Quarterly News from the WI Cancer Council Policy Committee | Sept. 2017
Latest ACA Repeal Bill: Repercussions for Cancer Community?
Congress returned to work after its summer recess and quickly revived efforts to reform the health care system - with three very different proposals. The Policy Committee reviewed these proposals during our September meeting. The tide in Washington now has shifted toward a plan to repeal and replace the Affordable Care Act, which would have significant impacts on the cancer community.

The bill at a glance
The repeal effort, initiated by Sens. Lindsey Graham (R-SC) and Bill Cassidy (R-LA) and joined by Sens. Dean Heller (R-NV) and Ron Johnson (R-WI),  retains many of the changes included in  prior repeal bills that would hamper cancer prevention and control efforts - including repealing the Prevention and Public Health Fund, blocking Planned Parenthood from receiving Medicaid reimbursements for cancer screenings and other health services, and capping Medicaid funding through a per-capita gap or block grant.
The  "Graham-Cassidy" bill would redistribute money to states through  a complicated formula. States would use these block grants to establish their own programs for providing health insurance coverage through a small menu of options outlined in the bill, such as creating new systems of premium subsidies and establishing state  high-risk pools.
Under these block grants, people with pre-existing conditions could face lifetime limits and increased costs. The bill allows states receiving block grants  to request waivers for ACA requirements that currently protect cancer patients and survivors from discrimination and significant financial risk. For example, states could opt out of  essential health benefi ts  - a set of 10 benefits that insurance plans are required to cover without  annual or lifetime limits  - and community rating, which prohibits insurers from charging more based on a patient's past or current health status.
The Senate intends to vote on Graham-Cassidy next week, as they have only until Sept. 30  to pass legislation using the "reconciliation" process that requires a simple majority. The non-partisan Congressional Budget Office has indicated it will  not be able to provide a full analysis  of the bill's impacts on the deficit, health coverage, or health insurance premiums in time to meet that deadline.
For a detailed breakdown of Graham-Cassidy and how it compares to the ACA and previous repeal bills,  check out this comparison table.
>> Read the full story.
Compare Proposals to Replace the ACA - K aiser Family Foundation

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Facing Federal Cuts, Health Insurance Navigators Scramble to Fill Service Gaps
Wisconsin's health insurance navigator agencies are facing significant funding cuts and a dramatic reduction in services that could affect cancer survivors and others who need help finding affordable health insurance coverage.

Last month the Centers for Medicare and Medicaid Services  announced it would be cutting  federal grant funds for programs that offer in-person enrollment assistance (known as navigators) by about 40 percent, as well as federal funding for Affordable Care Act advertising by 90 percent. 
Three navigator agencies  currently serve Wisconsin. The largest, Covering Wisconsin (previously known as Covering Kids and Families), received a 42 percent cut. As a result the group  has announced  it will need to eliminate services in at least 12 of the 23 counties it serves and reduce services statewide outside of the open enrollment period,  shortened this year  to run only six weeks, Nov. 1-Dec. 15.
These cuts mean fewer people could enroll in health insurance and premium costs could rise.  Eighty-percent of people helped by navigator programs say they would not have the confidence to apply for health insurance on their own. And cuts to outreach and enrollment assistance can lead to increased premiums throughout the market, according to the  Congressional Budget Office.
Navigator agencies  perform community outreach, educate consumers on complicated health insurance concepts, and provide support before, during, and after enrollment. This assistance is especially critical for cancer patients and survivors who have the added stress of finding a plan that covers their doctors or treatments, and helps them best manage the  high costs of their care.
What happens next
Navigator groups are still working to provide Wisconsinites with the information they need to navigate the health insurance system. Covering Wisconsin, for example, is currently looking for ways to fill service gaps through other funding sources and by joining with partners. Funding for navigators and other outreach and enrollment efforts has been proposed as part of bipartisan solutions to stabilize the health insurance marketplaces, like that proposed by Govs. Kasich and Hickenlooper, currently stalled within the Senate.
>> Read the full story.
Palliative Care Council Gains Momentum
Efforts to create a Palliative Care Advisory Council in Wisconsin are gaining momentum in the state legislature.
Palliative care is a team-based approach focused on providing patients with relief from the symptoms, pain, and stress of serious illness. 

"It's not just hospice," explained Sara Sahli, Wisconsin government relations director for the American Cancer Society Cancer Action Network (ACS CAN). "The phrase we use is, 'any age, any stage.'"
More than 92 percent of patients and caregivers say they would want this kind of integrated care if they or their loved ones were sick. But access in Wisconsin is uneven, as  not all hospitals offer palliative care programs, and the workforce suffers from a shortage of palliative care specialists.
Twenty states have created palliative care councils - comprised of experts from throughout the state who work together to identify barriers to palliative care, increase public and provider awareness of palliative care and its benefits, and recommend solutions to policymakers.
In Wisconsin, a bill to appoint a 20-member palliative care council is being pursued by Rep. Ken Skowronski (R-Franklin). The bill could be introduced within the next few weeks, with hopes for passage in late 2017 or early 2018.
This fact sheet from ACS CAN offers a helpful primer on the effort to create a Palliative Care Advisory Council in Wisconsin. 

>> Read the full story.

Wisconsin Cancer Caucus Attracts Support
The Wisconsin Cancer Caucus is a few steps closer to becoming a reality. If created, the Caucus would serve as a forum for state lawmakers to learn about topics spanning the cancer continuum - from updated information on prevention, advances in treatment, to issues affecting survivorship, and more.
Throughout August and September, proponents of the Wisconsin Cancer Caucus met with more than a dozen legislators from both parties to float the concept and recruit support.
By design, the Caucus would be bipartisan, bicameral, and open to all members of the state legislature. Eleven other states have established cancer caucuses or are in the process of doing so.
Instead of discussing specific bills, Caucus members would engage in broad conversation guided by members' interests and informed by health care experts.
Currently the WI Cancer Council sponsors a legislative drop once every two years - which serves as an opportunity to introduce the WI Cancer Council to legislators, share data on the cancer burden in their districts, and position the Council as an educational resource for policymakers on cancer prevention and control issues.
"I'm viewing the Cancer Caucus as a permanent legislative drop," said Courtney Harris, WI CCC Program policy coordinator. "It would provide us the opportunity to regularly educate lawmakers about cancer-related issues before advocates or lobbyists approach them with a particular bill."
Paul Westrick, Steering Committee chair, was inspired to organize the Wisconsin Cancer Caucus after witnessing the debate around the Oral Chemotherapy Parity Bill three years ago. During that debate, several legislators stood up to offer their personal cancer stories. To Westrick, this was yet another indication of the burden of cancer in Wisconsin. "Cancer is part of the human condition," Westrick said. "Why not  have this Caucus?"
Westrick is optimistic the Caucus will continue to attract support: "Our elected officials," he said, "are dying to find something that is positive and bipartisan."
The WI Comprehensive Cancer Control Program will keep WI Cancer Council members updated on specific ways you can participate in and support the efforts to create the Cancer Caucus. If you'd like to learn more, please contact Courtney Harris, WI CCC Program Policy Coordinator, at  charris2@wisc.edu

Additional notes from the Policy Committee meeting

>> The 2017-2019  state budget  now awaits Gov. Scott Walker's signature. Several 
positive areas for cancer control are included: level funding for cancer prevention and control, the Well Woman Program, the Tobacco Prevention and Control Program, the cancer registry, and the Farm-to-School program; new funding for the expansion of UW's Precision Medicine Molecular Tumor Board; and new funding for local public health to address communicable disease.

>>  The state legislature  missed an opportunity to close the tax loophole  that currently allows little cigars to be taxed at a lower rate than traditional cigarettes. The American Cancer Society Cancer Action Network has now turned its attention to promoting  AB 225 / SB 307 , which would help  reduce youth tobacco use  by requiring stores to place all tobacco products - including cigars and e-cigarettes -  behind the counter .

>>  The  Social Host Bill  ( AB 275 / SB 202 ), which would prohibit adults from providing a location  for underage drinking , is gaining support among state lawmakers.

>>  A bill in the Minnesota state legislature ( HF 1615) would f ix a data reporting  issue that currently leads to inaccurately low cancer incidence and mortality rates reported in border counties. The bill did not move this session, but momentum is picking up for potential movement in 2018.

>>  In Washington, the bipartisan "Removing Barriers to Colorectal Cancer Screening Act" ( H.R. 1017/ S. 479) would  end cost-sharing for Medicare recipients who have polyps removed during a colonoscopy.

>>  The US Food and Drug Administration  announced a plan to reduce nicotine in cigarettes to non-addictive levels, re-open the discussion of  how flavors influence youth use, and  delay regulation of e-cigarettes. This announcement was met with  mixed reviews in the public health community. 

Register for the all-member webinar, State of the State: Cancer Control in Wisconsin , Oct. 4, 2017, from 1-2 p.m.