News
9-7-10 Monthly Advocacy Update
Cancer Research and Prevention Programs
When Congress returns to Washington on September 13, there will only be a few weeks until the start of 2011 fiscal year (FY2011). With time short and much work remaining on the annual appropriations bills, FY2011 will begin under a Continuing Resolution, a temporary spending bill that maintains the current funding levels until the House and Senate approve and the president signs the annual appropriations bills. The expectation is that federally funded cancer research and prevention programs will be funded under a Continuing Resolution until some time after Election Day in November.
The delay in final decisions on FY 2011 spending levels underscores the need for ACS CAN advocates to continue making the case to Congress on the importance of funding cancer research and prevention. Even though there is a preliminary sense of what the funding levels for these programs will be in FY 2011, Congress still has the power to cut or increase funding for these critical programs.
The ACS CAN Leadership Summit and Lobby Day, which will bring more than 500 ACS CAN advocates to Washington, D.C. from September 26-29, arrives at a crucial time. In the meantime, ACS CAN grassroots volunteers have been busy building momentum for Lobby Day throughout the month of August in their Congressional districts with media events, letters to the editor, and face-to-face meetings with federal lawmakers.
Tobacco Taxes - California Ballot Initiative
Congratulations to the California Division on its recent success in having the California Secretary of State certify the California Cancer Research Act (CCRA) for the 2012 statewide primary ballot. The CCRA would increase the tax on cigarettes by $1.00 per pack and raise approximately $855 million annually in the first year with slight, predictable decreases in ensuing years. The Division is partnering with ACS CAN, the American Heart Association, the American Lung Association, and the Campaign for Tobacco Free Kids on the campaign.
Certification follows an extremely successful volunteer signature gathering effort. Division volunteers and staff set a goal of having volunteers gather 110,000 signatures and exceeded it by 4,518 signatures. Without the volunteer effort, the CCRA would not have made it to the ballot for voter consideration. Much work remains, but a significant first step has been taken thanks to volunteers in California.
If voters approve the CCRA during the next statewide election, 60 percent of the revenues (approximately $468 million in the first year), would fund research of cancer and tobacco related diseases. The remaining revenue would go toward facilities and capital equipment for research, tobacco prevention and cessation programs, and enforcement of anti-tobacco laws. Programs funded by existing tobacco tax revenue streams will be "backfilled" so that their revenue streams remain constant and no current programs are harmed.
Georgia
Congratulations to South Atlantic Division volunteers and staff. On August 26, the Savannah, Georgia city council passed a comprehensive smoke-free workplace, restaurant and bar ordinance on August 26 by a vote of 7 to 2. The law takes effect on January 1, 2011.
North Dakota
I am very pleased to share the news that on August 24, Bismarck, North Dakota city commissioner’s voted to ban smoking in bars in addition to restaurants and other workplaces. When the law goes into effect on November 1, 2010, Bismarck, the state’s second largest city, will become the fifth city in the state with a smoke-free workplace law that is stronger than the statewide law. Congratulations to ACS CAN volunteers and staff in the Great West.
Texas
Please join me in celebrating the High Plains’ Division major victory in San Antonio. On August 20, the City Council adopted a rule banning smoking in all workplaces, including bars and restaurants, making the city the latest in a long list of communities across the state to adopt comprehensive smoke-free laws. San Antonio is the last of Texas’ big cities to go smoke-free. Kudos and congratulations to volunteers and staff in the High Plains Division who made this victory possible! The new ordinance, which will go into effect on August 19, 2011, will close exemptions that currently allow smoking in bars, bingo and pool halls, and restaurants that have enclosed smoking areas. ACS CAN was proud to partner with the High Plains Division on the effort. With all of the state’s big cities now smoke-free – including Houston, Dallas, El Paso and Austin – momentum is building. Together with local coalition partners, the Division and ACS CAN are ramping up for a statewide smoke-free campaign when the Texas legislature starts its 2011 session.
Access to Care – Affordable Care Act
ACS CAN Comments on Interim Final Rule on Lifetime and Annual Limits
ACS CAN submitted comments to the Department of Health and Human Services (HHS) on the Interim Final Rules released in June. The rule would implement provisions of the Affordable Care Act relating to pre-existing condition exclusions for children, lifetime and annual dollar limits on benefits, rescissions and patient protections. Overall, the rule is strong and expands patients’ access to health care. Read the ACS CAN press release.
ACS CAN’s comments focus on several specific concerns relating to the structure of the rules on lifetime and annual limits. As drafted, the rules allow insurers and employers to apply non-monetary limits to specific benefits, such as incidences of treatment or the number of days of care. For patients with chronic illnesses that require a higher annual level of health care utilization, the burden of annual non-monetary limits could be as damaging as annual monetary limits in creating barriers to coverage. ACS CAN recommended that the rule be revised to include an anti–abuse provision to prevent plans from simply placing new limits on plan benefits as an alternative to the now prohibited limits on annual dollar coverage.
ACS CAN also recommended that the reinstatement rule for individual policies be revised to create greater parity between the group and individual markets. Under the draft rule, a participant in a group health plan is eligible for re-enrollment if he or she has reached the plan’s lifetime limit prior to the effective date of the Interim Rules. The reinstatement, however, does not apply to individuals who reached their lifetime limits on an individual health insurance plan. This is a major concern because ACS CAN believes that most consumers who reach a lifetime limit on their health plan are in the individual market. Read ACS CAN’s comments.
ACS CAN Comments on “Grandfather” Rule
ACS CAN also recently filed comments on the “Grandfather” rule in the Affordable Care Act, in an effort to more clearly define which plans will be exempt from certain provisions in the new law. Overall, the rule is strong and encourages plans to strengthen benefits for patients and ceases their “grandfather” status if they choose to reduce benefits or substantially shift costs to patients. Read the ACS CAN press release.
ACS CAN’s comments urge the Administration to further strengthen the law for people affected by cancer through greater disclosure to enrollees and more oversight of insurers. ACS CAN also responded to specific questions regarding changes to plan structure, physician network and formularies that would trigger a cessation of grandfathered status. Read ACS CAN’s comments.
National Association of Insurance Commissioners
Medical Loss Ratio
At the request of HHS, the National Association of Insurance Commissioners (NAIC) finalized a proposal for governing medical loss ratio (MLR), the percentage insurers spend on care versus administrative costs, in the Affordable Care Act. The proposal incorporated recommendations from an NAIC working group which consumer groups, including ACS CAN, generally supported. The proposal now goes to HHS, which is expected to issue a federal regulation to formalize the proposal in the next few months.
Many thanks go to Division staff who met and/or communicated with their State Insurance Commissioners office over the past few weeks to discuss the draft proposal. The NAIC took the patient and consumer perspective seriously and factored it in to their recommendation, no mean feat given the strong push from representatives for insurance brokers and agents who wanted to weaken the proposal. Although the work with NAIC is just beginning, the outcome of this proposal was a positive first step for patients.
Annual Meeting
Steve Finan, ACS CAN senior director of Policy, and other consumer representatives testified at a hearing during NAIC’s annual meeting on the establishment of state based health exchanges. NAIC has indicated that they will try to develop model legislation for the establishment of the state health insurance exchanges this fall, although the proposal is likely to address state agencies’ administrative authority to comply with the Affordable Care Act only, and with any specific policy options. NAIC is also forming new working groups to address more specific issues around the exchanges, including plan certification and ratings, enrollment processes, and information technology, in order to help state agencies better understand the issues and decisions they will have to make. ACS CAN will continue to monitor these discussions and keep you apprised.
Medicaid Protections
On August 10, the US House of Representatives returned to Washington, DC during their August recess to vote on the six-month extension of federal Medicaid funding for state health programs and benefits for low-income cancer patients and families across the country. The House passed H.R. 1586 247-to-161, and soon after the president signed the bill into law. ACS CAN was engaged in an extensive grassroots effort to urge Congress to approve the funding extension. State government relations staff in five states (CT, OH, MA, ME, NE) reached out to state legislators and other influential advocates in their states to engage them to call federal lawmakers and urge support for the funding. ACS CAN also targeted 16 senators, and engaged grassroots advocates in an “patch through” call campaign. ACS CAN advocates made more than 9,000 calls to the senators’ offices asking them to the funding extension. Many thanks to volunteers and staff nationwide for making this victory possible. Read the ACS CAN press release.
Johanns Amendment
ACS CAN has been working in recent weeks to defeat an amendment offered by Senator Mike Johanns (R-NE) to the Small Business and Jobs Credit Act that would effectively eliminate the Prevention and Public Health Fund created by the Affordable Care Act. A vote on the amendment is expected to be the item taken up by the Senate later this month.
Government Hosts Stakeholders Conference on Health Exchanges
The Department of Health and Human Services (HHS) hosted an all-day meeting on August 30 on health exchanges. The goal was to discuss some of the major issues that will need to be addressed in federal regulations of health exchanges. The day consisted of a series of panels with various stakeholders addressing their major concerns and interests. Steve Finan, ACS CAN’s senior director of Policy, was on the first panel, which looked at consumer and patient perspectives. Among those in the audience were staff from the Departments of HHS, Labor, and Treasury who will be involved in drafting the exchange regulations.
In addition, ACS CAN is working with other consumer groups to submit comments in response to a list of questions HHS published in July soliciting background information that will assist the department in drafting regulations. The group’s collective comments will be posted upon completion.
Potential Enterprise-wide Partnerships with State Ombudsman Programs
Society and ACS CAN representatives have begun conversations in several states about the possibility of partnering with state agencies responsible for implementing the state ombudsman program as part of the Affordable Care Act implementation process. The new law provides consumers with significant new protections, including the ability to choose a health plan that best suits their needs and to appeal denials of coverage. HHS recently announced new Consumer Assistance Grants totaling $30 million to help states strengthen consumer assistance programs, educate consumers and answer questions about their health options, and ensure access to accurate information. The grant announcement noted that very few states have experience with this kind of effort. States are being encouraged to enter into partnerships with non-profit organizations as a way to develop knowledge and expertise in designing programs to provide consumer services. The Society and ACS CAN are uniquely positioned nationwide to be a strong resource and partner for states in this endeavor.
Rand Study Says New Law Will Give More Workers Access to Health Care
The Los Angeles Times reports that a new Rand Corp study concludes that the Affordable Care Act will increase the number of workers who get insurance through their jobs. The study estimates that under the new law, 13.6 million more employees in the United States will be given access to health coverage through their employer, an increase that will raise the proportion of U.S. workers with employer-sponsored health insurance to 94.6 percent from the current 84.6 percent.
According to the Times, the study finds that the impact will be felt most among small businesses of 50 or fewer employees. Only 60.4 percent of small business employees currently have access to health insurance through their jobs. Rand researchers estimate that once the health insurance exchanges are functioning in 2014, nearly 86 percent of small business employees will be able to purchase health coverage through their employer, an increase of 10.5 million workers. According to Rand, the growth will be attributable in part to lower costs for policies offered through the exchanges and the ability of small businesses to join together to pool their risk.
Tobacco Control
New CDC Reports
On September 7, the Center for Disease Control and Prevention (CDC) featured two studies in its Vital Signs publication detailing adult tobacco use in the US and alarmingly high secondhand smoking rates among children. Read the ACS CAN statement.
And in its August 26 issue Morbidity and Mortality Weekly Report (MMWR), the CDC found that while smoking among middle and high school students was down from over the past decade, no overall declines were found from 2006-2009.
Litigation
As described below, the American Cancer Society Eastern Division and ACS CAN recently weighed in on two separate courts cases pending in New York.
Graphic Warnings Case