Thursday, June 8, 2017

Notebook Page 26 May/June 2017

Michigan is starting to wind down its budget work for the year with the federal government starting to talk about the budget, research funding, and others. Here's a breakdown of activity on both fronts for May and June.

Federal Update

American Health Care Act
On May 4, following months of negotiation between U.S. House leaders and the President, the U.S. House approved the American Health Care Act (AHCA) that would partially repeal and replace the current health care law.

The impact of the AHCA bill has been widely understood since the Congressional Budget Office (CBO) issued its updated assessment of the House-passed American Health Care Act (AHCA) – estimating the number of Americans who would likely lose health insurance as compared to current law, as well as the possible cost changes for those who maintain coverage.
The CBO projects that under the House-approved legislation the number of uninsured will increase by 14 million next year, 19 million in 2020 and, 23 million by 2026.  Low and moderate income seniors between the ages of 50-65 will experience significant premium increases due to changes in age rating.  Millions of lower-income Americans will be stripped of their Medicaid coverage.
Additionally, we do know that this legislation would allow states to opt out of insurance market rules in the current law that protect patients with pre-existing conditions from higher costs, and would allow insurers to offer plans that may not provide coverage for cancer screenings and treatments.  These requirements, which are in the current law, will become optional in certain states if the AHCA were to become law.
Essentially the AHCA would allow states to make these changes if they create a special high-risk pool to segment high-risk patients, such as those who have cancer, out of the private market insurance pool. The idea is to lower premiums for healthy people while placing sicker patients in the high-risk pool. The problem with such a solution, as we have pointed out numerous times to our elected representatives, is that high-risk pools were a failure when they were used prior to passage of the current law because they were never adequately funded.  And despite the assertions of AHCA’s supporters, high-risk pools are not adequately supported in this bill.  Very few states provided the sustained level of funding needed to serve patients with pre-existing conditions prior to the current law, and most imposing waiting periods, benefits caps, higher premiums and other restrictions designed to keep patients out of the insurance market.

ACS CAN opposed the AHCA and urged House members to vote “no” on behalf of the cancer community. Provisions contained in the bill that led the CBO to conclude that 14 million people would lose coverage next year, including the elimination of the Medicaid expansion, will now be debated in the U.S. Senate, and AHCA is unlikely to survive that experience in its current form.  A vote could happen in the U.S. Senate before the end of June.

ACS CAN have regularly noted that the current law has weaknesses and needs improvement. During the House debate, we have tried to work with lawmakers to identify ways to make the law work better for cancer patients – as have the American Medical Association, other patient groups, hospitals, and insurers.  ACS CAN is working closely with members of the Senate and our partners to craft legislation that helps improve the law and guarantees uninterrupted and meaningful health insurance coverage for cancer patients. 

Our grassroots engagement and media advocacy efforts were extraordinary and played a remarkable role in shaping the public debate, even now, when our opposition was noted the time and again in the media and by legislators. Patient stories, town halls, public rallies, customized messages on social media, patch-through calls, drop-in visits with members’ offices – each of these efforts amplified the patient’s voice.  And our #KeepUsCovered campaign logged more than 1.1 million impressions across all of Twitter and Instagram from our national Facebook page.

Cancer Research Funding
On May 23, the President introduced his proposed 2018 budget, which includes deep cuts to the National Institutes of Health (NIH), National Cancer Institute (NCI), the Centers for Disease Control and Prevention (CDC) and Medicaid. If approved by Congress, the cuts would decrease the NIH budget by 21 percent, decrease the NCI budget by 21 percent, cut the CDC’s chronic disease program by nearly 20 percent and reduce Medicaid funding by more than $600 billion.
Cutting the NIH budget by $7.1 billion would seriously jeopardize the development of new, potentially life-saving cancer diagnostic tools, prevention methods and treatments. It would also risk eroding the basic scientific research that, when combined with private investment, spurs American medical innovation and economic development. Most specifically, the cuts would completely undermine the increases for research secured in the bipartisan 21st Century Cures Act meant to accelerate progress against diseases like cancer.
A recent poll release showed an overwhelming 90 percent of voters believe federal funding for medical research is ‘very’ or ‘extremely’ important and 75 percent want Congress to significantly increase NIH funding. More than two-thirds oppose the cuts as proposed in the President’s budget.
Cancer research is on the verge of significant new breakthroughs that could help save lives from a disease that continues to kill more than 1,650 Americans each day. Just last week, the American Cancer Society released a report showing one in every five adult cancer diagnoses and two of every three childhood cancer diagnoses are considered rare. These patients and their families depend on the promise and progress of continued research investment to develop new therapies that will help to get and keep their specific diagnoses in check.  
In addition, cutting the CDC chronic disease budget by nearly 20 percent threatens to substantially weaken vital tobacco prevention and cessation programs as well as important efforts to address nutrition, physical activity, and obesity—all significant cancer risk factors.
The results of these cuts combined with the more than $600 billion reductions in Medicaid funding, could leave millions of Americans without access to meaningful health care and prevention services.
To date, the federal government has played a critical role in our ability to reduce the cancer burden. Such drastic budget reductions would have the potential to devastate the nation’s standing as the global leader in cutting-edge medical research and scientific discovery, hamper progress in detecting cancer early when it’s least expensive to treat and most survivable and severely restrict low-income patients’ access to critical safety-net health care coverage through Medicaid.
Moving forward, ACS CAN will continue to urge lawmakers to preserve their bipartisan commitment to research and prevention and reject these cuts when crafting the FY 2018 budget. 

Michigan Update

Numbers were released last month at the Consensus Revenue Estimating Conference that showed a deficit in Michigan’s state budget. The General Fund Revenues are down by a total of $392.7 million for three years.  We are now facing potential budget cuts. To fix this shortfall the House has proposed cutting funds for all prevention programs.  They’ve proposed cutting funds in half for the Cancer Prevention Program and Tobacco Prevention program.  There’s more support for maintaining funding levels for these critical programs in the State Senate.  ACS CAN is working hard to save our funding.  Final budget decisions are likely to be made by the end of June.

Healthy Food Access
Another area of appropriations that has been our focus is on Healthy Food Access. 
With the state budget, almost complete it appears we may make some gains in this area. 

This year’s budget will include additional funding for SNAP (Supplemental Nutrition Assistance Program) benefits which have been allowed to be used at farmer’s markets. Farmers markets are a great location to get fresh foods, but obstacles have persisted for SNAP benefits users. The new funding will allow for wireless devices to accept payments and funding to purchase those wireless devices for SNAP benefits.  The use of wired devices and the cost of wireless devices has become an obstacle for farmer’s markets to take SNAP benefits and many farmers don’t have the means to purchase expensive wireless devices. This funding will help remove that obstacle.

Additional funding for the 10 Cents a Meal program will be including in this year’s budget. The 10 Cents a Meal program in northern Michigan is providing schools 10 extra cents per child per meal to purchase fresh produce from local growers. The program only had funding for 16 schools to participate out of the 52 schools that applied.  Local farmers have the fresh fruits and vegetables that students need but are challenged to get it into the school systems. These additional funds will be used to continue and expand the pilot program to help schools get these fresh fruits and vegetables while helping local growers in the process. 

It looks like we will not be able to secure funds for our corner store initiative.  This initiative would have provided a one-time grant to corner stores and convenience stores to put in equipment that would make it easier to sell fresh fruits and vegetables in their stores.  These stores would be focused on areas in the state that do not have access to fresh fruits and vegetables and these stores are the only place that people
can get groceries.

Tobacco 21
Representative Tommy Brann (R-Walker) and Representative Abdullah Hammoud have introduced a package of bills that would prohibit the sale of tobacco products in Michigan to anyone under the age of 21.  Several states have already passed similar legislation.

Additionally, Genesee County is facing a legal challenge to their local tobacco 21 regulation.  The health organizations supporting the regulation believe that Genesee County is well within their legal means to pass and enforce a regulation of this type.  The plaintiffs are arguing that state law prohibits a local municipality from passing such a law.  ACS CAN will be submitting an amicus curiae brief along with many other health organizations including the Campaign for Tobacco Free Kids, American Heart Association, American Lung Association, and Trinity Health Systems to the court to defend the tobacco 21 regulation in Genesee County.  Amicus curiae is Latin for "friend of the court," meaning a person or group who is not a party to a lawsuit, but has a strong interest in the matter and seeks permission to submit a brief with the intent of influencing the court's decision.

Oral Chemotherapy Fairness
Oral chemotherapy fairness legislation will be introduced in the fall.  Negotiations between legislators and lobbying groups have delayed introduction.  There may be legislation introduced in both the House and the Senate this year.  ACS CAN will be focusing on House members and specifically members of the House Insurance Committee.  Throughout the summer, ACS CAN volunteers will be attending coffee hours and collecting postcards to send to State Representatives encouraging them to create oral chemotherapy fairness.

Take Aways:
·         Budgets are moving and money for tobacco and cancer prevention programs are at the threat of being cut in half.
·         Funding for healthy food initiatives have made their way in the budget and could stay.
·         Tobacco 21 legislation has been introduced in the State House to prohibit the sale of tobacco products to anyone under the age of 21 throughout Michigan.

·         Oral Chemotherapy Fairness legislation is expected to be introduced this fall and our focus will be with members of the Michigan House of Representatives.

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