American Cancer Society Cancer Action Network

Monthly Advocacy Update

History Made - Major Milestone for the Mission

On Tuesday, March 23, President Barack Obama signed health care reform legislation. After a small White House ceremony, the president spoke at an event before an audience that included George W.P. Atkins, chair of the American Cancer Society’s National Board, Alan Thorson, MD, FACP, president of the National Board, and John R. Seffrin, PhD, the chief executive officer of the Society and ACS CAN. Later in the week, the House and Senate approved a smaller package of improvements that the president signed on Tuesday, March 30.

Passage of the legislation is a significant step forward in the Society’s overall efforts to improve access to care nationwide and marks a major milestone in the fight against cancer. Society and ACS CAN volunteers and staff can be proud of what has been accomplished, not just on the legislative front, but of all that has ensued since the joint Access to Care initiative began in 2006 when the Society’s Board of Directors set nationwide goals calling for sweeping reductions in the number of people who are uninsured or cannot afford the out-of-pocket costs for lifesaving care.

Meaningful Improvements

Although the law is not perfect, overall the legislation meets ACS CAN’s reform priorities by:

1. Increasing the emphasis on disease prevention, such as by reducing or eliminating out-of-pocket costs for lifesaving cancer screenings,

2.Guaranteeing nearly all Americans access to quality, affordable health care, regardless of whether one has a pre-existing health conditions, and;

3.Emphasizing patients’ quality of life, such as by ensuring access to treatment for pain.

More specifically, ACS CAN's analysis concluded that the law would improve access to health care by ensuring the availability of adequate and affordable insurance coverage to nearly all Americans. Critical reforms would specifically eliminate discrimination based on health status and preexisting conditions, and abolish arbitrary limits on annual and lifetime benefits for most plans, which have been so detrimental to cancer patients over the years.

The law also would help to transform the health care system to focus more on prevention and early detection by requiring all insurance plans to provide coverage for essential, evidence-based preventive measures with no additional co-pays. ACS CAN also believes the bill would go a long way toward reducing the disparities in prevention and treatment of cancer among low-income and minority populations through the expansion of Medicaid and inclusion of tax subsidies.

Immediate and Near-Term Improvements

Many of the reforms will not take effect until 2014, but several provisions will be in place before the end of the year:

• Within 90 days of enactment, uninsured people with a pre-existing condition will be able to apply for coverage in a national high-risk pool;

• In six months, the ban on lifetime limits takes effect; health plans will be prohibited from denying coverage to children with pre-existing conditions’ dependents can stay on their parent’s insurance policy up to age 26; and health plans will be barred from dropping people from coverage when they get sick; and,

• Seniors will immediately begin to get relief from the gap in Medicare prescription drug coverage, also known as the “donut hole.”

Voices Heard

As you know, ACS CAN helped shape the debate and acted as a leading voice for patients throughout the process. This would not have been possible without the persistence of ACS CAN’s powerful grassroots volunteer movement who ensured that the voices of cancer patients, survivors, and caregivers were heard. In dozens of face-to-face meetings, media events, videos, and rallies, they educated lawmakers, the media, and the public about the many challenges cancer patients face in obtaining care in the nation’s current health care system. They also underscored the need for reform in thousands of calls, letters, and emails to their legislators. Most recently, ACS CAN advocates delivered more than 56,000 signed petitions to their Members of Congress, urging lawmakers from both political parties to seize the historic opportunity to pass meaningful health reform.

Unfortunately, the rhetoric has been very heated and the legislative process criticized as politically partisan. Please remember that for ACS CAN the issue has always been about patients, not politics. Throughout this effort ACS CAN has been singularly focused on whether the provisions of the legislation would meaningfully improve the health care system for cancer patients. ACS CAN has consistently encouraged bipartisan support for meaningful health care reform, and as a nonpartisan organization, ACS CAN’s ultimate goal has been to ensure that people with cancer are no longer denied lifesaving treatment, charged far more than they can afford for critical care, or issued insurance plans that are inadequate to meet their needs.

Moving Forward

The road to meaningful health care reform has been long and arduous, but the journey is not yet over as ACS CAN turns to implementation. I know many of you are getting questions (and have some of your own) about what happens next. Preparations for this phase have been underway since January. Now that the law is on the books, more comprehensive information and communication tools about its implications for the Society, ACS CAN, and constituents will be made available in the coming weeks and months.

A priority focus of this work will be to ensure the hard-fought protections for cancer patients remain intact. And while ACS CAN succeeded in strengthening the legislation during the months-long debate, what passed could have been stronger. ACS CAN must be vigilant to ensure not only that the law works in the most effective way possible for those with cancer and their families, but also that the law’s shortcomings are addressed and enhancements made as quickly as possible.

Finally, remember that health care reform is just one part of the Society and ACS CAN’s broader goal to expand access to quality care nationwide. Rest assured that moving forward, the Society and ACS CAN will continue to lead the way, achieve results, and make a major contribution on behalf of those fighting cancer.

Many thanks to volunteers and staff in the Mid-South and Midwest Divisions for waging successful campaigns to enact legislation in Iowa and Kentucky requiring insurers to cover the routine care costs of cancer patients in clinical trials. Thirty-two states and the District of Columbia now have such laws on the books or a voluntary agreement in place.

Cancer Research and Prevention Programs

ACS CAN’s campaign to fight cuts to cancer prevention programs and sustain investments in cancer research is in full swing. Over the past month, ACS CAN has been meeting with members of Congress and staff in Washington, DC and across the country. During the Presidents’ Day recess, ACS CAN volunteers targeted 70 members of Congress for outreach in their states and Congressional districts.

Throughout this spring, ACS CAN will be working to build support among Members of Congress to ensure that the proposed cuts to cancer screening and prevention programs are rejected. ACS CAN also is working to cultivate long-term support for the research programs that are essential to improving how cancer is prevented, detected, and treated.

Following the recess, ACS CAN and its partners in the One Voice Against Cancer (OVAC) coalition ran ads in Congressional publications and websites to promote the need for sustained support for cancer research. The message to Congress was clear: funding for cancer research is good for our nation’s health and our economy. View OVAC’s funding priorities for 2011 federal fiscal year.

The President’s budget provides a $1 billion increase for medical research over last year’s funding level, including an additional $161 million specifically for cancer research. This is an important step toward sustaining and capitalizing on the progress currently being made through research. ACS CAN and OVAC are asking Congress to ensure that the scientific discoveries of today are pursued to the fullest extend possible, and that the current level of support is sustained next year.

Breast and Cervical Cancer

In addition to promoting research investments, ACS CAN is fighting back hard against proposed cuts to the National Breast and Cervical Cancer Early Detection Program (NCCEDP). Most recently, ACS CAN sent letters to the Secretary of Health and Human Services and Congressional leadership, expressing strong opposition to the president’s proposal to strip $4 million from the NBCCEDP budget, which would result in 7,000 fewer women being screened for cancer next year. ACS CAN is urging Congress to reject this funding proposal and to fully fund the NBCCEDP.

ACS CAN recently won a reversal of an adverse breast and cervical coverage decision in Tennessee. Through the Health Insurance Assistance Service (HIAS) and the National Call Information Center (NCIC), ACS CAN learned that the state had wrongfully denied Medicaid coverage to a patient because she had a “cancer-only” private insurance policy even though having such coverage should not have precluded her from Medicaid as the state contended.

ACS CAN worked through its Judicial Advocacy Initiative to make the federal Centers for Medicare and Medicaid Services (CMS) aware of the case as an example of a practice that could affect the ability of many other women in the state to obtain cancer care through Medicaid. At CMS's request, Tennessee performed a comprehensive review of their records and found that this was an isolated case and reinstated the patient’s Medicaid eligibility.

ACS CAN will continue to monitor screening and treatment programs to ensure enforcement of all related laws and regulations as part of the ongoing effort to improve access to care.

Colorectal Cancer

Kudos to the Mid-South! Volunteers and staff in Arkansas secured $5 million in the state budget for the statewide colorectal cancer screening program for the underserved. The money, which will be administered through the University of Arkansas Medical System, will be available beginning July 1, 2010 and because of state budget rules it cannot be eliminated or reduced. The Society in Arkansas was instrumental in the creation of a pilot program that led to the statewide program and lawmakers’ commitment to it.

ACS CAN and 11 partner organizations issued the 2010 Colorectal Cancer Legislation Report Card this month and unfortunately it showed the least improvement in a single year since the report began in 2004, with Vermont being the only state in 2009 to pass a bill to require insurance carriers to cover the full range of screenings. The state also capped out-of-pocket costs at $100. Read the press release.

The slowed progress is likely attributable to state legislators waiting to see the outcome of the federal health care reform debate. Including Vermont, 22 states and the District of Columbia received A’s. Ten other states require varying degrees of coverage, with scores of B, C or D. Eighteen states received Fs for failing to require any screening coverage.

Protecting Kids from Big Tobacco

On March 18, the U.S. Food and Drug Administration (FDA) announced landmark restrictions on marketing tobacco products to children and teens as part of the federal government’s implementation of the Family Smoking Prevention and Tobacco Control Act, which granted the FDA the power to regulate the manufacture, marketing and sale of tobacco products. The restrictions take effect June 22, 2010, the one year anniversary of the law. Read the ACS CAN press release.

The tobacco industry spends more than $35 million every day to aggressively market its products to addict new, young smokers, keep current users from quitting and mislead the public about the harms of its products. Every day, 3,500 children pick up their first cigarette and 1,000 children become addicted smokers. Placing restrictions on these addictive and deadly products is a critical step toward saving lives.

On March 30-31, the U.S. Food and Drug Administration (FDA) held the first meeting of its new Tobacco Products Scientific Advisory Committee. Established as part of the Family Smoking Prevention and Tobacco Control Act, the 12-person Committee is tasked with making recommendations to the FDA commissioner regarding safety, dependence, and health related to tobacco products. Priority issues to be addressed include the use of menthol and the impact of dissolvable tobacco product.

Earlier this month, Mark Stuart Clanton, MD, MPH, chief medical officer of the High Plains Division was appointed to the panel as a voting member. Dr. Clanton is also a former deputy director of the National Cancer Institute and former National Board officer. Serving as the committee’s chair is Jonathan M. Samet, MD, MS, voluntary co-chair of the Society’s Cancer and the Environment Subcommittee and chair of the Preventive Medicine Department at the University of Southern California’s medical school. Read the ACS CAN press release.

Smoke Free Successes

Smoke-free laws save lives. Secondhand smoke causes cancer, heart, and lung disease and kills an estimated 50,000 Americans each year. Strong smoke-free laws that include all workplaces, including restaurants and bars, are the only effective way to protect all workers and the public from the health hazards of secondhand smoke. Smoke-free workplaces and public places also make it easier for smokers to quit and discourage kids from picking up this deadly habit.

While I am still reeling from my beloved Jayhawks’ loss in the NCAA tournament, I am overjoyed the governor of my home state of Kansas signed legislation on March 12 that will make nearly all workplaces in the state, including bars and restaurants, 100 percent smoke-free. The law takes effect on July 1, 2010. Read the ACS CAN press release.

This victory would not have been possible without the diligence and persistence of High Plains Division volunteers and staff over many years. ACS CAN has been proud to partner with the Division during this time, providing strategic counsel, material support, and technical assistance.

Currently 19 states have laws prohibiting smoking in restaurants, bars, and all other non-hospitality workplaces. An additional four states, including Kansas, have passed such laws and are awaiting implementation. Following Michigan, Kansas becomes the second “red” state (states with no statewide 100 percent smoke-free workplace protections) to go “green” (states with laws that cover 100 percent of all workplaces, including bars and restaurants) since ACS CAN launched its “Red to Green” project late last year.

Thanks to the work of volunteers and staff in South Carolina and their coalition partners, the city councils in Cayce and West Columbia approved smoke-free ordinances this month. Both will be implemented on June 1, 2010. With these victories, South Carolina now boasts 32 local smoke-free ordinances.

In Missouri, the Lake Saint Louis Board of Aldermen passed a comprehensive smoke-free ordinance that includes all workplaces, bars and restaurants. The city is the first in St. Charles County to go smoke-free and should provide additional momentum for a possible county-wide effort, making this victory especially sweet for the volunteers and staff who worked so hard to pass it. The law will be enacted in approximately six months.

Congratulations to everyone in the High Plains and South Atlantic Divisions!

In mid-March, ACS CAN launched a new webpage on acscan.org designed to assist communities and states fighting to enact comprehensive smoke-free laws. The new page includes an interactive map that provides information on each state’s smoke-free status. The site also provides an opportunity for people to get involved on the issue and a space where they can share personal stories asserting their right to breathe clean air. Fact sheets and key studies that underscore the need for smoke-free laws are easily available too. Access the page at http://acscan.org/smokefree.

Tobacco Tax Victories

Research has consistently shown that every 10 percent increase in the price of cigarettes reduces youth smoking by 7 percent and overall cigarette consumption by about 4 percent.

This month New Mexico and Utah became the first states to raise tobacco taxes in 2010. These lifesaving victories would not have been possible without the hard work of ACS CAN volunteers and staff in the Great West Division. Read the ACS CAN press release.

New Mexico’s tax is slated to go up by 75 cents cigarette tax, putting the state’s tax at $1.66 per pack, the 18^th highest in the nation. The revenue will be directed to the state’s general fund, the funding source for most of the state’s health programs.

Utah's legislature approved a $1.005 increase in the cigarette tax, for a total tax of $1.70 per pack. The tax on other tobacco products is also going up, from 35 percent of average manufacturers price (AMP) to 86 percent -- a 51 percent increase. In addition, the tax on moist snuff will go from 75 cents per ounce to $1.83 per ounce. Revenue from the taxes will go to the general fund and will be used to restore prenatal care for low income expectant mothers, highway patrol funds, and other important programs.

On July 1, 2010, the average state cigarette tax will be $1.38 per pack, with rates ranging from a low of seven cents in South Carolina to a high of $3.46 in Rhode Island.

Research has consistently shown that every 10 percent increase in the price of cigarettes reduces youth smoking by 7 percent and overall cigarette consumption by about 4 percent. Currently 279,000 adults and 22,000 youth smoke in New Mexico. In Utah, an estimated 172,000 adults and 11,000 children smoke.

ACS CAN and the Society are currently working on numerous campaigns to increase tobacco taxes nationwide. Since 2002, 46 states, the District of Columbia and several U.S. territories have raised their cigarette tax in 97 separate instances, including 14 states and the District of Columbia in 2009 alone.

Earlier this month the Senate and House of Representatives passed the Prevent All Cigarette Trafficking (PACT) Act, which requires Internet tobacco vendors to make a full tax payment to states and localities before they can deliver their product to online consumers, setting up a system that no longer allows the vendors to skirt state excise tax rules. In addition, the legislation requires Internet vendors of cigarettes to take several steps to ensure that their products are not sold directly to minors, such as by requiring age and ID verification online at the time of purchase and at the time of delivery. The bill is now awaiting the president’s signature. Read the ACS CAN statement.

The American Cancer Society and five public health partners -- the American Heart Association, American Lung Association, Americans for Nonsmokers’ Rights, the National African American Tobacco Prevention Network and the Tobacco-Free Kids Action Fund (an advocacy affiliate of the Campaign for Tobacco-Free Kids) – recently petitioned the US Supreme Court to hear a case that would allow a lower court to require major cigarette manufacturers to pay for a broad public education campaign against smoking, as well as programs to help smokers quit. The groups also asked that the trial court be empowered to require the tobacco companies to forfeit profits they made during decades of illegal activity. Read the press release.

The request for the high court to consider the case stems from a landmark ruling in 2006 in which the cigarette manufacturers were found guilty of violating the Racketeer Influenced and Corrupt Organizations Act (RICO). The Society and its health partners are intervenors in the RICO case, which was brought by the US Department of Justice, and thus formal parties to the lawsuit.

American Cancer Society Chief Medical Officer Otis W. Brawley, M.D. testified before the House Oversight and Government Reform Committee at a hearing on prostate cancer screening and awareness on March 4, just one day after the Society released its newly updated prostate cancer screening guidelines. In addition to reviewing the guidelines, Dr. Brawley discussed specific areas that are essential for improving prostate cancer outcomes in the United States. Read the ACS CAN press release.

Molly Daniels

Interim President

American Cancer Society Cancer Action Network

Massachusetts Updates

Massachusetts Campaigns

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