Notebook Page 21, December 2016

Snow and the coming holidays didn't keep the legislature away from finalizing the work of Michigan’s 98th legislature. Two major issues that ACS CAN was working on surrounded access to drugs; regulations for biosimilar drugs and oral chemotherapy fairness. Both issues at the start of December seemed to have some life but would they be able to make it across the finish line.

Earlier in the year House Bill 4812, the bill that provides the needed regulations for the substitution and dispensing of biosimilar drugs in Michigan took a major turn for the worse in the Senate Health Policy committee just before the summer recess. Groups in favor of the legislation, as it came out of the House, were found scrambling and trying to find ways to amend the legislation back to the version that had passed the House and included the critical language that required notification to physicians of substitution. The Fall brought very little activity around the legislation but rather conversations with Senators about a possible amendment on the Senate floor back to the House version and then passage during the end of the year.

Amendments were drafted and a key Senator was named as a champion for the amendment. Lame duck started; the time in the legislature when at segments all right and reason seem to escape people and deals begin to develop to get legislation moving and passed before the end of the session. This legislation was no different and rather than having productive discussions around the legislation the opposite happened. Discussions by groups with Senators about the amendment started a destructive movement against the legislation. Finally, the chairman of the Senate Health Policy committee said enough was enough and the legislation was dead for the year, leaving groups that had worked on the legislation at the doorstep with nowhere to go and lawmakers frustrated over the issue.

We have documented throughout the year that oral chemotherapy fairness was a key issue for ACS CAN. In May of this past year, the Michigan Senate passed Senate Bill 625 with all but one vote. The legislation had huge bipartisan support in the Senate, which usually sends a message to those working in or with the legislature that it should have the same support in the House. We learned this term that the House and Senate, although controlled by the same party, were the furthest philosophically from each other then they have been in years. Several large key issues made their way from the Senate with worked out compromises, only to have the House completely tear it up and write their own deals. 

Oral fairness was no different. The Senate worked hard with all of the stakeholders to ensure that the legislation that would move was a compromise. Groups like ACS CAN and the Leukemia and Lymphoma Society (LLS) took some concessions but so did groups like Blue Cross / Blue Shield (BC/BS) and the Michigan Association of Health Plans (MAHP) The legislation was finally in a place that it had never been, where the major health plan in Michigan (BC/BS) was not supportive but would not stand in the way of it moving through the legislature and patient groups were in support. Then the wall appeared in the House and MAHP worked with the House leadership to have the legislation sent to a committee that shuttered at the slight notion of anything that is a "mandate". Just the slightest notion of having a prescribed function in the legislation left the committee wanting to know more, slowing down the process considerably.

Summer came and went with ACS CAN volunteers spending time in local coffee shops, on their phones calling into their lawmaker's office, sending quick e-mails to their lawmakers asking for support, and even dusting off stationary and pen sets to send the hand written letters. Lawmakers knew what oral chemotherapy fairness was by the end of the Summer, leaving now just action from the committee. No hearings came and lawmakers came and went, off to finish their campaigns. So ACS CAN ran a campaign of our own.

Volunteers all around Michigan took a poster to bring around to their activities having people sign them to show their support for oral fairness. A mobile petition you could say; twenty posters were created. After Thanksgiving, we received eighteen posters back and started to put a plan in motion to make a final run at getting oral fairness passed. The first full week in December ACS CAN hosted a two-day drop in lobby day where we took volunteers to the House chamber doors and sent in notes for their lawmakers to come out and discuss oral fairness. This started on a Tuesday morning and by the afternoon of that Tuesday, the answers from lawmakers were becoming consistent, oral fairness will not move without drug price transparency. We knew that lawmakers were talking with each other about the issue, which raised its visibility and caught the attention of the Capitol news corp. We also brought those posters to the Capitol and displayed them for everyone to see. The posters and our activities were noticed by the media and were featured in two news stories and several interviews on radio and television.

Tuesday night our coalition created an amendment to counter the problem that the price transparency ask was attempting to address. Volunteers continued to come on Wednesday and continued to talk about the issue with their lawmakers and included that ACS CAN and others had an amendment to solve the problem that price transparency was addressing. Lawmakers took that information back to their colleagues, but still, the House leadership was convinced that the need for transparency was too great.  Thursday came and went and lead us into the last week of the session. The first day of the last week was Tuesday and leadership was still not willing to move, which left us dead in the water, having to wait until next term to finally get the fairness patients deserve. 

Throughout that second to last week of the 98th session, we had over twenty volunteers make the drive to Lansing to discuss oral fairness with just a couple weeks notice. We had over 250 calls go into the Speaker of the House's office asking for action. We had amendments to solve problems, we had over 2000 signatures from people all around Michigan, several hundred emails were sent from volunteers, but MAHP won the day. MAHP did find out though that the patient groups are a passionate force and will win this battle one day.

As we move forward in 2017, we just want to say thank you for all of your efforts in 2016. We won't let those efforts go to waste and use them to build on a great 2017. As always if you have any questions please contact Andrew (andrew.schepers@cancer.org) and Matt (matt.phelan@cancer.org) and Happy New Year!

Notebook Page 20 November 2016

November has come and gone leaving on the most unpredictable elections this country has seen in quite some time. The top of the ticket had some impact in Michigan. The only chamber that was up for re-election or election was the House of Representatives. Many around Lansing were saying that the controlling Republicans would lose some seats in the House but will still hold a majority; but as we got closer to the election date that all seemed to change.

Elections:

Federal House:

No real changes in the Michigan House of Representatives in terms of the amounts of Republicans and Democrats that represent Michigan in the Federal House. We did welcome two new lawmakers to the fold with the election of Representative-Elect Maj. General Jack Bergman (Ret.) from the 1st congressional district. He saw a tough election with Democrat Lon Johnson, a former state democratic party chair. The another newcomer to the delegation is Representative-Elect Paul Mitchell from the 10th congressional district. Mr. Mitchell will be taking the reins from Representative Candice Miller. Some of you make remember Mr. Mitchell due to his failed bid to win the Republican primary in Michigan's 4th congressional district in 2014.

State House:

Term limits bring the biannual revolving door of some lawmakers making their way out and new folks making their way back in. The current makeup of the House is 63 Republicans and 47 Democrats. Many in Lansing were thinking that the coat tails of the Republican Presidential nominee would not be able to carry candidates down ticket and that the nominee would actually lose Michigan and Republicans would lose seats in the House. The closer we got to election day we saw things starting to change. There was more activity around the top of the ticket in Michigan and things were starting to move towards the Republicans and they did. Republicans did not lose seats in Michigan nor did they gain any, we saw the same makeup that we are working with now, but there was one major difference, we saw the makeup become more conservative. The more conservative leaning could provide some challenges for us on our issues but not insurmountable.

State Update:

Sandra Westover with her posters.

There are still session days left on the calendar and at the start of December, we have three weeks left to push through our critical issue of Oral Chemotherapy Fairness. During November we asked our ACT leads and others to help us out by providing a visual representation of the people that are affected by oral chemotherapy in one way or another by giving out posters that people could sign to show their support for fairness. ACS CAN along with it coalition members had 20 posters created and spread all around the state.
We will have these on display in the Michigan Capitol on December 6th and 7th along with having a lobby day type activities on both of those days. If you are interested in registering for the event please click here to register. We need your help more than ever with Oral Chemotherapy Fairness, look for action alerts to come your way very soon!.

Notebook Page 19 October 2016

October has been a quiet month for the legislature. The House was scheduled for one day of session
and cancelled that and the Senate was in Lansing for one week’s worth of work during the
middle of the month. The only issue that concerned ACS CAN was the fix for the Medicaid funding
mechanic called HICA (Health Insurance Claims Assessment).

HICA was created a few years ago by the legislature when they found out the way they were collecting funding for Medicaid was not acceptable to the Centers for Medicare and Medicaid services (CMS). CMS stated that Michigan could not tax health insurance plans for having the ability to provide Medicaid services. So the legislature created HICA which taxed the health plans on the back end of service, taxing them at a rate of 1.25% of each claim they submitted to Medicaid for payment. This funding was then bundled and sent to the federal government where it could be matched and sent back to Michigan to pay claims.

Recently CMS has stepped in again saying that the funding source for matching funds needs to
come from a broad based revenue stream. This means they are looking for revenue that would
impact everyone in Michigan rather than just those using Medicaid. So the legislature created a
plan to deal with this situation. First the HICA would be repealed. The business community has
always been at odds with the HICA since it’s inception a few years back. Secondly a fund would
be created that would be used just to fund Medicaid. This fund would not be accessible by any
other programs. Finally a percentage of the income tax would be directed to this new fund leaving
less dollars for the state to appropriate in other programs.

This creates a major shift in how we fund Medicaid and it is the hope that this will allay the
concerns that CMS has about Michigan’s Medicaid funding. The legislation was passed by the
Senate and was sent to the Governor’s office for his signature. The governor and his administration
signaled during this process that they were not in favor of the legislation because they didn't
feel it addressed the problems stated by CMS. On Thursday, October 27 the Governor honored
his concerns and word and vetoed the legislation. It is unknown at this time if the legislature will return to override the Governor’s veto.

If the legislature doesn’t return for a veto vote right away, they won’t see real business until after
the Thanksgiving/Hunting break in the middle of November. This lawmaking period will really
be controlled by the elections. Looking at some of Michigan’s battleground seats in the House,
the chances of the House moving to a 55/55 split of Republicans and Democrats is looking better
and better every day. This would mean that Republicans would lose control of the House
and we could see a ton of legislation move that fits in the agenda of conservative republicans
during lame duck session. So we are in a wait and see mode for the upcoming elections.

Notebook Page 18, September 2016

September found Michigan’s legislators returning to Lansing full time from their summer in-district work periods. Due to all of the activity of volunteers in support of Oral Fairness (Parity) legislation, they returned with oral chemotherapy on the forefronts of their minds. This summer ASC CAN saw hundreds of communications to lawmakers from all around the state on the importance of oral chemotherapy fairness and asking for support of Senate Bill 625 in its current form. In addition to our efforts, a strong coalition of ACS CAN, Leukemia and Lymphoma Society, the Michigan Society of Hematologists and Oncologists, and others from around the state and beyond have engaged and activated their volunteers into action for the final push this fall.  We feel more confident than any other time that this issue could finally make it out of the legislature and on to the Governor for his signature.

The other issue that had ACS CAN’s attention was the reworking of the Health Insurance Claims Assessment or HICA tax in Michigan’s Medicaid program. The purpose of HICA is to gain revenue for Michigan’s Medicaid program by taxing the claims that each HMO that services Medicaid processes. The HMO’s pay 1% of each claim to the state. That money goes into a fund that is sent to the federal government so that it can be matched by the federal government and sent back to Michigan to fund their Medicaid program. It can be thought of a user fee for the HMO’s who decided to carry Medicaid products. The issue that arises out of this is that the Centers for Medicare and Medicaid services says that the only way the states can collect revenue to send for matching funds is through a “broad-based” revenue collection process. This is why the House and Senate worked on legislation that would change how HICA worked.

First HICA monies would be shifted from Medicaid to the general fund.  Secondly a portion of the income tax dollars the state collected would be shifted into a fund specifically for Medicaid that would be used for the federal match dollars. Finally, the HICA would be sunsetted in 2018, where it was originally 2020. This could provide some funding problems for the Medicaid program along with other programs if HICA is sunsetted without other revenue, it will ensure cuts within the state’s budget. Lawmakers now head home to continue on working on their campaigns for the upcoming general election. I would expect activity on oral chemotherapy after the election and the Senate may act on the HICA issues in the one week they are in Lansing in October.

Federal Update

More than 600 cancer patients, survivors and their loved ones from all 50 states and nearly every congressional district were on Capitol Hill on September 13 to ask members of Congress to make the fight against cancer a national priority. A dozen volunteers from Michigan attended the ACS CAN national Lobby Day to urge lawmakers to increase funding for cancer research and prevention programs, advance legislation that supports patients’ quality of life and ensure lifesaving colon cancer screenings are affordable for seniors.
ACS CAN advocates asked members of Congress to increase the budget for the National Cancer Insititute (NCI) by $680 million to support the Cancer Moonshot initiative.  The Cancer Moonshot, led by Vice President Joe Biden, has the potential to accelerate progress against cancer through increased research funding and the development of new targeted detection tests, treatments and therapies.

In meetings on Capitol Hill, ACS CAN advocates from Michigan urged lawmakers to increase federal research funding at the National Cancer Institute (NCI) through the appropriations process and by passing 21^st Century Cures legislation.  The 21^st Century Cures legislation was introduced by Michigan Congressman Fred Upton.  Michigan advocates met with Rep. Upton and he supported increasing the NCI budget by $680 million.
Advocates also encouraged lawmakers to advance legislation that supports patients’ quality of life by increasing access to palliative care, an extra layer of support that can be provided at any age or any stage of illness. Additionally, advocates called on lawmakers to close a loophole in Medicare that often results in surprise costs for seniors when a polyp is found during a routine colonoscopy.

In addition to meeting with all members of the House of Representatives, Michigan advocates also met with Senator Debbie Stabenow and Senator Gary Peters.  Both Senators were extremely supportive of all three priorities with Senator Peters telling advocates he’ll do whatever is needed to increase cancer research funding

Notebook Page 17, July 2016

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

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

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

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

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

Notebook Page 16, June 2016

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

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

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

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

Notebook Page 14, April 2016

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

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

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

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

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

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