News
April 2012 Monthly Advocacy Update
ADVOCACY ACCOMPLISHMENTS REPORT
Advocacy Accomplishments 2011 Year in Review, a joint publication of the American Cancer Society and the American Cancer Society Cancer Action NetworkSM (ACS CAN), is now available. This annual report provides a comprehensive summary of legislative, policy, grassroots, regulatory, litigation, and media advocacy achievements at the local, state, and federal levels. This year's report highlights the Society and ACS CAN's joint Access to Care initiative and the continued implementation of, and education about, critical patient protections in the Affordable Care Act that are expanding access to quality, affordable care, placing an increased focus on prevention, and improving quality of life for cancer patients and their families. The report can be ordered through the Nationwide Distribution Center. Item/Catalogue Number is 7660.11. The report is also posted online at https://www.fightcancer.org/accomplishments.
STATE LEAD AMBASSADOR SUMMIT
On April 28-29, ACS CAN hosted its sixth annual State Lead Ambassador Summit in St. Louis for 48 volunteer leaders and their staff partners. Substantial time was dedicated to ACS CAN's voter education program, Cancer Votes. Thanks to fundraising gains, ACS CAN is conducting its most robust effort yet, with volunteers receiving tool kits for the first time and learning about effective techniques for engaging candidates on the issues that matter most in the fight against cancer. The Summit also included a town hall meeting where volunteers and staff discussed the Affordable Care Act. Later, smaller briefings were held on specific provisions in the law most important to cancer patients and their families. Additional workshops and round table discussions further enhanced participants' skills and knowledge base and provided opportunities for them to network and share best practices.
CANCER RESEARCH AND PREVENTION
The House and Senate Appropriations Committees set subcommittee allocations in late April.
In the Senate, the Appropriations Committee subcommittee that funds health programs received a spending allocation for the 2013 fiscal year (FY 2013) of $157.7 billion. This figure represents a little less than a one percent increase in the subcommittee's allocation over the 2012 fiscal year (FY 2012) spending levels.
On the House side, in accordance with the House-passed budget resolution, discretionary spending is cut by more than $19 billion below the spending level set for the 2013 fiscal year (FY 2013) in the Budget Control Act, the law passed in August 2011 to raise the debt limit and greatly reduce federal spending. The House subcommittee that funds health programs received an allocation of $150 billion for FY 2013, more than four percent below FY 2012 spending levels. The allocation is also more than $7.7 billion (5.15 percent) below the Senate subcommittee allocation.
The final House and Senate appropriations bills are likely to differ greatly, making the outcome of the FY 2013 appropriations process more drawn out and uncertain than originally contemplated. ACS CAN continues to monitor developments and meet with members of Congress to discuss cancer funding priorities. ACS CAN volunteers are also engaged in ongoing activities to urge their representatives and senators to make investments in cancer research, prevention, and early detection a national priority. ACS CAN is also working with its partners in One Voice Against Cancer (OVAC) on the issue, with OVAC lobby days planned for May 9 and July 9-10.
Congratulations to the Florida Division, which led a successful campaign to secure state funding for its breast and cervical cancer program, garnering a $1.24 million appropriation from the legislature and overcoming a veto threat thanks to the hard work of many volunteers and staff as well as thousands of supporters who contacted the governor. The move marks the first time the state has supplemented federal funding for this lifesaving program.
The second anniversary of the Affordable Care Act on March 23 provided an opportunity for ACS CAN and Society Divisions to educate the public about key provisions in the law that are helping cancer patients and their families access quality, affordable health care. Outreach activities included participating in coalition events, pitching cancer patients' stories to the media, and placing op eds, like the one that appeared in The Flint Journal, and letters to the editor, like this one in The Bangor Daily News.
Americans' views of the Affordable Care Act remain divided according to the latest Kaiser Health Tracking Poll. Currently 41 percent of Americans think favorably of the law and 40 percent have an unfavorable view, figures little different from a poll taken a few weeks after the law was signed in March 2010.
Also in the news, the creative approach New York took in inventing "Exchangopoly." Designed to mimic the classic board game Monopoly, it maps out the case for establishing an exchange.
Essential Health Benefits
On April 27, California joined Washington state in being the only two states to designate a benchmark plan for the private health insurance market that will serve as the essential health benefits (EHB) for all individual and small group plans offered inside the exchange and in the outside market. The selection in California, as designated by the legislature, is the Kaiser Small Group HMO Plan. As it is a "small group" plan, it will include all state health mandates passed in the state through 2011.
States have until September 30 to designate a benchmark plan from a group of 10 already offered in the state to serve as the EHB. States that do not make a choice by then will automatically default to the level of benefits offered in the largest (by enrollment) small group plan in the state. All states must choose a benchmark plan from among 10 plans already in place. If states do not select a benchmark plan by September 30, the decision will automatically default to the largest small-group plan in the state. In addition, states need to decide on a Medicaid benchmark plan for newly eligible Medicaid enrollees, which will take effect on January 1, 2014. The deadline for the decision is not yet final, but ACS CAN is concerned that the traditional Medicaid program may not provide an adequate essential benefits package for cancer patients. During 2014 and early 2015, HHS will evaluate the effectiveness of the benchmark plans and their impact on consumers and patients before moving forward with guidance for essential health benefits in 2016 and beyond.
ACS CAN, along with other consumer and patient advocacy groups, are working to determine how this approach assures adequate coverage, "adequate" being one of the Society and ACS CAN's "four A's for expanding access to care. To that end, together with the American Diabetes Association, American Heart Association and Multiple Sclerosis Society, Society Divisions and ACS CAN developed a survey for state insurance commissioners designed to help measure the level of benefits provided to beneficiaries within the largest (by enrollment) small group plans in each state and whether the plans have any "inside limits" on benefits, such as restrictions on the number of times a patient can use a particular service, e.g. lab tests or doctor visits, each year. While not intended to be an exhaustive list, the survey is rather a sampling of the most commonly used services across 10 categories mandated by HHS. No information on cost-sharing is being sought as those issues will be addressed through separate HHS regulations.
In Congress
This week the House considered the Sequester Replacement Reconciliation Act, which would cut mandatory funding for a number of health-related programs authorized in the Affordable Care Act (ACA), as well as make cuts to the Medicaid program. ACS CAN, the American Diabetes Association and the American Heart Association sent a joint letter to all House members opposing the repeal of mandatory funding currently set aside to promote prevention and public health, as well as funds to establish state-based health insurance exchanges. There are no plans for the Senate to vote on this legislation.
Additionally, ACS CAN opposes provisions in the legislation that would erect barriers to access to care for low- and moderate-income families by repealing repayment caps for subsidized insurance purchased on state exchanges. Certain provisions also would roll back requirements to maintain coverage for millions of people with disabilities and severe chronic illnesses on Medicaid who don't have other ways to receive adequate and affordable care.
Prevention and Public Health Fund
The House of Representatives approved a measure that diverts funding from the Prevention and Public Health Fund to keep down the costs of student loans. ACS CAN sent a letter to all House members opposing any legislation that would cut prevention and public health funding for any purpose, including as an offset for the student loan program. ACS CAN strongly supports the Prevention and Public Health Fund, which is making an historic investment in refocusing the nation on preventing disease before it occurs, rather than waiting to treat people until they get sick. The Senate version has not been voted on yet due to a filibuster. Read the ACS CAN press release.
ACS CAN strongly supports the Prevention and Public Health Fund, which is making an historic investment in refocusing the nation on preventing disease before it occurs, rather than waiting to treat until people they get sick. 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 to fund a total of $15 billion in proven effective prevention and public health approaches to keep Americans healthier. ACS CAN is working to persuade national leaders that sacrificing disease prevention makes no economic sense and diminishes our ability to improve public health.
Employer-Sponsored Insurance
The Treasury Department recently released a notice requesting comments on several approaches to determining "minimum essential coverage" under the Affordable Care Act. Beginning in 2014, large employers (50 or more workers) will be required to offer plans that cover at least 60 percent of allowed costs for certain categories of benefits. (This is different than the essential health benefits requirement, which only applies to health plans in the individual and small-group markets.) If an employer fails to meet the coverage level, it may be subject to an assessment by the government.
Although the notice is only the first step in the regulatory process and much could change, ACS CAN and other consumer groups are concerned about the approach outlined in the notice. The minimum level of coverage, though low, is in the law; however, the calculation methods Treasury suggests could be subject to manipulation that results in a level of coverage that is inadequate for a cancer patient. ACS CAN is very concerned that some large employers could decide to provide substandard coverage. Workers in such organizations would be disqualified from receiving more adequate, subsidized coverage in the exchange. The minimum essential coverage standard could fall well short of the adequate coverage ACS CAN wants to establish for plans subject to the ACA's essential benefits provision.
ACS CAN is working with other consumer groups to press for more rigorous standards and levels of coverage employers must meet to satisfy minimum essential coverage requirements for large group market and self-insured plans.
Consumer Rebates
Under the Affordable Care Act, health plans must meet minimum medical loss ratios (MLR), the percentage of premium dollars that are actually spent on medical benefits rather than administrative costs and profits). For the first time, health insurance companies are required to disclose information that is intended to help consumers understand the value they are getting for the premiums they pay. The MLR is 80 percent for the individual and small group markets and 85 percent for the large group market. The provision is in effect this year, and the first rebate checks will be issued in August based on 2011 data. According to a Kaiser Family Foundation issue brief, rebates this year are estimated to be $1.3 billion. In another analysis, the Commonwealth Fund reported that consumers would have received an estimated $2 billion in been rebates or reduced premiums if the MLR provision had been in effect in 2010.
ACS CAN believes the MLR provision is one of the most important short-term consumer protections the Affordable Care Act provides and it is having a real impact on premiums nationwide as it prompts insurers to be more transparent and accountable. The rebates benefit those whose plans have provided too little value. As importantly, the transparency has created new pressure on insurers to manage costs more efficiently, to the benefit of the consumer. Insurance premiums have been rising at a considerably lower rate this year than in the past few years, and the MLR and rate review provisions in the law are undoubtedly important contributing factors.
FYI, there is widespread opposition to the MLR from the insurance brokers who believe their costs should not be included in the MLR calculation. ACS CAN opposes legislation desired by the brokers, now pending in both the House and Senate, which would exempt broker costs from the MLR. If enacted, the legislation would likely reduce premium rebates to consumers in the future.
Exchanges
ACS CAN, the American Heart Association, the American Diabetes Association, and the National Multiple Sclerosis Society convened a webinar to review research the groups commissioned highlighting voter attitudes toward the creation of health insurance exchanges under the Affordable Care Act. The research will be helpful in determining messaging that will engender public support for implementation of key provisions in the law that are improving access to quality, affordable health care for people with life-threatening chronic diseases and those at risk of developing them. Click here to access the recording.
FINAL.electeds.CommunicationsTips.Exchange..pdf FinalVoters.CommunicationsTips.Exchange.pdf presentation.Herndon exchanges for April 23rd webinar.final.pdf
DISPARITIES
On April 18, in recognition of National Minority Cancer Week and National Minority Health Month, ACS CAN partnered with provider groups to discuss the importance of research and prevention in achieving health equity to members of Congress and their staff. Representative Barbara Lee spoke about the increased need for federal funding for research, prevention and access to care and Dr. Lawrence Tabak, principal deputy director at the National Institutes of Health, addressed the importance of health disparities research and improving diversity in both the research workforce and clinical trial participation. Angelina Esparza, the Society's director of health equity, and other national experts were also on hand to discuss the impact chronic diseases have on communities of color and what more needs to be done to close the gap.
FAMILY SMOKING PREVENTION AND TOBACCO CONTROL ACT
World Trade Organization
The World Trade Organization (WTO) ruled against the US in a complaint brought against it by Indonesia, which claims that the Family Smoking Prevention and Tobacco Control Act's (FSPTCA) ban on clove cigarettes, but not menthols, is discriminatory and violates international trade agreements. Indonesia is the largest producer and exporter of clove cigarettes to the US. There will now be a protracted period of discussions between the two nations regarding a timeline for the US to comply. Short of an agreement, Indonesia will be able to seek WTO approval of remedies to compensate for what it sees as American discriminatory practices. As a leading supporter of the FSPTCA, ACS CAN is developing a set of recommendations to the US government on how to address the dispute.
Under the FSPTCA, candy, fruit, and clove flavorings were banned from cigarettes effective September 2009. Menthol was referred for study to a Food and Drug Administration (FDA) scientific advisory committee on tobacco. In a March 2011 report, the committee found that menthol impacts smoking initiation and cessation efforts and advised that its removal would benefit public health. ACS CAN strongly supports the committee's findings and conclusions and is urging the FDA to implement the committee's recommendation in a way that maximizes the public health benefits. The FDA is now deliberating what, if any, action it is going to take. While the law gives the FDA broad authority to address menthol flavoring, it does not mandate any particular action or timeline for action.
Graphic Warning Labels
A three judge panel from the DC Circuit Court of Appeals heard arguments on April 10 in the US government's appeal of a lower court decision holding that the provision in the FSPTCA that calls for the placement of larger, more graphic warning labels on cigarette packs and ads are unconstitutional infringements on the commercial free speech rights of the tobacco industry . The Society, ACS CAN, and their public health partners filed a brief in support of the FSPTCA that provides scientific data on the dangers of smoking, as well as specific evidence on the efficacy of graphic warnings in other countries.
TOBACCO TAXES
California
On April 19, ACS CAN announced completion of a $1 million donation to the campaign to pass the California Cancer Research Act, a ballot initiative known as Proposition 29 that would increase the cigarette tax in California by $1 per pack and increase other tobacco product taxes to fund cancer research and promote tobacco control in the state. ACS CAN had pledged to match every $1 million raised by the Yes on Prop 29 campaign with a $100,000 donation -- up to an additional $1 million, but decided to release the remaining money immediately to support Yes on Prop 29's new ad campaign. To date, Big Tobacco has spent $20 million on advertising plus another $15 million on other tactics aimed at defeating Prop 29.
ACS CAN's donation was made possible thanks to a grant from the Society's Mission Delivery Council. ACS CAN and the California Division have now contributed a combined total of nearly $2.25 million to the campaign. The vote takes place on June 5, 2012. Read the ACS CAN press release, the Daily Democrat story, and an op ed by David Veniziano, the California Division's top executive.
Several leading newspapers in the state came out in favor of Prop 29, including The Bakersfield Californian, The Desert Sun, The Press Democrat, The Sacramento Bee, The San Francisco Chronicle, and The San Jose Mercury News.
Missouri
Kudos to volunteers and staff in the High Plains Division for collecting more than 200,000 signatures to ensure a proposal to increase Missouri's tobacco tax is on the state's November ballot. The initiative calls for a 73-cent increase in the state cigarette tax, which is currently the nation's lowest at 17 cents per pack. A tax increase of this size translates into 40,100 Missouri kids not becoming addicted smokers and 22,200 people averting premature death. Twenty percent of the new revenue would go toward tobacco control and the remainder toward education. The High Plains Division is leading the campaign with support from a broad coalition that includes ACS CAN, which has contributed $580,000 to date.
Vermont
Congratulations to the New England Division on succeeding in changing Vermont law so that little cigars are taxed at the same rate as cigarettes. Price differences between little cigars and cigarettes have allowed tobacco companies to use a loophole in the tax system to create other tobacco products that appeal to youth due to the lower cost and added flavorings. As noted earlier, candy- and fruit-flavored cigarettes are prohibited under the FSPTCA, but the provision has not yet been applied to little cigars. ACS CAN and its coalition partners have been urging the FDA to assert its regulatory authority to cigars since the FSPTCA passed in 2009.
SMOKE-FREE
Please join me in congratulating the Great Lakes and Mid-South Divisions on two significant smoke-free victories. Both campaigns were very hard fought and the wins are the product of years of hard work and persistence on the part of many volunteers and staff.
In the Mid-South, the city council of Birmingham, Alabama voted unanimously for a strong 100 percent smoke-free workplace law on April 17. Read an op ed by Immediate Past President of the Society Ed Partridge, MD, published a few days before the city council vote. Dr. Partridge also spoke before council members on the night of the vote. And on April 19, the Great Lakes saw Indianapolis' mayor sign a smoke-free ordinance that covers 100 percent of workplaces, restaurant and bars and includes e-cigarettes effective June 1.
ACS CAN was proud to partner with the Divisions in these campaigns and ensure their success, for example ACS CAN arranged for "patch through" calls to connect citizens supportive of the smoking ban with city council members. Tactical support such as advertising and media outreach was also provided. Significantly, ACS CAN resources enabled the Birmingham campaign to hire a full time campaign manager and a part-time grassroots organizer. In Indiana, ACS CAN underwrote the salary of a full time grassroots staff person to work on Indiana's state and local smoke-free campaigns.
Kansas
Kudos to volunteers and staff in the High Plains Division for successfully ensuring an attempt to greatly weaken the Kansas Indoor Clean Air Act failed. Following their protests, a bill to exempt bars and other establishments employing and serving adults 21 and older from the state's strong smoke-free law was referred back to a legislative committee and is unlikely to come up for a floor vote this year. Current law bans smoking in all workplaces, including bars and restaurants and enjoys a 70 percent public approval rating.
Although this is very good news, it is also a reminder that enactment of a smoke-free law does not necessarily settle the issue. In addition to fighting for new smoke-free laws, ACS CAN is ever vigilant in defending existing protections.
TOBACCO CONTROL WINS
The Vermont legislature provided a $500,000 increase for the state's tobacco control program. This is a significant win given that many other states are drastically cutting budgets for such programs. Kudos to the New England Division.
Noteworthy wins also occurred in the Great West Division. Colorado restored the use of tobacco tax revenue to fund its tobacco control program following several years in which the revenues were used for other purposes. As a result, Colorado's tobacco control program will receive nearly $23.5 million. In Idaho, the tobacco control program will receive $2.8 million, more than doubling the previous year's funding. Finally, Washington State's Quit Line received $1.7 million, enabling the program to resume operations. Many thanks to the volunteers and staff who secured these wins.
Federal Advertising Campaign
In the week that followed the launch of the Centers for Disease Control and Prevention's historic anti-smoking advertising campaign featuring the stories of people with various tobacco-related illnesses, the government's QUIT NOW hotline received a 130 percent increase in calls over the same period in 2011. Quit For Life, a cessation program sponsored jointly by the Society and Alere Wellbeing, reported an 88 percent increase in calls over that same timeframe.
PRESCRIPTION DRUG DEVELOPMENT AND SHORTAGES
ACS CAN is encouraged by efforts in Congress to advance legislation that would reauthorize and expand the industry-supported user fee program that pays for expeditious FDA review of new pharmaceutical drugs and medical devices. Renewing this important industry-government partnership is tantamount to ensuring that cancer patients, survivors and their families have access to the latest evidence-based treatments. Congress is also for the first time recommending a similar Generic Drug User Fee program that would collect fees from generic drug manufacturers to accelerate review and approval of generic drugs.
Additionally, the user fee legislation contains provisions aimed at mitigating the ongoing drug shortage problem. The legislation directs manufacturers to provide the FDA with early notification of a prospective discontinuation or interruption in the drug manufacturing process that could lead to a shortage of a particular drug. It also establishes an FDA task force to work with manufacturers and the HHS Secretary to ensure the availability of alternative sources of drug supply in case of an ongoing or prospective shortage. The Society and ACS CAN have been working with Congress, the FDA and representatives of the pharmaceutical industry for many months to find a solution to this problem. Proper notification and the creation of a task force along with the new generic drug user fee is a good start that will begin to alleviate some of the shortages now in effect.
TANNING BEDS
Another win in Vermont, which has joined California as the second state to completely ban tanning bed use for those under the age of 18. Thanks to the hard work of volunteers and staff in the New England Division, this victory will help build momentum for efforts in other states.
ORAL PARITY
Hawaii's governor signed an oral chemotherapy parity bill into law on April 20. Although a similar law had already been in place, the new version adds more consumer cost protections in place so that oral chemotherapy is similar in cost to IV chemotherapy. This is a huge win for cancer patients in the state. Congratulations to volunteers and staff on their great work.
Chris Hansen | President
ACS Cancer Action Network | American Cancer Society Cancer Action Network, Inc.