Thursday, August 10, 2017

Notebook Page 27 Summer Update

The Legislature is finally home for the summer leaving the Michigan ACS CAN team preparing for their return in September. Activities this summer have focused on access to oral chemotherapy, but we did take a moment to celebrate some big wins in the access to healthy food space.

In June the Legislature finished its budget work. ACS CAN along with other partners were working on three issues that were in the Health and Human Services and the K-12 School Aid budget. This year’s budget included additional funding for farmer's markets. The new funding changes Michigan's contract to allow wireless credit card devices to accept SNAP payments and funding to purchase those wireless devices.  The contract only included the use of wired devices making the cost of wireless devices an obstacle for farmer’s markets to take SNAP benefits.  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 is currently in northern Michigan and 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 into Washtenaw County to help schools get these fresh fruits and vegetables while helping local growers in the process. 

We were not 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. It is our plan to obtain this funding in the coming month.

We are now shifting our focus to oral chemotherapy fairness. Senator Goeff Hansen, our sponsor last year, submitted another bill for this session. His oral chemotherapy legislation is Senate Bill 492, which in its current form we do not support. This time around there is an opt out section in the legislation that would allow health plans to opt out of providing coverage raises their premiums by 1%. The last session when we offered this type of amendment it was in a way that used true data from the health insurers, this time around it allows the insurance companies to forecast their potential impact of providing parity and if their forecast says it would raise premiums by 1% then they could opt out. Since the numbers will be fictional we are opposed to using any data that is not gathered from experience.

All of these developments, we put into place a postcard program that allows those wanted to share their support for oral chemotherapy fairness to send it to their representative or senator voicing their support. This is to show that efforts need to be taken to provide fairness and they need to be done in the right way.  If you are interested in obtaining some postcards please contact Matt at 

Senate Fails to Replace Health Care Law
In the early morning hours of July 28, the U.S. Senate fell short of the votes needed to pass legislation that would have repealed parts of the current health care law. Had the legislation passed, it would have likely resulted in millions losing health insurance and patients paying more for less coverage.

The Senate vote came nearly three months after the House approved the American Health Care Act (AHCA) – legislation that would have replaced the current health care law.
Our grassroots engagement and media advocacy efforts were extraordinary and played a remarkable role in shaping the public debate. Our opposition was noted the time and again in the media and by legislators. We elevated the patient voice through volunteer mobilization, media advocacy, social media campaigns, direct lobbying and coalition work, targeting House and Senate members from 15 key states. Our  “Keep Us Covered” Campaign placed the voice of cancer patients, survivors and their families front and center in the debate.

ACS CAN patient volunteers from 14 of the 15 target states traveled to Washington, DC in late June to make lawmakers aware of the opposition by patient communities to the Senate’s Better Care Reconciliation Act (BCRA). The ACS CAN-led patient fly-in was held in coordination with 12 other organizations including the American Diabetes Association, the American Heart Association, the American Lung Association, Consumers Union and the Cystic Fibrosis Foundation. The groups collectively flew in over 60 patients from all 15 target states. Senators from the target states were expected to play a major role in deciding if the bill moved forward. The patients participated in an ACS CAN-led training, and over 100 advocates, including patients and staff from participating organizations, were in attendance. In meetings with lawmakers, patient stories were particularly effective at providing the cancer perspective and illustrating how insurance market reforms in the current law provide greater access to preventative screenings and quality comprehensive health insurance coverage.

Prior to scheduled calls between a select group of governors and Senate leadership, ACS CAN sent a letter to governors of both parties across the country detailing our concerns about proposals that would result in dramatically reducing Medicaid funding; reintroducing discrimination based on health history; waiving minimum essential benefits requirements; eliminating steady funding streams that subsidize affordable health insurance coverage; and instituting continuous coverage requirements that could discriminate against those who cannot work due to illness or who have to take leave to care for a loved one.

ACS CAN has regularly noted that the current law has weaknesses and needs improvement. During the House and Senate debate, we tried to work with lawmakers to identify ways to make the law work better for cancer patients – as did the American Medical Association, other patient groups, hospitals, and insurers.

ACS CAN’s goal from the beginning has been to urge lawmakers on both sides of the aisle to fix the portions of the current law that are not functioning properly so that it is strengthened and improved in ways that reduce the national cancer burden. We have intentionally positioned ourselves as a resource to help federal legislators do just that. As part of that positioning, our staff and volunteers executed a deliberate campaign to educate lawmakers on the adverse impact certain aspects of the proposed legislation would have had on those with a history of cancer or those that are at risk.
A few metrics:
ACS CAN continues to call on lawmakers to work together and we stand ready to assist Congress in developing practical, bipartisan solutions that ensure any future health care proposal meets the needs of cancer patients, survivors, and their families.

Federal Research Funding Cuts Proposed
The President’s budget, released March 16, proposed funding changes for the remainder of the current fiscal year (FY17) and funding levels for next year (FY18). The federal government is the nation’s largest single funder of cancer research and prevention. The budget submitted to Congress would:
  • cut funding of the National Institutes of Health (NIH) by $1.2 billion (FY17);
  • scale back programs at the Centers for Disease Control and Prevention (CDC), including funding for state cancer registries and tobacco control, by $65 million this year (FY17);
  • reduce funding to the NIH by an additional $7.2 billion next year (FY18), including an estimated $1.2 billion cut to the National Cancer Institute (NCI); and
  • cut CDC funding for cancer prevention and other chronic disease programs and consolidate the programs into block grants for states (FY18).
The proposed cut to the NIH budget for next year would constitute the largest reduction in medical research funding in history. If enacted, these cuts would also wipe out funding for the Cancer Moonshot initiative approved by Congress late last year with the strong bipartisan support and the enabled funding in the 21st Century Cures Act. It would, in effect, set the NIH back nearly 20 years and prove disastrous. 

House Slashes Funding for CDC’s Office on Smoking and Health 
On July 19, the House Appropriations Committee passed its fiscal year 2018 funding bill which includes the CDC. The bill slashed funding for Office on Smoking and Health (OSH) by nearly 25 percent from $205 million to $155 million. This cut would significantly undercut the OSH efforts to prevent kids from using tobacco products and help smokers quit.

One program that is funded by OSH and would likely end, is the highly visible and tremendously successful effort called Tips from Former Smokers campaign, the first ever paid national tobacco public education campaign. It was launched in 2012 with paid advertisements of real smokers telling their stories of the consequences they have experienced because of smoking or exposure to secondhand smoke. The TV, print, radio, and internet ads focused on cancer, heart disease, stroke, preterm birth, and diabetes, among other health effects of smoking. In the first three years, the campaign has helped 5 million smokers make a quit attempt, 300,000 smokers quit for good, and saved at least 50,000 lives.

ACS CAN will be working to ensure that when the Senate considers its version of the bill this fall, it does not significantly cut OSH.

Congress Works to Undercut FDA Authority over Certain Tobacco Products 
On July 13, the House Appropriations Committee passed a bill which would fund the U.S. Food and Drug Administration (FDA) for fiscal year 2018. Two of the bill’s provisions would significantly undercut FDA oversight of e-cigarettes and many cigars currently on the market and completely exempt some cigars from FDA oversight authority.

One week later, the Senate Appropriations Committee passed its version of the bill which leaves the FDA’s tobacco products oversight authority intact. ACS CAN continues work to ensure that the Senate committee version of the FDA funding prevails in the negotiation of a final bill.

FDA Delays Implementation of Final Guidance on Tobacco Deeming
Congress granted the Food and Drug Administration (FDA) authority over tobacco products in the Family Smoking Prevention and Tobacco Control Act in 2009. Using this authority in 2016, FDA regulated cigars and e-cigarettes in the “deeming rule,” which prompted numerous lawsuits. The previous administration defended the rule in the first lawsuit, but the current administration asked for time extensions in two related cases so that it could review its position.

In May, FDA announced it will defer enforcement of all future compliance deadlines for all deeming rule products for three months.

ACS CAN and other public health groups filed an amicus brief in the first case, Nicopure Labs v. FDA. On July 25, a federal court upheld the deeming rule in its entirety.

However, concerned that the government may decide not to defend the rule in other pending cases, ACS CAN and public health partners petitioned the courts on July 24 seeking intervenor status in the two related lawsuits. If intervenor status is granted, the public health groups become parties to the cases and participate in all phases of the litigation.

ACS CAN Responds to Nutrition Labeling Delays
Despite becoming law in 2010 as part of the Affordable Care Act, the FDA has yet to implement the law requiring menu labeling of calories for restaurants and other food service establishments. The regulations to implement the law were set to go into effect in early May but the administration delayed the implementation until May 7, 2018, and opened the implementing regulation to potential modification at the behest of supermarkets, convenience store associations and the pizza industry. ACS CAN submitted comments on the regulation, opposing the delay in implementation and any changes to the menu labeling requirements to make the information less useful in informing healthy choices.

Meanwhile, on July 27 the House Energy and Commerce Committee passed the Common Sense Nutrition Disclosure Act of 2017, which would make changes to the menu labeling requirements that could make it more difficult for consumers to access and use calorie information in their food and beverage purchase decisions. The bill now awaits consideration on the floor of the House of Representatives. A companion bill is in the Senate.

ACS CAN will continue to work to secure implementation of the current law and in opposition to passage of the House and Senate bills which would undercut the current law and the availability of calorie information which would be beneficial to consumers.

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