News
April 2011 Monthly Advocacy Update
CANCER RESEARCH & PREVENTION PROGRAMS
The federal government continues to operate under a stopgap spending measure for the 2011 fiscal year (FY 2011), with the current one set to expire on April 8. This is likely the last stopgap measure, as a growing number of members of both parties and both chambers indicate that they will not support another short-term bill. A final compromise bill that would fund the government through the remainder of the FY 2011 year is reportedly near, but a government shutdown is still a possibility, although it may last just a few days.
House Leaders Propose 2012 Fiscal Year Budget
Attention is turning toward the 2012 fiscal year (FY 2012) budget, with Representative Paul Ryan (R-WI), Chairman of the House Budget Committee, unveiling the House leadership's FY 2012 budget proposal today. The budget calls for $6 trillion in cuts over 10 years. The vast majority of it comes from entitlement programs such as Medicare and Medicaid and major changes to the programs would accompany the budget cuts.
ACS CAN has strong reservations about the budget’s proposal to finance Medicaid through block grants, which could lead to new restrictions in eligibility, enrollment and benefits that could deny cancer patients the care they need. The budget would also turn Medicare, which has provided affordable, adequate health care to seniors for nearly 50 years, into a vaguely defined voucher program with limited benefits that could have devastating consequences for cancer patients. With more than half of newly diagnosed cancer patients over the age of 65, seniors would be forced to make tough choices about what care they receive and what they forego.
Furthermore, the bill will stall progress against cancer by reducing the funds available for research and defunding a historic investment in prevention, namely the Public Health and Prevention Fund. Eliminating this funding would compromise our nation’s efforts to combat obesity, promote tobacco cessation and support community programs that offer access to proven cancer screenings. Read the ACS CAN statement.
ACS CAN and LIVESTRONG Speak Out Against Cuts
ACS CAN volunteers nationwide continue to press their representatives and senators to protect funding for lifesaving cancer research and prevention programs. On March 24 ACS CAN and LIVESTRONG held a press event in Washington, DC featuring ACS CAN Chief Executive Officer John Seffrin and LIVESTRONG founder Lance Armstrong, who deliveried the message that cancer patients cannot afford to wait for new lifesaving treatments, and that Congress must commit to sustained federal funding for cancer research and prevention. National Institutes of Health Director Dr. Francis Collins and ACS CAN volunteer Tracy Elliman, whose participation in a clinical trial was cut short due to lack of funds, also spoke at the event. Read the ACS CAN press release and watch video from the event.
New Poll
On March 24 ACS CAN also released new polling data showing that more than three-quarters of the public opposes cutting funding for cancer research (77 percent) and prevention programs (76 percent) as part of the effort to reduce federal spending. Eight out of 10 respondents overall oppose cutting cancer funding when informed that:
• 40,000 fewer women would get recommended breast and cervical cancer screenings (81 percent)
• Cuts would mean one-third fewer federally-funded cancer clinical trials that are in the last phase of research (81 percent)
• Cuts would mean less research to develop diagnostic tools for the cancers currently lacking accurate screening tests (79 percent)
Working with OVAC
ACS CAN also continues to work with its partners in the One Voice Against Cancer (OVAC) coalition. ACS CAN and OVAC were on Capitol Hill on March 2 to urge Congress to oppose cuts to cancer research, prevention, and early detection programs, which would squander progress made in the fight against cancer over the past few years. Read the ACS CAN press release and view OVAC’s new ad.
Coaches Video
ACS CAN has a new video featuring college basketball coaches who participate in the American Cancer Society's Coaches vs. Cancer program. The coaches joined ACS CAN at the 2010 Leadership Summit and Lobby Day where they were interviewed about why they were so involved in the fight against cancer. Their stories were deeply personal and very touching. Like ACS CAN, these coaches feel very strongly about the importance of increasing funding for cancer research. Special thanks to our staff colleagues who work on the Coaches program for their help.
Watch the video at www.fightcancer.org/coaches and please share it with your friends and family.
In the States – Utah
Congratulations to ACS CAN volunteers and staff in Utah who overcame the odds in a very tough budget and political climate. At the start of the state legislature’s session, the proposed state budget for the 2012 fiscal year contained cuts to priority cancer programs ranging from 75 to 100 percent over the previous year’s levels. ACS CAN in Utah led a vigorous campaign in concert with several partner organizations. As a result, funding was completely restored to the previous year’s levels.
One Year Anniversary
March 23 marked the one year anniversary of the Affordable Care Act being signed into law. The American Cancer Society and ACS CAN’s efforts to educate staff, volunteers, and the public about provisions of the law that are important for cancer patients and their families are ongoing.
Read the ACS CAN press release and watch a video of patients who the law has helped.
In support of these activities, ACS CAN launched a new tool on its website -- a short online quiz about how provisions of the Affordable Care Act help cancer patients and survivors. At the end of the quiz, people are invited to view the Society’s consumer booklet about the law and share the quiz with others. Please see for yourself and test your own knowledge: http://fightcancer.org/quiz.
In Congress
As you may remember, in February the House passed a 2011 fiscal year (FY 2011) spending bill that stripped out funding to implement the Affordable Care Act, including the development of regulations that will govern the health benefit exchanges and determine the essential benefits package. Although the Senate voted down the House bill, efforts are still being undertaken to defund implementation.
Most recently, the House Energy and Commerce Health Subcommittee approved a bill to eliminate mandatory funding for several programs created in the law, including funding for the Prevention and Public Health Fund and funds for state-based exchange grants. ACS CAN opposes the legislation. The Prevention and Public Health Fund provides critical funding to local communities across the country to address issues including obesity and tobacco use. The state-based exchange grants help states plan for the new exchanges that will serve as a marketplace for consumers to obtain information and purchase health insurance.
Turning to hearings, committees of jurisdiction for health care in both the House and Senate held several in advance of the one-year anniversary of the Affordable Care Act being signed into law. The Senate Finance Committee’s hearing featured Secretary of the Department of Health and Human Services (HHS) Kathleen Sebelius and highlighted the law’s accomplishments, including insurance market reforms that have gone into effect and the work that HHS has done to rein in increases on insurance premiums. The Senate Health Education Labor and Pensions Committee hearing included testimony from HHS representatives to discuss the work the department is doing now to lay the groundwork for the state-based insurance exchanges that must be up and running by 2014.
On the House side, the Oversight Health Subcommittee held a hearing to look at the waivers HHS has granted that allow states and insurers to bypass specific requirements in the law. Representatives from HHS testified that the waivers are needed to keep the insurance market stable until the state exchanges are fully up and operating in 2014. The Ways and Means Health Subcommittee focused on Medicare payment rates to providers as well as the Affordable Care Act's reductions in payments to Medicare Advantage. Earlier in the month, the House Energy and Commerce Committee brought in several governors to testify about Medicaid.
Floor votes are expected later today on the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act. ACS CAN, the American Diabetes Association, and the American Heart Association sent a letter to senators urging them to vote against the bill. Although the groups support repealing the burdensome 1099 reporting requirement passed in the Affordable Care Act, the proposed offset would require consumers to pay back premium subsidies, which could discourage individuals and families from enrolling in health insurance coverage through state-based exchanges, potentially resulting in an additional 250,000 uninsured Americans. ACS CAN is, however, asking federal lawmakers to pass an amendment to further research the issue. Read the ACS CAN press release.
In the States
Nearly half of states have seen at least one legislative attempt to set up a health benefit exchange, and in some states there have been multiple proposals. ACS CAN’s foremost concern is the size and makeup of exchange governance boards. We have strongly discouraged large boards, which would be more likely to become divisive and unable to efficiently address the many critical decisions that need to be made to have a functioning exchange by 2014. Also important is that a board’s voting members and their immediate family have no financial or employment relationships that would pose a conflict of interest.
An additional concern is that the proposals to date have not clearly detailed the power and responsibility the state insurance commissioner needs to prevent insurance companies from cherry picking healthy applicants. Insurers outside and inside the exchanges should compete on a level playing field, but so far very few proposals have adequately addressed this problem.
Finally, many states have not explicitly spelled out in their legislative proposals the level of coordination and transparency that must exist between the state Medicaid program and the exchange to ensure both succeed in properly serving their intended audiences.
Legal Challenges
The Society and ACS CAN have again partnered with the American Heart Association and the American Diabetes Association to file an amicus brief, this time in the Fourth Circuit Court of Appeals, which will consider cases filed in Virginia. The brief is virtually identical to the one filed in the Sixth Circuit in January on the suit filed in Michigan. The groups will also file the same brief in the 11th Circuit Court on April 11, where a three judge panel will hear the federal government’s appeal to the ruling in the multi-state lawsuit out of Florida. The judge in that case found the law unconstitutional. Oral arguments in all jurisdictions have been scheduled for May and June. As you know, regardless of outcome, all decisions will almost certainly be appealed to the U.S. Supreme Court, which is expected to hear the case during the 2012 spring term and rule before its summer recess that year.
Read the organizations’ joint statement and ACS CAN’s new fact sheet on the complex interplay of contradictory state litigation and legislation associated with the Affordable Care Act.
GAO Report on Individual Mandate
The Government Accountability Office (GAO) made public a report Senator Ben Nelson (D-NE) requested regarding potential alternatives to the Affordable Care Act’s (ACA) individual mandate provision, which requires most Americans to purchase health insurance beginning in 2014. The report studied mechanisms other than the individual mandate, but the results were inconclusive, with little evidence showing that any of them would lead to equivalent, economically sustainable insurance coverage for the 32 million additional Americans who will be covered once the ACA is fully in effect. ACS CAN believes that the critical patient protections in the ACA, including those that end discrimination in the insurance market against people with cancer, would not be economically viable without the law’s individual responsibility provision. Read ACS CAN’s press release.
Medical Loss Ratio
The Affordable Care Act requires health plans in the individual and small group markets to have a medical loss ratio (the percentage of premium dollars that is spent directly on medical care versus other costs such as administrative expenses) of 80 percent. For large plans, the MLR is 85 percent. If a plan falls short, the insurance company must give a rebate to consumers. ACS CAN and many other groups representing consumers, patients, and workers believe the measure strikes a good balance between the interests of consumers and insurers.
Insurance brokers and agents, however, want to change the law because their commissions are classified as administrative expenses. Brokers and agents are aggressively lobbying the National Association of Insurance Commissioners (NAIC), HHS and Congress to change the law to exempt their commissions. ACS CAN is strongly opposed because the proposed legislation would severely weaken the MLR requirement and eliminate the incentive for insurers and others to find more efficient ways of improving administrative systems and helping consumers. Consumer groups have pointed out that excluding the broker and agent fees could increase insurance premiums, making the MLR essentially meaningless, and denying consumers $1.4 billion in rebates they would likely otherwise receive under the Affordable Care Act.
The NAIC has not yet weighed in, but its opinion will resonate. Thanks to extensive work by ACS CAN, Society Divisions, and other consumer groups in the states and at the most recent NAIC quarterly meeting, the commissioners decided to seek more information before voting on whether to support or oppose the change to the Affordable Care Act. ACS CAN will closely monitor NAIC activities in the coming weeks, and continue to partner with Division advocacy staff and volunteers to deliver let insurance commissioners know that changing the MLR is not in the best interest of patients, consumers, and meaningful insurance reform.
Quality Care
On March 21, HHS released the National Strategy for Quality Improvement in Health Care called for under the Affordable Care Act. According to HHS, “the strategy is the first effort to create national aims and priorities to guide local, state, and national efforts to improve the quality of health care in the United States.” The report to Congress emphasized managing chronic disease, affordability, payment reform, measuring quality, and health information technology. ACS CAN was given an opportunity to share its views on the issue to HHS as the strategy was developed.
Seniors Benefiting from Medicare Wellness Visit
HHS released a report on March 17 showing that in less than two months since the new wellness visit in Medicare benefit started January 1, more than 150,000 seniors and others with Medicare have taken advantage of the visit. This new visit is a no-cost preventive benefit available to Medicare beneficiaries as a result of the Affordable Care Act. Read the ACS CAN fact sheet on