Showing posts with label Healthy Food Access. Show all posts
Showing posts with label Healthy Food Access. Show all posts

Thursday, August 10, 2017

Notebook Page 27 Summer Update

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

In June the Legislature finished its budget work. ACS CAN along with other partners were working on three issues that were in the Health and Human Services and the K-12 School Aid budget. This year’s budget included additional funding for farmer's markets. The new funding changes Michigan's contract to allow wireless credit card devices to accept SNAP payments and funding to purchase those wireless devices.  The contract only included the use of wired devices making the cost of wireless devices an obstacle for farmer’s markets to take SNAP benefits.  Many farmers don’t have the means to purchase expensive wireless devices; this funding will help remove that obstacle.

Additional funding for the 10 Cents a Meal program will be including in this year’s budget. The 10 Cents a Meal program is currently in northern Michigan and is providing schools 10 extra cents per child per meal to purchase fresh produce from local growers. The program only had funding for 16 schools to participate out of the 52 schools that applied.  Local farmers have the fresh fruits and vegetables that students need but are challenged to get it into the school systems. These additional funds will be used to continue and expand the pilot program into Washtenaw County to help schools get these fresh fruits and vegetables while helping local growers in the process. 

We were not able to secure funds for our corner store initiative.  This initiative would have provided a one-time grant to corner stores and convenience stores to put in equipment that would make it easier to sell fresh fruits and vegetables in their stores.  These stores would be focused on areas in the state that do not have access to fresh fruits and vegetables and these stores are the only place that people
can get groceries. It is our plan to obtain this funding in the coming month.

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

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

Thursday, June 8, 2017

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 21st 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.

Friday, April 28, 2017

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.