News
June 2012 Monthly Advocacy Update
Stay up to date in between Monthly Updates with Cancer CANdor, a blog from ACS CAN's President.
SUPREME COURT
Decision Recap
On June 28, the US Supreme Court issued its ruling in the lawsuit brought against the Affordable Care Act brought by 26 states and other parties who challenged the law's constitutionality in two key ways: (1) the requirement that all citizens have health insurance, the so-called individual mandate, and (2) the expansion of Medicaid.
On the individual mandate, the court held that it is a valid exercise of constitutional authority under Congress's power to tax. As a result, critical insurance reform protections in place for cancer patients, survivors, and their families will remain in place remain in place as do other vital provisions that are already expanding access to care.
The Court went on to affirm the law's call for states to offer Medicaid coverage to newly cover all individuals under the age of 65 with incomes below 133 percent of the federal poverty line. At the same time, however, the Court said the federal government's power under the law to deny existing Medicaid funding to states that opt out is unconstitutional. Although the decision leaves open the possibility that some lesser penalty might be acceptable, the federal government does not appear to have such authority at this time. The law could be amended, but that seems extremely unlikely in the near term. States may, however, expand Medicaid programs voluntarily.
In short, the ruling leaves critical insurance reform protections in place for cancer survivors, but upends the Medicaid expansion to be determined on a state-by- state basis. Read the ACS CAN press release.
Medicaid Expansion - Next Steps
In a July 10 letter to the nation's governors, Health and Human Services (HHS) Secretary Kathleen Sebelius encouraged states to participate in Medicaid expansion voluntarily even as several governors rejected the option, citing costs and philosophical differences. If all states opt in, the Medicaid expansion is expected to provide more than 17 million people with access to comprehensive health care coverage that includes proven cancer prevention and early detection measures, cancer treatment, and follow up care.
The Administration is confident a majority of states will ultimately participate given the generous federal underwriting for those newly eligible beneficiaries. Currently the federal government pays between 50 to 76 percent for services states cover under Medicaid, with matching rates varying by state. Under the Affordable Care Act, starting in 2014, the federal government will cover 100 percent of the costs associated with the newly eligible population in states not already providing such coverage. The figure is reduced to 90 percent in 2020, but will then apply to every state.
ACS CAN supports Medicaid expansion as a way to increase access to lifesaving cancer care, and will be conducting webinars, developing and disseminating backgrounders and fact sheets, and assisting Divisions in efforts to engage policy makers in governor's offices, Medicaid agencies and state legislatures to make the case for it.
State Exchanges
On July 2, Secretary Sebelius announced that new funding was being made available to help states establish exchanges. States that have held off on implementation while awaiting the Supreme Court decision are now under some pressure to act. Special sessions could be called or governors could opt to establish exchanges via executive order as happened in Kentucky on July 17. States planning to operate exchanges are required to apply to HHS for certification by November 16, 2012. If HHS rejects the application, or if a state does not apply in the first place, the state defaults to a federally facilitated exchange in 2014. Read an op ed by former Senate Majority Leader and surgeon Bill Frist (R-TN) entitled "Why Both Parties Should Embrace ObamaCare's State Exchanges."
HHS will host four regional forums during August to provide state and local stakeholders with updates on exchange implementation and other issues. Many questions regarding the Medicaid expansion are anticipated. ACS CAN plans to have representatives at all of the meetings.
Repeal and Replace
On July 11, the House of Representatives voted 244-185 to repeal the Affordable Care Act, the first such vote since the Supreme Court ruling. The vote was mostly on party lines, with five Democrats joining the House Republican majority in support of the bill. Also on July 11, separate hearings were held in the House Oversight Committee and the Ways and Means Committee to examine the impact of the law on small businesses and the economy.
ACS CAN Volunteers Respond to Supreme Court Ruling
The stories of cancer patients were in great demand in the flurry of media that led up to and followed the Supreme Court ruling. Many thanks go to the volunteers who made themselves available as well as to Division media advocacy, advocacy, and communications staff for their efforts to ensure patient voices were heard. The American Cancer Society and ACS CAN's efforts to improve access to health care were also prominently mentioned. The payoff has been tremendous as you will see in the attached spreadsheet.
SCOTUS Decision ACA Coverage.xlsx
Moving Forward
The Affordable Care Act represents a meaningful improvement in the ability of cancer patients, survivors, and their loved ones to access lifesaving care, but we all know that it is not perfect. ACS CAN is calling upon elected officials to work together in a bipartisan effort to improve the law where necessary and implement it as strongly as possible for patients and their families.
IMPLEMENTATION
Employer Wellness Programs
The Society and ACS CAN and several other leading health care organizations have joined together to develop guidance for the use of outcomes-based incentives in employer-sponsored wellness (or health management) programs. The guidance, which was published in the July 13 issue of the Journal of Occupational and Environmental Medicine, is intended to help ensure that worksite wellness programs utilizing such incentives are effective and fair to all employees, and improve health results. Read the press release.
Outcomes-based incentives are expected to become more common in the workplace as a result of provisions in the Affordable Care Act that encourage their use. They are a relatively new concept in which employees receive a financial reward for meeting a specific health outcome or a penalty may be imposed for failure to meet a health standard, While the ability of outcomes-based incentives has not been well researched or documented, the impact of incentives linked to participation in wellness programs has been demonstrated by leading researchers as a means to increase employee participation.
Essential Benefits
On July 3, HHS released information on the three largest small group health plans in every state. The document was released to facilitate states' selection of a benchmark level for essential health benefits that will apply to all individual and small group plans in a state beginning in 2014.
HHS' information will also be helpful to ACS CAN's efforts to gauge the adequacy of the insurance plan a state ultimately selects. As you know, ACS CAN, Society Divisions, the American Diabetes Association, the American Heart Association, and the National Multiple Sclerosis Society developed an essential benefits survey for state insurance commissioners and departments asking for information on whether plans available in the state covered 31 different benefits considered vital for individuals with chronic diseases, including cancer. Some insurance commissioners have been unable to complete the survey because they lacked the necessary information, which can now be obtained through the HHS document.
ACS CAN is particularly interested in flagging any "inside limits" that may exist within these plans -- for example, restrictions on the number of times a patient can use a particular service, such as laboratory tests or doctor visits each year. By identifying any major gaps early in the process, we can work to eliminate or lessen them before they become problematic for individuals who are fighting diseases such as cancer.
Consumer Rebates
HHS announced that 12.8 million Americans will benefit from $1.1 billion in rebates from insurance companies this summer because of the Affordable Care Act requirement that insurers spend at least 80 percent of premiums on health care services as opposed to salaries and administrative costs. Insurance plans that do not meet the standard (also called the "medical loss ratio") must rebate the difference to consumers no later than August 1. Consumers in every state will receive a notice from their insurance company informing them of the rule and letting them know whether the company met the standard.
The average rebate for each family covered by a policy will be $151. Consumers will receive rebates in one of the following ways: (1) rebate check in the mail; (2) lump sum reimbursement to the same account that they used to pay the premium if by credit card or debit card; or (3) reduction in future premiums. Employers could provide the rebates to their employees in one of the ways listed above, or they may choose to apply the rebate in a way that benefits the employees. For many consumers, the rule has motivated their insurers to lower prices or improve their coverage to meet the standard. Click here to use HHS' new tool to see the average rebate your insurer is required to pay.
Obesity Screening
Late last month the US Preventive Services Task Force designated obesity screening as a "B" recommendation, making it eligible as a free preventive service in new health plans and Medicare under the Affordable Care Act. Only preventive services rated "A" or "B" by the Task Force qualify under the law. Referrals to behavioral interventions for weight loss, such as diet and exercise, were also part of the recommendation.
Preventive Services
HHS reports that more than 16 million Medicare beneficiaries have had at least one free preventive service provided by the Affordable Care Act since January 2012, including 1.35 million who had the Annual Wellness Visit. In 2011, 32.5 million people in Medicare received one or more preventive benefits free of charge. The figures are encouraging as less than half of US adults received selected preventive services prior to enactment of the law Act in 2010 according to a Centers for Disease Control and Prevention study.
Coverage for Young Adults
The National Center for Health Statistics reported that the percentage of adults aged 19 to 25 with health insurance coverage increased from 64.4 percent in September 2010 to 74.8 percent in December 2011, for a total of 3.1 million young adults gaining coverage after enactment of the Affordable Care Act.
Disparities
On June 30, former Society Chair Jennie Cook and Citseko Staples, ACS CAN senior specialist for State and Local Campaigns, spoke during a plenary session of the Intercultural Cancer Council's 12th Biennial Symposium on Minorities, the Medically Underserved and Health Equity on how the Affordable Care Act affects cancer patients and their families, with an emphasis on its impact on ethnic, racial, and low income populations..
CANCER RESEARCH, PREVENTION, AND EARLY DETECTION PROGRAMS
Appropriations
On July 18 the House Appropriations Subcommittee that funds health programs approved a spending bill for the 2013 fiscal year (FY 2013) that flat lines cancer research and eliminates funding for critical programs that would improve access to chronic disease prevention and treatment. Read the ACS CAN press release and Cancer CANdor blog post.
Specifically, the bill: provides no funding to implement the Affordable Care Act including state grants to support the establishment of state exchanges and the Prevention and Public Health Fund; flat funds the National Institute of Health and reduces the National Cancer Institute budget by about $2 million; and cuts the budget for the Centers for Disease Control and Prevention (CDC) by 11 percent. ACS CAN is urging lawmakers of both political parties to work together to increase funding for cancer research and prevention and restore funding to programs that will improve patients' access to adequate, affordable health care. The bill next goes to the full House Appropriations Committee.
OVAC Lobby Day
ACS CAN volunteers joined cancer patients, survivors, caregivers, physicians, and researchers in Washington, DC, on July 10 for the One Voice Against Cancer (OVAC) coalition's annual Lobby Day. Nearly 150 advocates from 41 states came together to urge Congress to support federal funding for cancer research and prevention programs in more than 160 meetings with members of Congress and staff. Read the ACS CAN press release, and Chris Hansen's Cancer CANdor blog, which features OVAC's newest ad.
In addition to holding a successful lobby day, OVAC announced the winners of its first ever "Film it to Fight It" video contest, in which volunteers were invited to submit an original and creative video in support of federal funding for cancer research. First place went to "Julie's Story" by Joshua Hawker of Spokane Valley, Washington. The short and moving film explained why federal support for cancer programs is so important to his young family was shown at a reception OVAC hosted for lobby day participants and Congressional staff on July 9. In addition, the 2012 OVAC Congressional Cancer Champion Awards were presented to Senator Barbara Mikulski (D-MD) and Senator Jerry Moran (R-KS) for their leadership in the fight against cancer and efforts to increase funding for cancer research and prevention.
Sequestration
OVAC's Lobby Day was especially important given the strong threat of cuts research and prevention programs, particularly those stemming from across-the-board reductions to defense and discretionary spending, known as "sequestration," due to take effect on January 1, 2013 under the agreement Congress and the president reached last year in their deal to reduce the deficit and raise the debt ceiling. If sequestration takes effect as currently designed, it will be "devastating" to the NIH, according to agency director Dr. Francis Collins' June 21 testimony to Congress. Also read recent letters to Congress and the Administration that ACS CAN signed as part of the Coalition for Health Funding about sequestration and the need for a balanced approach to deficit reduction.
Cancer Center Event
ACS CAN brought cancer community leaders together at the Dartmouth Hitchcock Norris Cotton Cancer Center in Nashua, New Hampshire on June 22 to urge the state's congressional delegation to commit to sustained federal funding for cancer research. The event was the fifth in a series of cancer center visits ACS CAN is organizing in partnership with local cancer centers and Divisions to highlight the benefits of federal investments in cancer research. Read the ACS CAN press release, coverage in The Manchester Union Leader and Nashua Telegraph, and a letter to the editor by ACS CAN volunteer Cheryl Cutting in The Concord Monitor.
US Representative Charlie Bass (R-NH), one of the state's two representatives in Congress, spoke at the event and staff representing the state's two senators and other representative attended. Mark A. Israel, MD, director of Norris Cotton highlighted breakthroughs made possible by cancer research. Andy MacLean, chairman of the Board of the New England Division, spoke about the Society's role in supporting research while Chris Hansen gave an update on the status of cancer funding in Washington, DC. Central to the program were remarks from Gerald Gehr, MD, an oncologist and hematologist based in Norris Cotton's facility in Manchester. Dr. Gehr discussed how research advances move from the lab to patients in active treatment and spoke about several patients in the audience who received lifesaving treatments at Norris Cotton. Following the program, a tour was given to congressional staff of the center's treatment facilities.
SMOKE-FREE
The march toward a smoke-free nation is making progress, with four new 100 percent smoke-free laws that cover all workplaces, including bars and restaurants, adopted in local communities during the first two weeks of July. The communities are:
- Lisbon, North Dakota, which will be the ninth city in the state to become 100 percent smoke-free when the law takes effect on September 1, 2012;
- Lawrence, Indiana, effective October 1, 2012;
- Vestavia Hill, Alabama, effective August 16,2012; and
- Hartsville, South Carolina, which will be the seventh community in the state to pass a comprehensive smoke-free law this year, and the 48th community overall, when the law takes effect on October 1, 2012.
Read The New York Times story on the growing number of smoke-free communities and laws in the South.
TOBACCO TAXES
Unfortunately, California's Proposition 29 was narrowly defeated in a historic vote that took nearly three weeks to decide. Prop. 29 was defeated after the tobacco industry spent $50 million on a statewide misinformation campaign to distract public attention from the ballot initiative's public health and economic benefits. Read the ACS CAN press release.
Despite the outcome, the campaign gave the Society and ACS CAN a better sense of how to collaborate more effectively and leverage opportunities to advance our shared mission. In this case, the Society's Enterprise Leadership Team worked with ACS CAN and the California Division to devote critical resources that closed the gap in the campaign's final weeks and brought us to within less than one percentage point of victory. The Yes on Prop. 29 campaign gathered 115,000 signatures to get the initiative on the ballot, generated more than 300,000 phone calls from coalition volunteers to voters, and involved thousands of people across the state who devoted their personal time and resources to saving lives from cancer.
The election results are a disappointment, but Prop. 29 will serve as a rallying cry as ACS CAN continues to wages vigorous campaigns at the local, state, and national levels for proven tobacco control policies that save lives. The tobacco industry is not backing down, and neither will we.
POINT OF SALE WARNINGS ON TOBACCO
In a disappointing but not entirely unexpected decision, the US Court of Appeals for the Second Circuit ruled that a 2009 New York City Health Department requirement that cigarette retailers to display graphic warnings about the dangers of tobacco at the point of sale was invalid. The court agreed with the tobacco retailers and manufacturers who brought the case that federal law preempts the city's action.
Under the Federal Cigarette Labeling Act and the Family Smoking Prevention and Tobacco Control Act (FSPTCA), only the Food and Drug Administration (FDA) or other federal agency can regulate the "content" of promotion or advertising of cigarettes. Those federal laws also provide that states and localities may regulate the "time, place, and manner" of tobacco advertising and promotion. Under the Second Circuit's ruling, the city's requirement regulated "content," and was therefore not permitted under federal law. There was, however, some good news in the decision as the Second Circuit acknowledged that states and localities can pass other types of restrictions that would not be preempted.
The court reached no conclusion on the plaintiffs' further claims that the city had violated their First Amendment right to free speech because the suit had been decided on preemption grounds. As you know, FDA regulations requiring graphic warnings on every pack of cigarettes are being challenged in a separate lawsuit pending in the US Court of Appeals for the DC Circuit. The FDA's general authority to require graphic warnings has already been upheld in a third lawsuit decided by the US Court of Appeals for the Sixth Circuit that the industry plans on appealing to the US Supreme Court.
The Society, ACS CAN, and other health groups filed friend of the court briefs in support of New York City and the FDA in all of the lawsuits mentioned above.
Two bills were introduced in Congress on July 19 aimed at reducing suffering and improving the quality of life of patients undergoing care for serious illnesses such as cancer by expanding palliative care. Thousands of patients who are suffering from the side effects of treatment for chronic disease have no idea that palliative care is available to them and can help relieve their symptoms and help them focus on getting well. The legislation is intended to mitigate this barrier. ACS CAN worked closely with the lawmakers and their staffs in the drafting of these bills, and we're encouraged by the attention lawmakers have paid to this crucial issue for cancer patients. With greater access to palliative care, cancer patients will suffer less and be able to focus more on getting well. Read the ACS CAN press release and Cancer CANdor blog post.
The first bill, known as the "Palliative Care and Hospice Education and Training Act," was introduced by Senator Ron Wyden (D-OR) and Representative Eliot Engel (D-NY) to address the deficit in palliative care training offered in the nation's medical schools through the creation of new incentives for the training and development of interdisciplinary health professionals in palliative care. The "Patient Centered Quality of Life Act," introduced by Representatives Spencer Bachus (R-AL) and Emanuel Cleaver (D-MO), would draw more national attention to palliative care through research, workforce training and the building of best practices. Such efforts are needed to put into place the building blocks of a national effort to improve the fragmented care that people with cancer and other serious diseases often receive.
ACS CAN is launching an ad campaign in print and online Capitol Hill publications starting July 23 to educate lawmakers about the issues and encourage them to support the legislation. The ad features a woman in ballet shoes above the word "cancer," which has been changed to read "dancer" and emphasizes that palliative care restores patients' quality of life by treating them as well as their disease.
NUTRITION AND PHYSICAL ACTIVITY
ACS CAN formally requested that the US Surgeon General prepare a comprehensive report on the impact of sugar-sweetened beverages on the American public's health. Likening the effort to the 1964 Surgeon General's landmark report on tobacco, ACS CAN believes an unbiased and authoritative report on the subject would raise public awareness and "change the direction of public behavior in their choices of food and drink." According to the a recent Institute of Medicine report, sugary soft drinks account for 20 percent of weight increases in US from 1977 to 2007. Read the ACS CAN press release.
New Hampshire Candidate Forum
On June 27, ACS CAN, through its Cancer Votes program, partnered with the New Hampshire Institute of Politics at Saint Anselm College to sponsor a candidate forum focused on health care issues. The six gubernatorial hopefuls in this hotly contested race took the stage in front of a standing room only crowd, and spent an hour debating issues such as the individual mandate provision of the Affordable Care Act, state tobacco taxes, smoke-free laws, and Medicaid cuts. ACS CAN Deputy President Molly Daniels was there to speak about the need to make cancer a national priority. As the event's chief sponsor, ACS CAN had a hand in shaping the questions that were posed to the candidates and Cancer Votes signage was prominently displayed onstage. Thirty ACS CAN volunteers and staff attended the event, which we expect to be the first of several Cancer Votes sponsored candidate forums this year.
Training
A Cancer Votes webcast training focused on message development, volunteer recruitment and management, and organizing tactics was held on July 17. More than 150 volunteers and staff participated.
GLOBAL HEALTH
Brazil Breast Cancer Coalition
This month, ACS CAN, in partnership with the Society's Global Health Department, delivered a three day advocacy workshop to the Brazilian breast cancer advocacy coalition FEMAMA. Seventy-five volunteers and staff representing more than 40 individual nongovernmental organizations in Brazil participated in the training, which focused on developing an advocacy strategy for influencing public health policy at the state and federal levels and strengthening the country's breast cancer movement. In addition to sharing best practices on strategic planning around advocacy, ACS CAN provided technical assistance to FEMAMA in planning its first ever lobby day in the capital Brasilia. ACS CAN offered further support by brokering the pro bono services of a top Brazilian government relations firm to assist the young coalition in navigating the legislative process. Grassroots advocacy, from a patient perspective, is a precedent setting concept in Brazil. If successful, the project has the potential to become a model for other partners in Latin America.
2012 World Cancer Congress
The Society and ACS CAN are playing key roles in organizing the International Union for Cancer Control (UICC) World Cancer Congress, an annual meeting that brings together leaders in the fight to end cancer from all over the world and will take place this year in Montreal. ACS CAN secured the participation of Lois Quam, executive director of the US government's Global Health Initiative, to be the keynote speaker at a Society-sponsored symposium occurring as part of the meeting and Society and ACS CAN CEO John Seffrin, PhD, will address a plenary session. In addition, the Society and ACS CAN will host a training session for international advocates engaged in campaigns to elevate the issue of non-communicable diseases on the global health agenda.
DISPARITIES
ACS CAN representatives recently participated in two events geared to communities of color. At the 2012 League of United Latin American Citizens (LULAC) Annual Convention held in Orlando from June 25-30, ACS CAN and the Florida Division worked together to recruit volunteers and educate conference participants about the Affordable Care Act.