Notebook Page 19 October 2016

October has been a quiet month for the legislature. The House was scheduled for one day of session
and cancelled that and the Senate was in Lansing for one week’s worth of work during the
middle of the month. The only issue that concerned ACS CAN was the fix for the Medicaid funding
mechanic called HICA (Health Insurance Claims Assessment).

HICA was created a few years ago by the legislature when they found out the way they were collecting funding for Medicaid was not acceptable to the Centers for Medicare and Medicaid services (CMS). CMS stated that Michigan could not tax health insurance plans for having the ability to provide Medicaid services. So the legislature created HICA which taxed the health plans on the back end of service, taxing them at a rate of 1.25% of each claim they submitted to Medicaid for payment. This funding was then bundled and sent to the federal government where it could be matched and sent back to Michigan to pay claims.

Recently CMS has stepped in again saying that the funding source for matching funds needs to
come from a broad based revenue stream. This means they are looking for revenue that would
impact everyone in Michigan rather than just those using Medicaid. So the legislature created a
plan to deal with this situation. First the HICA would be repealed. The business community has
always been at odds with the HICA since it’s inception a few years back. Secondly a fund would
be created that would be used just to fund Medicaid. This fund would not be accessible by any
other programs. Finally a percentage of the income tax would be directed to this new fund leaving
less dollars for the state to appropriate in other programs.

This creates a major shift in how we fund Medicaid and it is the hope that this will allay the
concerns that CMS has about Michigan’s Medicaid funding. The legislation was passed by the
Senate and was sent to the Governor’s office for his signature. The governor and his administration
signaled during this process that they were not in favor of the legislation because they didn't
feel it addressed the problems stated by CMS. On Thursday, October 27 the Governor honored
his concerns and word and vetoed the legislation. It is unknown at this time if the legislature will return to override the Governor’s veto.

If the legislature doesn’t return for a veto vote right away, they won’t see real business until after
the Thanksgiving/Hunting break in the middle of November. This lawmaking period will really
be controlled by the elections. Looking at some of Michigan’s battleground seats in the House,
the chances of the House moving to a 55/55 split of Republicans and Democrats is looking better
and better every day. This would mean that Republicans would lose control of the House
and we could see a ton of legislation move that fits in the agenda of conservative republicans
during lame duck session. So we are in a wait and see mode for the upcoming elections.

Notebook Page 18, September 2016

September found Michigan’s legislators returning to Lansing full time from their summer in-district work periods. Due to all of the activity of volunteers in support of Oral Fairness (Parity) legislation, they returned with oral chemotherapy on the forefronts of their minds. This summer ASC CAN saw hundreds of communications to lawmakers from all around the state on the importance of oral chemotherapy fairness and asking for support of Senate Bill 625 in its current form. In addition to our efforts, a strong coalition of ACS CAN, Leukemia and Lymphoma Society, the Michigan Society of Hematologists and Oncologists, and others from around the state and beyond have engaged and activated their volunteers into action for the final push this fall.  We feel more confident than any other time that this issue could finally make it out of the legislature and on to the Governor for his signature.

The other issue that had ACS CAN’s attention was the reworking of the Health Insurance Claims Assessment or HICA tax in Michigan’s Medicaid program. The purpose of HICA is to gain revenue for Michigan’s Medicaid program by taxing the claims that each HMO that services Medicaid processes. The HMO’s pay 1% of each claim to the state. That money goes into a fund that is sent to the federal government so that it can be matched by the federal government and sent back to Michigan to fund their Medicaid program. It can be thought of a user fee for the HMO’s who decided to carry Medicaid products. The issue that arises out of this is that the Centers for Medicare and Medicaid services says that the only way the states can collect revenue to send for matching funds is through a “broad-based” revenue collection process. This is why the House and Senate worked on legislation that would change how HICA worked.

First HICA monies would be shifted from Medicaid to the general fund.  Secondly a portion of the income tax dollars the state collected would be shifted into a fund specifically for Medicaid that would be used for the federal match dollars. Finally, the HICA would be sunsetted in 2018, where it was originally 2020. This could provide some funding problems for the Medicaid program along with other programs if HICA is sunsetted without other revenue, it will ensure cuts within the state’s budget. Lawmakers now head home to continue on working on their campaigns for the upcoming general election. I would expect activity on oral chemotherapy after the election and the Senate may act on the HICA issues in the one week they are in Lansing in October.

Federal Update

More than 600 cancer patients, survivors and their loved ones from all 50 states and nearly every congressional district were on Capitol Hill on September 13 to ask members of Congress to make the fight against cancer a national priority. A dozen volunteers from Michigan attended the ACS CAN national Lobby Day to urge lawmakers to increase funding for cancer research and prevention programs, advance legislation that supports patients’ quality of life and ensure lifesaving colon cancer screenings are affordable for seniors.
ACS CAN advocates asked members of Congress to increase the budget for the National Cancer Insititute (NCI) by $680 million to support the Cancer Moonshot initiative.  The Cancer Moonshot, led by Vice President Joe Biden, has the potential to accelerate progress against cancer through increased research funding and the development of new targeted detection tests, treatments and therapies.

In meetings on Capitol Hill, ACS CAN advocates from Michigan urged lawmakers to increase federal research funding at the National Cancer Institute (NCI) through the appropriations process and by passing 21^st Century Cures legislation.  The 21^st Century Cures legislation was introduced by Michigan Congressman Fred Upton.  Michigan advocates met with Rep. Upton and he supported increasing the NCI budget by $680 million.
Advocates also encouraged lawmakers to advance legislation that supports patients’ quality of life by increasing access to palliative care, an extra layer of support that can be provided at any age or any stage of illness. Additionally, advocates called on lawmakers to close a loophole in Medicare that often results in surprise costs for seniors when a polyp is found during a routine colonoscopy.

In addition to meeting with all members of the House of Representatives, Michigan advocates also met with Senator Debbie Stabenow and Senator Gary Peters.  Both Senators were extremely supportive of all three priorities with Senator Peters telling advocates he’ll do whatever is needed to increase cancer research funding