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ACS CAN Legislative Priorities
A Primer on our Issues
September 22, 2008
Who We Are & Why We Are Here
• CATHY CALLAWAY - ACS CAN Senior
Specialist, State And Local Campaigns
GREGG HAIFLEY - ACS CAN Associate
Director, Federal Relations
• WHY WE ARE HERE: To provide
information on the ACS CAN State and
Federal Legislative priorities to empower
advocates to secure passage of legislation
to prevent, screen for, and treat cancer.
Who We Are & Why We Are Here
• JOHN DANIEL - South Atlantic Division,
Vice President, Federal & Emerging Issues
• PETER AMES – New England Division,
State Director of Government Relations &
Advocacy
• WHY WE ARE HERE: To provide
information on the ACS CAN State and
Federal Legislative priorities to empower
advocates to secure passage of legislation
to prevent, screen for, and treat cancer.
State Issues
• Colorectal Cancer Screening
• Pain & Palliative Care
• Breast & Cervical Cancer
Screening
• Tobacco Control
Colorectal Cancer Screening
ACS & ACS CAN believe all patients, in
consultation with their doctor, should have
access to the full range of colorectal
cancer screening tests that are best for
that individual's medical situation, and that
all screening tests should be covered by
private insurance for employees of all size
companies regardless.
Colorectal Cancer Screening
• This year, the American Cancer Society,
in conjunction with many other
professional medical organizations,
released new, updated screening
guidelines for colorectal cancer.
• 26 states and the District of Columbia
now have cancer screening mandates in
effect for private insurance.
• Many states have begun programs to
screen for and treat colorectal cancer in
uninsured populations.
Access to Care-Colorectal Cancer
Screening Coverage
WASHINGTON
2007
MONTANA
OREGON
2005
NORTH
DAKOTA
VERMONT
2006
MINNESOTA
2007
NEW HAMPSHIRE
IDAHO
WISCONSIN
SOUTH
DAKOTA
WYOMING
2001
NEW YORK**
2004
MICHIGAN
IOWA
NEVADA
2003
MAINE
2008
PENNSYLVANIA
NEBRASKA
2007
OHIO
UTAH
INDIANA
2000
ILLINOIS
2003*
CALIFORNIA
2000
KANSAS
MISSOURI
1999
*
2000
KENTUCKY
2008
TENNESSEE
ARIZONA
NEW MEXICO
2007
OKLAHOMA
MARYLAND
2001
DISTRICT OF COLUMBIA
2002
NORTH CAROLINA
2001
SOUTH
CAROLINA
ARKANSAS
2005
MISSISSIPPI
ALASKA
2006
RHODE ISLAND
2000
CONNECTICUT
2001
NEW JERSEY 2001
DELAWARE
2000
WEST
VIRGINIA
2000 VIRGINIA
COLORADO
MASSACHUSETTS
ALABAMA
GEORGIA
2002
TEXAS
2001
LOUISIANA
2005
FLORIDA
HAWAII
Screening law ensures coverage for the full range of tests
Screening law requires insurers to cover some tests, but not the full range
or Statewide insurer agreements are in place to cover the full range of tests
Screening law requires insurers to offer coverage, but does not ensure coverage
or There are no state requirements for coverage
Sources: Health Policy Tracking Service & Individual state bill tracking services
*In 2003, Illinois expanded its 1998 law to cover the full range
**The New York Health Plan Association, which serves 6 million New Yorkers, covers
the full range of colorectal cancer screening tests, as a part of a voluntary collaborative with ACS.
Pain and Palliative Care
ACS & ACS CAN believe that the full
range of cancer pain relief treatments and
medications should be available to all
cancer patients and that approved and
legal cancer pain relief medications should
be attainable without undue scrutiny or
suspicion cast upon the cancer patient
who may rely on those medications for
medical and/or quality of life purposes.
Pain and Palliative Care
• 31 states have a ‘B’ or better on the
University of Wisconsin's Pain & Policy
Studies Group (PPSG) report card.
• 5 states have achieved an ‘A’
• In September, new model legislation
and policy guidelines regarding state
electronic prescription monitoring
programs (PMPs) were rolled out to the
field.
Cancer Pain Management:
2008 State Policies and Practice
WASHINGTON
MONTANA
NORTH
DAKOTA
VERMONT
MAINE
MINNESOTA
OREGON
NEW HAMPSHIRE
IDAHO
WISCONSIN
SOUTH
DAKOTA
MASSACHUSETTS
NEW YORK
MICHIGAN
WYOMING
RHODE ISLAND
PENNSYLVANIA
IOWA
CONNECTICUT
NEBRASKA
NEVADA
OHIO
UTAH
ILLINOIS
DELAWARE
*
WEST
VIRGINIA
COLORADO
CALIFORNIA
NEW JERSEY
INDIANA
KANSAS
VIRGINIA
MISSOURI
MARYLAND
WASHINGTON, D.C.
KENTUCKY
NORTH CAROLINA
TENNESSEE
OKLAHOMA
ARIZONA
ALASKA
SOUTH
CAROLINA
ARKANSAS
NEW MEXICO
GEORGIA
MISSISSIPPI
ALABAMA
HAWAII
Well balanced policies and good
practices that enhance pain
management, with opportunities
for additional improvements to
achieve better pain management
TEXAS
Moderately balanced policies and practices; action
required to address some policy and practice
barriers that impede pain management
Numerous policy and practice barriers exist that impede pain
management and require concerted action to address
LOUISIANA
FLORIDA
*Source: Data from University of Wisconsin’s Pain & Policy Studies
Group, Achieving Balance in State Pain Policy: A Progress Report Card
(2008). http://www.painpolicy.wisc.edu/Achieving_Balance/index.html
State Appropriations for Breast & Cervical Cancer
Screening Programs
WASHINGTON
VERMONT
MONTANA
NORTH
DAKOTA
MAINE
MINNESOTA
OREGON
NEW HAMPSHIRE
IDAHO
WISCONSIN
SOUTH
DAKOTA
MASSACHUSETTS
NEW YORK
WYOMING
MICHIGAN
RHODE ISLAND
IOWA
CONNECTICUT
PENNSYLVANIA
NEBRASKA
NEW JERSEY
NEVADA
OHIO
UTAH
DELAWARE
ILLINOIS* INDIANA
CALIFORNIA
*
WEST
VIRGINIA
COLORADO
KANSAS
MARYLAND
VIRGINIA
MISSOURI
DISTRICT OF COLUMBIA
KENTUCKY
NORTH CAROLINA
ALASKA
TENNESSEE
ARIZONA
NEW MEXICO
OKLAHOMA
SOUTH
CAROLINA
ARKANSAS
GEORGIA
MISSISSIPPI
ALABAMA
TEXAS
LOUISIANA
HAWAII
FLORIDA
American Cancer Society
National Government Relations Department
Policy
Updated June 20, 2008
State Allocation/CDC award > 100.0%
State Allocation/CDC award between 0.01-99.9%
States do not allocate funding more than the required match
Source: 2007 data from the Centers for Disease Control and Prevention and unpublished data collected
from NGRD, Divisions, including input form NBCCEDP directors.
* Illinois expanded their program to serve all uninsured women in Illinois in the age group served.
Policy Initiatives to Fight Breast & Cervical Cancer
• Protect the Breast and Cervical Cancer
Prevention and Treatment Act
• Funding the Patient Navigation Program
• Eliminate Medicare co-pays for breast
screening services
• Increase access, education and use of the
HPV vaccine.
• Ensure quality healthcare is available to all.
Tobacco Control
• Smoking accounts for at least 30% of all
cancer deaths and 87% of lung cancer
deaths.
• The Solution:
» Regular increases in the price of tobacco
products
» Fully funding & implementing comprehensive
research-based tobacco control programs
according to CDC’s Best Practices
» Passing & implementing smoke-free policies
State Cigarette Tax Rates
WASHINGTON
$2.025
VERMONT
$1.99
MONTANA
$1.70
NORTH
DAKOTA
MINNESOTA
44¢
MAINE
$2.00
$1.504
OREGON
NEW HAMPSHIRE $1.08
$1.18
IDAHO
WISCONSIN
SOUTH
DAKOTA
57¢
WYOMING
$1.77
$2.75
$1.53
MICHIGAN
RHODE ISLAND $2.46
$2.00
60¢
PENNSYLVANIA
IOWA
NEBRASKA
NEVADA
80¢
$1.36
UTAH
ILLINOIS
84¢
87¢
KANSAS
79¢
NEW JERSEY $2.575
$1.25
INDIANA
98¢
COLORADO
CALIFORNIA
DELAWARE $1.15
WEST
VIRGINIA
99.5¢
55¢
MISSOURI
30¢
17¢
*
VIRGINIA
30¢
KENTUCKY
NORTH CAROLINA
TENNESSEE
OKLAHOMA
ARIZONA
ALASKA
$2.00
NEW MEXICO
$2.00
91¢
$1.03
35¢
62¢
SOUTH
CAROLINA
ARKANSAS
59¢
7¢
GEORGIA
MISSISSIPPI
18¢
ALABAMA
37¢
42.5¢
TEXAS
$1.41
36¢
LOUISIANA
33.9¢
FLORIDA
HAWAII
$1.80
Equal to or above $1.14 per pack
Between $0.57 and $1.13 per pack
Equal to or below $0.56 per pack
CONNECTICUT
$2.00
$1.35
OHIO
64¢
69.5¢
MASSACHUSETTS $2.51
NEW YORK
MARYLAND $2.00
WASHINGTON, D.C.
$1.00
Tobacco Control Funding
• ACS & ACS CAN support funding and
implementation of tobacco control
programs according to the 2007 CDC
Best Practices for Comprehensive
Tobacco Control Programs
–
–
–
–
–
State & Community Interventions
Health Communications Interventions
Cessation Interventions
Surveillance & Evaluation
Administration & Management
100% Smoke-free Policies
• 65.1% of US population
protected by 100% smoke-free
workplace and/or restaurant
and/or bar law.
• 2,883 municipalities restrict
smoking
• 28 states plus DC & Puerto Rico
have strong smoke-free laws
Percent of US Population Protected
• 49.7% of US population resides in
a community with a smoke-free
workplace law.
• 62.6% with a smoke-free
restaurant law
• 50.6% with smoke-free bar law
• 34.7% have 100% smoke-free
workplaces & restaurants & bars.
FEDERAL ISSUES
• GRANTING FDA THE AUTHORITY TO
REGULATE THE PRODUCTION AND
MARKETING OF TOBACCO
PRODUCTS
FEDERAL ISSUES
• INCREASING FUNDING FOR
RESEARCH FOR CANCER
PREVENTION AND EARLY
DETECTION, AND TREATMENT
FEDERAL ISSUES
• ESTABLISH A CDC COLORECTAL
CANCER SCREENING AND
TREATMENT PROGRAM AND
INCREASE FUNDING OF THE CDC
NATIONAL BREAST AND CERVICAL
CANCER EARLY DETECTION
PROGRAM (NBCCEDP)
FDA REGULATION OF PRODUCTION AND
MARKETING OF TOBACCO PRODUCTS
HR 1108/S 625
• Stops aggressive tobacco company
marketing to children – curbs youth
access to tobacco products
• Requires unmistakable health warnings
on packages
• Requires tobacco companies to disclose
the content of their products
FDA REGULATION OF PRODUCTION AND
MARKETING OF TOBACCO PRODUCTS
HR 1108/S 625
• Allows FDA to order changes in tobacco
products.
• Stops the tobacco industry from making
false and misleading claims about their
products.
• Gives states and local governments
authority to regulate tobacco marketing
within their jurisdictions.
WHAT THE FDA BILL DOES NOT DO
• Does not overtax the resources and
capability of the FDA
• Does not mislead the public into thinking
that the FDA has found tobacco products
to be safe to consume
• Does not assert any new authority over
tobacco farms or tobacco growers
• Does not add to the annual federal deficit
or to the national debt
THE BUDGET AND THE NATIONAL
CANCER FUND
• Cancer research and prevention funding
has not kept pace with inflation and
increased needs.
• Since FY 2003, when accounting for
inflation, the NCI’s budget has decreased
by more than $630 million (13.7 percent).
• Since FY 2003, CDC’s cancer budget has
shrunk by nearly $14 million (5 percent)
• In FY 2007, NCI funded 300 fewer new
research project grants than just three
years ago.
WHY FUNDING MUST INCREASE
• Research is providing breakthroughs in
prevention and early detection, and new
treatments for the deadliest cancers.
• But the budgets for NCI and CDC
cancer programs are falling below
where they need to be.
• Fewer clinical trials have been started
and fewer patients are being enrolled
than five years ago.
WHY FUNDING MUST INCREASE
• The development of new drugs, devices, and other
tools for treating cancer is being delayed.
• CDC’s National Breast and Cervical Cancer Early
Detection Program served 44,000 fewer women in
2006 than in 2005 – a decline of 7.5 percent.
• CDC’s colorectal cancer screening initiative is
under-funded and unable to increase public
awareness about the need for colorectal screening.
Full funding of the national colorectal screening
and treatment program would cost approximately
$525 million a year and would save more than
30,00 lives.
THE FUNDING WE NEED – FY 2009
• National Institutes of Health - $30.81
billion ($1.88 billion (6.5 percent) over
FY 2008)
• National Cancer Institute - $5.26 billion
($455 million (9.5 percent) over FY
2008)
• Centers for Disease Control Cancer
Programs - ($136 million over FY 2008)
WE WON’T ACCEPT EXCUSES
• Appropriations bills aren’t going
anywhere this year ….
• Response: The funding bills will have to
be passed at some point (early next
year if not late this year) – will you
support our funding increase request?
WE WON’T ACCEPT EXCUSES
• We just doubled NIH’s budget ….
• Response: If you take inflation into
account, the funding is down
WE WON’T ACCEPT EXCUSES
• NIH needs to do a better job managing its money
….
• Response: Nearly 80 percent of the NCI portion
of NIH funding goes out the door to support
research at more than 650 universities, hospitals,
cancer centers, and other sites across the
country. Research leads to breakthroughs in
screening and treatments and often leads to
clinical trials that directly benefit cancer patients.
WE WON’T ACCEPT EXCUSES
• Wasn’t there just a big fundraiser for
cancer?
• Response: Stand Up To Cancer
generated about $100 million in pledged
donations for cancer research – a good
thing but not enough to meet our
research needs.
THE NATIONAL CANCER FUND HR 6791
• Provide a dedicated source of funding to
supplement existing appropriations of funds for
combating cancer.
• Increased, sustainable and predictable funding
would allow for long-term planning and support
for cancer research, early detection, and
screening projects.
• Dedicated, sensible, sustainable, well supported
funding.
BENEFITS OF A NATIONAL CANCER
FUND
• Expanded access to health care for
underserved and underinsured.
• New research to discover prevention
and early detection tools for the most
deadly cancers, including, but not
limited to, pancreatic, ovarian, and lung
cancers.
BENEFITS OF A NATIONAL CANCER
FUND
• Expanded breast and cervical cancer
early detection and treatment programs to
cover screening and treatment for women
who do not have access to health care.
• Expanded colorectal cancer early
detection and treatment programs to
cover men and women who do not
otherwise have access to health care.
BENEFITS OF A NATIONAL CANCER
FUND
• Increased number of qualified NIH
research grants.
• Increased access to federally sponsored
clinical trials.
ESTABLISH A CDC COLORECTAL CANCER
SCREENING AND TREATMENT PROGRAM
• Colorectal cancer is the second most
common cause of cancer death in men
and women in the United States.
• Yet, colorectal cancer can be prevented
in many cases through the early
identification and removal of precancerous polyps, detectable only through
colorectal cancer screenings.
ESTABLISH A CDC COLORECTAL CANCER
SCREENING AND TREATMENT PROGRAM
• Of the 49,960 people expected to die of
colorectal cancer in 2008, 50-80% could
be saved if they were tested.
• The uninsured and underinsured are at
particular risk of being diagnosed with
later-stage colorectal cancer. Over 80
percent of uninsured adults between the
ages of 50 and 64 have not been
screened for colorectal cancer.
ESTABLISH A CDC COLORECTAL CANCER
SCREENING AND TREATMENT PROGRAM
• H.R. 1738 establishes a program at the
CDC to provide screenings and treatment
for colorectal cancer for low-income,
uninsured and underinsured.
• The Senate Labor/HHS appropriations bill
includes $25 million for CDC to spend
through pilot sites to do colorectal cancer
screening – this would allow CDC to
expand its current colorectal cancer
screening efforts.
INCREASE FUNDING OF NATIONAL
BREAST AND CERVICAL CANCER EARLY
DETECTION PROGRAM (NBCCEDP)
• The NBCCEDP provides low-income, uninsured
and underinsured women access to breast and
cervical cancer screening tests, follow-up
services and access to treatment.
• Since its inception in 1991, the NBCCEDP has
provided more than 7.5 million screening tests to
more than 3.1 million women and diagnosed
more than 33,000 breast cancers, 2,000 cervical
cancers and 88,000 pre-cancerous cervical
lesions.
INCREASE FUNDING OF NATIONAL
BREAST AND CERVICAL CANCER EARLY
DETECTION PROGRAM (NBCCEDP)
• However, NBCCEDP served 44,000
fewer women in 2006 than in 2005 – a
decline of 7.5 percent.
• Fulfill the promise of the NBCCEDP
Reauthorization Act of 2007 by
accelerating an increase in resources
for the program to $250 million, which
would allow at least an additional
130,000 women to be served.
Thank you!
• Thank you for your advocacy.
• Together we will make a difference.
• Success will mean reducing the
incidence of cancer, increasing
screening, expanding research,
securing treatment, and saving lives.