News
November 2012 Monthly Advocacy Update
2012 ELECTION
As ACS CAN continues to analyze how the election results will impact our work at the federal, state and local levels, one thing is certain -- we are ready to engage new and returning lawmakers in the fight against cancer. With the election behind us, it's time for our nation to renew its commitment to bringing cancer under control as a major health problem by adopting laws and policies that help people fight the disease. We're looking forward to working with lawmakers from both sides of the aisle on our priority issues so we can move closer to eliminating suffering and death from this devastating disease.
ACCESS TO CARE - AFFORDABLE CARE ACT
Post-Election Outlook
Voters remain divided in their views of the Affordable Care Act according to exit polls, but President Obama's re-election virtually assures that implementation of provisions in the health reform law important to cancer patients and their families will continue. There is much work to be done leading up to the January 1, 2014 implementation deadline and we will continue to call upon elected officials to work together in a bipartisan effort to implement the health care law as intelligently as possible for patients and their families.
The American Cancer Society made it a priority to improve access to quality health care nationwide after Society research showed that people without health coverage are more likely than those with private insurance to be diagnosed with cancer at advanced stages -- and are less likely to survive the disease. ACS CAN has been the voice of people with cancer throughout the debate and worked to ensure the law included critical patient protections and initiatives to prevent disease. The Affordable Care Act is by no means perfect, but is an important means of helping to advance the Society and ACS CAN's lifesaving missions.
Draft Regulations
Department of Health and Human Services (HHS) released a series of long awaited draft regulations on November 20. Of greatest importance to cancer patients and their families are proposed regulations on essential health benefits (EHB), state insurance market reforms, and wellness programs. It is important to note that these are proposals, not final regulations, and the policies outlined in them are subject to change in the final rule. Because the administration needs to finalize the regulations soon, they have only provided short comment periods, with comments due by December 26 for the EHB and insurance market reform proposals, while the wellness regulation comment period closes in late January.
ACS CAN is reviewing and digesting the lengthy regulations, but after an initial read it appears the Administration has taken significant steps toward effective implementation of insurance market reforms that should benefit cancer patients. ACS CAN does, however, have some concerns that the level of flexibility being given to states may result in benefit restrictions and other limitations for people with cancer. ACS CAN will emphasize its concerns in comments to HHS. In the meantime, ACS CAN issued a brief statement on the importance of the EHB package for people with chronic diseases like cancer.
Attached is a brief summary of the regulations.
Summary of Draft Regulations.docx
Fiscal Cliff
Congress returned to Washington, D.C.. after the election for a lame duck session focused on the looming "fiscal cliff" -- the expiration of tax cuts on December 31 and deep across-the-board spending cuts scheduled to take effect January 2, known as sequestration. ACS CAN is actively monitoring the discussions, and will be weighing in through the "cancer lens". It is imperative for Congressional leadership, as well as individual members of Congress directly involved in the budget negotiations, to prioritize investments in cancer research, prevention, and early detection programs; funding to implement the Affordable Care Act; and protecting lifesaving programs such as Medicare and Medicaid that serve people with cancer and their families nationwide.
Exchanges
Despite a November 16 deadline for states to declare whether or not they will run their own health insurance exchange, many waited until the presidential election was decided before acting. As a result, HHS Secretary Kathleen Sebelius extended the deadline to December 14. HHS also gave states until February 15 to submit plans to establish a state-federal partnership exchange. ACS CAN has been leading efforts at the state level to ensure the exchanges meet the needs of cancer patients.
Enrollment
ACS CAN's work to raise public awareness about key provisions in the Affordable Care Act is continuing and we anticipate the pace of activity will accelerate as we move closer to full implementation. Current efforts include ongoing participation in the Health Care and You coalition and distribution of the Society's consumer friendly guide to how the Affordable Care Act helps cancer patients and their families. ACS CAN is also on the advisory board of Enroll America, a nonprofit dedicated to educating uninsured Americans about the law and helping them to enroll in a health plan as the exchanges go live. The group enjoys support from a diverse group of private companies, patient and consumer advocates, professional associations, and faith based groups. Articles on their work recently appeared in CQ HealthBeat and The Washington Post.
Medicaid
A Kaiser Family Foundation released a report showing that states with relatively large uninsured populations are likely to see increases in state costs should they offer Medicaid coverage more broadly to uninsured adults as called for in the Affordable Care Act. The increases, however, are expected to be small relative to decreases in the uninsured population and increases in federal matching funds. Meanwhile, States that offered broader Medicaid coverage prior to the Affordable Care Act may see savings mainly due to the higher federal matching rates.
The analysis further indicates that if all states took advantage of the Affordable Care Act's Medicaid provision, state spending would increase less than three percent, while federal Medicaid spending would increase by 26 percent. As a result, an additional 21.3 million people would gain health coverage by 2022. Taken together with other coverage provisions of the Affordable Care Act, the number of uninsured individuals could be cut by 48 percent.
The report also points out that Medicaid enrollment and spending is expected to rise even in states that do not expand coverage because of other Affordable Care Act provisions, such as the requirement to simplify enrollment and health exchange implementation, that could increase Medicaid enrollment among people who are currently eligible but not yet enrolled in the program. Several governors have said their state will opt out, but ACS CAN expects a significant number of legislatures to take up the issue in 2013.
ACS CAN believes all Americans need the security of quality health coverage. The money that has already been programmed for states to cover more uninsured people would increase access to lifesaving cancer prevention and early detection measures, treatment, and follow up care. ACS CAN's work to educate state policy makers on the health and economic benefits of offering Medicaid to more of its citizens is are ongoing.
Primary care
A study in Annals of Family Medicine found that the US will need nearly 52,000 more primary care physicians by 2025 because of the population growth, aging, and health care reform. One of the Society and ACS CAN's "4 A's" of meaningful health coverage is timely access to the full range of evidence-based health care services, including primary care. The Affordable Care Act strengthens the primary care workforce through student financing, additional primary care residency programs at teaching health centers, and training in cultural competency.
Ballot Initiatives
On Election Day, Florida voters rejected an amendment to the state constitution to overturn the law's individual mandate. Voters in Montana, Alabama and Wyoming approved similar amendments; however, the amendments do not have any impact on the federal law.
RESEARCH, PREVENTION, & EARLY DETECTION
Lawmakers returned to Washington for a lame duck session to address the "fiscal cliff" -- the looming expiration of tax cuts on December 31 and deep across-the-board spending cuts set to take effect on January 2, known as sequestration. Sequestration was set in motion under the Budget Control Act of 2011 and would come on top of significant spending cuts already made as part of the law. Lawmakers may act, or they may leave the heavy lifting to the next Congress.
The bottom line is that if nothing changes, priority cancer programs could be cut by nearly eight percent starting January 2, 2013. Specifically, research at the National Institutes of Health (NIH) would be cut by $2.5 billion, including more than $450 million for cancer. Cuts to NIH would also lead to 2,300 fewer research grants, 33,000 fewer jobs nationwide, and $4.5 billion in decreased economic activity. The Centers for Disease Control and Prevention (CDC) would be cut $464 million. It is unclear how the cut would impact specific CDC programs, but if applied proportionately 50,000 fewer breast and cervical cancer screenings would be provided. For more, see the attached state-by-state fact sheets on the impact of sequestration on research and prevention.
ACS CAN Sequestration Fact Sheet - Prevention.pdf ACS CAN Sequestration Fact Sheet - Research.pdf
ACS CAN was out in force on Capitol Hill the week after the election with the One Voice Against Cancer coalition and Research!America to urge Congressional leadership and individual members directly involved in the budget negotiations to protect lifesaving investments in research, prevention, and early detection. In total, 28 participants from 16 organizations, including ACS CAN, held 42 meetings with Congressional leaders and other members playing a pivotal role in the ongoing negotiations.
A study published in the November issue of Cancer Epidemiology and Biomarkers found that the type of cancer a patient had influences their quality of life. The report underscores the need to enact bills introduced in Congress this summer with strong backing from ACS CAN. The legislation is aimed at reducing suffering and improving quality of life for patients facing serious illnesses such as cancer by expanding access to palliative care. ACS CAN volunteers are urging federal lawmakers to cosponsor the bills. In fact, nearly 30 lawmakers signed on as cosponsors after hearing from ACS CAN volunteers at our September Lobby Day. ACS CAN advertising running in Capitol Hill publications is also helping to enlist more cosponsors.
Indiana
Johnson County, Indiana commissioners voted unanimously to make worksites in the county smoke-free, including bars and private clubs. The ordinance takes effect on January 1, 2013. Kudos to volunteers and staff in Great Lakes on this important victory, which will help build momentum for a strong statewide law.
Smoke-free Cities
A recent CDC report found that residents in 30 of the nation's 50 largest cities are covered by a comprehensive smoke-free law covering all private workplaces, restaurants, and bars. The Society and ACS CAN have played a major role in nearly every state and local campaign to enact comprehensive smoke-free laws. The report was released November 15 to coincide with the Society's 37th annual Great American Smokeout. ACS CAN volunteers around the country used the occasion to call for tobacco control laws in their states and local communities. Read the ACS CAN statement.
TOBACCO TAXES
Illinois
Thanks to the efforts of ACS CAN volunteers and staff in Illinois, the Cook County Board voted 10-6 to increase the county cigarette tax by $1. The increase is scheduled to take effect on March 1, 2013. Combined with the state's recent $1 cigarette tax increase enacted earlier this year, Cook County's tax rate will be $3 per pack. Chicago, which is in Cook County, has a local tax as well, pushing the tax on cigarettes to $6.67 per pack, the second-highest in the nation behind New York City's $6.86. Congratulations Illinois!
DEPARTMENT OF JUSTICE LAWSUIT
On November 27, US District Court Judge Gladys Kessler ordered corrective statements intended to compensate for the tobacco industry's long history of misleading the public about the dangers of its products and prevent it from committing similar offenses in the future. Tobacco companies are required to include the statements in national broadcast and print advertisements and on corporate websites and cigarette box inserts. ACS CAN welcomes Judge Kessler's decision. The industry is guilty of knowingly and willfully deceiving the American public about the hazards of its products, and the corrective statements reflect that fact.
The Society and five other public health groups -- Americans for Nonsmokers' Rights, American Heart Association, American Lung Association, the Campaign for Tobacco-Free Kids Action Fund and National African American Tobacco Prevention Network -- are intervenors in the federal case, which was filed by the Department of Justice in 1999 to hold the tobacco industry accountable for more than 50 years of fraudulent and deceptive marketing practices. The industry has 60 days from the dates of the decision to file notice of appeal. Given past practice, we anticipate they will do so.
TOBACCO CONTROL
The number of adults who smoke and the intensity level of those that do declined between 2005 and 2011, according to a CDC report issued on November 8. Overall adult smoking rates fell from 20.9 percent to 19 percent between 2005 and 2011. However, there was no significant decline in smoking rates between 2010 and 2011. So while the data is promising, there is more to be done. In a statement, ACS CAN called on lawmakers at all levels of government to enact legislation and support measures proven to reduce tobacco use and save lives.
Non-Communicable Diseases
Society and ACS CAN CEO Dr. John Seffrin was a panelist at a recent Union of International Cancer Control (UICC) roundtable on non-communicable diseases (NCDs) held in tandem with consultations on the World Health Organization (WHO) Global Monitoring Framework on NCDs in early November.
The consultations resulted in member countries adopting nine global targets and 25 indicators for the Framework. Another important outcome was the inclusion of 16 non-governmental organizations in the discussions. ACS CAN is monitoring the process and working closely with HHS and partner organizations to ensure cancer is addressed strongly in the WHO NCD action plan.
Tobacco
From November 12-17, representatives of 140 of the 176 countries that are parties to the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) met in Seoul, South Korea for the 5th semi-annual Conference of the Parties to consider recommendations, guidelines, and protocols for implementation of the FCTC treaty. Although the United States has not ratified the treaty and therefore does not have the status of a party, the US is implementing provisions of the treaty through Food and Drug Administration regulation of tobacco products, as well as through state and federal tobacco taxes and smoke-free policies.
The Society and ACS CAN sent representatives to the Conference where their expertise, particularly on tobacco tax policies and international trade, helped shape the agenda. Deliberations at the conference will influence tobacco control policies worldwide as the FCTC is implemented. Progress is critical because tobacco use will cause an estimated one billion deaths globally in this century.
Over the past year, ACS CAN, in partnership with the Society, has expanded its involvement in tobacco related trade issues to ensure US trade policies reflect public health priorities. Big Tobacco's relentless pursuit of global markets is unacceptable and we must put an end to their misuse of trade agreements and international tobacco control laws.
Training
With support from ACS CAN, the Society provided an intensive advocacy workshop for partner groups in Brazil from November 21-23. The training was aimed at strengthening advocacy skills. Focal topics included an advanced overview of legislative, executive and judicial decision making process, coalition building, federal health appropriations, and public health policy. Curriculum design and training was delivered by a premiere government relations firm based in Brasilia and was brokered by ACS CAN.
The training was part of the Society's long term and ongoing efforts in Brazil to strengthen advocacy efforts for comprehensive cancer control, including women's cancers, tobacco control, and palliative care. Brazil is the largest country in Latin America with a significant cancer burden and is a strategic priority for the Society in global mission delivery efforts.
ADVOCACY INTEGRATION
Please join me in welcoming ACS CAN's new senior regional directors: Paul Hull (Central), John Killpack (Western), Robert Morris (Southern), and Ruth Parriott (Central). Paul, Robert, and Ruth come to ACS CAN after years of successful leadership of advocacy campaigns and programs in the Florida, Mid-South, and Midwest Divisions respectively. John joins ACS CAN from AARP, where he was national director for Campaign Strategy. The positions were created as part of the new regional structure that integrates ACS CAN and Division advocacy programs. They report to Kelly Headrick, vice president, Field Operations and will greatly enhance ACS CAN's ability to support volunteers and staff as we become more efficient, strategic, and effective in mission-critical advocacy efforts nationwide.
Chris Hansen | President
ACS Cancer Action Network | American Cancer Society Cancer Action Network, Inc.