News
September 2012 Monthly Advocacy Update
ADVOCACY INTEGRATION
On September 1, ACS CAN became a fully integrated and aligned organization. Federal, state, and local advocacy programs in every Division are now part of ACS CAN. As the American Cancer Society implements transformational change, it's clear that the ability to influence public policy is becoming increasingly important to moving our lifesaving mission forward.
The alignment of Division advocacy with ACS CAN gives us the increased capacity and nationwide reach we need to accelerate achievement of our lifesaving mission and allows us to be more strategic and deploy resources more effectively. In addition, our new regional structure better positions us to support the needs of volunteers and staff in every Division. We will be able to strengthen our grassroots network, gain greater leverage for our cause at home and abroad, and pass more laws and policies that help people fight cancer.
The combined talents and hard work of our volunteers and staff have already made ACS CAN the premiere organization dedicated to fighting cancer through advocacy. I believe this alignment will ultimately result in us being the vanguard of a worldwide issue advocacy and grassroots movement. Thank you for all you have done to support the alignment process and ensure that we have hit the ground running. I look forward to continuing to work with you for "more CAN" and less cancer.
Presidential Campaign
Both President Obama and Governor Romney have responded to ACS CAN's presidential questionnaire. Click here to see a preview of the voter guide being released to the public and posted on cancervotes.org next week. The candidates' answers appear verbatim.
In addition, on October 3 Cancer Votes will have a booth at the University of Denver's "DebateFest," a free festival featuring a live, outdoor telecast of the first presidential debate of the 2012 general election being held on campus that evening.
Debates and Forums
The number of candidate debates and forums Cancer Votes is sponsoring for candidates seeking state and federal office has grown considerably. Since last month's update, four days of debates were scheduled in Montana for the gubernatorial race and seats in the state legislature (read coverage from The Missoulian) while in Nebraska, ACS CAN volunteers turned out at the state fair for a debate between the candidates for the open US Senate seat. In the coming weeks events are planned for Maine, New Mexico, North Dakota, and West Virginia. Cancer Votes is teaming up with a diverse set of national and statewide partners that include the American Lung Association, New Mexico PBS, North Dakota Chamber of Commerce, and West Virginia Public Radio.
New Mexico
A multi-week Cancer Votes van tour is underway in New Mexico. The van has generated media interest and traveled to public events where ACS CAN volunteers have been able to ask questions of candidates for Congress. In addition, ACS CAN is photographing people who visit the van and then helping them complete a card with their personal story of why cancer is an issue for them in this election.
Oklahoma
Cancer Votes is proving effective in recruiting ACS CAN supporters. In Oklahoma, volunteer Mandy Winton attended a town hall meeting for candidates in the First Congressional District when a young woman named Devin overheard her telling one of the candidates she was an ACS CAN volunteer. Devin's father is battling cancer and she came to the event because she wanted to ask the candidates if they would protect people with preexisting conditions who need health insurance. Devin, who will turn 18 before November and will be voting in her first election, left the event with a Cancer Votes palm card and a T-shirt.
Cancer Votes Oklahoma volunteers also got the word out about making cancer an election issue this past Labor Day at the city of Henryetta's Labor Day parade. During the parade, they were able to talk with several candidates and parade-goers about Cancer Votes.
Texas
Cancer Votes has invited community members in the 23rd Congressional district to join ACS CAN volunteers at one of 12 nonpartisan "Eat and Greets" being held between September 24 and October 2. ACS CAN has also met with the campaigns of the Republican and Democratic candidates for the open US Senate seat.
Wisconsin
Late last month ACS CAN launched Cancer Votes in front of Wisconsin's Capitol building in Madison. Volunteers came wearing shirts emblazoned with the number 87 -- the number of people in Wisconsin who are diagnosed with cancer each day. News coverage of the event included stories in The Cap Times, Milwaukee Community Journal, and the Sun Prairie Star, as well as on Wisconsin Public Radio.
Wisconsin offers Cancer Votes a tremendous opportunity to educate voters about cancer issues given it is considered a potential swing state in the presidential election and also home to one of the most competitive US Senate races in the country. Read ACS CAN volunteer Kirby Davidson's letter to the editor about making cancer an issue in the Senate campaign.
Volunteers Speak Out
Read why these ACS CAN volunteers are involved in Cancer Votes: Delia Oleveri of Nevada, Tom Stalnaker of West Virginia, Jennifer Varner of Michigan, and Anne and Len Yorden of Florida.
ACS CAN LEADERSHIP SUMMIT AND LOBBY DAY
More than 600 ACS CAN volunteers and staff from all 50 states and nearly every Congressional district gathered in Washington, D.C... from September 12-15 for the sixth annual ACS CAN Leadership Summit and Lobby Day. Over the course of the event, the top two leadership tiers of ACS CAN's national volunteer organization -- state lead ambassadors (SLAs) and ambassador constituent team (ACT) leads -- and their staff partners met with members of Congress and later took advantage of skills training, issue briefings, and networking opportunities. Participants heard from 2012 Olympic gold medal swimmer and cancer survivor Eric Shanteau and cancer researcher Suzanne O'Neill, PhD. Read the ACS CAN press release.
Lobby Day itself was on Thursday, September 13. ACS CAN advocates participated in 452 meetings (including every Senate office and 80 percent of House offices) where they urged representatives and senators to sustain funding for proven cancer research, prevention and early detection programs. Participants also educated lawmakers about two new bills aimed at making palliative care more widely available. As a result, nearly 30 lawmakers agreed to cosponsor the bills.
Coaches vs. Cancer Rally
ACS CAN further amplified its presence on Capitol Hill with a rally featuring four NCAA Division I men's college basketball coaches, US Senators Tom Harkin (D-IA) and Frank Lautenberg (D-NJ), Representative Jared Polis (D-CO) Society and ACS CAN CEO John R. Seffrin, PhD, and me. The event stressed the vital importance of federal investment in cancer research, prevention and early detection to cancer patients, survivors, and their families. The participating coaches -- Mike Rice of Rutgers University, Tad Boyle of the University of Colorado, Paul Hewitt of George Mason University, and Fran McCaffery of the University of Iowa -- are members of Coaches vs. Cancer®, a nationwide collaboration between the Society and the National Association of Basketball Coaches that empowers coaches, teams and communities to join the fight against cancer.
Media Coverage
Also on Lobby Day, volunteers conducted seven television interviews with local news stations across the country. Many volunteers were also featured in local newspaper stories and had letters to the editor published in the days leading up to and following Lobby Day.
2012 Lobby Day clips.xlsx
Top Advocacy Honors Presented
On Friday, September 14, ACS CAN named US Senator Olympia Snowe (R-ME) and Governor Deval Patrick (D-MA) as the recipients of the 2012 National Distinguished Advocacy Award, ACS CAN's most prestigious advocacy honor for leadership in the fight against cancer. Earlier in the week longtime Society and ACS CAN Board Member volunteer Rob Youle received the ACS CAN Volunteer Award for Excellence in Advocacy, ACS CAN's highest national honor for volunteer advocacy.
Lights of Hope
On the evening of Friday, September 14, ACS CAN held its second straight Lights of Hope event at the Capitol reflecting pool. Lobby Day participants and others gathered to reflect as 7,000 lights (more than triple the number from last year) shone in honor of cancer survivors and in memory of loved ones lost to the disease.
Summary of Benefits and Coverage
Beginning this week, all health insurers and group health plans are required to provide applicants and interested parties with an easy-to-understand summary of a plan's benefits and coverage. The summary must be provided during the plan's next open enrollment period. The new requirement is designed to help consumers better understand and evaluate their health insurance choices. The new forms include a short, plain-language Summary of Benefits and Coverage (SBC) and a uniform glossary of terms commonly used in health insurance coverage, such as "deductible" and "copayment."
All insurance companies and group health plans must use the same standard SBC form to help compare health plans. The SBC form also includes details, called "coverage examples," that allow consumers to see what the plan would generally cover in two common medical situations - maternity care and diabetes. ACS CAN is advocating for the inclusion of a cancer example in future versions of the form.
The SBC is modeled after the nutrition facts label required for packaged foods that enables consumers to make healthy and informed decisions about their diet. The SBC's standardized and easy to understand information about health plan benefits and coverage allows you to more easily make "apples to apples" comparisons among your insurance options. A consumer has the right to receive the SBC when shopping for or enrolling in coverage, or if he or she requests a copy from an insurer or group health plan. A consumer may also request a copy of the glossary of terms from your health insurance company or group health plan.
SBC sample FINAL Sept 12.pdf
The SBC is a significant achievement, consistent with one of the Society and ACS CAN's "4 A's" of meaningful health coverage -- administrative simplicity. It is an important step in enhancing consumer awareness and understanding of health insurance. The White House received more than 3,000 communications from our dedicated volunteers in December insisting that consumers need access to comprehensible information to be able to make the most educated decisions they can about their coverage. In addition, ACS CAN Dr. John Seffrin personally lobbied the White House to enact the SBC in a timely manner and joined his counterparts from several other patient and consumer advocacy groups in a letter to the president arguing for a strong SBC regulation. The final product is in part the result of these efforts.
Read ACS CAN's media statement and my blog post on the SBC. In addition, ACS CAN's Media Advocacy team will be following up with ideas for promoting SBCs at the regional and local levels, once consumers start receiving them.
Medical Loss Ratio
On September 20, the House Energy and Commerce Committee marked up and approved the Access to Professional Health Insurance Advisors Act (HR 1206). The legislation would remove the commissions of health insurance agents from the medical loss ratio calculation, a provision in the Affordable Care Act requiring insurers to spend at least 80-85 percent of premium dollars on health care for the individual/small group markets and large group market respectively, as opposed to salaries and other administrative expenses. ACS CAN opposes the bill because it would weaken the law's promise to attribute the majority of consumers' premiums toward medical benefits. It is unclear at this time whether the bill will go to the House floor during the upcoming post-election lame duck session. Read the consumer group letter ACS CAN signed to House Energy and Commerce Committee Members.
120919_sign_on_for_hr1206_markup_final.pdf
State Exchanges
The Department of Health and Human Services (HHS) released another round of state exchange establishment grants in late August. Four states -- Connecticut, Maryland, Nevada and Vermont -- were awarded multi-year "Level Two" grants, which are awarded to states that have made measurable progress toward creation of an exchange. California, Hawaii, Iowa and New York received one year "Level One" grants designed for states at earlier stages in the process.
A total of 34 states have now received exchange grants to date. The deadline for states to declare what type of exchange they will have -- be it state-run or a state-federal partnership - is November 16, 2012. The federal government will operate exchanges in states that decline to operate their own exchange or to partner with the federal government.
Meanwhile, the Center for Medicare and Medicaid Services (CMS) has been holding regional stakeholder teleconferences to discuss strategies to educate the uninsured, under-insured and small businesses about the exchanges. ACS CAN staff has been participating in the calls.
Essential Health Benefits
The essential health benefits (EHB) provision in the Affordable Care Act requires all health plans in the individual and small-group market (inside and outside state insurance exchanges) to offer patients a minimum standard of benefits beginning in 2014. Each state has been tasked with defining an EHB package that covers 10 broad categories defined by the federal government through selection of a "benchmark" health plan from among several plans already available in the state. ACS CAN believes the EHB is one of the most critical insurance reforms in the law and have been at the forefront of efforts to ensure EHB packages include benefits vital to treating, preventing, and detecting cancer and other chronic diseases.
To date, just two states -- California and Washington -- have selected benchmark plans, but September 30 is the deadline for states to select a plan. (States that fail to do so default to the largest small-group plan in the state.) ACS CAN is providing oral and written testimony in multiple states to raise concerns about the lack of specifics on the benefits offered in many of the plans under consideration. For example, ACS CAN wants to ensure that "medical necessity" is defined in a way that prohibits insurers from circumventing the EHB, gives patients and doctors the freedom to determine the best course of treatment, and does not limit what cancer drugs doctors may prescribe.
As you know, the Affordable Care Act expands Medicaid eligibility to 138 percent of the federal poverty level (FPL), but state participation is now optional as a result of the Supreme Court ruling. The Urban Institute recently estimated that between 21 and 45 states would save money by expanding Medicaid. Analyses done by the states of Arkansas and Oklahoma, and of Arizona by a nonprofit institute, confirm this conclusion.
As reported by Inside Health Policy, analyses by the states of Arkansas and Oklahoma of the Affordable Care Act Policy found that Medicaid expansion would save their states hundreds of millions of dollars over 10 years. Oklahoma has not officially released its figures, but Arkansas estimated that the state would save $372 million from 2014 through 2021. The Associated Press has since reported that Arkansas' governor has reversed his opposition to Medicaid.
Inside Health Policy_Arkansas, Oklahoma Say Expanding Medicaid Would Save Them Millions_8.23.12.docx
More recently, the nonpartisan Grand Canyon Institute recommended that Arizona expand its Medicaid program after finding that the state's general fund would save $1.2 billion over four years while also complying with the 2000 citizen initiative "Healthy Arizona" which raised Medicaid eligibility to 100 percent of the FPL. The Institute also concludes that the state would create 21,000 new jobs through the Affordable Care Act's Medicaid expansion as opposed to the 15,000 jobs created under the Healthy Arizona policy.
ACS CAN supports Medicaid expansion as a way to increase access to lifesaving cancer prevention and early detection measures, treatment, and follow up care. At the same time, ACS CAN continues to fight state policies that restrict Medicaid eligibility and limit benefits, such as cancer care for women diagnosed through the National Breast and Cervical Cancer Early Detection Program.
HealthCareandYou.org Features ACS CAN
The Health Care & You coalition, which provides the public with straightforward, easy-to-understand information about the Affordable Care Act, continues to add important content to its website. The latest is a series of videos about different aspects of the law, featuring representatives of the coalition, including one featuring yours truly discussing provisions of the law that benefit people with pre-existing conditions. ACS CAN is a founding member of the coalition.
Health Insurance Assistance Service
The Society's Health Insurance Assistance Service (HIAS) recently reached the milestone of completing 50,000 cases. HIAS, a service operating out of Society's National Cancer Information Center, was created in 2005 to help cancer patients navigate the private health insurance system. Callers with questions or problems regarding health insurance work with trained health insurance specialists who gather detailed information about the callers' needs and circumstances, diagnose the health insurance problem, and offer information about possible solutions. More than 7,000 cancer patients, survivors and their advocates seek out HIAS each year and many of their stories help ACS CAN put a face on the health care challenges confronting thousands of cancer patients.
Earlier this year, HIAS reported that they have had greater success in finding coverage for cancer patients since the creation of the Pre-Existing Condition Plan (PCIP) state high-risk pools under the Affordable Care Act. PCIP was designed to provide access to quality, affordable health care to people in every state with pre-existing conditions such as cancer who have gone uninsured for six months or more. HIAS is looking forward to being able to help even more cancer patients find affordable, adequate health care coverage once the Affordable Care Act is fully implemented in 2014. The Commonwealth Fund has a new issue brief on lessons learned from PCIP and how to apply them to the Affordable Care Act.
A new report by the Society, the Kaiser Family Foundation, and the National Colorectal Cancer Roundtable shows that not all consumers are receiving screening for colorectal cancer free of charge, as required by the Affordable Care Act. Depending on their provider, insurer, or the state they live in, consumers may face cost sharing, which could discourage screening. Consumer complaints appear to center on unexpected colonoscopy bills that result from providers coding the procedure as diagnostic or treatment rather than preventive. Similar issues may also occur with other screening and early detection procedures, such as mammography.
ACS CAN is seeking remedies to the problem and has endorsed a bill in Congress that eliminates cost sharing for Medicare beneficiaries receiving a colonoscopy, even if a polyp is removed. ACS CAN also continues to advocate for passage of federal legislation to establish a program, modeled after the NBCCEDP, to provide access to colorectal cancer screening for uninsured, underinsured, and low-income populations, including treatment and follow-up care. Read the ACS CAN press release announcing ACS CAN support for the colorectal bills.
In addition, because the Affordable Care Act only requires coverage for three types of colorectal cancer screening, ACS CAN continues to advocate for state laws and policies requiring insurers to cover all evidence based colorectal screening tests for people ages 50-64 as well as for individuals at high risk for the disease. Currently, 23 states and the District of Columbia have such laws. For more on state colorectal cancer coverage laws, see page 39 of ACS CAN's 2012 How Do You Measure Up? report.
Care Transitions
CMS issued a proposed rule for the Medicare Physician Fee Schedule that would create a new billing code that would provide reimbursement for the work of clinical staff and non-physician practitioners involved in coordinating the transition of care for a Medicare patient after he or she is discharged from a hospital or skilled nursing facility.
ACS CAN filed comments with CMS highlighting the vital role patient navigators play in helping cancer patients with complex and chronic illnesses navigate the nation's complex and fragmented health care system. Patient navigation is a proven intervention shown to aid patients in managing complicated transitions across care settings.
Health Care Law Saved Consumers an Estimated $2.1 Billion
The Affordable Care Act has saved consumers an estimated $2.1 billion on health insurance premiums, according to a new HHS report. New rate review rules in the health care law prevent insurance companies in all states from raising rates with no accountability or transparency. The health care law provides states with Health Insurance Rate Review Grants to enhance their rate review programs and bring greater transparency to the process. To date, rate review has helped save an estimated $1 billion for Americans. Additionally, the law's medical loss ratio provision -- or 80/20 rule -- is helping deliver rebates worth $1.1 billion to nearly 13 million consumers.
Insurance Coverage
New census data shows that for the first time since 2007, the number of Americans without health insurance declined by 1.3 million from 2010 to 2011. The decrease can be attributed in good part to roughly 3 million young adults who have taken advantage the Affordable Care Act's provision allowing them to stay on their parents' insurance plans until age 26. At the same time, with poverty on the rise, the number of people covered through Medicaid increased.
CANCER RESEARCH, EARLY DETECTION AND PREVENTION
On September 14, the White House released a report on the impact of across-the-board budget cuts, known as sequestration, scheduled to take effect on January 1 under the Budget Control Act (BCA) of 2011. Sequestration would be in addition to significant cuts to non-defense discretionary programs already made as part of the BCA. The report confirms what ACS CAN and others in the public health community have long known - that the sequestration would deprive medical research and disease prevention programs of critical federal dollars needed to fight life-threatening diseases such as cancer.
Of specific concern to ACS CAN is the 8.2 percent reduction for health agencies that fund priority cancer programs. The National Institutes of Health budget would be reduced by $2.5 billion and would likely mean a more than a $450 million cut in cancer research funding. The Centers for Disease Control and Prevention (CDC) would be cut $464 million. It is unclear how the cut would be applied, but if distributed proportionately nearly 50,000 fewer women having access to breast and cervical screenings.
Congress has adjourned, so the earliest any action could be taken to revise or rescind the sequestration would be in a post-election lame duck session. The current Congress could also defer any decisions to the next Congress and whoever wins the presidency. In the meantime, the federal government begins operating under a six month long stop gap spending measure at the start of the 2013 fiscal year on October 1. All federal spending will be held at 2012 funding levels.
ACS CAN is working to ensure that these cuts are never enacted. In addition to the September 13 Lobby Day, ACS CAN advocates are talking to their representatives and senators in their districts. A whole range of tactics, such as phone calls, advertising, and rallies, will also be deployed as soon Congress takes up the issue. ACS CAN continues to work closely with its partners in the One Voice Against Cancer coalition as well.
Kudos to the Pennsylvania Division for working with their state to secure an additional $198,835 for its breast and cervical screening program through a CDC grant funded by the Affordable Care Act's Prevention and Public Health Fund. An estimated 650 more women will be served by this lifesaving program as a result. Funding runs from September 30, 2012 through September 29, 2013.
FAMILY SMOKING PREVENTION AND TOBACCO CONTROL ACT
Under the Family Smoking Prevention and Tobacco Control Act (FSPTCA), the Food and Drug Administration (FDA) has the authority to regulate cigars, but has not yet acted on it. ACS CAN believes a new CDC report provides further proof of tobacco industry efforts to undermine the intent of the FSPTCA by marketing flavored cigars, which are more attractive to children. The report found that nearly 60 percent of cigar smokers aged 18-24 smoke flavored cigars, compared to 42.9 percent for all cigar smokers. Fruit- and candy-flavored cigarettes are banned under the FSPTCA. ACS CAN and its coalition partners have been urging the FDA to assert its regulatory authority to cigars since passage of the FSPTCA in 2009 and are also now fighting a bill Big Tobacco is pushing in Congress to exempt many