ACS CAN Testifies on the FY 2021-22 New York City Budget

Date:      March 15, 2021

To:         Members of the Committee on Health and the Committee on Mental Health, Disabilities, and Addiction

From:     Michael Davoli, New York City and New Jersey Government Relations Director

Re:         American Cancer Society Cancer Action Network Testimony Regarding the Fiscal Year 2021-2022 Budget

Chair Levine, Chair Louis, members of the Committee on Health and the Committee on Mental Health, Disabilities, and Addiction, thank you for the opportunity to testify today.  My name is Michael Davoli and I am the New York City and New Jersey Director of Government Relations for American Cancer Society Cancer Action Network (ACS CAN), the nonprofit, nonpartisan, advocacy affiliate of the American Cancer Society. 

As we all know, the COVID-19 pandemic has upended lives and the economy. But as this virus grips the nation, cancer is ever-present; 1 in 2 men and 1 in 3 women in the United States will be diagnosed with cancer in their lifetime. On average 40,531 new cancer cases and 12,776 cancer deaths occurred in New York City annually between 2012-2016 according to the New York State Cancer Registry.

Cancer patients have long faced significant barriers to accessing care. COVID-19 has magnified these barriers, with 46% of cancer patients and survivors reporting a change in their ability to pay for care due to the pandemic, and 79% experiencing delays in active treatment.

The pandemic has also shone a spotlight on health disparities across populations. Individuals from marginalized groups including communities of color are more likely to be uninsured, increasing the likelihood they will be diagnosed with advanced cancer. The 5-year relative survival rate is lower in Blacks than in Whites for every stage of diagnosis in the four most common cancer sites.

While policymakers are addressing acute needs related to COVID-19, cancer patients need changes that promote innovation, expand access, and drive towards health equity to relieve suffering during the pandemic and beyond. Eliminating cancer relies as much on public policy as it does on scientific discovery and innovation. To reinforce New York City’s commitment to the fight against cancer ACS CAN recommends the following be addressed in the FY 2021-2022 city budget.

Prevention and Early Detection

The New York City Department of Health and Mental Hygiene Cancer Prevention and Control Program leads efforts in New York City to ensure that all men and women who lack health insurance have access to free cancer screening for breast, cervical, colorectal and prostate cancer. When detected early, these cancers are more easily treated. Failing to have these cancers detected early can lead to deadly consequences.

These efforts have never been more important to the health of New Yorkers. The COVID-19 pandemic and resulting economic downturn have led to loss of health coverage among low-income New Yorkers. According to the Community Services Society, 22 percent of low-income New Yorkers who lost employment income in their household due to COVID-19 said that they or someone in their household lacked health insurance coverage since the start of the pandemic, double the share of those who did not experience wage or job loss (11 percent).[1]

Budget recommendation #1:

• New York City should renew its commitment to reducing cancer death rates by maintaining its current commitment of $1.6 million in 2021-2022 to the New York City Department of Health and Mental Hygiene Cancer Prevention and Control Program. This funding will allow the DOHMH to focus on getting cancer prevention and early detection screenings, and especially stool-based test options for colon cancer, to those who need them.
• The City Council should also renew its $1 million Cancer Initiative commitment. This critical funding goes out to community partners working to improve screening in under-resourced communities.

Reducing the Toll of Tobacco

Every year in New York City more than 12,000 lives are lost to tobacco related illness. The number one cancer killer in New York City is lung cancer. Cigarette smoking is the number one risk factor for lung cancer and in the United States, cigarette smoking is linked to about 80% to 90% of lung cancer deaths.[2]

While New York City experienced a historic decline in smoking rates between 2003 and 2017, that decline has leveled off and early reports show that many New Yorkers have once again picked up smoking during the COVID-19 pandemic.[3]

These trends are especially troubling given the fact that according to the CDC, being a current or former smoker increases the risk of severe illness from COVID-19. Smoking impairs the immune system and lung function, making it harder for the body to fight off coronaviruses and other respiratory diseases.

It is critical that New York City step up its efforts to curb tobacco use.

Budget recommendation #2:

• New York City should maintain its current $7.2 million in funding to the New York City Department of Health and Mental Hygiene's Tobacco Control Program. A well-funded tobacco control program will not only produce long-term savings but can have an immediate benefit.
• New York City must end the sale of menthol cigarettes and reform enforcement of current tobacco laws. Ending the sale of menthol cigarettes will contribute to a further reduction in smoking rates, especially in communities of color, and contribute to a reduction in tobacco related health expenditures paid for by New York City taxpayers. As part of any effort to end the sale of menthol cigarettes New York City should reform enforcement of all current tobacco laws to ensure that they are first and foremost public health measures and the enforcement of such laws does not have unintended consequences. These reforms are in accordance with ACS CAN’s commitment to addressing systemic racism in the enforcement of commercial tobacco control as explained in the policy paper Tobacco Control Enforcement for Racial Equity_FINAL_20201011.pdf (fightcancer.org)[4].

Reduce Disparities in Cancer Research

Clinical trials are a key step in advancing potential new cancer treatments from the research setting to the clinic, and patient participation in trials is crucial to this success. Most patients express a willingness to participate in clinical research, yet only a small fraction ultimately enrolls in cancer clinical trials because of barriers that make participation difficult or even impossible.

Participation levels in clinical trials have historically been far lower and less diverse than the actual demographics of patients living with cancer and the prevalence of the disease. Marginalized communities including communities of color, members of the LGBTQ community, and older adults, are all dramatically underrepresented in clinical trials, often despite equal or higher cancer incidence rates compared to the general population.[5] [6] [7]

Budget recommendation #3:

• New York City should immediately ensure that the NYC Care program’s benefit design be amended to include coverage of routine care costs for clinical trials. As program participation continues to expand, it is critical that all NYC Care enrollees are encouraged to participate in clinical trials. This change would bring NYC Care in line with existing requirements for Medicare, most private insurance plans, and – beginning in January 2022 – all state Medicaid plans.
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ACS CAN’s mission is to support evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. With that objective in mind, we appreciate the Council’s commitment to the fight against cancer. With your support of the above-mentioned budget priorities in 2021-2022 you can reduce New York City’s cancer rate; help identify cancers at their earliest- and often most treatable- stage and ensure that cancer patients are adequately supported from the public policy standpoint as they battle this devastating disease.

While COVID-19 may have stopped many things in our lives, cancer hasn’t stopped. So, neither have we. We thank you again for the opportunity to testify today.