News
May 2011 Monthly Advocacy Update
CANCER RESEARCH AND PROGRAM FUNDING
2011 Fiscal Year
Congress approved a spending bill on April 14 that funds the government for the remainder of FY 2011. Overall $38.5 billion was cut from the budget, including more than $320 million from the National Institutes of Health, one percent below its FY 2010 level. How the cut will impact research is not fully known, but it is a relief that Congress rejected far deeper cuts to cancer research funding. The National Cancer Institute's budget for FY 2011 will be $5.06 billion, a $42 million reduction. Also note that no funding was set aside for the NIH Cures Acceleration Network, an initiative designed to reduce the time between discovery and development of drugs and therapies and their application. Read the ACS CAN press release.
Unfortunately, the Centers for Disease Control and Prevention (CDC) experienced a staggering 11 percent cut that will put its budget below 2006 levels. These severe cuts could prevent as many as 40,000 women nationwide from accessing lifesaving breast and cervical cancer screenings, and greatly impede efforts to expand access to colorectal cancer screenings for low-income and underserved individuals. Two programs, the Geraldine Ferarro Blood Cancer Program and the Gynecologic Education and Awareness Program (Johanna’s Law) were zeroed out.
Of the other health priority programs that ACS CAN and its partners in the One Voice Against Cancer (OVAC) coalition support, the federal Patient Navigator program and Title VIII nursing program at the Health Resources Service Administration will take significant hits. Only the Food and Drug Administration received an increase. With a total budget of $2.45 billion, the agency is up $90 million, or four percent, over FY 2010.
2012 Fiscal Year
On April 15, the House passed a 2012 budget (FY 2012) plan authored by Representative Paul Ryan (R-WI), Chairman of the House Budget Committee. The budget calls for $6 trillion in cuts over 10 years and repeals the Affordable Care Act by denying the funds needed to implement the law, such as subsidies for middle-class Americans to purchase insurance in state exchanges and elimination of the Public Health and Prevention Fund.
Most of the focus on the House Republican 2012 budget has centered on the approach to Medicare and Medicaid, but it’s important not to lose sight of the fact that the proposal also poses a grave threat to priority federal cancer research and prevention programs. Discretionary spending is slated for a 25 percent cut, with budgets frozen at those levels for five years. Health program funding would revert back to 2008 fiscal year levels. Given the pace of medical inflation, research investments could not keep pace and progress would slow.
The House Appropriations Committee released the FY 2012 appropriations subcommittee allocations late last week. The allocation for the Appropriations Subcommittee that funds labor, health, and education programs for FY 2012 is $139.2 billion, $18.2 billion (11.5 percent) below the FY 2011 enacted levels. This is also the lowest allocation since FY 2004, when the subcommittee drafted a bill that totaled $138 billion.
An $18 billion cut below current funding levels puts all the programs that OVAC advocates for at risk and will require a collective effort to defend them. The House announced that the bill will be marked-up in committee the last week in July.
Capitol Hill Event
ACS CAN organized a breakfast held on May 12 for a bipartisan group of House members with Dr. Harold Varmus, director of the National Cancer Institute on Capitol Hill. Long-time cancer research champions and senior appropriators Representatives Bill Young (R-FL) and Rosa DeLauro (D-CT) served as co-hosts. The event provided the representatives and Dr. Varmus with an opportunity to have an informal dialogue about cancer research currently taking place across the country and hear about promising research in the pipeline.
Cancer Center Briefing
ACS CAN and the High Plains Division hosted a briefing for Congressional staff on the local impact of federal cancer research dollars in partnership with MD Anderson Cancer Center in Houston. The briefing is the first of several that will be held at cancer centers across the country.
For more details and photos, read the ACS CAN blog post.
Representative Gene Green attended as did district staff from five congressional offices as well as Society and ACS CAN volunteers and staff, ACS CAN corporate partners, officials from MD Anderson. Reporters from the local news stations were also on hand to cover the event. Watch the KTRK story and read the Houston Chronicle ‘s editorial on the subject as well as an the paper published op ed co-authored by Mark Clanton, MD, Chief Medical Officer of the High Plains Division, and John Mendelsohn, MD, President of MD Anderson.
2011 Fiscal Year
In the agreement that keeps the federal government operating through the rest of FY 2011, funding to implement the Affordable Care Act was left mostly intact. In a separate vote, however, the House of Representatives approved a measure to prohibit funds from being used to implement the Affordable Care Act. As part of the overall agreement on the larger spending bill, the Senate also took up the measure, but it failed on a party line vote.
Defunding
Before adjourning for its spring recess, the full House approved a bill to repeal the Prevention and Public Health Fund in mid-April. ACS CAN believes eliminating the Prevention Fund would reverse an unprecedented nationwide effort to refocus the health care system on keeping people healthy instead of treating them when they get sick. Read the ACS CAN press release
On May 3, shortly after returning from recess, the House approved a bill abolishing funding for state health insurance exchange planning grants. Read ACS CAN’s statement urging representatives to vote against the bill.
In the States
On May 11, Washington State became the fourth state with a law to establish a health insurance exchange, joining California, Maryland, and West Virginia. Also this week, Vermont’s legislature sent a bill to set up a state insurance exchange to their governor, who is expected to sign it. Vermont’s exchange is of special interest because it would establish a single-payer health insurance system in the state. Bills in Colorado and Hawaii are also awaiting signatures, while New Mexico’s governor vetoed an exchange bill. Finally, the governors of Georgia, Indiana and Missouri are bypassing the legislative process, and initiating state exchanges via executive order.
ACS CAN’s senior director of policy, Steve Finan, testified before the Maine legislature’s Joint Standing Committee on Insurance and Financial Services in opposition to proposals to repeal existing state laws on guaranteed issue and adjusted community rating. Repealing such laws would represent a big step backwards and make it significantly more difficult for patients to access lifesaving health care. Finan encouraged lawmakers to focus their energy and efforts on using existing law to develop a strong state health exchange that would benefit all.
Medicaid Maintenance-of-Effort
On May 12, the House Energy and Commerce Health Subcommittee approved the “State Flexibility Act,” which would repeal Medicaid maintenance of effort (MOE) provisions in the Affordable Care Act. Under the law, states are barred from making eligibility more restrictive before the exchanges are in place in 2014. The repeal attempt is expected to be one of the next and most significant fights, with support coming from many Republican governors and possibly some Democratic governors. If the bill is enacted, states would be allowed to cut Medicaid spending or reduce enrollment without losing matching funds from the federal government.
ACS CAN opposes the measure since it would eliminate life-saving benefits for cancer patients and their families. The MOE helps to ensure that states don't tighten eligibility requirements for their Medicaid programs. Read the statement ACS CAN, the American Heart Association, and the American Diabetes Association issued to the media.
Prevention
As you know, the president named Dr. Seffrin to the Advisory Group on Prevention, Health Promotion, and Integrative and Public Health earlier this year. The group, which held its first meeting last week, was established as required by the Affordable Care Act to provide policy and program recommendations, and to advise the National Prevention, Health Promotion and Public Health Council (National Prevention Council) on chronic disease prevention and management, integrative health care practices and health promotion. The advisory group will provide guidance on the creation of the first-ever national strategy to build a healthier population.
1099 Tax Reporting Requirement Repealed
The president signed the so-called “1099 bill” into law, which repeals a burdensome tax reporting requirement for small businesses in the Affordable Care Act. ACS CAN supported the legislation, but, along with its public health partners, opposed the offset, which requires consumers receiving federal premium subsidies to return the entire amount if they later take a new job or receive a raise that causes them to exceed the income threshold. As a result, families could receive unexpected tax bills for as much as $10,000 at the end of the tax year. In addition, individuals and families may be discouraged from purchasing coverage through state-based exchanges. ACS CAN supported an amendment, which unfortunately failed, that would have mitigated the impact on families. Read the ACS CAN press releases on the bill and the amendment.
Litigation
On May 10, a three-judge panel from the Fourth Circuit Court of Appeals heard oral arguments in two cases brought in Virginia, marking the first time that an appeals court has considered a lawsuit challenging the Affordable Care Act. The judges asked probing questions of both sides, including some implying that the state of Virginia may not have standing to sue the federal government gained particular notice. Under that theory, only individuals forced to purchase insurance against their will would be eligible to bring such a case against the federal government. The Fourth Circuit is often referred to as the "rocket docket" because it tends to rule faster than most appeals courts, meaning its decision could be announced within the next few weeks. Meanwhile, oral arguments are scheduled for early June in the Sixth and 11th Circuits, which will hear the Michigan and Florida cases. For further reading, Washington Post columnist E.J. Dionne’s “Health Care Lawsuits: Delaying the Inevitable” may be of interest.
As you know, the American Cancer Society and ACS CAN filed amicus briefs jointly with American Diabetes Association and the American Heart Association in all federal circuits hearing appeals. The briefs argue that the individual mandate is necessary to the overall function of the Affordable Care Act's new health insurance coverage, and that health insurance status is clearly linked to health outcomes.
To date, three federal trial judges have upheld the law on the merits, and two have struck down the law in whole or in part. Most experts believe the US Supreme Court will ultimately decide the challenge, with a hearing in the spring of 2012 and a final decision before the Court’s summer adjournment.
Affordable Care Act Guide Now Available in Spanish
The Affordable Care Act: How It Helps People With Cancer and Their Families, the Society’s consumer-friendly guide produced with ACS CAN that explains how provisions of the ACA help people with cancer and their families, is now available in Spanish through Ariba, item number 5600.10. The English version item number is 5600.00.
DISPARITIES
The President's Cancer Panel released a report on health disparities that points to an urgent need to expand research and improve understanding of the factors that influence cancer risk and outcomes among diverse populations. Read the executive summary, the Affordable Care Act addendum to the report, and the American Cancer Society statement.
FAMILY SMOKING PREVENTION AND TOBACCO CONTROL ACT
On May 9, the American Cancer Society and ACS CAN filed an amicus brief along with Public Citizen, the American Academy of Pediatrics, and other public health organizations in litigation challenging the expertise and authority of the Tobacco Products Scientific Advisory Committee. Established as part of the Family Smoking Prevention and Tobacco Control Act (FSPTCA), the 12-person Committee, which includes Mark Clanton, MD, MPH, chief medical officer of the High Plains Division, is tasked with making recommendations to the Food and Drug Administration (FDA) commissioner regarding safety, dependence, and health related to tobacco products. Seven of the panel’s nine voting members are from the medical and scientific community, while the eighth and ninth voting members represent the government and the public at large respectively. The tobacco sector holds the remaining seats, but do not have voting rights. They are, however, provided the opportunity to submit information and hear discussions.
As you may recall, the Committee recommended a ban on menthol cigarettes in March, finding them more harmful than regular cigarettes and appealing to youth. ACS CAN and other leading public health organizations support the Committee’s conclusions, which are based on an exhaustive review of the scientific evidence regarding the public health impact of menthol cigarettes. Soon after the report’s release, tobacco manufacturer Lorillard sued the FDA, claiming that the Committee’s experts did not meet the Federal Advisory Committees Act requirement that membership on such committees be "fairly balanced."
The amicus brief the Society, ACS CAN, and its partners filed seeks to uphold the appointment of the Committee’s experts and provides the court with background on the FSPTCA as well as general information on the purpose of scientific advisory committees and the need for experts to be able to participate without fear of litigation. In an unusual development, Lorillard refused to agree to public health groups’ filing. The brief was filed regardless and the court granted a motion to accept the brief.
SMOKE-FREE WINS