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Advocacy Update - January 16, 2012

January 16, 2012

Advocates in Action

Columbus, Ohio – Nick Menedis, Support Group Leader from Columbus, Ohio is scheduled to attend an interested party meeting tomorrow, January 16 to discuss the oral chemotherapy access bill (SB 194) in Ohio. The bill author, Senator Oelslager, patient advocacy organizations, insurers, and others who have a strong interest in the bill will join Nick. The main purpose of the meeting is to have a hearing scheduled by the Insurance, Commerce and Labor committee to which it has been referred.  We thank Nick for being there to represent the IMF and myeloma patients in Ohio.

New Jersey – The oral chemotherapy access bill, A.2666 / S.1834 passed both the Assembly and the Senate and is awaiting Governor Christie’s signature. If you haven’t already taken action to ask him to sign the bill, please do so TODAY!

Happenings on the Hill

Essential Health Benefits Guidance Document Released by HHS
The Affordable Care Act, commonly referred to as the health reform law, created health insurance exchanges to help uninsured people obtain health insurance. The law requires that the insurance plans offered through the exchanges provide coverage for essential health benefits. There are 10 broad categories of services considered to be essential health benefits, including hospitalizations, maternity care, and prescription drugs. Additionally, the law says that the benefits should be similar to those offered in the typical employer plan. On December 16th, the Department of Health and Human Services released initial guidance regarding the essential health benefits that plans offered in the Insurance Exchanges will have to cover.  The Guidance is the first indication of how the government will implement the essential health benefits requirements.  
Broadly, the guidance allows states to choose an insurance plan whose covered services will define the essential health benefits for other plans offered in the state.  States can choose between one of the three largest small group, state employee, federal employee or HMO plans offered in the state.  The state must pick a plan that includes all 10 categories.  So, if a set of services isn’t included – such as mental health services – they must be added. This plan would then serve as the benchmark for all other plans included in the exchanges, meaning that they would have to meet or exceed the benefits provided in the benchmark plan.

The government is accepting comments on this guidance document through the end of the month. Already, many stakeholders have expressed concern that the federal government has given a lot of discretion to the states because they had hoped that there would be a federal standard to ensure adequate insurance coverage.

Federal Cancer Appropriations Update
Just before the end of the year, Congress passed legislation setting the appropriations, or federal spending levels, for fiscal year 2012 (FY2012). The National Institutes of Health received a $240 million increase for NIH, a little less than one percent over the budget for FY2011. And the newly created Cures Acceleration Network received $10 million to start its work on reducing the time it takes to move new drugs and treatments from research to the clinic. In the final bill, Congress also agreed to establish within NIH the National Center for Advancing Translational Sciences, an entity that will seek to “reengineer” the process by which new discoveries in fundamental science move from lab to clinic. Overall, total research spending for FY2012 stands at $142 billion, approximately $1.9 billion or 1.4% below FY2011 levels.

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