News
November 2011 Monthly Advocacy Update
CANCER RESEARCH AND PREVENTION PROGRAMS
Appropriations
The 2012 fiscal year budget process and the work of the Joint Select Committee on Deficit Reduction, or "super committee," continue to move forward. Congress is beginning to pick up the pace on spending bills for the current fiscal year as the committee approaches a November 23 deadline to produce a deficit reduction package.
The Senate has started to take up a series of "mini-bus" appropriations bills that bundle several spending measures for consideration at one time, as opposed to an omnibus package that would fund the government as a whole. Once the bills funding health agencies are approved in each chamber of Congress, the House and Senate will have to resolve disagreements over spending levels as well as serious policy differences. A resolution on the bill may not arrive until sometime in December.
In the meantime, ACS CAN continues to engage super committee members, congressional leadership, and House and Senate appropriators to ensure that the fight against cancer is a priority in all policy discussions. A recent "phone in" campaign generated more than 20,000 calls to members of Congress.
OVAC
One Voice Against Cancer (OVAC) held its second government relations staff Lobby Day of the year on October 18. Thirty-five people from 20 patient advocacy and professional organizations participated in 48 meetings with House and Senate offices, including leadership offices, 15 members of the House and Senate Appropriations Committees, and 10 out of 12 members of the Super Committee. Follow-up opportunities for ACS CAN are expected to result from many of these meetings.
OVAC participant groups are now working with their grassroots to urge members of Congress to sign onto a "Dear Colleague" letter being circulated by Representative Ed Markey (D-MA). The letter affirms support for the House Appropriations Committee's 2012 fiscal year health funding bill proposal to increase the National Institutes of Health (NIH) budget by $1 billion and calls on the committee to fight for this funding level in negotiations with the Senate. Importantly, the letter also states that funding for the Centers for Disease Control and Prevention and other health care programs should not be used to pay for the NIH increase.
Common Rule
The American Cancer Society and ACS CAN submitted comments to the Office of Human Research Protections at HHS regarding changes to the Common Rule, which governs the conduct of medical research funded by 15 different federal agencies. The Common Rule creates a tremendous administrative burden on cancer researchers, delaying the time between discovery and delivery to treat patients. The comments sought to ease the administrative burdens while improving privacy protection of patient-identifiable information. Read the ACS CAN press release.
ACS CAN partnered with the NFL on a joint ad promoting the National Breast and Cervical Cancer Early Detection Program. The ad is ran in Roll Call and Politico.
Litigation
The Obama Administration and the plaintiffs in five of the six major cases challenging the Affordable Care Act have petitioned the U.S. Supreme Court to consider the law's constitutionality during the current term. The justices will meet in conference November 10 and could accept, defer, or deny the petitions at that time. Their decision is likely to be announced November 14, and court watchers predict that they will agree to hear the case during this term to resolve inconsistent rulings throughout the country. If those predictions prove accurate, the American Cancer Society, ACS CAN, the American Diabetes Association, and American Heart Association will file an amicus brief that reflects the position the organizations took in the amicus brief that was jointly filed at the appellate level.
The crux of each challenge is that Congress exceeded its constitutional authority in requiring individuals to purchase or obtain health insurance (the so-called "individual mandate"). Some lower courts have upheld the mandate while others have struck it down. This split, coupled with the importance of the constitutional issues at stake, virtually guarantees that the high court will hear it.
In other developments, on October 20 a three judge panel in the Eighth Circuit Court of Appeals heard oral arguments in a case challenging the Affordable Care Act brought by Missouri Lieutenant Governor Peter Kinder.
Essential Benefits
The Affordable Care Act specifies just 10 broad categories of benefits that must be provided and gives the Secretary of Health and Human Services (HHS) very broad authority to develop the specifics for an essential health benefits package. On October 7, the Institute of Medicine (IOM) released a long-awaited report providing principles for how to decide what benefits to cover. The news headlines stressed the report's recommendation that affordability of coverage should be a higher priority than the comprehensiveness of the list of benefits.
In addition, the IOM specifically recommends that existing state mandates not be given special consideration, arguing that many, if not most, mandates are not based on significant analytical or scientific review. The Affordable Care Act's requirement, however, that new plans cover US Preventive Services Task Force screenings with "A" and "B" recommendations means that evidence-based cancer screenings will almost certainly be included in any package.
Overall, the report represents a very important step forward in defining this crucial piece of health care reform. A robust essential benefits package has the potential to provide an historic improvement over a system that has resulted in insurers selling health plans that are wholly inadequate to meet the needs of someone with a chronic disease such as cancer. ACS CAN and other consumer groups will engage administration officials in the coming weeks to better understand how HHS intends to proceed with developing a proposed regulation for the essential benefits package. Read the ACS CAN statement.
Prevention
American Cancer Society and ACS CAN CEO John R. Seffrin, PhD testified alongside leaders from the American Diabetes Association and American Heart Association on October 12 before the Senate Committee on Health, Education, Labor and Pensions at a hearing on the need for a health care system that better incorporates, coordinates and values quality and prevention. Read Dr.Seffrin's testimony and ACS CAN's press release.
Dr. Seffrin, a member of the Affordable Care Act-created federal Advisory Group on Prevention, Health Promotion, and Integrative and Public Health, argued that a unified focus on prevention relies upon individuals, governments, and nonprofits. Coverage for preventive screenings, the creation of the National Prevention Strategy and initiatives supported by the Prevention and Public Health Fund are key elements of this approach. Any cuts to the Prevention and Public Health Fund would undermine our nation's ability to better focus our health care system on health and wellness.
Prevention Benefits
The Centers for Medicare & Medicaid Services (CMS) reported that nearly 20.5 million people with Medicare reviewed their health status at a free Annual Wellness Visit or received other preventive services with no deductible or cost sharing this year. In addition, nearly 1.8 million people with Medicare have received discounts on brand-name drugs in the Medicare Part D coverage gap, also known as the "donut hole," between January and August of this year. The total value of discounts to people with Medicare in the donut hole is nearly $1 billion through August of this year, with an average savings of $530 per beneficiary.
Exchange Comments
ACS CAN filed comments on October 24 with the Department of Health and Human Services (HHS) on the proposed rule on the development of marketplaces for insurance plans sold to individuals and small businesses under the Affordable Care Act. The comments encourage the administration to:
- Clarify and strengthen the rule to benefit patients and consumers, such as by defining parameters for a federally-run health exchange as well as scenarios that would constitute a federal-state exchange partnership that would guarantee consumers seamless access to meaningful health care;
- Require state-run health exchanges to offer coverage that is comparable in adequacy and affordability to plans offered in federally-run exchanges
- Prohibit members with conflicts of interest from sitting on exchange governing boards; and,
- Provide consumers with the most comprehensible information to make enrollment as user-friendly as possible.
Health Benefits Information
ACS CAN filed comments with HHS, the Department of Labor, and the Internal Revenue Service on the proposed rule that defines the standard information that must be available to consumers to explain which health benefits are offered in each plan as required under the Affordable Care Act. The comments build on an already strong rule in an effort to increase the availability of information that will help consumers make the best decision about coverage for themselves and their families through the inclusion of consumer-tested language, availability of plan materials in multiple languages and commitment to improve the standard document over time to best accommodate the information needs of existing and perspective plan holders.
Accountable Care Organizations
The Centers for Medicare and Medicaid Services (CMS) late last week released the final rule for the Affordable Care Act's key health care delivery reform -- Accountable Care Organizations (ACOs). ACOs are groups of providers and hospitals that agree to come together to deliver higher quality care at a reduced cost. ACOs will be paid bonuses for saving Medicare money and performing well on certain quality measures.
ACS CAN submitted comments to HHS acknowledging the potential of ACOs to improve the health and quality of care for cancer patients. Although HHS did not address all of our specific recommendations in the final rule, ACS CAN is pleased that the final regulation supports a strong foundation in primary care; incentives to deliver more coordinated, integrated care to patients with chronic diseases such as cancer; and ongoing performance monitoring to improve quality. ACS CAN will continue to monitor ACOs and other delivery reforms to assess their impact on cancer patients.
State Update
Listening Tours Resume
HHS resumes its series of "listening tours" this month, this time on the topic of the Essential Benefits provision in the Affordable Care Act. The Essential Benefits regulation has not been released yet, but, as you know, the Institute of Medicine issued recommendations that will inform that process. The first two meetings are scheduled for Friday, November 4 in Chicago and Tuesday, November 8 in Boston. The format is similar to the listening tours held in September on the proposed health insurance exchange regulations released during the summer. Formal testimony is not allowed, but general comments are permitted. ACS CAN will provide ACS CAN and/or Division advocacy staff planning to attend with relevant background material.
Exchanges
Although the vast majority of states are not in session, many are working on legislation to establish a health insurance exchange so the implementation process can begin as early as possible in 2012. ACS CAN is working closely with Division staff across the country to lay the groundwork for state health exchanges that support the needs of cancer patients and their families. As you know, the federal government plans to operate exchanges in states that do not have a HHS-certified exchange by January 1, 2013.
Community Health Centers
Five hundred community health centers in 44 states across the country will receive approximately $42 million over the next three years that was authorized in the Affordable Care Act. The funding will help improve the coordination and quality of care community health centers deliver to people with Medicare. This demonstration project, operated by CMS in partnership with the Health Resources Services Administration (HRSA), will test the effectiveness of doctors and other health professionals working in teams to coordinate and improve care for up to 195,000 Medicare patients. Participating health centers are expected to help patients manage chronic conditions as well as actively coordinate care for patients.
Disparities
HHS announced it has finalized new standards to improve the monitoring of health data by race, ethnicity, sex, primary language, and disability status. The standards for collection and reporting are intended to help federal agencies refine population health surveys so that researchers can better understand health disparities and implement effective strategies for eliminating them.
CLASS Act
HHS recently announced that the Community Living and Assisted Support Services (CLASS) Act, enacted as part of the Affordable Care Act, would not be implemented. The CLASS Act was intended to create a voluntary, long-term care services insurance program. During the legislative process, serious doubts were raised about its financial viability. Per Congress' direction, HHS conducted additional analysis and after extensive study concluded that the program was not financially viable and would not be implemented. ACS CAN did not take a position on the CLASS Act during the legislative debate.
The CLASS Act is a stand-alone section of the law, the program is not connected to any of the other substantive provisions, and its termination does not affect implementation of any other aspect of the Affordable Care Act. Although it has no policy implications for other provisions in the Affordable Care Act, it does affect the overall budget because premiums collected through the CLASS program would have counted as revenue. When the Affordable Care Act was enacted, the Congressional Budget Office estimated that the law would reduce the deficit by $143 billion over 10 years. Cancellation of the CLASS Act reduces that figure by approximately $73 billion.
Workplace Wellness
Attached is a joint response from ACS CAN, the American Diabetes Association, and the American Heart Association to a segment on Comedy Central's Daily Show that claimed the groups opposed legislation that would allow employers to offer incentives to people who exercise. In fact, the bill enabled employers to reduce the health care premiums of people who met specific health targets (such as not smoking or maintaining low blood pressure), but also penalized people with pre-existing conditions who could not meet the targets by charging them more. ACS CAN and its preventive health partners worked with the lawmaker in an effort to improve the bill in question. ACS CAN carefully communicated its position to The Daily Show as they were preparing the segment. It is also important to note that language almost identical to provisions of the bill in question actually did become law as part of the Affordable Care Act.
ACS CAN and the American Cancer Society support comprehensive wellness and health promotion programs that utilize incentives, such as discounted gym memberships, for employees, but oppose restricting access to health care for those who need it most. As the statement says, ACS CAN and its partners continue to work openly and constructively with lawmakers to encourage healthy lifestyles and improve access to quality, affordable health care for all Americans.
This message is being sent to NHO Senior Staff, ACS Division Mission Vice Presidents, ACS Advocacy Leaders, ACS Advocacy Personnel, Media Advocacy and ACS CAN Staff.
Health Care and You Web Chat
Health Care and You, the coalition of national health groups representing seniors, doctors, nurses, hospitals, pharmacists, and patients, held a Web chat on October 27 about the Pre-Existing Condition Insurance Plan (PCIP) created in the Affordable Care Act. Erin Reidy, associate director of policy at ACS CAN, was a featured guest and answered questions throughout the chat. ACS CAN is a founding member of Health Care and You, which is educating providers, patients, and the public nationwide with straightforward information about the Affordable Care Act and its provisions.
Videos
The Robert Wood Johnson Foundation has produced a series of animated, consumer-friendly videos about the Affordable Care Act, available on the Foundation's You Tube channel.
FAMILY SMOKING PREVENTION AND TOBACCO CONTROL ACT
The Society and ACS CAN filed an amicus brief in federal court supporting the Family Smoking Prevention and Tobacco Control Act (FSPTCA) following the industry's filing of yet another lawsuit challenging efforts to implement the FSPTCA's strong graphic warning labels.
The brief provided the court with critical information on the health effects of tobacco use, as well as studies citing the efficacy of such graphic warnings used in other countries.
Congratulations to the South Atlantic Division! The town of Hampton, South Carolina passed a comprehensive smoke-free ordinance on October 19. When the law takes effect on January 1, 2012, it will become the state's 42nd 100 percent smoke-free community.
TOBACCO TAXES
Louisiana voters approved a measure that includes a provision to keep the cigarette tax at its current rate rather than being reduced by 4 cents.
TANNING
Big news from the California Division -- California enacted the nation's first law banning tanning bed use by anyone under the age of 18. This law reflects the policy of the Society which supports a ban on tanning bed use for minors. Congratulations to volunteers and staff on a groundbreaking achievement!
QUALITY OF LIFE
President Obama issued an executive order in an effort to alleviate and address the drug shortage issue. ACS CAN believes the move was an essential step to address the growing drug shortage crisis, which is denying people with cancer access to lifesaving medications. The executive order takes similar steps as those called for in bipartisan legislation, which ACS CAN supports, that would give the Food and Drug Administration the ability to receive advance notification from drug manufacturers about factors that could lead to drug shortages that leave potentially lifesaving medicines out of reach for patients. Read the ACS CAN statement.
ELECTORAL PROGRAM
ACS CAN has been working to create visibility on issues important to the fight against cancer in off-year state elections in New Jersey, mayoral and city council races in Indianapolis, and a special state Senate election in Iowa. Candidate questionnaires on issues such as state health insurance exchanges, smoke-free laws, tobacco control, and funding for cancer research, prevention, and early detection programs are central to the effort. Other voter education efforts are being employed as well. See the New Jersey, Iowa, and Indianapolis voter guides and check out the WIBC-Indianapolis story.
Christopher W. Hansen
President
American Cancer Society Cancer Action Network (ACS CAN)