Notebook Page 24 March 2017

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

State:

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

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

Federal:

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

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

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

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

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

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

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

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

Michigan Day at the Capitol:

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

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

www.acscan.org/milobbyday 

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

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

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

Take Aways:

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

Notebook Page 22 January 2017

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

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

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

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

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

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

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

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

Availability

·         No pre-existing medical condition restrictions

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

·         Availability and renewability of coverage is guaranteed

Affordability

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

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

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

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

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

Adequacy

·         No lifetime and annual coverage limits

·         Coverage of preventive health services with no cost sharing

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

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

Administrative Simplicity

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

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

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

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

Notebook Page 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 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

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.