Notebook Page 24 March 2017

March came in like a lamb as far as the Michigan legislature is concerned but on the federal level, the roar of the health care lion was heard loud and clear nationwide. House Republicans in Congress said that the time was now to finally repeal the Affordable Care Act and replace it with the American Health Care Act. By the end of March would House Republicans have the ability to move the legislation across the finish line in the House, let's review March.

State:

In Michigan, the legislature continued crafting their policy legislation for the coming term. Many new members in the House were just starting to have their first bills introduced on the House floor, while the Senate will moving legislation as if nothing was new in their chamber. The House and Senate concentrated on their respective budgets by continuing and finalizing hearings. Earlier in the year, the House attempted to pass a cut to the state's income tax that would leave a $1.1 Billion hole in the State's budget. Now it appears that the House is looking to start making some of those cuts without cutting the income tax with reductions seen in most budgets that the House has passed already. The Health and Human Services budget hasn't been passed yet by the subcommittee and full appropriations committee as of yet. It is the largest budget in state government so it may take a week to finalize the budgetary numbers.

On the policy side, there is a large push with the introduction of several bills that would control the availability, accessibility, and the clinical use of opioids. Pain management is a part of palliative care and ensuring that patients have access to quality palliative care continues to be a top priority for ACS CAN. We will be working with the legislature, policy makers, and those groups working to ensure that quality access continues to be at the forefront of the discussion. Our legislation around oral chemotherapy fairness and tobacco taxes should be finished and ready for introduction by the end of April.

Federal:

On March 24, the U.S. House of Representatives failed to vote on the American Health Care Act (AHCA). This bill would have significantly altered the accessibility, adequacy, and affordability of meaningful health insurance for millions of Americans, including those who have coverage through Medicaid. ACS CAN does not support this legislation because it would undermine access to affordable, quality coverage, and put patient protections at risk.

The bill would significantly reduce the number of Americans able to access and afford quality health insurance. According to an initial report on the legislation by the Congressional Budget Office, 15 million more Americans would have been uninsured by next year and 52 million Americans would be uninsured by 2026—24 million more than under current law. This includes millions of low-income Americans who, because of significant Medicaid funding cuts, a reduction in the premium tax credit and expanded age-rating, would be priced out of the health insurance market. Many of these same Americans also have higher risk factors for cancer.

In the end, House Speaker Paul Ryan, his leadership team, and the Administration decided to pull the vote on Repeal & Replace of the Affordable Care Act since they could not secure the necessary votes to pass the legislation.  Although the current law is not perfect it is critical for so many as it relates to our cancer mission.

The President recently introduced a proposed the fiscal year 2018 budget that includes deep cuts to medical research. If approved by Congress, the cuts would represent 19 percent of the National Institutes of Health’s (NIH) total budget and would likely result in a $1 billion cut to the National Cancer Institute (NCI).

The proposed reduction in NIH funding of $5.8 billion would represent a significant setback for millions of American cancer patients, survivors, and their families. It would also dramatically constrain the prospect for breakthrough American medical innovation—an essential American economic driver.

If enacted, the budget proposal would likely result in a nearly $1 billion decrease for cancer research at NCI—making it the largest funding reduction in its history. The cuts would set research funding back to the level it was in 2000 when accounting for inflation.

In December, Congress passed the 21st Century Cures Act. This bill represented lawmakers' overwhelming bipartisan commitment to the promise and necessity of medical research to our country's future.  The legislation included $4.8 billion in new funding for the NIH, including $1.8 billion for the National Cancer Moonshot Initiative. This legislation provided substantial new investment in research and will lead to new ways to prevent, detect and treat cancer and other serious diseases.  The proposed cuts that have been introduced will erase all of that.

NIH-funded medical research is conducted in thousands of labs and universities across the country. These grants in turn spawn increased private investment and development. Drastically reducing NIH's budget would jeopardize our nation's potential to save more lives while simultaneously risking America's position as the global leader in medical research.

Michigan Day at the Capitol:

ACS CAN advocates were very active around this issue and the hard work showed as key members of Congress backed away from their initial support for the legislation.  Our work on the Affordable Care Act is not over and ACS CAN will remain diligent in our efforts to ensure that health care is adequate and affordable for everyone.

Registration for Michigan’s Day at the Capitol (formerly called Lobby Day) has been open for just about a month now.  The Day at the Capitol will be on Wednesday, May 3rd.  Registration will close on April 21st.  This year, we’ll be holding our event at the Radisson Hotel in downtown Lansing.  The agenda for the day will be similar to previous years with some small changes.  The URL below will take you to the registration site.

www.acscan.org/milobbyday 

Any ACS volunteer is welcome to attend, but please let ACS CAN staff know prior to inviting anyone to ensure we are getting the right volunteers. We are looking for volunteers that are motivated to make a difference in the fight against cancer, are passionate about our mission, and are willing to share their cancer story.  Volunteers do not need to be advocacy volunteers or have any experience advocating. Appointments with lawmakers will be scheduled for all volunteers that attend.  

Our Day at the Capitol will focus on three important issues this year:
·        The need to increase tobacco taxes to curb youth tobacco use and provide much-needed funding for Michigan’s prevention programs, which have been drastically cut over the past decade, to provide cancer services and tobacco prevention to Michigan residents that need it the most.
·        Increase access to cancer drugs through Oral Chemotherapy fairness.
·        Create a roadmap for the future of Palliative Care in Michigan

If you have any questions about Michigan's Day at the Capitol or any other questions, please contact Matt Phelan (matt.phelan@cancer.org) or Andrew Schepers (andrew.schepers@cancer.org)

Take Aways:

• No changes planned at this point for tobacco and cancer prevention funding levels in the budget.
• Legislation to limit the ability to prescribe and use opioids has been introduced and could affect cancer patients and their pain management.
• Register for Michigan's Day at the Capitol at www.acscan.org/milobbyday

Notebook Page 22 January 2017

The Michigan legislature is finally back in full swing and the Governor provided his annual state of the state address, providing a report card on how Michigan is doing. The new session means a new year for ACS CAN as well and the start of a new educational process with over 40 new lawmakers in the House of Representatives.

Governor Snyder’s State of the State speech to most pundits didn’t move mountains. The speech really provided a report card on how Michigan is doing. Health wise there were not many mentions of major health initiatives except for the efforts in Flint and Healthy Michigan. At last count, Michigan has over 640,000 people on the Healthy Michigan Plan, which is being touted as one of the models of how Medicaid expansion can work in all states. Over the next several months, while discussions are happening around the Affordable Care Act, Governor Snyder will continue to deliver his message that Healthy Michigan is the right direction for the country.

ACS CAN will continue to support the Healthy Michigan Plan and educate lawmakers on why it’s important to continue to offer in Michigan. Along with that, we will be educating on our major campaigns for the year. This year ACS CAN is working on issues surrounding Palliative Care, Tobacco Taxes, Oral Chemotherapy Fairness, and others.

Our efforts surrounding Palliative Care are built off of the report that ACS CAN and partners from ACS and other health groups from around the state put together that outline some of the major hurdles surrounding Palliative Care. One of the major asks in the report is the creation of a Palliative Care Commission on a state level that will look at the palliative care and provide actionable items to the Legislature to better our palliative care systems. We are working with Governor Snyder to create this commission through executive order rather than make it statutorily. Our goal is to have this ready to go by summer 2017.

Tobacco taxes will again be a major campaign for us this year. Michigan currently falls into the bottom third of the country in terms of tobacco prevention funding. Youth are shifting away from traditional tobacco and moving towards new emerging products and the state continues to face future financial issues in it’s Medicaid program. All of those issues and others leads us to ask for an increase in the cigarette tax by $1.50, create parity for other tobacco products, and regulate and tax e-cigarettes as tobacco products. This will provide substantial ongoing revenue for the state to help fund prevention and Medicaid issues.

Finally, Oral Chemotherapy Fairness is back again. I know all of the hard work that all of you did to help us move this issue over the finish line last time but we fall short due to politics rather than common sense. This time around we is fearful that our sponsor last term will be willing to cave to any of the demands from the health insurers, which could potentially leave us on the other side of the issue fighting against the legislation since it would do harm to patients than good. We will continue to keep engaged throughout the process to work and engaged with your volunteers and accounts to fight to greater access to these needed drugs.

On January 28 ACS CAN hold their annual Michigan volunteer training at Michigan State University.  Volunteers from all over the state attended and learned about ACS CAN’s state and federal priorities for 2017.  The top priority at this time is guaranteeing that any replacement for the Affordable Care Act includes the same or better protections for cancer patients.

ACS CAN will focus on four areas, or what we call our four A’s, for any Affordable Care Act replacement.  These are the four areas:

Availability

·         No pre-existing medical condition restrictions

·         Plans are prohibited from rescinding or canceling coverage when someone gets sick except in instances of fraud or misrepresentation

·         Availability and renewability of coverage is guaranteed

Affordability

·         Plans are only able to charge more or less in premiums based on family structure, geography, the generosity of the benefit, age (limited to a ratio of 3 to 1), and tobacco use (limited to a ratio of 1.5 to 1)

·         Plans cannot charge higher premiums because an individual has had a cancer diagnosis

·         Plans can charge older Americans no more than 3 times what they charge younger persons. This keeps health insurance more affordable for older Americans

·         Refundable tax credits provide premium assistance for individuals and families up to 400 percent of the federal poverty level for coverage in a marketplace plan

·         Out-of-pocket spending maximums for individuals and families

Adequacy

·         No lifetime and annual coverage limits

·         Coverage of preventive health services with no cost sharing

·         Requires all plans to provide a minimum level of benefits. Plans offered in the small group and individual markets have additional requirements to provide coverage of 10 categories of essential health benefits.

·         Requires plans to spend at least 80 percent of premiums on healthcare and quality improvement

Administrative Simplicity

·         Standardized summary plan documents that make it easier for consumers to compare plans when shopping

·         Insurance companies are required to streamline insurance appeals process to provide consumers with information about their appeals and the opportunity for external appeals

·         Plan navigators and other health insurance enrollment specialists help consumers apply for and understand coverage in the marketplaces and Medicaid

As always, if you have any questions please don’t hesitate to contact Matt (matt.phelan@cancer.org) or myself (Andrew.schepers@cancer.org) with any of your questions. Thanks again and remember pitchers and catchers start reporting on February 14^th!

Notebook Page 17, July 2016

ACS CAN continues to push for the passage of SB 625, the oral chemotherapy fairness legislation. The Senate overwhelmingly passed SB 625 by a 36-1 vote in May. The legislation sits in the House Insurance committee. The chairman has not confirmed a hearing or vote for the legislation and time is running out before the end of session. 

We are working with coalition partners and others to get the legislation moved before the November election date. Grassroots have taken place throughout the summer to keep the issue in the spotlight for members of the House Insurance Committee.  ACS CAN and Relay for Life volunteers have taken over Insurance Committee Chair Tom Leonard’s coffee hours in June and July and put a major focus on the oral chemotherapy legislation.

An ordinance to make the purchase of tobacco products illegal for any under age 21 was introduced in Ann Arbor on July 18^th.  The ordinance is set for a final vote on August 4^th. If passed, Ann Arbor would become the first municipality in Michigan to pass a tobacco 21 ordinance.

Recently, Michigan State Representative Julie Plawecki passed away suddenly.  Rep. Plawecki was a champion for health issues in the Michigan legislature and was set to introduce statewide legislation for tobacco 21 in July.  That legislation has been put on hold until a new sponsor can be found.  Additionally, Rep. Plawecki was the sponsor of colorectal cancer screening legislation that is now 

ACS CAN advocates in Michigan have been pushing Congressman Fred Upton to act on HR 3119, the Palliative Care and Hospice Education & Training Act (PCHETA).  This legislation has a total of 170 co-sponsors in the House of Representatives and currently sits in the House Energy and Commerce Committee which is chaired by Congressman Fred Upton from southwest Michigan.  ACS CAN will continue doing activity over the summer to encourage Congressman Upton to put the legislation up for a hearing in his committee. 

Notebook Page 10 December 2016

The legislature begins its final three weeks of session for 2016 this article we want to take a look back at what 2015 meant for CAN in Michigan.

January:

Governor veto's legislation to regulate E-Cigarettes. The Governor says in his veto statement:

"I believe the preferred way to ensure that e-cigarettes are regulated in the interest of public health is to revise the existing definition of a tobacco product to make clear that e-cigarettes (and other novel nicotine-containing vapor products) are tobacco products subject to any restrictions generally applied to tobacco products under the Youth Tobacco Act, including the minimum age law."

Efforts have been made to reintroduce the legislation that is similar to what passed and was vetoed last session, We continue to work with the legislature to create common sense legislation and regulations surrounding E-Cigarettes.

February:

Governor presented budget to the legislature, restores funding for cancer prevention and included a $100k increase for tobacco prevention.

April:

Over 90 plus cancer advocates take over the Michigan Capitol to ask that cancer and tobacco prevention be a funding priority in the state's budget. With the over 70 volunteers that joined staff at the State Capitol, almost every volunteer met with their lawmakers. Jennifer Varner received CAN's Michigan Volunteer of the Year award and Governor Snyder received Michigan's Distinguished Advocate Award with his efforts around E-Cigarettes and the Healthy Michigan Plan. Lieutenant Governor Brian Calley spoke to the crowd at the end of our busy lobby day!

June:

Legislature finalizes the budget, includes $500k for cancer prevention and $1.6 Million for tobacco prevention. Attempts were made by the Senate to move the cancer prevention line to the Health Endowment Fund; a privately controlled fund set up by the legislature and Blue Cross. If those efforts would have been successful it would've meant that the State would not fund any cancer prevention programs. This was a huge victory for us and other groups that were afraid of losing their program funding.

June-August:

Summer recess! Volunteers made in district meetings and drop by's with state and federal lawmakers, working hard to get our messages to the lawmakers. 

As a result, U.S. Senators Gary Peters and Debbie Stabenow signed on as co-sponsors to S 624, the Removing Barriers to Colorectal Screening bill.

Members of Michigan’s Congressional delegation were targeted for co-sponsorship and support of the 21^st Century Cures Act. Michigan ended up with 11 members signing onto the act and all but one member of Congress voted in support.

September:

The State and Federal legislatures got back to work. In Michigan regulations for Bio-Similar products was a hot topic for the state. Creating regulations for these products could allow them to come to market in Michigan and make them available, creating lower cost options for biological products. This debate would go through until the end of October.

More than 700 volunteers and staff took part in the annual Leadership Summit and Lobby Day in Washington DC. Michigan's delegation represented the state extremely well gaining co-sponsors on critical legislation around polyp removal coverage legislation and legislation supporting palliative care training. Michigan Governor Rick Snyder was recognized at the event with the National Distinguished Advocacy Award.

October - November:

October and November saw bio-similar products at the forefront of the legislative activity. Additionally, the foundation was being set to start a large campaign issue for 2016. ACS CAN started the Prevention Michigan coalition. The coalition’s goal is to raise the tobacco taxes and use the funding to support prevention efforts in cancer and tobacco and to support the state's trauma system. We kicked off our activities with a poll and release the week of the Great American Smoke Out. The poll found 6 out of 10 Michiganders support an increase in the cigarette tax and 6 out of 10 provide more support when they know the new funding would go towards health initiatives. This shows clear support from the State for an increase in the tax and support for health in Michigan. We continue to grow our coalition to gain more support throughout the health community.

December:

December looks as if it might be quiet for our issues in Michigan. We will continue our work on Bio-Similar products, support the newly introduced oral parity legislation and continue our work around the tobacco taxes. Petitions for the Prevention Michigan campaign are being collected with a goal of 5,000 petitions collected in 2016.

We also want to take a moment to say thank you. Our volunteers, ACT Leads, State Lead Ambassador, Community Ambassadors, and others give so much of their time to help support our efforts. Without your voice, the voice of cancer would go away. Thank you for all that you do and we hope you have a great 2016.

Notebook Page 9 November 2015

October found the state in full gear working on trying to find a solution to the road situation in Michigan.  This left a lot of the health issues and others on the back burner for many different groups including ACS CAN. The House Health Policy Committee did consider one issue that ACS CAN has some interest in; Bio-similars.

Biologic drugs are a classification of drugs that are made through a process that involved a living organism. The process uses that living organism to create the active ingredient in the drug that will be used to fight whatever the drug has been approved for. Biological drugs have been used to treat breast cancer and other cancers  so access to these critical medications is crucial. Today, the science is evolving and how biologic drugs are being made is changing. Many manufactures are creating what’s called a Bio-similar medication. That drug is similar to the biologic that it is trying to replicate but not quite the same thing. 

The US Food and Drug Administration (FDA) has created regulations that govern these bio-similar products creating two classifications, bio-similars and interchangeable bio-similars, which are even closer in resemblance to the primary biological drug.  These drugs are usually less costly to the patients, making access to them extremely important. Michigan does not have any regulations that would allow these drugs to come to market and the first bio-similar is about to hit store shelves here in the next couple months, therefore regulation of these products is needed. 

House Bill 4812 was introduced by Representative John Bizon, a physician from Battle Creek, to provide regulations around bio-similars. A critical part of his legislation provided an avenue for physicians and pharmacists to communicate when an interchangeable bio-similar is changed out for a biologic. For safety reasons physicians have the knowledge if there is a switch and the patient has an adverse reaction. For the patient it can provide a piece of mind that the physician knows what is happening with their care. Another piece of legislation was introduced, House Bill 4437, which we oppose that does not provide the communication piece in the legislation.

The House Health Policy Committee took testimony on House Bill 4437 with the majority of the testimony being against the legislation. ACS CAN provided written testimony explaining our support for communication for safety and peace of mind. We expect the House committee to take up HB 4812 since there is a lack of support for HB 4437. 

This past month we also had our second meeting of the Michigan Palliative Care Summit. Health leaders from around the state met in Lansing and began work on a road map to quality palliative care in Michigan. Close to twenty health care professionals and patient advocates participated in the great work that was done. We are hopeful that with all of the great notes that were taken by each work group a draft document can be created to provide the road map that Michigan needs.

Lastly, Michigan has leveraged Breast Cancer Awareness month to push Governor Snyder to increase funding for the Cancer Prevention Program.  Michigan’s Cancer Prevention Program houses the Breast and Cervical Cancer Control Navigation Program.  This program is vital to making sure all women have access to the screenings and follow-up care necessary to make an accurate cancer diagnoses and secure the proper treatment.  Volunteers from around the state have been collecting postcards throughout the month asking the Governor to increase funding by $2 million in his next budget.  Over 2,000 postcards have been sent to the Governor so far.

Notebook Page 7 August 2015

The summer recess for Michigan’s Legislature is quickly coming to an end and while lawmakers have enjoyed some time off, ACS CAN has remained hard at work preparing for the fall session.

One of our ongoing priorities is the issue of palliative care. On August 27^th ACS CAN hosted the Michigan Palliative Care Summit in Lansing.  The summit brought together patient leaders, physicians and others from around the state to take an in-depth look at ways to improve palliative care and patient quality of life in Michigan.

Debbie Webster, from the Michigan Department of Health and Human Services, started the program and provided information on Michigan's Cancer Plan and what the Michigan Cancer Consortium’s five year goals are around palliative care. She was joined by Dr. Gary Roth, the medical director of the Michigan Health and Hospital Association's Keystone Center. The Keystone Center is charged with finding quality measures and initiatives surrounding high risk or critical areas in medicine. He is also a thoracic surgeon

Presentation from Debbie Webster from MDHHS

with extensive experience using palliative care with his patients.  Finally, Dr. Michael Stellini, palliative care director for the Veterans Administration Hospital in Detroit, spoke about his experience in a multi-year VA initiative creating comprehensive palliative care teams—including doctors, nurses, social workers and chaplains—and how that has worked to improve patient care.

The presentations provided a framework for a robust round table discussion wherein our experts and others focused in on a few major hurdles facing palliative care in Michigan. Namely: workforce development, availability of in-home care, education and awareness of palliative care among families and patients, and reimbursement and data tracking for providing such care. The group left the event energized and excited to start tackling these issues ahead of the next October gathering.

In addition to palliative care, the ACS CAN Michigan team continues to narrow down our priorities for the 2016 legislative session. If your office is interested in a sneak-peak at what’s to come this session, please contact Matt Phelan at matt.phelan@cancer.org to set up an office lunch and learn.