Quarterly News from the WI Cancer Council Policy Committee | June 2018
Progress on Palliative Care Advisory Council

Advocates are laying the groundwork for reintroducing legislation in early 2019 to create a statewide Palliative Care Advisory Council, after a similar bill gained bipartisan support but stalled in the last session .

If approved, the bill would create a panel of experts to study the state's palliative care landscape and recommend ways to improve and expand access to palliative care throughout the state.
Last year, the American Cancer Society's Cancer Action Network made progress with positive conversations with lawmakers and key partners, as well as hearings in both the WI Assembly and Senate.
ACS CAN is now preparing for a renewed effort next session by working to confirm Senate and Assembly champions for the legislation, continuing to educate policy makers about the critical need for this legislation, and strategizing with key partners. This issue will be the focus of ACS CAN's lobby day in May 2019.

"It's important to understand the full range of what palliative care really means," said Sara Sahli, WI government relations director for ACS CAN. "This speaks to the need for the advisory council."

Simultaneously, ACS CAN is supporting a federal bill  authored by WI Sen. Tammy Baldwin that would complement this work by supporting palliative care workforce development, research, and public awareness efforts.
Advanced Directives Registry Gains Steam 
The Wisconsin Medical Society is leading an effort to create a statewide registry of advanced directives, with the goal of making advanced care planning documents more accessible to health care providers in times of patient need.
At least a dozen other states have passed legislation creating advanced directives registries. Each registry is structured differently -- some require a filing fee, most are web-based, and all have different requirements for how documents are filed, who can access the registry, and how they do so. Lessons can be learned from the challenges in other states, including state budget and staffing constraints, as well as creative solutions to patient reminders, public education, and ensuring documents are legally valid.
A bipartisan bill in Wisconsin introduced at the end of last session, Assembly Bill 987, would have given the Department of Health Services the authority to create such a registry and determine the structure and other details through the administrative rules-making process. The bill did not advance, but the Medical Society plans to continue this effort next session.
The Policy Committee discussed several considerations, including how to integrate a registry with current advanced care planning processes, and electronic systems to ensure effectiveness and accessibility-especially for community health centers, the Veterans Administration, and other providers serving vulnerable patients.  
Improving the accessibility of advanced care planning documents within and across health care systems is key to improving end-of-life care for cancer patients and is supported by the WI CCC Plan 2015-2020. We will continue to monitor this effort and potential implications for cancer patients as it moves forward next session.


Patients   - WI Cancer Council
Alcohol and Cancer FAQ - WI Cancer Council
What is JUUL? - Tobwis
Report: Public Health Consequences of E-cigarettes - National Academies of Sciences, Engineering, and Medicine
WI County Cancer Profiles - Cancer Health Disparities Initiative
Follow us online

           Like us on Facebook   Follow us on Twitter

Policy-Related Takeaways
The 2018 WCC Regional Meetings were a success all around, including the positive feedback we received on our 2018-2020 Policy Agenda. As you saw in last week's ENGAGE, members are excited about the Council's policy work and are interested in getting more engaged.
Members also agreed that our policy agenda is reflective of member priorities overall. We heard that costs of care and access-meaning everything from insurance coverage to transportation-remain significant barriers to quality cancer care and screening throughout the state. We heard that helping patients navigate insurance coverage is a huge challenge, and that folks are excited about working to educate their communities and decision makers about the alcohol and cancer connection.
We also learned of emerging policy issues of interest to our members-such as the effort to create an advanced directives registry and concerns about new tobacco products like JUUL.
Bottom Line: We heard you, are excited about your enthusiasm, and want to encourage you to continue providing feedback and raising issues by contacting Courtney Harris, Policy Coordinator, or a member of the Policy Committee.
What is JUUL and Why Is It a Problem?
Image courtesy of TruthInitiative.org
JUUL is a new tobacco product that has quickly taken over nearly half of the e-cigarette market. The JUUL device looks a lot like a USB drive, and despite it being illegal for minors to purchase, possess, or use, its discreet size and kid-friendly flavors make it especially popular with youth.
"JUULing" hits the user with highly concentrated levels of nicotine-as much as a pack of cigarettes in one JUULpod. This means these products are highly addictive, and research shows youth who use them are up to seven times more likely to move on to other forms of tobacco.
Policymakers at all levels are beginning to take action. The FDA cited several retailers and manufacturers of JUUL and similar products for selling or marketing them to appeal to youth. The WI Department of Health Services is continuing their campaign to educate parents on the changing nature of tobacco products. The Milwaukee City Council voted to add e-cigarettes to their municipal code , making it easier to cite retailers for violations. And it made national headlines last month when voters in San Francisco upheld a ban on all flavored tobacco products in their city-the strictest such ban in the country.
With e-cigarette use on the rise among middle and high school students in Wisconsin, efforts to reduce youth access to these products are essential. Learn more about JUUL here, and explore the UW-CTRI website for a collection of the latest research on e-cigarettes generally.
New Challenges for Cancer Patients
New challenges to the Affordable Care Act (ACA) may affect the cost and availability of health insurance for cancer patients and survivors. 
S tate and federal officials have offered several proposals that experts say could increase costs for people with pre-existing conditions, as healthy consumers leave ACA marketplaces in favor of cheaper plans with fewer benefits and protections.  One example is a rule the Trump Administration proposed in February that would expand access to short-term health plans . Consumers who select these plans could be vulnerable to large bills or loss of coverage if they become sick, and both internal and external analyses show the rule could significantly raise premiums in the ACA marketplaces. After a huge outpouring of public comments by health groups and others in response to the rule, the comment period closed in April and a final rule could be released soon.    
In mid-April, the Administration finalized an annual rule making updates to the ACA marketplaces. Among other changes, the rule gives states more flexibility when choosing which benefits they include in their " essential health benefits" package for plans beginning in 2020. Although any new benefit packages still must meet  certain requirements , patient and health care advocates are concerned this rule change could ultimately lead to health plans with fewer benefits. The rule also made changes to the navigator program, which when added to funding concerns, could mean less in-person enrollment assistance from organizations like Covering Wisconsin again this year.
Finally, last week, the Justice Department announced it would not fight a lawsuit being brought by Wisconsin and several other states arguing that the ACA is unconstitutional after the individual mandate penalty was zeroed out in the tax bill. Currently, the ACA protects cancer survivors and others with pre-existing conditions from being charged more or denied coverage due to their health. In agreeing with the states, the DOJ has argued these popular protections should be invalidated. While the case is far from decided, insurers and experts predict that this additional uncertainty in the insurance market could mean higher prices or fewer options for people in the ACA marketplaces in the meantime.

>> The Medical College of Wisconsin is exploring the possibility of creating a rural health care disparities task force aimed at identifying potential policy solutions to address
cancer and other health disparities affecting Wisconsin's rural communities .

>> This summer, the 2018 Legislative Council Study Committee on Alcohol Beverages Enforcement , chaired by Rep. Swearingen (R-Rhinelander), will explore how Wisconsin enforces its alcohol beverage laws. Proposed public members represent primarily alcohol industry groups and do not include public health or law enforcement. Alcohol policies have the power to create environments that discourage excessive drinking and reduce the risk of alcohol-related cancers by making alcohol less available, attractive, and affordable, and misuse less acceptable . Currently, Wisconsin communities enjoy significant control over their own alcohol environments. Public health advocates worry legislators could change this by passing state laws that prevent local communities from enacting alcohol rules stricter than state law - this action, known as preemption , has been a common tactic in the tobacco control arena .

>>  During the summer legislative recess, the American Heart Association is working with local communities on policy, systems, and environmental changes to increase access to healthy foods and built environments that support physical activity. This includes working with city officials in Milwaukee and Madison on projects that help retailers offer affordable, healthy food options in low-access areas, and advocating for a Complete Streets policy in Milwaukee.

>> Exposure to radon, a naturally occurring, odorless, radioactive gas , is the second-leading cause of lung cancer. Wisconsin has relatively high levels of indoor radon, yet evidence shows testing and mitigation-installing a system that can prevent and reduce indoor radon levels-is uncommon. A coalition of stakeholders, led by WI Cancer Council member Ryan Denu , is currently pursuing a package of bills aimed at addressing this issue. The package aligns with policy strategies outlined in the WI CCC Plan 2015-2020 , such as integrating educational materials about the lung cancer risk of radon into real estate transactions, and requiring testing and mitigation in rental properties, schools, and child care centers.

Get more news like this. Follow us on Facebook and Twitter.  

Like us on Facebook   Follow us on Twitter