This blog post was written by Jacob Barrera, a current student in the Health Law and Policy Clinic. Jacob is pursuing his Masters of Public Health from the Harvard T.H. Chan School of Public Health.
Nothing like a tornado watch to kick off the Tackling Lung Cancer in Kentucky Policy Workshop! Whether it was falling trees or flooded roads – nothing could stop the 75 participants from coming together on March 1 in Louisville to talk about next steps for those with and/or at risk of developing lung cancer in the Bluegrass State.
The workshop opened with an overview of the rapidly shifting federal health care landscape, delivered by Center for Health Law & Policy Innovation (CHLPI) of Harvard Law School students Jacob Barrera (Harvard T.H. Chan School of Public Health ’18) and Mike Cunniff (Harvard Law School ’18). Presenters focused on what’s at stake for Kentuckians if the Affordable Care Act (ACA) is repealed. A particular area of concern for potential ACA-repeal is the fate of the barrier-free insurance coverage for critical tobacco cessation services and medications and lung cancer screening that many Kentuckians currently have access to under Obamacare.
After an overview of federal health policy, Emily Beauregard of Kentucky Voices for Health presented an overview of the Kentucky health policy landscape, with a focus on the fate of Kentuckians enrolled in Medicaid if ACA repeal and replace proposals were successful. Kentucky expanded Medicaid in 2014 under the leadership of then-Governor Steve Beshear. Changes to the Medicaid program proposed at the federal level and at the state level by Governor Matt Bevin could impact all of the 1,220,788 people currently enrolled in Medicaid and the Children’s Health Insurance Program (CHIP) in Kentucky. Ms. Beauregard emphasized that because Medicaid expansion has been so successful in reducing the number of uninsured individuals in Kentucky, the state has been able to divert funds previously reserved for supporting charity care for the uninsured to other uses. This means that if and when Medicaid excludes more individuals under new rules, the newly uninsured will fall back on a safety net that is significantly weaker than it was prior to 2014. Efforts to repeal the Affordable Care Act will therefore have quite a large impact on Kentucky.
Workshop participants then heard from Erica Palmer of the American Cancer Society Cancer Action Network (ACS CAN) and Heather Wehrheim of the American Lung Association on active bills relevant to lung cancer in the current legislative session. Ms. Palmer and Ms. Wehrheim coordinate the grassroots efforts to urge state legislators to support measures to: require insurers to cover tobacco cessation medications; require daycares to test for elevated levels of radon (exposure to radon is a major risk factor for lung cancer); and require all public school campuses throughout the state to be 100% tobacco-free.
Following a quick break to stretch our feet and to browse the exhibits in the LeRoy Neiman Gallery, participants listened to a panel discussion of five experts in their respective fields, comprised of representatives from Freedom from Radon Exposure and Smoking in the Home (FRESH), ACS CAN, the Campaign for Tobacco Free Kids, and the University of Louisville’s Kentucky Cancer Program. These individuals highlighted priority areas for policy change relevant to lung cancer in Kentucky. They spoke about increasing the tobacco excise tax, directing funding from the excise tax to tobacco prevention and control activities in the state, reducing exposure to secondhand smoke and radon, combatting the stigma associated with smoking and lung cancer, and encouraging primary care providers to learn more about lung cancer through continuing medical education.
Following lunch and a presentation about how to organize around a policy priority, workshop participants were split into groups for a facilitated discussion about the priority areas for policy change outlined by the panel experts. The group was charged with narrowing the policy priorities down to two in an effort to delve into concrete next steps around advocating for immediate legislative change on these issues. In the end, requiring insurers to offer barrier-free coverage of cessation services (supporting the active Senate Bill 89) and increasing the tobacco excise tax surfaced as the two issues that the group democratically voted upon, with stickers, of course!
The table that I was seated at affectionately called Senate Bill 89 Bobbye’s Bill, after Bobbye Gray from the KY Tobacco Prevention and Cessation Program, who was seated at my table. Bobbye has been working to get the bill passed for the last six years, working with her legislative champion, Kentucky Senator Julie Raque Adams (R-36th District). Senator Adams has been working tirelessly to get the bill passed before the close of the legislative session on March 8. As of March 7, the bill had passed the Senate, moved out of Committee in the House, and was waiting for a hopefully favorable House vote before moving onto Governor Bevin’s desk for his signature.
Being part of the Kentucky Cancer Summit allowed me to not only learn a new state’s health care landscape, but it also allowed for me, as an outsider, to observe potential challenges that these lung cancer champions face in this uphill battle. The room was filled with passionate people ready to fight for the rights of lung cancer patients. Participants put forward many excellent and creative ideas about how to approach these policy priorities and engage with stakeholders on these issues throughout the state. However, one of the challenges that arose is the need to coalesce under an evidence-based political strategy to help overcome many of the obstacles to policy change, especially around increasing the tobacco excise tax. Although a challenge, it is also an opportunity for further connection and coordination as a group. A next step in the fight for health equity for all those who are low-income and are considered vulnerable, including those who have or are at risk of developing lung cancer, may be the hiring of a political strategist who can help move lung cancer into the issue-attention cycle for Kentucky legislators, turning the increase of the tobacco excise tax into a more urgent issue that requires immediate attention.