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 matt.phelan@cancer.org. 

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:

• 128,000 total petition signatures, action pledges and messages sent to Congress
• Nearly 20,000 new volunteers have joined ACS CAN through the campaign
• #KeepUsCovered hashtag used over 16,000 times and reached 42 million people on social media
• More than 30,000 calls in to Capitol Hill offices since February
• More than 720 national and regional clips (with numerous placements in 15 target states) since January 1, including The Washington Post, USA Today, Bloomberg News, NPR, the Los Angeles Times and cable news networks like MSNBC
• A national and regional advertising campaign that was highlighted in The New York Times 

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.

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 21^st 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

Appropriations

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.

Notebook Page 25, April 2017

The legislature continues in its budgetary work with the both chamber Appropriations committees starting to finalize their first round of budgets. The income tax reduction continues to linger on in the House, leaving members on the Appropriations trying to cut back on the budget so that the money will be available for those who want to cut taxes. Let's review major activity in the House and Senate over the past few weeks.

Appropriations committees took their first stabs at putting together a budget for the coming fiscal year. ACS CAN have been active in the appropriations in three major areas this go around. The usual tobacco and cancer prevention funding dollars continues to stay as a top priority for ACS CAN. Funding for the programs has seen a stabilization over the past couple cycles due to a great amount of advocacy work done by those all-around Michigan. This year both chairmen of the Health and Human Services budget indicated that there would be no change in the funding levels for the tobacco and cancer prevention programs in the first go around. We will continue to monitor the situation as the bills move forward in the process.

Our second activity in the budget surrounds healthy food access. There were three asks in the budget this year that ACS CAN worked on with coalition partners. The first was providing a one tine 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. We know there are 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. Our hope is with this funding we can grow the access to the needed food.

Farmers markets are a great location to get fresh foods. SNAP benefits in the past few years have been allowed to be used at farmer’s markets. One of the great programs around the SNAP program is one that allows for a doubling up for SNAP dollars for those buying food at farmer’s markets. One of the major hurdles is the way that SNAP benefits are taken. The market needs to have a hard-wired device to accept the payments. Many farmer’s markets don't have that luxury to allow for that so this leaves this option unavailable for those with SNAP. Wireless devices are available but they are costly and currently not required under contract with the SNAP vendor. ACS CAN is advocating for that to change. We are asking the legislature to change the contact to allow for wireless devices and make them available at all farmer’s markets in Michigan that want them. 

Finally, fresh fruits and vegetables have a hard time making into our children's lunches sometimes. Local farmers have the produce but have hard times making it into the school systems. That all changed with the 10 Cents a Meal program. This is a pilot program in northern Michigan that is providing schools 10 extra cents per child per meal to purchase fresh produces from local growers. ACS CAN supported the proposal last session and saw that 16 schools participated in the program with 52 applying. This year we are asking for a continuation of the pilot to help schools get the fresh fruits and veggies they need and help local growers in the process.

As you have likely heard in the news, the efforts to repeal and replace the Affordable Care Act are continuing.  The American Health Care Act (AHCA) is the replacement plan that has been debated. This bill would significantly alter the accessibility, adequacy and affordability of meaningful health insurance for millions of Americans, including those who have coverage through Medicaid. ACS CAN did not support this legislation when it was moving through the process back in March 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.

Unfortunately, the bill has been amended and is now even worse for cancer patients.  An amendment has been added that would allow states who set up high-risk pools to waive the Essential Health Benefits, meaning that cancer patients would no longer be guaranteed coverage for chemotherapy, prevention, or hospitalization. While in theory plans would have to accept everyone, insurers could set up plans that don’t cover the services that people with chronic illnesses like cancer need, thus opening the door for backdoor discrimination.

The amendment would also allow patients with pre-existing conditions to be charged much more for their plans, and could price people out of the market. The bottom line is that it could make plans both worse and more expensive for cancer patients and survivors. Congressional leadership is trying to get the votes to pass this bill.  ACS CAN strongly opposes this bill as it is not a replacement that is better than the current system.

Take Aways:

·        Budgets are moving and money for tobacco and cancer prevention programs are safe for the moment

·        Funding for healthy food initiatives have made their way in the budget and could stay.

That activity has been front and center for us over the past month but I would also look for issues surround tobacco and oral chemotherapy fairness to make their way to the surface in May. If you have any further questions please don't hesitate to reach out to myself (andrew.schepers@cancer.org) or Matt Phelan (matt.phelan@cancer,org) with any questions. 

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 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 6 July 2015

Session has finally come to the summer recess with both chambers passing their versions of a road funding solution for Michigan. Now the question is how the state will generate the revenue to cover the crumbling road situation. This is a good time for us at ACS CAN to take a step back and review the activities of the past six months.

This year started with the governor taking a strong stance on e-cigarette regulation by vetoing the legislature's attempt to classify those products separately from tobacco products Governor Snyder wrote in his letter to the legislature:

"Michigan should not enact new state law that is not consistent with a legally-mandated approach proposed by the U.S. FDA, which is to regulate e-cigarettes as tobacco products. To do so will unnecessarily sow confusion, send a mixed health message to the public on a subject that is already complex and confusing to many and effectively conflict with the Sottera ruling issued in 2010 by the Federal Court of Appeals for the District of Columbia at the request of the e-cigarette industry itself."

The governor went on to say:

"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."

The governor's leadership provided a strong victory against the tobacco industry's attempt to create their own harmful regulations. 

This year's budget cycle started at the end of January with Governor Snyder offering his recommendations for the state's coming fiscal year. His budget proposal appropriated $500,000 for cancer prevention and $1.6 million for tobacco prevention. This was the first time in a while that tobacco prevention has seen an increase in funding, and the cancer prevention appropriation was a win, since an executive order earlier in the year took away the $500,000 that was appropriated last year. 

This lead into our Day at the Capitol where our volunteers asked lawmakers for $1 million for both cancer prevention and tobacco cessation.  86 volunteers and staff from across the state made the trip to Lansing to speak with the Legislature We took time to highlight our Volunteer of the Year, Jennifer Varner from Freeland. Jennifer has worked tirelessly to further the mission of ACS CAN and the fight against cancer. It was only fitting that she would receive the award this year.  We also awarded Governor Rick Snyder our Distinguished Advocacy Award for 2015. His leadership and efforts surrounding the Healthy Michigan Plan (Medicaid Expansion), e-cigarettes and restoring cancer prevention funding made him worthy of the award.

All of the efforts from our Day at the Capitol were seen over the next several months as lawmakers tried to tie down the budget. The Senate was still trying to decide what to do with the prevention money as they had taken half, including all funding for cancer prevention, and moved it out of the budget. The House kept with the governor’s recommendations and left the money in the budget for prevention. Volunteers from around the state called and e-mailed the Senate Health and Human Services Committee Chair Senator Marleau to discuss why it was important to keep this funding in place. There were more than 200 contacts to Senator Marleau and other members of the conference committee. Those contacts ultimately kept prevention funding in place for this year, which was another huge victory for Michigan.

Now that the budget session is over for another eight months, we are now starting to focus on the other issues that are swirling around the Capitol. E-cigarette regulation, oral parity for chemotherapy drugs, a tobacco tax increase and legislation that would allow for medication synchronization will be on the forefront of our agenda for the fall. 

The grassroots side has been extremely active as well. Issues surrounding the one degree campaign and 21st Century Cures legislation that has been introduced by Congressman Fred Upton from St. Joseph have been creating a lot of buzz around the state.

Some of our ACSCAN Michigan ACT Leads teamed up with the Lansing Lugnuts at Cooley Law School Stadium to raise awareness of the national One Degree campaign on June 21.  The event was one of dozens nationwide where minor league baseball teams are teaming up with ACS CAN and Fans for the Cure as part of the One Degree campaign to make cancer research funding a national priority.

Our ACT leads staffed tables during the baseball game to collect petitions and raise awareness about the One Degree campaign.  ACSCAN and the Lugnuts sent a joint press release prior to the game that resulted in a great television news segment featuring ACT Lead Jennifer Varner that ran in the Lansing area on WILX.  Additionally, this exposure led to ACT Lead Beth Trierweiler being interviewed on the television and radio program Current Sports with Al Martin the next day.

ACT Lead Beth Trierweiler and Heidi Varner were honored at the game by throwing out the first pitch. This was a great awareness event for ACSCAN in Michigan and lead to a good amount of social media interaction.

Michigan Congressman Fred Upton is the lead sponsor on the 21^st Century Cures Act so Michigan has been targeted for grassroots activity.  Recently, ACSCAN pushed to secure co-sponsors for the bill.  Michigan has secured 11 out of 14 members of the Michigan delegation as co-sponsors.  This included Congressman Mike Bishop, Dave Trott and John Moolenaar who were all targeted with a social media campaign by ACSCAN volunteers that successfully pushed them to sign onto the bill.

Notebook Page 5 May 2015

The House and Senate are in the final days of the budget writing process. Last month, Proposal 1 was rejected by Michigan voters.  This proposal would have funded many state programs through a one percent increase in the sales tax.  Since the proposal was defeated, Legislators have been searching for ways to fund programs without raising taxes which has resulted in many cuts in the state budget.  Fortunately, revenue expectations show a small increase for the coming fiscal year.  Legislators are prepared to finalize Michigan's state budget with fewer cuts than expected.

This year, with the budgetary picture being pretty grim, our volunteers’ efforts through phone calls, emails and Lobby Day brought a victory for cancer and tobacco prevention in Michigan. The House and Senate agreed that cancer prevention should not lose funding, as the Senate had suggested, and maintained funding levels at $500,000 for the next fiscal year.  Additionally, tobacco prevention will actually see a $100,000 increase in funding for the next fiscal year.

Saving these programs from being cut was a significant victory made possible by the actions of our advocates.  In the final weeks of budget negotiations Community Ambassadors were asked to contact State Senator Jim Marleau, the chair of the conference committee.  Community Ambassadors sent Senator Marleau over 30 emails and called his office around 20 times within several days.  We believe this pressure assured our programs would be saved.  In addition, an action alert was sent out targeting the conference committee that resulted in over 200 actions being taken.

Overall, it was a great budget cycle for cancer and tobacco prevention. We may not have seen the increases that we advocated for during Lobby Day, but we did avoid the fate that other programs saw with a loss of funding. Moving forward, we want to ensure that our programs don't find themselves in the crosshairs of the legislators in the next budget cycle. So we will work hard to find a permanent funding solution for these programs in the coming months.

Notebook Page 4 April 2015

SLA Phil Moilanen Starting
Lobby Day

Last week, ACS CAN and its volunteers took Lansing by storm with its annual Lobby Day at the Michigan Captiol. Cancer and tobacco prevention funding was on the minds of the volunteers and staff who took part in the annual event. ACS CAN had a total of 86 volunteers and staff from across the state made the trip to Lansing to speak with their lawmakers.

This year, our main speaker was Dr. Eden Wells from the Michigan Department of Health and Human Services. Dr. Wells laid the foundation for the meetings with lawmakers that were slated to happen later that day with her presentation on the epidemiology of cancer throughout Michigan.

Lung cancer still continues to be the number-one killer in Michigan when it comes to cancer. Smoked tobacco usage rates continue to fall in Michigan, but with the introduction of e-cigarettes, the trend is shifting from smoked to "vaping." The Centers for Disease Control (CDC) also reported that teenagers’ use of e-cigarettes has risen over the past few years. This is causing young people to become addicted to nicotine and move on to other tobacco products.

Jennifer Varner with
Matt Phelan with her
Volunteer of the Year Award

Now it was time to know why we were in Lansing. Sarah Pagano, a cancer survivor, shared her story with the group, bringing perspective on why our work was so needed. Sarah's story of strength brought an electricity to the room, charging up those who were going to be talking to lawmakers that day.

Following Sarah’s remarks, we awarded our Volunteer of the Year Award to Jennifer Varner, an ACT lead from Freeland. Jennifer has worked tirelessly to further the mission of ACS CAN and the fight against cancer. It was only fitting that she would receive the award this year. 

Now armed with information, our volunteers were ready for the House members to join them for lunch. Lawmakers and staff filled the room to hear volunteers’ personal cancer stories and why the Legislature needed to prioritize the fight against this disease. . There was support from many House members for the increase in funding for the cancer and tobacco prevention programs in Michigan.

ACS CAN Volunteer Jay Kalisky with
Rep. Michael McCready

From there, ACS CAN members met with senators and their staff to talk about the need for cancer and tobacco prevention funding. Afterward, we met back at the Capitol to rally around why we were in Lansing that day. Joining us was Lieutenant Governor Brian Calley. He was there on behalf of the governor to support our efforts in raising the bar for cancer prevention and discuss the importance being actively engaged in the legislative process.

At the end of the day, we had an opportunity to present the ACS CAN Distinguished

Group photo with Lt. Governor Calley
after the rally.

Advocacy Award to Governor Snyder in his office. Since the governor was not able to attend the rally, he asked that we stop by for a quick chat in his office and to take a photo of the group with him receiving the award. Governor Snyder has been a great champion for ACS CAN by supporting the Healthy Michigan Plan, restoring cancer prevention funding in his budget this year and vetoing the tobacco industry's attempt to classify e-cigarettes as something other than a tobacco product. 

ACS CAN presents our Distinguished Advocate Award
to Governor Rick Snyder

Wrapping up the day, many approached us and explained how they truly enjoyed Lobby Day this year and felt it was extremely effective. We have already seen the positive effects with many lawmakers talking about cancer and tobacco prevention in Michigan.

Thank you to all of those who made the trip the Lansing to speak to your lawmakers! Your voice made a difference in the fight against cancer. Remember that there is still more to do. Contact us or watch for e-mails talking about coffee hours, or set up meetings in your hometown to meet with your lawmakers. We need to continue to keep cancer prevention on the forefront lawmakers’ minds. 

Notebook Page 3 April 2015

Things started to heat back up in Lansing this week with lawmakers making their way back from a two-week long spring break. What is ahead of them from here until summer? Budget work is the number one issue on everyone's mind.

Let’s review the happenings from this first week back from break:

House:

The House Education Committee took testimony on Senate Bill 139, which would allow for bake sale fundraisers in schools. Under current federal regulations, if items that are being sold are not within nutritional standards, they are not allowed to be sold. There are exceptions for items that are prepackaged like Boy Scout popcorn or Girl Scout cookies.

ACS CAN is a member of the Healthy Kids Healthy Michigan (HKHM) coalition that supports better nutritional standards, better health education classes and more activity for kids while at school. We joined HKHM in opposition of the legislation, since it would weaken the nutrition standards in schools, with the hope of seeing substantial changes to the legislation . We are looking forward to working with HKHM and others to change the bill moving forward.

Senate:

The Senate were working on other issues this week that were tied in to Auto No-Fault reform. 

Budget:

The Senate Appropriations Committee started to move its budget bills this week. The Department of Community Health Budget is scheduled for action on Tuesday. The House has scheduled its appropriations committee for every day they are in Lansing this week (Tuesday, Wednesday and Thursday). We will be watching the movements of the budget with this hurdle over and several more to go.

Federal:

One federal note from our last notebook entrance. House Resolution 2 was passed by the Senate and was sent to the President for his signature. This is huge for us since it allowed for re-authorization of funding for Federally Qualified Health Centers until 2017. This is important because now the federal government will keep funding these centers that provide health care to those who are undeserved. 

As always, if you have any questions, please don't hesitate to contact me at andrew.schepers@cancer.org.