Connecticut Action Center

Cancer Research and Prevention Programs

Despite the tough economic times, representatives and senators on the Appropriations committees showed solid support for cancer research and prevention programs before adjourning for the August recess.

Senate Action

On July 29, the Senate Appropriations Committee approved a $1 billion (3.2 percent) increase for the National Institutes of Health (NIH) over the 2010 fiscal year (FY10) budget, for a total of $32 billion in FY11. This amount includes $5.2 billion for the National Cancer Institute (NCI). Read the ACS CAN press release.

Unfortunately an amendment from Senator Arlen Specter (D-PA) that would have added another $1 billion to the NIH budget failed. The NIH budget does, however, include $50 million for the Cures Acceleration Network authorized in the Affordable Care Act through a bill by Senator Specter. The Network was created to bridge the gap between lab discoveries and life-saving therapies. Housed in the NIH Director’s office, the Network identifies and directs funding to priority “high need cures” for which commercial market incentives are unlikely to result in adequate or timely development.

ACS CAN advocates were also successful in an effort to have the Committee include language in its bill report urging NCI to maintain support for the Breast Cancer Surveillance Consortium. The Consortium is designed to improve surveillance and clinical practices and for nearly 20 years has been a strong complement to Society-sponsored breast cancer research. The language also calls for the Consortium to expand current data collection and surveillance systems to other widely prescribed cancer screening tools.

The Committee also allocated $582 million for the cancer programs at the Centers for Disease Control and Prevention (CDC). This is $101 million over last year’s budget and $120 million over the president’s request. The Office of Smoking and Health received an $87 million increase for a total of $197 million when funding from the Prevention and Public Health Fund created by the Affordable Care Act is included. The Comprehensive Cancer Control Initiative received $30 million, up from $21 million in FY10, a 45 percent increase.

Most CDC programs, however, were flat funded, including the Colorectal Cancer Screening, Education and Outreach Program. Funding was restored to two programs the president’s budget eliminated: the Geraldine Ferraro Blood Cancer Program and the Gynecologic Education and Awareness program will both be funded at the same level as last year, $5 million and $7 million respectively.

The Committee set funding levels for the Health Resources and Services Administration (HRSA) Nursing Program at $292 million, up from $48 million in FY10, a 20% increase. The HRSA Patient Navigator Program, which ACS CAN fought to create, received $5 million, the same as last year.

House Action

In the House, the Labor-HHS Appropriations Subcommittee approved its FY 11 spending bill on July 15 by a vote of 11-5. Like the Senate version, the bill included a $1 billion (3.2 percent) increase for NIH for a total of $32 billion, $1 billion more than FY10, with $5.2 billion of that going to NCI and $50 million to the Cures Acceleration Network. Read the ACS CAN press release.

The House bill also includes nearly $6.8 billion total for the CDC, $32 million more than FY10 and $170 million above the President’s request. Funding levels for CDC cancer programs, such as the National Breast and Cervical Cancer Early Detection Program, are not yet available. The CDC will receive an additional $594 million from the Prevention and Public Health Fund created by the Affordable Care Act. Like the Senate bill, the House Subcommittee allocated $292 million for the HRSA nursing programs, a 20 percent increase over FY10.

Recess Activities

During the August congressional recess ACS CAN advocates will be making the case for federal funding for vital cancer programs directly to lawmakers as they return home. Activities include creation of an online “National Family Album” with photos and stories from cancer survivors about how research has affected them, promoting ACS CAN’s poll of families affected by cancer in the media and other venues, and partnering with a local cancer center on an activity or media event. The grassroots activities will build momentum for the ACS CAN Leadership Summit and Lobby Day being held September 26-29 in Washington, DC.

National Breast and Cervical Cancer Early Detection Program

ACS CAN Launches Ad Campaign

On August 9, ACS CAN launched a print and online advertising campaign in targeted congressional districts to highlight the need for more funding for the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). The program has provided more than 9 million screening exams to more than 3 million women and diagnosed more than 40,000 cases of breast cancer and more than 2,000 cases of cervical cancer since it launched in 1990. But with limited funding, the program is able to serve fewer than 1 in 5 eligible women. Read the ACS CAN press release.

The print ad features a blindfolded woman beside text that reads, “We can’t fight cancer if we can’t see it.” The ad goes on to say, “When it comes to cancer, screening is seeing…  It's time to take the blindfolds off and to stop cancer before it starts.” Online advertising that features the “Screening is Seeing” theme will also run this month.

Congress showed its commitment to making prevention and early detection a national priority by including an increase for the NBCCEDP in FY 2011, funding bills approved by the Senate Appropriations Committee.  But even with increases, funding continues to fall short of the program’s fully authorized level of $255 million.

In addition to the ad campaign, ACS CAN advocates will be working through the congressional recess to boost both federal and state funding that supports the NBCCEDP. Activities include a radio media tour featuring American Cancer Society Immediate Past President, Elizabeth “Terry” T.H.  Fontham, MPD, DrPH, educational forums for state and federal lawmakers, partnering with Making Strides Against Breast Cancer participants, and sending anniversary cards to lawmakers.

ACS CAN Marks NBCCEDP’s 20^th Anniversary

On July 27, ACS CAN hosted an event to mark the 20th anniversary of the NBCCEDP on Capitol Hill. Speakers included: Senator Debbie Stabenow (D-MI), Representative Sue Myrick (R-NC), and Representative Debbie Wasserman Schultz (D-FL), Dr. Marcus Plescia, director of the CDC’s Cancer Prevention and Control Division, and ACS CAN volunteer Vonnie Uzoukwu, a breast cancer survivor who benefited from the program. Read the ACS CAN press release.

During the event, ACS CAN unveiled Decades of Detection: Progress and Challenges of the National Breast and Cervical Cancer Screening and Treatment Program, a new report that highlights stories of women who the NBCCEDP successfully served and emphasizes the need for adequate funding so the program can screen more women.

How Do You Measure Up?

On July 28, at the National Conference of State Legislatures’ annual meeting, ACS CAN released the eighth annual How Do You Measure Up?: A Progress Report on State Legislative Activity to Reduce Cancer Incidence and Mortality . The report evaluates each state’s policies (as a result of a legislative vote or a ballot initiative) on six specific issues: breast and cervical cancer early detection program funding; access to care for the uninsured; colorectal screening coverage laws; smoke-free laws; funding for tobacco prevention programs; and tobacco taxes. The report also examines affordability of health coverage, pain management, and investments in nutrition and physical activity promotion. Read the ACS CAN press release.  Look inside the report to find out how your state did.

Unfortunately, nearly half of all states are falling short on legislative solutions to prevent and fight cancer, with 23 states reaching ACS CAN’s benchmark on none or only one of the six priority areas. No state has met all of the benchmarks for effective cancer-fighting policies and only one state — Hawaii — reached benchmarks in five of the six areas. Seven states — Alabama, Florida, Idaho, Mississippi, Oklahoma, South Carolina, and Tennessee — did not meet the benchmark on any of the six issues. Sixteen states received high marks on only one issue.

But despite budget crises in many states, there was some positive progress:

•        Since the 2009 report, 11 states and the District of Columbia have passed tobacco tax increases. The current national average tax is $1.45 per pack, up from $1.28 in 2009. Forty-seven states have increased tobacco taxes since 2002. 

•        Nearly 79 percent of the US population is covered by some kind of smoke-free workplace law, with three states — Kansas, Michigan, and Wisconsin — implementing comprehensive smoke-free workplace laws in the past year. Thirty-five states plus the District of Columbia and Puerto Rico have 100 percent smoke-free workplaces and/or restaurants and/or bars. Twenty-two of those states plus the District of Columbia and Puerto Rico are 100 percent smoke-free in all three categories.

•        Twenty-seven states and the District of Columbia have laws ensuring private insurance coverage for the full range of colon cancer screenings.

•        Ten states spend more than 50 percent of the CDC-recommended funding level towards tobacco prevention. In 2010, North Dakota became the first and only state to fully fund its tobacco control program.

•        Many states are working on policies and programs to reduce the cancer risk related to poor nutrition, lack of physical activity, and obesity. In addition, many state legislatures fought hard to preserve coverage for lifesaving cancer screenings and treatments and to stave off attempts to cut state funds that support these programs, such as the National Breast and Cervical Cancer Early Detection Program.

The report was distributed to national health policy reporters and Washington-based bureaus. ACS CAN also worked with Divisions to localize press releases. Stories have appeared in publications such as The Detroit Free Press and Birmingham Business Journal. A nationwide radio media tour covered national outlets, including ABC Radio, Wall Street Journal Radio, and National Metro Networks, and 15 targeted states where Division spokespeople conducted 32 interviews reaching more than 5,100 station affiliates and a potential audience of more than 18 million. ACS CAN also did outreach through blogs and social media networks, such as Twitter.

Access to Care - Affordable Care Act

Regulations

Prevention Benefits

On July 14, the Department of Health and Human Services (HHS) released interim final rules for prevention benefits included in the Affordable Care Act.

The regulations require new individual and group health plans to provide beneficiaries with certain preventive benefits at no cost starting September 23, 2010 (“grandfathered plans” do not have to comply with the regulation). Preventive services with a rating of "A" or "B" in the current recommendations of the United States Preventive Services Task Force, including cancer prevention tools such as mammograms, colonoscopies, and tobacco cessation counseling, must be offered at no cost. The rules will encourage millions of people to protect their health by taking advantage of lifesaving preventive measures. ACS CAN will submit comments on the rules within the 60-day public comment period. Read ACS CAN’s press release.

The rules were announced at an event at George Washington University Hospital in Washington, DC featuring First Lady Michelle Obama, Dr. Jill Biden (wife of Vice President Joe Biden), and HHS Secretary Kathleen Sebelius. Also in attendance was ACS CAN volunteer and Wisconsin State Lead Ambassador Kathi Hansen, a seven-year breast cancer survivor whose cancer was detected early thanks to a routine mammogram. 

Consumers’ Right to Appeal

On July 22, HHS released an interim final rule on provisions in the Affordable Care Act that will standardize internal and external processes that patients can use to appeal decisions made by their health plan. Beginning on or after September 23, 2010, new health plans must adopt an internal process that allows consumers to file an appeal when a claim for a covered service has been denied. Those plans are required to instruct consumers about how they can begin the appeals process. In addition, states will have to provide consumers with access to a standard external appeals process. HHS will work with states to establish or update their external appeals process to meet the new federal standards. If state laws do not meet federal standards, comparable federal external appeals standards will protect consumers in those states.   

ACS CAN has reviewed the regulation and considers it to be an important improvement in providing patients with important rights and clear information about those rights. ACS CAN will work in partnership with other organizations to make formal comments for improvements and clarifications on specific issues raised in the regulation.

High Risk Pools

The federal Pre-Existing Condition Insurance Plan (PCIP) has been up and running since July 1, as have several new state-run high-risk pools across the country. On July 31, HHS released interim final rules for the High-Risk Pool Program created in the Affordable Care Act to clarify the rights that consumers have if they participate in the new high-risk pool plan. The regulation is generally very good, but there are a few specific areas where ACS CAN may recommend changes or clarifications.

State Health Exchanges

On August 3, HHS requested public comments in advance of final rulemaking on provisions in the Affordable Care Act regarding the creation of state-based health exchanges. Specific areas that HHS is interested in include: what type of information will be useful for consumers when they trying to enroll in a plan, what resources people will need to navigate the health exchange and purchase health insurance successfully, and how eligibility and enrollment can be coordinated more effectively among the State Children’s Health Insurance Program, Medicaid and the Exchanges. ACS CAN will submit comments in conjunction with other patient and consumer groups that address these areas.

FDA Takes First Step Toward Implementing Menu Labeling Provisions

Last month the Food and Drug Administration (FDA) announced that it will solicit comments from the public on how to proceed with new federal menu labeling requirements under the Affordable Care Act. The provisions require chain restaurants and retail food establishments with 20 or more locations that offer substantially the same menu items to list calorie information on menus and menu boards, including drive-through menu boards. Other nutritional information — total calories, total fat, saturated fat, cholesterol, sodium, total carbohydrates, complex carbohydrates, sugars, dietary fiber, and total protein — must be available in writing. The new law also requires vending machine operators who own or operate 20 or more vending machines to disclose the calorie content of the items. 

Prior to the Affordable Care Act, some state and local governments required restaurants in their jurisdiction to post nutritional information. ACS CAN has worked on this issue on the state level for a number of years, and will submit formal comments to the FDA. The Affordable Care Act requires the FDA to issue proposed regulations to carry out these provisions by March 23, 2011. 

Consumer Assistance Grants Program

On July 22, HHS unveiled the Consumer Assistance Grants Program, which will provide $30 million in grants to states and territories to educate consumers about their health coverage options, help them enroll in health coverage, and assist them in filing complaints and appeals against health plans. Eligible applicants include state insurance departments, state attorneys general, independent state consumer assistance agencies, and other state agencies. States and territories may also partner with non-profit organizations with a track record of working with consumers. 

Medicaid Protections – Federal Medicaid Assistant Percentages (FMAP) Funding

On August 5, the Senate passed a bill that will provide $16.1 billion to extend increased state Medicaid funding for an additional six months. The extension will protect the health coverage of thousands of cancer patients, and prevent many states from making cuts to life-saving cancer prevention programs across the board. The House will return to vote on the measure this week. Read the letter that ACS CAN, the American Diabetes Association and the American Heart Association sent to senators and shared with the media last week urging swift passage of the legislation.

Constitutionality of the Affordable Care Act

Twenty-two states are now involved in two lawsuits challenging the constitutionality of the Affordable Care Act’s requirement that all individuals have health insurance beginning in 2014, the so-called “individual mandate.” Most Constitutional scholars believe these lawsuits will ultimately fail and Supreme Court precedents uphold the federal government’s power to regulate a wide variety of commercial activity. Similar challenges were brought against the Social Security Act, the Civil Rights Act, and other historic legislation, all of which failed. Thus far the American Cancer Society and ACS CAN have declined to intervene in these lawsuits, but we are monitoring them closely because many reforms in the law — such as the requirement that insurers cover individuals with pre-existing conditions — can only be effective if everyone is part of the system.

Virginia’s attorney general filed a lawsuit separate from the other 21 states, which are parties to a case pending in the federal district court in Florida. On August 2, the federal district court in Virginia denied the federal government’s motion to dismiss the Virginia attorney general’s suit. This was a procedural ruling that allowed the suit to move forward. The court did not rule on the merits of the claim, only that the Virginia attorney general has standing to challenge the law.

Opponents of the legislation have also launched ballot initiatives and legislative efforts in several states to overturn the mandate. On August 3, Missouri primary voters passed Proposition C, a ballot initiative designed to oppose the individual mandate. Two weeks ago a Florida state circuit court judge threw out a proposed state constitutional amendment opposing the individual mandate planned for the November ballot. The case is being appealed to the Florida Supreme Court.

Family Smoking Prevention and Tobacco Control Act

On July 15-16, the Food and Drug Administration (FDA) Tobacco Products Scientific Advisory Committee heard testimony from the tobacco industry regarding menthol flavoring in cigarettes. Not surprisingly, industry representatives denied that menthol has any effect on smoking initiation, ability to quit, or health consequences beyond those associated with smoking non-mentholated cigarettes. Read ACS CAN and its public health partners’ comments to the FDA on the public health standard for menthol.

Established as part of the Family Smoking Prevention and Tobacco Control Act, which gave the FDA the authority to regulate tobacco products, the Committee is tasked with making recommendations to the FDA by March 2011 on the impact of the use of menthol in cigarettes on public health. Specifically, they will look at use among children, African-Americans, Hispanics, and other racial and ethnic minorities.

Smoke-Free Successes

Congratulations to the South Atlantic Division’s volunteers and staff on their recent win in Chapin, South Carolina. The town passed a 100 percent smoke-free ordinance on August 3 covering all workplaces, including bars and restaurants. The ordinance took effect upon passage. Chapin is the sixth local community in the state to pass a smoke-free law in 2010 and the 36^th statewide. The Division is also celebrating the Irmo Town Council’s rejection, by a vote of 4 to 1, of a weak law that would have only required establishments to post their smoke-free policies at the entrance of the business. Volunteers and staff will continue to push for a comprehensive smoke-free law in Irmo, which is now the only major community in the Columbia area without limits on workplace smoking according to The State newspaper.

Child Nutrition

On August 5, the Senate passed the Healthy Hunger-Free Kids Act which reauthorizes federal child nutrition programs. The House is expected to take up the legislation when it returns from its August recess. Provisions in the bill include:

•        Encouraging the adoption of the Institute of Medicine’s recommendations to update the nutritional and meal standards for National School    Nutrition Programs;

•        Increasing meal reimbursement in National School Nutrition Programs;

•        Updating nutritional standards for foods not served through the National School Nutrition Programs, including food sold in vending machines and in a la carte lines; and,

•        Strengthening school wellness policies for quality physical education, health education, and nutritional education.

Approximately one-third of all cancer deaths are attributable to poor diet, physical inactivity, and being overweight and obese. Obesity among adolescents has tripled over the past three decades. Because overweight and obese children are more likely to be overweight or obese as adults, efforts to establish healthy body weight patterns should begin in childhood. A nationwide strategy to improve nutrition and physical activity in children is critical to tackling the problem. Read the ACS CAN press release.

ACS CAN Cancer Poll Now Online

A consumer-friendly guide summarizing ACS CAN's poll of people with cancer and their families is now available online. Grassroots volunteers will deliver the guides to congressional offices during the ACS CAN Leadership Summit and Lobby Day. The poll is a valuable tool to demonstrate how the health care system before the Affordable Care Act was failing people with cancer and their families.

As a reminder, the poll, which was released June 23, found that:

•        A large proportion of cancer patients and survivors struggled to gain access to quality, affordable health care in the system that existed prior to the Affordable Care Act.

•        Although a minority of cancer patients and survivors are familiar with specific provisions of reform that will benefit patients, an overwhelming majority supports those provisions after learning about them.

•        Few cancer patients have had meaningful conversations with their doctor or other health care providers about quality of life issues including pain and the emotional impact of fighting cancer.

•        Large majorities of people with cancer are likely to re-elect a Member of Congress who supports increasing federal funding for cancer research, and large majorities support increasing the federal tobacco tax to help fund such research.

Christopher W. Hansen

President

American Cancer Society Cancer Action Network (ACS CAN)

Connecticut Updates

• 1-26-12 Affordable Care Act Update
• 1-19-11 Affordable Care Act Update
• 1-6-12 Affordable Care Act Update
• December 2011 Monthly Advocacy Update
• 12-22-11 Affordable Care Act Update
• 12-15-11 Affordable Care Act Update
• 12-8-11 Affordable Care Act Update
• November 2011 Monthly Advocacy Update