ACCESS TO CARE
Senate Wrestles with Health Care Legislation
Leadership in the U.S. Senate is currently indicating they are looking to vote on a health care bill before the July 4 recess. Unlike the U.S. House of Representatives, the Senate must wait for the Congressional Budget Office (CBO) to score the legislation they want to bring to the floor to ensure that it complies with complex budget reconciliation targets. Proposed reductions to Medicaid funding remain a major sticking point, especially among the states that opted to expand access to Medicaid under the Affordable Care Act (ACA).
Assuming a repeal bill passes the Senate by June 30, Republicans would have one month before the August recess to merge the House and Senate bills, which are expected to have major differences.
ACS CAN is urging the Senate to preserve critical patient protections in the current law, including prohibiting medical underwriting, banning annual and lifetime caps on coverage, and guaranteeing access to essential health benefits regardless of where you live.
Health coverage must be affordable both in premium and in total out-of-pocket costs. Income-based premium tax credits, cost-sharing reductions, and the Medicaid expansion work together to maximize the number of people who can obtain health coverage. A flat credit along with Medicaid cuts would significantly affect the ability of millions of patients to afford and access health insurance. It is the combination of these proposed changes to the current law that resulted in the CBO to conclude that the House passed bill would reduce the number of insured by an estimated 23 million people.
Another important stakeholder in this debate are the nation's governors. Prior to scheduled calls between a select group of governors and Senate leadership this week, ACS CAN sent a letter to governors of both parties across the country detailing our concerns about proposals that would result in dramatically reducing Medicaid funding; reintroducing discrimination based on health history; waiving minimum essential benefits requirements; eliminating steady funding streams that subsidize affordable health coverage; and instituting continuous coverage requirements that could discriminate against those who cannot work due to illness or who have to take leave to care for a loved one.
Activities in the states
- In response to ACS CAN's team of determined and persuasive volunteers in Mississippi, the state's entire congressional delegation has signed on to the Removing Barriers to Colorectal Cancer Screening Act. This legislation would eliminate surprise costs to seniors on Medicare who have a polyp removed during a routine colonoscopy. In addition to the full congressional delegation signing on as co-sponsors, Sen. Roger Wicker was the first Republican co-sponsor to sign on to the original bill when it was first introduced in the Senate. He did so at the request of his constituents on the ACS CAN Mississippi team.
- Effective July 1, Nebraska's colorectal cancer screening program will provide funding for outreach and follow-up. ACS CAN advocates for initiatives aimed at increasing colorectal cancer screening rates.
- On May 26, Gov. Brian Sandoval signed into law bills to expand the Nevada Cancer Drug Donation Program. The revised program will include all prescription drugs – except controlled substances – and authorize the substitution of biosimilars.
- On May 23, Texas governor Greg Abbott, signed into law a bill that provides patient protections related to step therapy protocols for prescription medications. Step therapy practices begin medication for a medical condition with the most cost-effective drug therapy and progresses to costlier therapies only if necessary. The new law becomes effective September 1.
CANCER RESEARCH, PREVENTION, AND EARLY DETECTION
White House Budget Proposal Threatens Cancer Funding
The White House submitted a detailed Fiscal Year 2018 (FY18) budget proposal to Congress last month that would cut funding for the National Institutes of Health (NIH) by nearly $7.2 billion (21 percent). This amount includes a proposed $1.2 billion (21 percent) cut to the National Cancer Institute (NCI) and an $18 million (5 percent) reduction of the Center for Disease Control (CDC) cancer control programs. Additionally, the Office of Smoking and Health would be eliminated under a proposed consolidation of CDC chronic disease programs. Congress is now holding budget oversight hearings and we expect to see a FY18 budget begin to work its way through Congress later this month.
ACS CAN continues to actively advocate for strong Congressional support for cancer research and prevention funding on various fronts. In addition to our direct lobbying, ACS CAN leads the One Voice Against Cancer (OVAC) coalition that held grassroots lobby days on June 5 and 6. ACS CAN is also mobilizing grassroots advocates to meet with their representatives when lawmakers return home for upcoming Congressional district work periods. Our broad traditional and social media strategy continues to both thank Congress for support for the recent increase in research funding and to call on members of Congress to prioritize NIH and NCI funding in FY18.
Through our participation in United for Medical Research (UMR), ACS CAN is working to make the case that NIH funding is good for economic growth. UMR recently released a new report that estimates that FY16 NIH funding supported 380,000 jobs and $65 billion in economic activity across the country. The report also estimates the potential job losses under the proposed cut in the president's budget.
ACS CAN Supports Bill to Accelerate Childhood Cancer Drug Development
On May 1 and 2, the Alliance for Childhood Cancer, of which the American Cancer Society and ACS CAN are members, held its sixth annual Action Day. During their meetings on Capitol Hill, more than 200 childhood cancer patients, survivors, and family members urged their members of Congress to cosponsor two bills to increase funding for childhood cancer research at the National Institutes of Health (NIH) and National Cancer Institute (NCI).
The Research to Accelerate Cures and Equity (RACE) for Children Act is bipartisan legislation that ACS CAN endorsed in late March. The bill seeks to modify the Pediatric Research Equity Act (PREA), a law that was intended to increase the number of drugs available to treat pediatric illnesses. While PREA has been successful in driving pediatric drug development in other diseases, exemptions in the law have prevented it from ever applying to cancer drug development. The modifications proposed by the RACE for Children Act would ensure that the provisions of PREA apply to cancer drugs.
A separate bill, the Survivorship, Treatment, Access, and Research Act (STAR) would increase transparency of and expertise on pediatric cancer research at NIH, and explore the long-term side effects of childhood cancer and its treatments.
Activities in the states
- The Arizona legislature approved a level funding appropriation of $1.37 million for the Arizona Well Woman HealthCheck Program to provide mammograms and Pap tests to uninsured women.
- Final appropriations in Colorado included cancer, cardiovascular, and pulmonary disease grant funding of more than $19.8 million; tobacco education, prevention and cessation grant funding of more than $23.5 million; and breast and cervical cancer screening program funding via the Women's Wellness Connection of more than $4.6 million.
- Minnesota governor Mark Dayton approved several appropriation measures for both new funding and continued funding for programs hard won in past sessions. They include:
- $35 million of continued full funding for the State Health Improvement Program, which provides grants to communities for tobacco and obesity prevention efforts;
- $2 million in continued funding for Safe Routes to Schools;
- $8 million in new funding for a University of Minnesota program to expand access to clinical trials; and
- $250,000 in new funding for Good Food Access Fund to improve access to healthy food in underserved communities.
Final appropriations in North Dakota included nearly $520,000 for colorectal cancer screening and $400,000 for the Women's Way breast and cervical cancer program.
House Bill Intends to Make Veterans Health Administration Smoke-Free
On May 17, the House Veterans' Affairs Committee advanced legislation that would make Veterans Health Administration (VHA) facilities smoke-free. The bill (H.R. 1662) would prohibit the use of cigarettes, electronic cigarettes, cigars, pipes, and other combustible tobacco products inside any VHA facility soon after it becomes law, and would prohibit smoking outside VHA facilities by 2022. ACS CAN along with 43 additional public health and medical groups signed a letter of support for the bill. The bill now awaits a vote on the House floor.
State & Local Advances
- On June 1, Oklahoma governor Mary Fallin signed into law a $1.50 per pack cigarette price increase. This is a major public health victory which demonstrates that significant price increases on tobacco are possible regardless of a state's ruling party.
- More than 510,000 Americans will be protected by new or revised smoke-free ordinances in the following cities:
- Laguna Beach and Windsor, California
- Sandpoint, Idaho
- Santa Fe, New Mexico
- Arlington and Palmhurst, Texas
- Los Gatos, California enacted a tobacco retail license ordinance that restricts the sale of all flavored tobacco—including menthol cigarettes—to adult-only retailers. The ordinance also prohibits tobacco sales to persons under the age of 21; bans sales in pharmacies; and blocks new retailers from locating within 1,000 feet of schools, parks, and playgrounds, or within 500 feet of another tobacco retailer.
- On May 15, Excelsior Springs, Missouri passed a Tobacco-21 ordinance which went into effect immediately.
QUALITY OF LIFE
- In accordance with legislation ACS CAN supported in 2015, Gov. Jerry Brown's revised budget reversed a decision by the California Department of Managed Health Care that would have delayed implementation of adult palliative care services in Medi-Cal.
- ACS CAN teams led efforts in Iowa, Minnesota, Nebraska and Nevada to pass measures to promote palliative care access. All four were signed into law in May and will improve quality of life for patients and families facing cancer and other serious illnesses.
Global Health Agenda Prioritizes Cancer Control
On May 30, at the 70th World Health Assembly (WHA) of the World Health Organization, health leaders from across the globe reaffirmed cancer control as a critical health and development priority by adopting "Cancer prevention and control in the context of an integrated approach," a new cancer resolution.This was the first time a cancer-specific agenda item had been discussed at the WHA since 2005. The resolution, co-sponsored by the U.S., is the culmination of more than a year's work by the Union of International Cancer Control (UICC), the American Cancer Society, ACS CAN and other supporters. It provides countries with updated and integrated guidance on health promotion and risk factor reduction, with emphasis on the tobacco control and anti-cancer vaccines. The Society and ACS CAN are continuing efforts to transform that commitment into increased resources and action to address cancer. Beyond the resolution, momentum continued to build around cancer and other noncommunicable diseases (NCDs). Among the record 26 cancer-related events were discussions on cervical cancer, tobacco control, nutrition and obesity, adolescent health, financing for NCDs, health systems and universal health coverage.
ACS CAN Releases 2016 Advocacy Accomplishments Report
The 2016 Advocacy Accomplishments report, "Advocates in Action: Impacting the Cancer Burden," is now available online at acscan.org/accomplishments. This annual report highlights ACS CAN's legislative, policy, grassroots, regulatory, global health advocacy, media advocacy and judicial advocacy achievements.