News
May 2012 Monthly Advocacy Update
TAKING ON TOBACCO
TOBACCO TAXES
California
Although the election results for Proposition 29 have not yet been certified, it has become clear, with nearly all the votes counted, that Proposition 29 was likely defeated by Big Tobacco's $50 million campaign of deception. Prop 29 would have saved more than 104,000 lives, stopped more than 228,000 kids from smoking and invested more than $500 million annually into cancer research in California and its defeat is a loss for California, which would have benefitted from the measure's lifesaving impact, unprecedented investment in cancer research and billion-dollar reductions in health care costs. It is also proof that Big Tobacco will go to any lengths to protect their profits and hide the truth: that tobacco is the only legal product that kills when used as directed. The industry leveraged its largesse to systematically distract the public from Prop. 29's proven health benefits and to fixate instead on outright myths about the measure.
As you know, the race was extremely close. Faced with an avalanche of spending approaching $50 million by Big Tobacco and its allies, the public health community waged a fierce fight to save lives from cancer and other tobacco-related diseases. Through the voices of people with cancer and their families, we put the tobacco industry on notice that we will fight its ongoing campaign of addiction and death at every opportunity. The result should serve as a battle cry for the rest of the nation that we cannot afford to back down against the predatory practices of Big Tobacco.
Many, many thanks go to the thousands of volunteers and the millions of families in California impacted by cancer who stood up with us against Big Tobacco. The Society and ACS CAN also extremely grateful to Division and ACS CAN staff for their dedication and hard work. Finally, the American Heart Association, the American Lung Association, LIVESTRONG and Michael R. Bloomberg deserve special recognition for their tireless commitment to Prop. 29.
Know that our work to save lives and protect kids from the harms of tobacco use does not end here. The Society and ACS CAN continue to work in all 50 states to pass and protect effective tobacco control policies that have been proven to save lives by establishing smoke-free workplaces, increasing tobacco taxes and funding tobacco prevention and cessation programs. Details on recent wins in Illinois, Maryland, Missouri, Ohio, and West Virginia can be found below as we stand together to reject the tobacco industry's relentless assault on our children, health, and economy.
Illinois
After a three year campaign, the Illinois legislature approved a $1 cigarette tax increase. The governor is expected to sign the bill shortly. When it takes effect on June 24, Illinois' new cigarette tax will be $1.98, the 16th highest in the country, making for a new national average tax of $1.49 per pack. As a result, an estimated 75,000 Illinois youth will not become addicted smokers, nearly 60,000 adults will be prompted to quit, and 38,600 premature deaths will be averted. In addition, the tax on other tobacco taxes was doubled, although moist tobacco was exempted from the increase. ACS CAN has been proud to partner with the Division over the course of the campaign. Congratulations to volunteers and staff in Illinois on passage of the first state cigarette tax increase of 2012!
Maryland
The governor of Maryland signed a budget that includes a significant increase in the tax on small cigars and doubles the tax on smokeless tobacco products. ACS CAN was proud to support the South Atlantic Division by providing technical assistance. Kudos to the volunteers and staff that made it happen.
Tax Parity for Other Tobacco Products
ACS CAN endorsed a Senate bill that would equalize federal tax rates on all tobacco products and close a loophole in the Children's Health Insurance Reauthorization Act of 2009, which increased the federal tax on cigarettes by 61 cents. The law set the tax rate for small cigars and roll-your-own cigarettes at the same level as cigarettes, but taxes for large cigars, smokeless tobacco and pipe tobacco remained dramatically lower. As a result, roll-your-own cigarette and small cigar manufacturers adjusted their products just enough to qualify for the lower tax rates, making them more affordable to youth and leaving the full public health benefits of the tax increase unrealized. In addition, the federal government is losing an estimated $615 million to $1.1 billion in revenue. The Senate bill is a necessary and welcome measure that will reduce tobacco use, especially among youth, and stop rampant tax avoidance. Read the ACS CAN press release and Chris Hansen's Cancer CANdor blog post.
SMOKE-FREE SUCCESSES
Missouri
There was good news out of Missouri following local elections as ACS CAN and the High Plains Division, joined by our public health partners, were victorious in defending a comprehensive smoke-free law in Springfield. The tobacco industry waged an aggressive battle to overturn the law, but voters supported it by a wide margin of 64 percent to 36 percent. Thank you to all the volunteers and staff who worked so hard to ensure public health protections prevailed.
The win bodes well for another battle with the tobacco industry in November, when Missouri voters statewide will consider a proposal to increase the state tobacco tax from the current 17 cents per pack, the lowest in the nation. Missouri is a difficult state in which to pass tobacco control measures, but the dynamics of this campaign are in some ways more favorable. ACS CAN and the High Plains Division have for some time been laying the groundwork with our public health partners for a highly coordinated effort that will emphasize the proven benefits of tobacco tax increases in the form of lives saved and keeping kids from starting to smoke. Having fresh "lessons learned' from the California campaign, ACS CAN and the Division will also be more proactive than ever in exposing the tobacco industry's deceptive and deceitful tactics.
Ohio
In a 7-0 decision, the Ohio Supreme Court ruled May 23 that the state's smoke-free law is constitutional and affirmed the state's ability to impose penalties on establishments that violate the law. The state is expected to collect $2.5 million in fines that accrued over the past few years but were not collected due to the litigation. Ohio's 100 percent smoke-free workplace, bar, and restaurant law passed by ballot initiative in November 2006 and has been the subject of litigation ever since. ACS CAN was proud to support the East Central Division's efforts to put the law fully into effect by covering the costs for defense attorney and filing an amicus brief in partnership with the Society and other public health partners.
Please join me in congratulating volunteers and staff in the East Central Division on their long and hard fought victory.
West Virginia
Kudos to the South Atlantic Division on their success in making Taylor County, West Virginia the 21st county in the state to eliminate indoor smoking in all workplaces, including bars and video lottery establishments. The regulation is set to take effect July 1, 2012.
HOLDING BIG TOBACCO ACCOUNTABLE
On June 7, the Society and other public health groups filed notice in federal court of Altria Inc.'s continued efforts to deceive the public about its products and marketing practices. The filing with US. District Court Judge Gladys Kessler in the long-running case brought by the Department of Justice (DOJ) against the major tobacco companies called the court's attention to two recent Altria advertisements that ran in Capitol Hill newspapers claiming the company markets its deadly products responsibly. One of the ads, which features the headline "Recognizing Our Responsibilities," claims that Altria and its tobacco subsidiaries market their products "responsibly" and that "we take our responsibilities seriously." The other ad, titled "Helping Find Solutions," makes similar claims. Read the ACS CAN press release.
The filing follows a May 23 letter ACS CAN sent to Altria CEO Martin Barrington demanding proof that Altria engages in responsible marketing practices, and evidence of the effectiveness of those efforts. Because even as Altria attempts to convince members of Congress that it is a responsible corporate citizen, the company and its subsidiaries, including Philip Morris USA, are engaged in multiple efforts to undermine existing and proposed laws that would curb tobacco use. The company has yet to respond to ACS CAN.
The Society and five other public health groups - the Campaign for Tobacco-Free Kids Action Fund, American Heart Association, American Lung Association, Americans for Nonsmokers' Rights and National African American Tobacco Prevention Network - are intervenors in the federal case, which DOJ filed in 1999 to hold Big Tobacco accountable for more than 50 years of fraudulent and deceptive marketing practices. In a landmark 2006 opinion, Judge Kessler found the major cigarette manufacturers guilty of violating civil provisions of the Racketeer Influenced and Corrupt Organizations Act (RICO) with powerful evidence that the industry was well aware that smoking and nicotine are addictive and that they strategically market to youth.
According to the decision, the tobacco industry must make corrective statements to explain their decades of lies and dishonesty to the American public. The public health intervenors and DOJ last year urged the court to require strong statements such as, "We manipulated cigarettes to make them more addictive," and "Smoking is very addictive. And it's not easy to quit." As expected, the industry submitted significantly weaker recommendations.
The pressing need for forceful corrective statements is further exemplified by Altria's advertisements, which state that the company only markets its products to consumers 21 and older, works with retailers to restrict in-store promotions and communicates about the health risks of tobacco. The corrective statements, which the Court has directed to appear on TV, in newspapers, on packaging and on company websites when they are finalized, remain critical to preventing Altria from continuing to misrepresent itself and its products.
Litigation Update
The Supreme Court decision on the constitutionality of the Affordable Care Act () is expected to be announced before the court recesses for the summer at the end of June. At this time it is unclear what day the court will announce the decision, but whenever it occurs, ACS CAN plans to host a conference call that afternoon to discuss the ruling and provide information and talking points on ACS CAN's response to the decision. Please make a note to look for an e-mail from Chris Hansen containing the call in information shortly after the decision is announced.
In other news, three of the nation's largest health insurance companies -- Aetna, Humana, and UnitedHealthcare -- announced this week that regardless of how the Supreme Court rules on the Affordable Care Act that they will retain many of the law's most popular insurance reforms, such as the ban on retroactive policy cancellations, free prevention services, and coverage for young adults on their parents' plans until age 26. Pointedly, none of the insurers mentioned whether they would retain the law's provision banning denials of coverage based on pre-existing conditions, which is already in effect for children.
Federally-Facilitated Exchanges
Under the Affordable Care Act, the federal government will create and operate exchanges in any state that has not established an exchange or that has an exchange that fails to receive federal certification. The Department of Health and Human Services (HHS) recently announced that states have until November 16, 2012 to apply for certification. States that do not file an application by then will be in a federally-facilitated exchange in 2014. Moreover, a state application is subject to review and if it is deemed unacceptable, those states, too, will have a federally-facilitated exchange in 2014.
In addition, HHS issued a white paper detailing how such so-called federally-facilitated exchanges (FFEs) will operate. Generally, the paper reflects policy positions HHS has disclosed previously: Federal exchanges will have to perform all functions required of state-based exchanges as defined in the final exchange regulation issued in March 2012. States that do not want to operate an exchange have the option of partnering with the federal exchange to perform plan management functions (i.e. certification and approval of qualified health plans), provide consumer assistance services (e.g. navigators), or both. In addition, the state can determine Medicaid eligibility based on information the federal exchange provides or it can allow the federal exchange to perform that work using state eligibility criteria. Read the ACS CAN statement and a CQ story.
One area of some concern to ACS CAN is the decision to allow any qualified insurer to participate in the federal exchange for at least the first year. In other words, the federal exchange would not follow an "active purchaser" model wherein the exchange operator has the ability to negotiate directly with insurers. ACS CAN and many other consumer groups have advocated for an active purchaser model because it can lead to more competition and higher quality coverage. However, ACS CAN recognizes that the primary goal is to have operational and effective federal exchanges in place in 2014. HHS has clearly indicated that they will consider an active purchaser model after 2014 if conditions warrant a change.
State Exchanges
HHS released grants totaling $181 million to Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington to support the establishment of state health exchanges. To date, 34 states and the District of Columbia have received such grants.
Essential Health Benefits
Responses to an essential health benefits survey for state insurance departments and insurance commissioners, which was created by Society Divisions and ACS CAN in partnership with the American Diabetes Association (ADA), the American Heart Association (AHA), and the National Multiple Sclerosis Society (National MS Society), are beginning to arrive. As of June 7, five states have completed the survey (Alaska, Delaware, Iowa, Vermont and Virginia) and we have secured commitments from Insurance Commissioners (IC) in four additional states (Arizona, Idaho, Illinois and Minnesota) to provide the information requested.
The survey covers 31 different benefits considered vital for individuals with chronic diseases, including cancer, and will help gauge the adequacy of state insurance plans that may eventually be chosen as the benchmark level for essential health benefits for all individual and small group plans in a state beginning in 2014, when the health insurance exchanges are up and running. 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.
ACS CAN and Division advocacy staff are working in partnership to spearhead follow up to the survey. Given a variety of external factors that made it almost impossible for many state insurance commissioners to respond in the original time frame, the June 1 deadline has been extended. Follow up will continue and Society Divisions and ACS CAN will continue to work with ADA, AHA, and the National MS Society in this effort. Many states are also recruiting other organizations that have been allies on other state and local campaigns and projects to help in this critical data collection effort.
A recent Commonwealth Fund report underscores the importance of conducting this survey. The report's authors found that more than half of the plans currently sold on the individual market do not meet the standards set for essential health benefits as articulated in the Affordable Care Act.
National Prevention Council Action Plan
On Wednesday, HHS announced the release of the National Prevention Council Action Plan, which aims to increase the number of Americans who are healthy at every stage of life. The plan was created by the National Prevention Council, an organization of 17 federal departments and agencies that was established under the Affordable Care Act. The plan provides comprehensive strategies for Americans to tackle health issues including tobacco use, obesity, health disparities and chronic diseases such as cancer.
John Seffrin, PhD, chief executive officer of the American Cancer Society and ACS CAN, serves on the National Prevention Council's Advisory Group, which was established to provide policy and program recommendations on chronic disease prevention and management, integrative health care practices and health promotion.
In Congress
The Senate recently considered a measure that would have diverted funding from the Prevention and Public Health Fund to keep down the costs of student loans. Although similar legislation passed the House of Representatives in late April, the Senate version failed 34 to 62. ACS CAN strongly supports the Prevention and Public Health Fund and has consistently opposed attempts to eliminate or divert funding from prevention services. Read the ACS CAN press release.
Cost Containment
Massachusetts is expected to pass comprehensive legislation in the near future to overhaul the way physicians and hospitals are paid. The legislation creates incentives for payers to replace the current fee-for-service system with flat "global payments" to cover the cost of providing all care given to individual patients or groups of patients for a particular illness. Providers who remain within a set budget and perform well on certain quality measures would be eligible for bonus payments. The legislation also sets a cap on state health care spending. To date, these efforts go further than other states in trying to contain costs. Read Boston Globe columnist Scott Lehigh's piece and an op-ed on by Donald Berwick, MD, who served as director of the Center for Medicare and Medicaid Services from July 2010 to December 2011.
ACS CAN is working with the New England Division to review the pertinent bills pending in the state legislature and assess their potential impact on cancer patients and their families. How these cost issues play out in Massachusetts is likely to inform debates over payment reform and cost containment in other states over the next few years.
Also of interest, a new Kaiser Family Foundation issue brief details how Massachusetts has fared six years after its health care reform law was enacted. As you know, the Massachusetts' law is cited as a model for the Affordable Care Act and the brief compares the two. The brief also provides context for the state's current debate over cost containment.
CANCER RESEARCH AND PREVENTION
Today the Senate Appropriations Committee approved a funding bill for the 2013 fiscal year (FY 2013) that provides for a $100 million increase for the National Institutes of Health (NIH) over current levels, an amount that includes a $13 million increase for the National Cancer Institute (NCI). In addition, the Centers for Disease Control (CDC) cancer programs would be funded at close to current fiscal year levels. While details for individual cancer prevention and control funding levels are not yet available, it is known that the bill does not consolidate chronic disease programs or collapse CDC cancer programs into a single budget line as proposed in the Administration's budget.
While ACS CAN is appreciative of the NIH increase, concerns remain that the amount, which is 0.3 percent increase over current spending levels, fails to keep pace with the growing cost of medical research and the needs of cancer patients who can't afford to wait for a better budget environment for new therapies and treatments. Coupled with flat funding for proven prevention programs after years of cuts to those same programs, Congress needs to make the fight to end death and suffering from this disease a higher national priority. Read the ACS CAN statement.
No action has been taken yet to allocate funding for federal health programs on the House side, although you may recall that the pertinent House Appropriations Subcommittee received an allocation of $150 billion for FY 2013, more than four percent below spending levels for the current fiscal year and more than $7.7 billion below the Senate subcommittee allocation.
On a related note, United for Medical Research, an umbrella organization representing 20 leading scientific research institutions, biomedical industries, and health and patient advocates, including ACS CAN, released a report showing that declines in federal funding for the NIH funding are threatening the United States' ability to compete globally. Read The Boston Globe editorial "NIH Funds Are Critical to Mass. Economy."
Sequestration
Looming large over the appropriations process, however, is the potential for across-the-board spending cuts, known as sequestration, for defense and domestic discretionary programs in January 2013. These cuts were put in place under the Budget Control Act, the law passed in August 2011 to raise the debt limit and greatly reduce federal spending. If the spending cuts are implemented, the National Institutes of Health (NIH) budget could be reduced by nearly eight percent. For further information, see Research!America's new report on how the sequestration could set back medical progress and stall economic growth.
New Advertising
As you may recall, last year ACS CAN launched a print and online advertising campaign urging Congress to increase funding for cancer research supported by the National Institutes of Health (NIH), so that past federal investments do not go to waste. The ad featured a beaker with text that reads, "There's promising cancer research in this beaker thanks to past federal funding." It went on to say, "Without additional funding, this powerful not-kidding-around science might just sit here as millions of families sit out there."
This week ACS CAN is running a new iteration of its "beaker" ad in Capitol Hill publications and online to coincide with the Senate Appropriations Committee's work The new copy reads: "Millions are fighting cancer out there while new lifesaving treatments sit in here."
ACSCAN_Beaker_June2012.pdf
OVAC Lobby Day
ACS CAN volunteers and staff from around the country will visit Capitol Hill on July 10 as part of the One Voice Against Cancer (OVAC) coalition's lobby day to make the case for sustained federal investments in cancer research, early detection, and prevention. More than 100 people are expected to participate representing 40 organizations. .
OVAC also hosted a smaller lobby day for Washington, DC-based staff of its member organizations on May 9. Forty meetings were held, including 23 Senate appropriators, seven House appropriators, and six House and Senate leadership offices. The remaining meetings were with other representatives and senators with whom OVAC is working to build support for cancer funding.
QUALITY OF LIFE
On June 13, the Senate Select Committee on Aging held a hearing entitled "Empowering Patients and Honoring Individual's Choices: Lessons in Improving Care for Individuals with Advanced Illness" chaired by Senator Sheldon Whitehouse of Rhode Island. ACS CAN worked with Senator Whitehouse and his staff on the hearing for a number of months to ensure that palliative care was on the agenda. With the help of the Center to Advance Palliative Care (CAPC), ACS CAN identified a patient, Dr. Gail Cooney of Florida, who was then invited to testify. Her statement is attached.
Cooney Senate Testimony 13Jun2012.docx
Dr. Cooney, a physician and a cancer survivor, shared her personal story with the panel and spoke of how her palliative care team was the lifeline she needed to receive successful treatment for stage III ovarian cancer. Her comments went a long way toward opening up a dialogue on the need for policies that allow for better patient centered coordinated care, and palliative care for individuals with serious illness like cancer. Her perspective as a patient allowed for a conversation with the Senators about how palliative care is not about end of life -- but that it is often times the lifeline that cancer patients need to coordinate their care and treatment.
Made up of doctors, nurses, and other specialists, such teams work with a patient's other doctors to provide an extra layer of support, especially in regards to addressing pain and other symptoms related to the treatment of serious illnesses such as cancer. The number programs in hospital settings have gone up 138 since 2000, from 600 a decade ago to more than 1,500 today. Ninety million Americans are now living with serious illnesses, a number that is expected to more than double over the next 25 years making the need to expand palliative care services more urgent. The Associated Press reports on the rapid pace at which hospitals are adding palliative care teams to their staffs.
Policy initiatives that address workforce needs, research, and patient access could rapidly bring palliative care to scale. ACS CAN's ongoing Quality of Life initiative is aimed at reducing patient barriers to palliative care in three key areas by: (1) ensuring sufficient numbers of specialists to teach doctors and nurses to provide high quality palliative care; (2) investing in research on way to improve patient quality of life through palliative care; and (3) delivering high-quality palliative care in hospitals and eventually other site where health care is delivered. ACS CAN is working to build support for draft legislation by identifying potential bill sponsors in Congress and building alliances with like-minded organizations.
DRUG DEVELOPMENT AND DRUG SHORTAGES
The House and Senate approved separate but similar bills reauthorizing and expanding the industry-supported user fee program that pays for expeditious Food and Drug Administration (FDA) review of new pharmaceuticals and medical devices. Renewing this important industry-government partnership is tantamount to ensuring that cancer patients, survivors and their families have access to the latest evidence-based treatments. The next step is for a House-Senate Conference to merge the bills and present them for another vote.
Both versions of the legislation include language to strengthen patient participation in the FDA's drug and device approval process. Having experienced treatment personally patients bring a unique perspective on the benefit and risks of new drug therapies and ACS CAN worked very hard to ensure the language was included in the bill. Read the ACS CAN statement.
The user fee legislation also takes important steps to address the drug shortage crisis by directing manufacturers to provide the FDA with early notification of a prospective discontinuation or interruption in the drug manufacturing process that could lead to a shortage of a particular drug. It also establishes an FDA task force to work with manufacturers and the HHS Secretary to ensure the availability of alternative sources of drug supply in the case of an ongoing or prospective shortage.
The Society and ACS CAN have been working with the FDA and representatives of the pharmaceutical industry for many months to find a solution to this critical problem. Proper notification and the creation of a task force along with the new generic drug user fee is a good start that will begin to alleviate some of the shortages now in effect.
NUTRITION AND PHYSICAL ACTIVITY
New York City Sugar-Sweetened Beverage Policy
New York City Mayor Michael Bloomberg proposed a ban on sales of large-sized sugary soft drinks in restaurants and theaters, as well as from street vendors. Research shows that large portion sizes encourage individuals to consume more, and t