News
November 2011 Monthly Advocacy Update
CANCER RESEARCH AND PREVENTION PROGRAMS
Super Committee
Shortly before its November 23 deadline, the bipartisan Joint Select Committee on Deficit Reduction, better known as the "super committee," announced it was unable to devise a deficit reduction plan that a majority of the committee's members could support. Under the Budget Control Act, the legislation that created the super committee, automatic across-the-board spending cuts are supposed to be made beginning in calendar year 2013. Cuts are to be shared equally between domestic discretionary and defense programs. Social Security, Medicaid, veterans' benefits, and other essential programs are exempt from the automatic cuts. Reductions to Medicare would be limited to two percent and impact providers only, with no cuts for beneficiaries.
The across-the-board cuts are in addition to an earlier round of cuts called for in the Budget Control Act, which total $900 billion over 10 years to domestic discretionary spending. No cuts were made to Medicare and Medicaid. Funding for cancer research, prevention and early detection programs are not likely to suffer serious cuts in 2012, but what happens in the following years is more difficult to predict.
The super committee's inability to reach an agreement, however, does not rule out the possibility that Congress will find another means of forestalling sweeping spending cuts. Since the reductions do not take place until January 2013 Congress is expected to revisit the issue after the 2012 election. So while the Budget Control Act saved the economy from major harm by forestalling an historic default on the nation's debt, the hardest choices are again being postponed, making it hard to predict beyond 2012 what the ultimate impact on research and other programs important to cancer patients and survivors will be.
Also important to keep in mind is that more than 50 percent of cancer patients rely on Medicare and Medicaid for their treatment. ACS CAN fought hard to prevent cuts and protect access to these programs. On that front, the lack of a super committee plan yielded a good outcome as the looming across-the-board cuts will not be applied to Medicaid and or result in cuts to Medicare benefits.
Appropriations
With the super committee process concluded, Congress is now focused on finishing its appropriations work. Funding for the agencies responsible for cancer research and prevention programs are among the nine bills still pending. Negotiations are underway to set the final spending levels and determine related policy provisions.
A stop gap spending measure currently funding the government expires on December 16. There will be either another temporary funding measure enacted to fund the government through early next year or the remaining bills are likely to be rolled into an omnibus package for the president's signature before the end of the year. Congress did complete several spending bills before Thanksgiving that the president signed, including one that funds the Food and Drug Administration (FDA). The FDA will receive $2.497 billion for the 2012 fiscal year (FY 2012), a $50 million increase above FY 2011, but $234 million below the president's request. Securing increased funding for the FDA is a priority for the ACS CAN-led One Voice Against Cancer (OVAC) coalition.
ACS CAN Campaign Update
ACS CAN advocates should be proud of the campaign being waged to ensure that the fight against cancer is a priority in all policy discussions. The most recent activities centered on the super committee are just a part of ACS CAN's broader efforts to encourage Congress to make cancer a national priority by protecting funding for cancer research, prevention, early detection and access to health care. ACS CAN's message and the urgency of its cause remain critical. Congress failed to propose a long term solution, but discussions over federal spending will continue and priorities will have to be set. In engaging super committee members as well as congressional leadership, and House and Senate appropriators, ACS CAN advocates laid down a marker. The campaign, furthermore, has been successful in energizing volunteers and sharing ACS CAN's message in the local communities and beyond.
A central feature of the campaign was a new national TV ad calling on Congress to make cancer a national priority by protecting funding for cancer research, prevention, early detection and access to health care. The national ad campaign is the second ever for ACS CAN. The ad debuted on Sunday, November 6 during NBC News' "Meet the Press" in the Washington, D.C. media market and later ran on network affiliates in the D.C. media market and on major cable networks nationwide, including CNN, Fox News and MSNBC. The ad is running again this week and next week and has been viewed more than 26,500 times on the ACS CAN You Tube channel. Read the ACS CAN press release.
The centerpiece of the ad is the creation of a "Wall of Hope" in front of the U.S. Capitol made up of more than 1,500 sticky notes filled with messages from people across the country to loved ones who have battled cancer. Following on the ad's theme, there were more than 5,000 entries in a "submit your own sticky note" story contest -- the highest number of participants ever for this type of call to action. The winning entry is featured in ACS CAN's new online ad.
Nationwide Activities
The TV ad is just one facet of ACS CAN's campaign to make cancer a national priority. In addition to the ad, grassroots events -- many of them inspired by the sticky notes concept -- are taking place nationwide to draw lawmakers' attention to ACS CAN's message in their districts and states. Read letters to the editor from ACS CAN volunteers in Kentucky and Michigan, coverage of events in Arkansas, Minnesota, and Mississippi, a preview of an event in Michigan as well as a Minneapolis Star Tribune editorial making the case for federal funding to fight cancer.
In Texas, volunteers and staff took ACS CAN's message on the road with a bus tour through communities in the Congressional district of super committee co-chair Representative Jeb Hensarling (R-TX). Petition signatures are being collected throughout the tour. Media coverage includes stories in The Athens Review, The Jacksonville Daily Progress, KNET/KYYK radio, and The Terrell Tribune.
University of Wisconsin Colleges Against Cancer chapters from four different campuses banded together to assemble their own sticky note "Wall of Hope." The activity received coverage from Channel 3000, WFXS, and Wisconsin Radio Network.
Litigation
Supreme Court Takes Case
The Supreme Court announced on November 14 that it will hear arguments in lawsuits challenging the Affordable Care Act. The announcement signals that the nation could receive the clarity it so urgently needs around whether the law, and the critical patient protections it includes, can be sustained in their current form.
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 fought to include these key provisions in the law to expand access to health care for people with cancer and their families. That support was based on the Society's 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. But these provisions are at risk from legal challenges to the constitutionality of the individual responsibility requirement. In response to those challenges, the Society and ACS CAN filed a friend-of-the-court brief at the federal appellate level in support of sustaining provisions that are critical for people with cancer and their families. The brief was filed jointly with the American Diabetes Association and the American Heart Association. The organizations plan to file a similar brief with the Supreme Court. 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.
DC Circuit Upholds Law
In another important development, the D.C. Circuit Court of Appeals in early November became the latest federal appeals court to weigh in on the constitutionality of the Affordable Care Act. The court upheld the law, including the requirement the individual mandate. In its opinion, the court reasoned that the U.S. Constitution allows Congress to pass laws that are necessary and proper to the regulation of interstate commerce. Rejecting challengers' arguments that requiring people to purchase a good or service is not "regulating commerce," the opinion discussed well-established principles outlined by the U.S. Supreme Court in previous cases that create precedent for this ruling.
To date, four federal appeals courts have issued rulings, with two upholding the law, one dismissing the case on technical grounds, and one striking down the individual mandate but leaving the rest of the law intact. For more information, see ACS CAN's updated primer on Affordable Care Act litigation.
Administrative Simplicity
The Affordable Care Act requires the development of a Summary of Benefits and Coverage, a document that would be issued by virtually every health plan beginning on March 23, 2012 to provide consumers with basic information about insurance plans that is not available today. The summary would be short and easy to understand, allowing consumers to compare plans based on coverage for significant medical conditions, premiums, and other information - not just within a company or exchange, but across employers as well for families that have multiple health insurance options.
This is an important component of the fourth "A" - administrative simplicity -- in the American Cancer Society and ACS CAN's four "A's" of meaningful health coverage. The objective is to provide all consumers with basic information they can use to compare plans and begin to understand differences ACS CAN submitted extensive comments developed in coordination with a number of other consumer groups on the proposed disclosure requirement regulation released over the summer. More recently, there have been indications that the issues raised in those comments may not be reflected in the final regulation. There may be plans to postpone the date the regulation takes effect and, more importantly, that many health plans, including large employer plans, may be exempt from the disclosure requirement. ACS CAN believes this would be a significant setback for administrative simplicity and consumer education and creating transparency in the marketplace - a key factor in assuring competition.
ACS CAN and its allies sent a letter to the White House and on November 18 invited volunteers who have taken action on health care reform and access to care issues to contact the White House via www.fightcancer.org/benefits and insist that consumers take precedence over insurance companies.
To date, hundreds of emails have been sent -- meaning the patient voice has been clearly articulated! ACS CAN will continue to press the importance of this issue with the White House through a variety of advocacy tools, an effort bolstered by the latest Kaiser Family Foundation health tracking poll showing that the summary of benefits and coverage requirement enjoys a 60 percent favorability rating.
State Update
The Department of Health and Human Services (HHS) announced the release of $220 million worth of grants to 13 states to support implementation of the Affordable Care Act and the establishment of state exchanges.
In addition, HHS' conducted a "listening tour" in November to gather feedback on what health benefits insurance companies should be required to cover under the Essential Benefits provision of the Affordable Care Act. The regulation has not been released yet, although the Institute of Medicine issued recommendations that will inform that process. Sessions were held in Atlanta, Boston, Chicago, Dallas, Denver, Kansas City, New York City, Philadelphia, San Francisco and Seattle. Society Division and ACS CAN staff and volunteers attending the meetings were equipped with materials and talking points from ACS CAN to ensure consistent communication about the need for an essential health benefits package that provides people with cancer access to the full continuum of care, from prevention and early detection to treatment to follow-up care.
Medical Loss Ratio
The Affordable Care Act requires insurers to spend at least 80 percent of their premium revenue on health care claims and quality improvement costs. Beginning this year, insurers who miss the target are required to rebate the difference to policy holders. Last week HHS released the final rule governing medical loss ratio (MLR) calculations, the percentage insurers spend on benefits versus administrative costs. Overall the rule is favorable to consumers and specifically states that insurance broker and agent fees are not to be included as part of the calculation. ACS CAN strongly supports this aspect of the rule, believing that the inclusion of fees and commissions more accurately reflects the proportion of spending by insurers on health care as opposed to administrative expenses. Removing commissions from the calculation would have violated the intent of the Affordable Care Act and rendered the MLR meaningless to consumers.
Prevention
During the super committee's deliberations, a proposal was floated to reduce the deficit in part by cutting $8 billion from the Prevention and Public Health Fund. ACS CAN wrote individually and with other groups to the super committee to voice strong objections to such a proposal.
Training
In late November ACS CAN kicked off a series of training sessions for ACS CAN and Division advocacy staff on the next steps in state implementation of the Affordable Care Act.
Polling
The latest Kaiser Family Foundation tracking poll shows that support for the Affordable Care Act rebounded somewhat after a dropping last month.
Health Leader Survey
The Commonwealth Fund's most recent survey of health care and health policy leaders found that nearly nine in 10 believe federal and state officials should continue to implement the Affordable Care Act. When asked about specific provisions such as the insurance reforms, Medicaid expansion, and tax subsidies for premiums, large majorities of the respondents remained supportive. On the insurance mandate, 84 percent said this was a key strategy to expanding and improving health care coverage.
FAMILY SMOKING PREVENTION AND TOBACCO CONTROL ACT
In a disappointing development, a federal district court judge in Washington, DC granted the tobacco industry an injunction barring the Food and Drug Administration (FDA) from proceeding with plans to place more graphic cigarette warning labels on cigarette packaging and advertising pending a decision on the merits of the industry's lawsuit challenging the regulation. In a particularly bad twist, the judge discussed whether the tobacco industry or the public would suffer "irreparable harm" if the regulations are put in place or delayed. Under this judge's analysis, the tobacco industry would suffer irreparable harm if the regulations are implemented on time, but the public would not suffer if the regulations were delayed. The federal government is appealing the decision to the DC Circuit Court of Appeals.
The tobacco industry argues that the labels infringe on their First Amendment right to free speech. A similar but broader lawsuit was filed last year in Kentucky, where a federal District Court judge upheld most provisions of the law, including the FDA's ability to require graphic warning labels generally. In that same decision, the court in Kentucky struck down some minor provisions of the law. An appeal is pending in that case at the Sixth Circuit Court of Appeals. ACS CAN and other health partners have filed amicus briefs in support of the FDA in both lawsuits, providing extensive citations of international studies proving that these warnings are effective and scientifically based.
Please join me in congratulating volunteers and staff in the Great West, Mid-South, and South Atlantic Divisions on several important victories. First, the town of Pendleton became South Carolina's 43rd smoke-free community in early November with a comprehensive ordinance that goes into effect on February 1, 2012.
In the Mid-South, city commissioners in Corbin, Kentucky voted 4-0 in favor of a 100 percent comprehensive smoke-free workplaces and public places ordinance on November 23. The law took effect immediately, making Corbin the 32nd smoke-free community in the nation's second largest tobacco growing state. On November 29, the city of Midfield, Alabama passed a comprehensive smoke free ordinance covering all workplaces, including restaurants, bars, hotels, motels, long-term care facilities, and private clubs. ACS CAN was proud to partner with the Division with funds to provide staff support to work on the Midfield ordinance.
Finally, the city council of Boise, Idaho unanimously approved a 100 percent smoke-free workplace ordinance that includes bars, restaurants, and private clubs. ACS CAN volunteers and staff in the Great West deserve great credit for leading this campaign, which ACS CAN underwrote. The law takes effect on January 2, 2012 and certainly paves the way for a statewide law.
TOBACCO CONTROL
State Tobacco Control Spending
ACS CAN joined with the Campaign for Tobacco Free Kids, the American Lung Association, the American Heart Association and the Robert Wood Johnson Foundation to release a new report on state funding for tobacco prevention and cessation programs. Entitled "A Broken Promise to Our Children: The 1998 State Tobacco Settlement 13 Years Later," the report concludes that spending levels are woefully inadequate as states have slashed funding for programs to reduce tobacco use by 12 percent in the past year and by 36 percent over the past four years, threatening the nation's progress against tobacco. Read the press release.
Issued annually, the report assesses whether states have kept their promise to use funds from the landmark 1998 settlement between them and Big Tobacco -- expected to total $246 billion over the first 25 years -- to fight tobacco use. In the fiscal year that began October 1, states will collect $25.6 billion in revenue from both the tobacco settlement and tobacco taxes, but will spend only 1.8 percent of it -- $456.7 million -- on programs to prevent kids from smoking and help smokers quit. This means the states are spending less than two cents of every dollar in tobacco revenue to fight tobacco use. With nearly 20 percent of Americans still smoking, the report warns that continued progress against tobacco use is at risk unless states increase funding for tobacco prevention and cessation programs. The report also calls on states to increase tobacco taxes and, for states that have yet to do so, to enact strong smoke-free laws that apply to all workplaces, restaurants and bars.
Major League Baseball Restricts Use of Smokeless Tobacco
Last week Major League Baseball (MLB) announced that its new contract with the players' union prohibits players from using and/or carrying smokeless tobacco products during games or when fans are present in the ballpark. In addition, smokeless tobacco products cannot be used during television interviews, at autograph signings, or at other fan-centered or team-sponsored events. Violators are subject to discipline. MLB and major league players will also participate in a nationwide public service campaign aimed at youth (and young ballplayers in particular) on the dangers of tobacco use.
The new tobacco limits are in part the result of hard work by a broad, national coalition of supporters and fans that included the American Cancer Society, which was a member of the Knock Tobacco Out of the Park Coalition. Although the final result fell short of the ultimate goal of prohibiting smokeless tobacco from ballparks entirely, the action is nevertheless a significant step forward, marking the first time the league and players have recognized that smokeless tobacco use is a health hazard and sets a poor example. Read the coalition's statement.
OBESITY
The Center for Medicare and Medicaid Services announced Medicare would begin covering weight loss counseling in an effort to reduce obesity. An estimated 30-plus percent of the Medicare population is thought to be obese. Under the Affordable Care Act, these services will be offered without cost sharing.
DRUG SHORTAGE
The American Cancer Society and ACS CAN are closely monitoring the nation's drug shortage. The overall number of drugs in shortage has grown dramatically in recent years, from 56 drugs in 2006 to a record 178 drugs in 2010. The number of drugs in shortage this year is expected to far exceed last year's total - perhaps topping 300. Read about a recent Congressional hearing on the issue.
Experts have cited several possible factors for the drug shortage problem, including:
- Manufacturing difficulties, such as quality control issues that shutdown production lines or inaccurate projections of demand for a certain drug;
- The small number of companies with the capacity to produce a drug if one manufacturer ceases production; and,
- Tight production schedules that are not readily altered if a manufacturing problem occurs or if demand increases faster than anticipated.
Some name-brand cancer drugs are part of the problem, but the situation is especially acute for cancer patients prescribed generic injectable drugs. Of the 34 generic cancer drugs on the market, 17 are currently in short supply. In many cases these drugs are essential to effective cancer treatment and their lack of availability can be potentially disastrous. Some cancer patients have been completely unable to obtain necessary drugs while others are forced to pay exorbitant prices on an emerging "gray market," where drugs in short supply are sold legally at a reported cost of up to 650 percent of the original price.
The Society and ACS CAN are actively engaged with other stakeholder groups, including Congress, the Administration, and generic and name-brand pharmaceutical companies, to better understand the causes of the problem and possible solutions to it. Also as part of this effort, the Society's National Cancer Information Center in Austin, Texas, is now tracking calls from patients who have experienced drug shortages. In addition, the Society and ACS CAN are asking Divisions to collect patient stories. A fact sheet prepared by the ACS CAN policy team is attached for further reading.
Chris Hansen | President of ACS CAN
ACS Cancer Action Network | American Cancer Society Cancer Action Network, Inc.