Health Care for Maine (HC4ME). The other steering committee members include AARP - Maine, Consumers for Affordable Health Care, Maine Center for Economic Policy, Maine Equal Justice Partners, Maine Medical Association, Maine Parent Federation, and the Maine People's Alliance and Maine People's Resource Center. The press event featured Maine people who have been positively impacted by the new law. The press event was covered on the WGME 13 evening news and on WGAN radio.

 

Affordable Care Act  - Seniors Benefiting from New Wellness Visit

HHS released a new report showing that in less than two months since the new wellness visit in Medicare benefit started Jan. 1,, more than 150,000 seniors and others with Medicare have received an annual wellness visit. This new visit is a no-cost preventive benefit available to Medicare beneficiaries. Beneficiaries must schedule the visit with a participating health care professional.

 

During the annual wellness visit, doctors and beneficiaries can develop and/or update a personalized prevention plan that takes into account medical and family history, and potential risk factors for diseases like cancer.  Doctors can also provide patients with personalized health advice, as well as and referrals when appropriate to education or preventive screening and counseling services and programs.

 

Read more about the report:

 

Affordable Care Act - Lawsuits

Several lawsuits challenging the constitutionality of ACA provisions are now being slated for appeal.  In the Eleventh Circuit -- which includes the state of Florida, where 26 states are among the named plaintiffs and a federal judge had invalidated the entire law -- the Court of Appeals has agreed to an expedited review of the case.  Amicus filings to defend the law will be due April 4.  The Society, ACS CAN, and our preventative health partners at the American Diabetes Association and American Heart Association plan to file an amicus brief in the Eleventh Circuit that is virtually the same as the one the groups previously filed in the Sixth and Fourth Circuits.  Oral arguments in the Fourth Circuit (Virginia) and Sixth Circuit (Michigan) are scheduled in May.  Regardless of outcome, those decisions will almost certainly be appealed to the U.S. Supreme Court, which is expected to hear the case during the spring term of 2012 and rule before its adjournment for summer recess that year.

 

Affordable Care Act - Quality Improvement Strategy Unveiled

Last week, the Department of Health and Human Services (HHS) released its National Strategy for Quality Improvement in Health Care. The National Health Care Strategy was required as part of the Affordable Care Act to coordinate state, local, and federal efforts directed at improving health care quality nationwide and is intended to serve as a guide for federal agencies to develop programs, regulations, and initiatives related to quality improvement.. The strategy articulates three broad aims - improving the quality of care by making care more patient-centered, making communities healthier by addressing the behavioral and social determinants of health, and making care more affordable by reducing health care costs. Read the HHS press release.

 

HHS developed the strategy with input from a variety of stakeholder organizations, including ACS CAN and other patient advocacy organizations In its recommendations to HHS on the strategy last October, ACS CAN expressed the importance of advancing quality improvement strategies that promote more integrated and coordinated care for individuals with serious and chronic illnesses -- a key theme expressed in the HHS framework. The document is a good foundation for developing a more coherent approach to quality throughout the nation's health system.

 

Affordable Care Act - Improving Quality of Care

The new Center for Medicare and Medicaid Innovation (CMMI) began holding meetings with a mix of diverse stakeholders, including patient advocacy and provider groups, to solicit ideas for new demonstration proposals to reform our current health care delivery system. The CMMI, which is part of the Centers for Medicare and Medicaid Services (CMS), was created by the ACA to give CMS greater authority to explore innovations in health care delivery and payment to enhance the quality of care delivered to Medicare and Medicaid beneficiaries. Proposals must reflect three key priorities: 1) better care for individuals, 2) coordinating care to improve health outcomes for patients, and 3) community care models. The law explicitly mentions that the CMMI consider reform models related to improving cancer care.

 

On March 11th, ACS CAN presented three ideas to CMS officials to improve cancer care for patients, including a demonstration to encourage hospitals to deliver palliative care services, a proposal to integrate cancer screening and prevention services into medical home demonstrations, and a request to urge CMS to consider including more cancer patients in future delivery system models designed to coordinate care for the chronically ill.

 

Living with Cancer Conference

The 2011 Living with Cancer Conference will be held on Wednesday, May 4, 7:45am-3:45pm at the Augusta Civic Center in Augusta. Please join us for Facing Cancer Together, a day of personal stories and medical information designed to help cancer patients and their families as they continue along their cancer journeys. At this conference, I will be leading a workshop on the Affordable Care Act and what it means for cancer patients. 

 

The American Cancer Society Cancer Action Network (ACS CAN) is the nonprofit, nonpartisan sister advocacy organization of the American Cancer Society, dedicated to eliminating cancer as a major health problem. ACS CAN works to encourage lawmakers and candidates to support laws and policies that will make cancer a top national priority.  Through ACS CAN, ordinary people can achieve extraordinary results in the fight against cancer. ACS CAN does not endorse candidates. Because we use your donations to support our citizen-based advocacy and lobbying efforts to end cancer, contributions to the American Cancer Society Cancer Action Network, Inc., are not tax-deductible.