Quarterly News from the WI Cancer Council Policy Committee | Feb/March 2018
Alcohol & Cancer FAQ
The WI Cancer Council released its latest policy resource in the February issue of ENGAGE : an Alcohol & Cancer FAQ . Courtney Harris, policy coordinator for the WI CCC Program, described how the FAQ can be used by members to support the Council's Policy Agenda and public awareness goals.
The FAQ equips members with the facts they need to discuss these issues with patients, clients, and community members. Using straightforward language, the FAQ explains how alcohol use increases cancer risk.
But it also does more.
The FAQ offers specific steps people can take to decrease individual cancer risk and the overall cancer burden in their communities. This includes individual behavior change, as well as environmental changes that discourage high-risk drinking by making alcohol less available, less attractive, and less affordable, and by making excessive drinking less acceptable.
Members are encouraged to share the FAQ with partners and community members, and on social media. (Download our social media graphic here.)
As a part of the Alcohol & Cancer Action Plan, the Policy Committee will be developing additional resources on the alcohol-cancer connection. We will be tailoring these resources based on areas and populations at highest risk.
To get involved in this work, please contact Courtney Harris.

The Alcohol & Cancer FAQ supports Priority 3 of the WI CCC Plan.
And the Policy Agenda
Every two years, the Policy Committee sets a new agenda that focuses the WI Cancer Council's policy work based on key priority areas, the policy environment, and emerging issues. As we begin deliberating the 2018-2020 Policy Agenda, the Committee turned to the Council's Action Plans for inspiration.
(You can see the current Policy Agenda here.)
Each Action Plan will have several important policy-related considerations -- since "policy, systems, and environmental change" is a cross-cutting issue of the larger WI Comprehensive Cancer Control Plan.
As a result, Committee members agreed that the next Policy Agenda should reflect the progress needed in the four Action Plan areas.

The Committee will meet again in March to finalize the 2018-2020 Policy Agenda. The full Council membership will get to see the final agenda - and the final Action Plans -- at the Regional Meetings in April.
If you haven't already registered for the Regional Meetings, you can do so here!


Introduction to the Federal Budget Process   - Center on Budget and Policy Priorities 


The Cost of Cancer Care: Policy and Programmatic Considerations - WI CCC Program


Snapshots of Recent State Initiatives in Medicaid Prescription Drug Cost Control - Kaiser Family Foundation 


States and the Rising Cost of Pharmaceuticals: A Call to Action - NASHP


State Roles Using 1332 Waivers - NCSL


Explaining Health Care Reform: Risk Adjustment, Reinsurance, and Risk Corridors - Kaiser Family Foundation 


Revisiting Wisconsin's Health Insurance Risk-Sharing Plan (HIRSP) - WI CCC Program


Retail Environment Toolkit - Tobwis


Palliative Care: Improving the Quality of Life for All Wisconsin Cancer Patients - WI CCC Program


Social Host Law Implementation Memo - WI Alcohol Policy Project


Understanding Short-Term Limited Duration Health Insurance - Kaiser Family Foundation 

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Cancer News in the Federal Budget
Bipartisan Budget Act
Congress passed the Bipartisan Budget Act of 2018 in early February, ending a brief government shutdown by extending funding for the federal government through March and lifting spending caps for the next two years.
Within this deal were several significant health measures that bolster cancer research and access to care for low-income Americans: Namely, an additional $2 billion in funding for the National Institutes of Health; an additional 4-year extension of the Children's Health Insurance Program (bringing the total to 10 years after a previous budget deal); and funding for community health centers.
Unfortunately, the bill also cut $1.35 billion from the Affordable Care Act's Prevention and Public Health Fund. This fund, which is perennially in jeopardy, provides funding to the CDC and other public health agencies to support key cancer prevention and control priorities such as immunization and tobacco use prevention.      
Trump's Budget Proposal
President Trump's Fiscal Year 2019 budget proposal, " An American Budget," was released in February and would dramatically affect cancer-related programs and funding. Though Presidential budget proposals historically gain little traction in Congress, they offer insight into an Administration's priorities.
The President proposed significant cuts to federal health programs - including restructuring some funding at the NIH, eliminating the CDC's Prevention and Public Health Fund, significantly reducing funding for Medicaid, and assuming passage of a bill similar to Graham-Cassidy to revive the repeal of the Affordable Care Act.
The budget also contained support for several of the Administration's earlier-released proposals to reduce prescription drug costs, primarily through public programs like Medicare and Medicaid.
Proposals to lower prescription drug costs are something the Policy Committee is monitoring very closely. Given the lack of progress on this issue at the federal level, individual health systems and states are beginning to pursue options to address drug prices on their own. Prescription drug prices are a significant driver of the high cost of cancer care, with major impacts for patient access and quality of life.
The President's proposal is the first step in a lengthy budget process. As the process moves forward, we will continue to monitor the potential impacts to cancer prevention and control initiatives and to cancer survivors.
WI Health Care Stability Plan
During his State of the State Address in January, Gov. Walker set forth a plan to stabilize Wisconsin's health insurance Marketplace and indicated his support for legislation that would ensure protections for people with pre-existing conditions, regardless of changes at the federal level.
The State Legislature has now moved forward with one of those proposals - the Wisconsin Healthcare Stability Plan (WIHSP) - which directs the state to apply for a Section 1332 State Innovation Waiver to create a reinsurance program. If the waiver is approved, this program would be in place for the 2019 benefit year. It received some bipartisan support in the Legislature and was signed into law by Walker this week.
A part of the ACA, Section 1332 waivers allow states to modify their Marketplaces in certain ways, as long as they provide similarly affordable and comprehensive coverage to enrollees, and do not increase the federal deficit.
A reinsurance program like WIHSP reimburses insurers for a specific amount of the costs they incur when they cover especially expensive patients - such as individuals who have cancer or other costly health conditions. The ACA requires that people with costly and/or pre-existing conditions be covered and not charged more based on their health. Under a reinsurance program, insurers are better able to predict their costs and incur fewer major losses, which theoretically should reduce premiums for all enrollees. Programs in other states, like Minnesota, have led to significant premium reductions.
The waiver process includes a public comment period, during which the Office of the Commissioner of Insurance (OCI) will hold public hearings to gather feedback on the proposed reinsurance plan. OCI expects this to occur during the month of March.
The WI Healthcare Stability Plan also requires the OCI to recommend options for additional Section 1332 waivers by the end of 2018. Some of these options could affect cancer survivors and others with pre-existing conditions, such as the return to a separate high-risk pool - an idea often floated in the health reform debate. We will continue to monitor these proposals moving forward.

>> Although a popular bipartisan bill requiring retailers to place all tobacco products behind the counter passed out of the Senate last year, it stalled in its Committee in the Assembly after receiving a public hearing, and will not pass this session. This bill is a priority for the American Cancer Society Cancer Action Network (ACS CAN) and will continue to be a focus next session.

>> Likewise, the bill to create a state palliative care advisory council will not advance this year. However, the bill did receive public hearings in both houses and has significant momentum going into next session. ACS CAN and experts in the palliative care field will continue educating key partners on palliative care concepts in preparation for a renewed effort in 2019. Check out our issue brief for more information on how palliative care affects quality of life for cancer patients and their families.

>> In a surprising turn of events, the bill to create a FoodShare healthy eating pilot program was added as an amendment to Special Session Assembly Bill 6, which has passed both houses as a part of the Governor's welfare reform push, and now awaits his signature. The pilot program will allow 2,000 households receiving FoodShare benefits to purchase fresh fruits and vegetables at a discount in an effort to incentivize healthy eating.

>>  A bill requiring that information regarding a woman's breast density be provided to her in her mammography summary also passed both houses and will become law, making Wisconsin the 32 nd  state to require this notification. Federal legislation that would require additional research into breast density, and create consistent clinical guidelines across states, is still pending before Congress and has received more support from patient advocacy groups .

>> Thanks to the passage of the state's Social Host Law earlier this session, it is now illegal across the state for adults to provide a location for underage drinking. However, communities still have significant control over how, and how strongly, the law is enforced. Alcohol's impact on cancer risk is greatest with heavy, long-term use, therefore efforts to reduce underage drinking are key to decreasing the cancer burden in the state. For more information on the Social Host Law and how your community can help support implementation, check out this memo from the WI Alcohol Policy Project.  

The Other Half of Health: An Introduction to Social Determinants
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