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 First the HICA would be repealed.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

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 16, June 2016

June signals the end of the budget discussions and more importantly the unofficial start of summer. The House and Senate began their work to revise the state budgets for the coming fiscal year. In mid-May the House and Senate Fiscal Agencies along with the State Treasurer sat down and gave their final revenue estimate for the coming fiscal year. Projections were down from the January meeting due to lower tax revenue from gasoline. This left the legislature with the need to find savings in the coming year. ACS CAN contacted the six-member conference committee for the Health and Human Services budget and asked that three items not be considered in their final deliberations.

Two of the items were money related to tobacco and cancer prevention.  We asked that the tobacco and cancer prevention lines stay at their current levels and not receive any cuts from the current fiscal year budget.

The third item dealt with access to cancer medications for those on Medicaid. Since the nineties, those on Medicaid never had to obtain prior authorization for certain classes of drugs. Those classes are arranged by condition rather than drug class. Cancer is a condition that is listed in the statute for those on fee-for-service Medicaid, those on an HMO plan receive the protection but it is not written in statute, but rather an internal policy of the Department of Health and Human Services. Language in this year’s budget would allow that protection to be codified for one year for those on an HMO plan. The committee is scheduled to meet during the week of June 6^th to finalized the budget.

Our other exciting news in Michigan is we are now one big step closer to have greater access to oral chemotherapy drugs in Michigan. The Senate overwhelmingly passed Senate Bill 625 by a 36-1 vote.  Senate Bill 625 is oral chemotherapy fairness legislation that ACS CAN has been working on with other coalition partners. The legislation now sits in the House Insurance committee where the chairman has signaled that the legislation would not move until after the elections. We are working with coalition partners and others to get the legislation moved before the November election date.  Grassroots activities will take place throughout the summer to keep the issue in the spotlight for members of the House Insurance Committee.

Notebook Page 14, April 2016

Spring has finally made its way to Lansing and with that Lawmakers are making their way out of Lansing for their two week spring break. Some budgets have moved out of their subcommittees but the Health and Human Services budget still finds itself being tweaked. Let's take a look at what happened last month in Lansing.

The House and Senate continue to work on their respective budgets for the coming fiscal year. This year the House signaled a trimming of the Health and Human Service budget which houses the programs that ACS CAN continues to support. Chairman VerHeulen said that the budget would see a reduction from the the Governor proposed for the coming fiscal year. It is unclear right now what funding will be effect in this large budget, but it is expected that both the cancer and tobacco prevention programs could be in the cross hairs. We expect to know after the legislature returns from its two week break.

The Governor signed Senate Bill 150 in March. Senate Bill would allow for patient to sync their medication for a one fill date rather than having multiple fill dates and having multiple trips to the pharmacy. ACS CAN staff worked with the legislature and interested parties to help push the legislation over the finish line. The legislation was widely supported by both the House and Senate and the Governor signed the legislation. The changes will become effective by July 2016.

More importantly Lobby Day is coming up in Michigan on April 19th. We have a ton of interest this year, thanks to everyone that has promoted our day. As we approach the deadline for Lobby Day registration next week (April 5), we’d like everyone to follow up on any potential attendees you’ve already talked with and avoid inviting any new volunteers at the last minute.  We still have dozens of potential volunteers to follow-up with so please make that a priority in the next few days. April 5th is a solid deadline due to the amount of interest we have this year for lobby day.

After the registration deadline, all registered participants will be receiving an email about logistics, transportation, and our legislative issues.  We’ll be having a call for volunteers on April 14^th at 7pm to cover the topics that will be discussed at Lobby Day.  Staff can expect an email from me soon to discuss transportation and car-pooling from your areas. Thank you again for everyone that has promoted lobby day around Michigan.

If you have any questions about what is happening in Michigan and beyond please don't hesitate to contact Andrew (andrew.schepers@cancer.org) or Matt (matt.phelan@cancer.org). 

Notebook Page 15, May 2016

Michigan's Cancer Advocates at the Capitol.

Spring has finally made it's way back to Michigan. With the arrival of spring also means that volunteers from around the state will start to make their way to Lansing to talk to our lawmakers about issues that are important to all of those who face cancer every day. Lets review the happenings of April in Lansing:

Michigan Lobby Day a Big Success!

Dr. Randy Hillard sharing his story
about oral chemotherapy fairness.

On April 19, 119 ACS CAN advocates and staff met with state legislators for our annual Michigan Lobby Day. Volunteers held 65 total meetings with legislators or their staff.  This year’s Lobby Day had over 30 more volunteers than last year and you could feel the electricity in the room.

This year’s Lobby Day focused on two policy areas: 1) support for oral chemotherapy fairness legislation and 2) increasing Michigan’s tobacco taxes and using this new revenue to fund Cancer and Tobacco Prevention Programs.

Phil Moilenan meeting with Rep. Maturen.

The day was highlighted by some great speakers.  Cliff Douglas, Vice President of Tobacco Control for the American Cancer Society and Carter Steger, Senior Director of State and Local Campaigns for ACS CAN gave the keynote address about the harms of all tobacco products.  Dr. Randy Hillard gave an inspiring talk about his battle with stomach cancer and how oral chemotherapy was available to him, but isn’t available to everyone because of its cost.

Michigan's Volunteer of the
Year Sandra Westover.

Hailey Urbach speaking at
the rally. 

To close the day, Miss Michigan International, Hailey Urbach from Grosse Pointe spoke during our rally in the Capitol rotunda.  Miss Urbach shared her mother’s story of battling breast cancer and the need to advocate for such important causes.

This year, ACS CAN awarded Sandra Westover from Frederic, MI with the annual Volunteer of the Year award for her outstanding contributions to ACS CAN and the American Cancer Society.

As a result of our Lobby Day, the Senate Insurance Committee passed our oral chemotherapy fairness legislation by a 7-0 the following day.  Our advocates pushed legislators to act and they responded.

State Update

As you can see from above the Senate Insurance committee passed out Senate bill 625 or the oral chemotherapy fairness legislation to the full Senate. It was thanks to the great work of our volunteers that helped the legislation have a smooth transition out of committee and over to the Senate floor. We will continue to monitor the legislation has it moves through the Senate. The expectation is that the legislation will move the first week in May. 

Budgets are also on the move in both chambers. This year's budgeting process is more straight forward with elections looming for House members in August and November. The two main funding lines that ACS CAN concentrates on in the budget are the tobacco and cancer prevention lines in the Health and Wellness Fund. Years past this fund has been used as a funding football but with this being an election year the funding for those programs has not been touched. This is a good first step in the movement of the budget. We will be watching now for the middle of May when both the House and Senate Fiscal agencies and the State Treasurer come together to finalize the expected revenue for the coming fiscal year. That will tell us whether the state needs to cut or if they will have more money than they expected. 

Federal Update

Colorectal cancer screening legislation is gaining momentum in Congress.   The Removing Barriers to Colorectal Cancer Act is legislation supported by ACS CAN to close a loophole in Medicare.  Many seniors are going in to get their regular colonoscopy, but it is standard practice that a doctor removes any suspicious polyp during the procedure.  We know that removing these polyps, saving lives.  The problem is that some seniors are getting bills in the mail after the procedure because the polyp removal is not considered a “screening”.  All screenings must be fully covered by insurance.  We are working hard to close this loophole to save more lives.  To find out more about this legislation, please visit http://www.acscan.org/coloncancer.

As always don't be afraid to reach out to us. Go to our Facebook page at http://www.facebook.com/AcsCanMichigan for all of the latest updates and action going on in Michigan.

Notebook Page 13, March 2016

Last month, Michigan Governor Rick Snyder released his official budget.  Unfortunately, Governor Snyder’s budget called for sustained funding for the state’s cancer prevention and tobacco prevention programs.  Governor Snyder also requested in his budget to use $720 million over 10 years from the tobacco master settlement agreement (MSA) to fix Detroit’s public school system.  ACS CAN does not support this move.  The Governor’s budget did not call for any increases in state revenue.

Work continues on Michigan’s campaign to raise tobacco taxes to fund prevention.  Our coalition called the Prevention Michigan Tobacco Free Campaign continues to grow.  We now have 24 groups on board including the major health organizations in the state.  Most recently, Michigan’s Prevention Network signed onto the campaign.

Recent gains with the Governor’s office toward support of a tobacco tax increase have been significantly delayed due to the water crisis in Flint.  The crisis in Flint is expected to distract the Governor’s office for the foreseeable future so our focus has now shifted towards the legislature. Michigan’s State Lead Ambassador, Phil Moilanen, will meet on March 4 with State Senator Mike Shirkey who is a key lawmaker in the State Senate. Action alerts will be going out to advocates throughout March and April leading up to Michigan’s Lobby Day.

Michigan’s annual Lobby Day will take place on April 19.  In addition to Lobby Day, we have added a Leadership Breakfast on the morning of the 19^th.  This ACS CAN Leadership Breakfast will be a fundraising event geared towards high profile volunteers and ACS CAN partners.  Dr. Randy Hillard and Vicki Rakowski, RN have agreed to serve as honorary chairs for this event.  Members of the legislative leadership and key legislators related to health policy have been invited to the breakfast to talk with those in attendance.

The legislative issues, or asks, have been finalized for Michigan’s Lobby Day.  The day will focus on two major issues, raising the state’s tobacco taxes and creating oral chemotherapy parity to increase access to cancer drugs.

At Lobby day, we’ll be asking legislators to increase the cigarette tax by $1.50 while bringing other tobacco products into parity with the cigarette tax to increase revenue.  We’ll also ask our legislators to invest $50 million of the new revenue created by this tax increase into our prevention programs.  Michigan’s Tobacco Prevention Program only receives $1.6 million in state funds annually while the Cancer Prevention Program only receives $500,000.  These amounts are far below the recommendations set by the Centers for Disease Control.

In 2004, Michigan saw its last increase in tobacco taxes with the majority of the dollars either being absorbed in Medicaid or in education. The funding for prevention efforts such as tobacco and cancer prevention has dropped off significantly during that same time. Additionally, other tobacco products like chew and e-cigarettes have sky rocketed in usage. More and more of our youth are now trying emerging tobacco products because they’ve been told these products “aren’t as bad” as cigarettes or chew tobacco.

The other legislative issue, or ask, that we’ll address at Lobby day will be oral chemotherapy parity, or “fairness.” This issue has finally started to see some action in the Senate. Senate Bill 625 has been introduced and was brought up for a hearing in the Senate Insurance Committee last month. Senate Bill 625 ensures that patients facing cancer won’t have to pay a higher price for chemotherapy taken orally, as opposed to intravenously in a hospital.

Currently, 40 volunteers and 19 staff are registered for Michigan Lobby Day.  Registration will end on April 5.

This week, market teams were pressed to move Lobby Day recruitment to the top of their priorities.  The larger markets of Detroit and Grand Rapids have been goaled at 12 volunteers recruited while the smaller markets (Flint, Lansing, Ann Arbor) have a goal of 6 volunteers.

For more information, go to our website at http://www.acscan.org/action/mi. 

Notebook Page 12 February 2016

February signals the start of budget season in Michigan with the governor scheduled to present his budget to the Legislature on Wednesday, February 10 at 11:00 a.m. You can watch the hearing here.  

 In addition to the budget, there are several other issues we’ve been focused on.

Oral chemotherapy parity, or “fairness,” has finally started to see some action in the Senate. Last month, a coalition, including ACS CAN, worked with Senator Goeff Hansen to have Senate Bill 625 introduced and brought up for a hearing in the Senate Insurance Committee. Senate Bill 625 ensures that patients facing cancer won’t have to pay a higher price for chemotherapy taken orally, as opposed to intravenously. ACS CAN presented a letter to the committee, outlining the need for access to these critical treatment options for patients facing cancer. Our coalition hopes to have the legislation sent to the House before the start of summer recess.

The Senate Health Policy Committee took up House Bill 4812, which would provide regulations for the use of biosimilar medications in Michigan. These are drugs that are almost identical to an original product manufactured by a different company. But unlike generic drugs, they are not exact copies. We continue to support interchanging biosimilar drugs with prescribed medications, as long as the patient’s health care provider is notified.  Because biosimilars are somewhat different from the originally prescribed drug, it’s important to notify a prescribing physician of the switch. This legislation is expected to make it out of the Senate before summer recess. 

Medication synchronization is another issue that the House will take up later this month. Senate Bill 150 would allow patients schedule their medications to be filled on the same day.  This ensures that patients and their caregivers won’t be running back and forth to the pharmacy to constantly refill prescriptions.  The bill has moved from the Senate to the House for further consideration.

February is a busy month for ACS CAN in Michigan. For more information,  go to our website at http://www.acscan.org/action/mi. 

Notebook Page 11 January 2016

Happy New Year and welcome to 2016. ACS CAN's campaigns are in full swing in Michigan with tobacco prevention and cancer prevention on the forefront of the agenda. Michigan lawmakers make their way back to Lansing on January 13th for the first day of session. Not much is expected to happen in the first couple days back since Governor Snyder will be giving his State of the State address on January 19th. We are interested in seeing what the Governor has in store for his agenda for 2016. 

As for issues happening in Michigan that ACS CAN is involved in, we are continuing to meet with our coalition focusing on tobacco prevention in Michigan. The coalition is made up of great partners that are interested in getting tobacco and e-cigarettes out of the hands of our kids in the right and responsible way. The Governor will be presenting his budget message for 2016 in February and we hope that prevention will be on his mind.

Oral Parity for Chemotherapy drugs will be starting as well. Currently, Senate Bill 625 is awaiting a tentative hearing date of January 20th in the Senate Insurance Committee. ACS CAN has been a part of a coalition of partners with the leadership of the Leukemia and Lymphoma Society and Celgene. We are hopeful that the legislation will make its way out of the Senate very soon!

2016 is setting up to have an exciting start to the year. Stay tuned to find out further information on our agenda, the Governor's agenda, and others for 2016