As most of you are aware, the Iowa Legislature adjourned for the year last Wednesday evening (5-9-12). It was three weeks later than expected, and it was a painful process as they haltingly ground to a close, trying to reach consensus on several high-profile, contentious issues.

Each year seems to bring a different experience lobbying and educating the Legislature and executive branch on cancer-related issues. This session started out with a lot of promise, took a big dip downward about a month in when many of our priorities died and the House again proposed eliminating the state tobacco control programs, and then rallied at the end.  Things could have been a lot worse. We appreciate that there isn't the same gridlock at the Iowa Capitol as there is in Washington, DC.

First let's celebrate our legislative successes:

• Increase of $400,000 on tobacco prevention and cessation funding, dedicated to the Quitline
• Increase of $500,000 in funding for cervical cancer education and screening
• New appropriation of $250,000 for IowaCare patient lodging for those required to travel to Iowa City for care and treatment.  This is of particular importance to cancer patients, who must often stay in Iowa City for many weeks.

There were many legislators who helped accomplish these victories, but I'd like to give special recognition to the co-chairs of the Health & Human Services Appropriations Committee - Sen. Jack Hatch and Rep. Dave Heaton. They both were strong advocates for maintaining and increasing funding for cancer-related programs and services.  Without their support these successes would not have happened.

And a huge Thank You to all of you for contacting your legislators, visiting the Capitol and attending legislative forums. None of our work can be accomplished without your voices!

Of course we still have work to do on some important policy issues such as establishing an Iowa Health Insurance Exchange, eliminating the casino smoking exemption, prohibiting tobacco products on school grounds, and reducing Iowans' exposure to deadly radon gas. We will be starting work soon on outreach and education to legislators and others on these issues.

The governor will have 30 days from the last day of the legislative session to sign, line item-veto appropriations bills, or veto entire policy bills. He has never been shy with his veto pen in the past, so we don't assume he will be now.  As soon as the governor deals with the HHS appropriations bill we will schedule a conference call open to all advocates to de-brief on the session. Stay tuned!

After weeks of no news or not-so-good news, I have THREE positive developments to share.

(1) The House late Wednesday passed its version of the Health and Human Services budget bill. I am happy to report they restored funding for tobacco prevention and cessation programs, going from $0 to $2.8 million!

The bill is headed to a conference committee, where differences will be ironed out. But because both chambers have now passed bills with AT LEAST the same amount of funding as this year, we are hopeful we will see an increase in funding for these critical programs for the next fiscal year.

We sent out some sample letters to the editor on this issue this week. Letters in local newspapers are read closely by legislators. If you are interested in submitting a letter to your paper, contact Cassandra Furlong at cassie.furlong@cancer.org.

(2) In that same bill, the House agreed with the Senate that the state should help IowaCare cancer patients receiving treatment at the University of Iowa Hospitals pay for their lodging costs if no other option exists. The Senate allocated $200,000 for this; the House did not put a cap on the amount. We are quite hopeful now that we will receive funding for this critical need.

(3) And finally, whether or not our K-12 tobacco-nicotine-free schools language will remain in the education reform bill and become law is now up to the conference committee negotiating differences between the House and Senate on the bill. We sent out an Action Alert on this yesterday. If you have not had a chance to respond, please do so now. If the 10 legislators on the conference committee get hundreds of requests to include this, it will be hard to ignore!

The question on everyone's mind is when the Legislature will adjourn since the 100^th day, the day their expense money ended, was Tuesday. Speculation runs rampant. I can tell you they still have quite a bit of work to do, but how fast they get it done depends on how badly they want to end the session. We will keep you posted, so stay tuned!

And as always, feel free to contact me directly with any questions or concerns - peggy.huppert@cancer.org.

Unfortunately this was another week of not much progress on our priority issues.  The Iowa House still has not taken up the Health & Human Services appropriations bill, so now it looks like the Senate will move a bill first next week. The good news in this development is that the Senate bill contains $5.3 million for tobacco prevention and cessation programs compared to $0 in the House bill and $2.8 million this year.

The Iowa House passed a bill this week that usually gets little attention - the annual Insurance Division bill, made up of changes to the law that the state Insurance Commissioner recommends. This year a number of amendments to the bill made it controversial. One, dealing with navigators in the health insurance Exchange (which has not yet been established by the Legislature), is of particular concern to us.

This amendment is plainly bad public policy, and here's why:

• It creates the potential to raise the cost of the navigators, thereby resulting in higher than necessary consumer out-of-pocket or premium costs.

• The new federal regulations allow the states to set up a licensure process for navigators, but the process in this amendment would be very similar to that of insurance agents and brokers, essentially making them de facto agents and brokers.

• The licensure process, fees and bond requirements in the amendment, none of which are required by federal law, will be a barrier for nonprofit organizations and individuals other than agents and brokers who may want to become navigators.

• The core function of the navigators is supposed to be to help consumers understand the range of options for which they are eligible within the Exchange, including public programs like Medicaid and S-CHIP. Navigators are also required to offer assistance with the tax credits available for anyone with an income below 400 percent of the federal poverty level. There is no mention in the amendment of these duties, nor the training required to carry them out.

• The amendment is an unnecessary, backdoor way of tying the hands of an Exchange in Iowa without creating a state Exchange.  The Exchange is the entity that has the obligation to establish the navigator system, train them, contract with them, and fund them.

• If this amendment becomes law, Iowa would be the first and only state to create a navigator licensure provision without having first established an Exchange.

In summary, this amendment could result in higher health insurance premiums, limit access to free navigator services, and potentially violate federal law. There is no question that it violates the principles agreed to by the Iowa Health Advocates, a coalition of patient and consumer groups of which the Cancer Society is a part.

We will be working to get this objectionable amendment removed from the bill or add language to make it more advantageous for patients and consumers. Stay tuned for an Action Alert early next week.

As always, feel free to contact me directly with any questions or concerns - peggy.huppert@cancer.org.

Do you think it's true that good and bad things come in threes? Well it certainly seemed that way this week in the Iowa Legislature, where it was the second "funnel" week of the session. By today all bills not dealing with spending or taxing have to pass out of their originating chamber and out of committee in the other chamber to remain alive. This eliminates many bills!

We had three disappointments related to our legislative agenda:

(1)  The bill to legalize online poker was brought up for debate in the Senate. An amendment requiring that all casinos applying for the new license be smoke free was offered by Sens. Bob Dvorsky (D-Iowa City) and Randy Feenstra (R-Orange City). Unfortunately the amendment was determined to be not relevant (germane) to the bill so was not even debated. The House did not take the bill up so it is now dead for the session. The stand-alone bills eliminating the casino smoking exemption died earlier in the session, so it seems likely this issue will not be addressed this session.

(2)  The education reform bill was passed in the House this week. The massive bill had dozens of amendments, most of which were defeated. One of those amendments, offered by Rep. Ako Abdul-Samad (D-Des Moines), would have required that all K-12 school property be tobacco and nicotine free.  That amendment was ruled not relevant, so Rep. Abdul-Samad requested that the House suspend the rules to consider the amendment. That motion failed, so the amendment was not considered.

(3)  A bill sponsored by Sen. Jack Hatch, D-Des Moines, establishing a consumer-friendly health insurance exchange was eligible for consideration in the Senate but was not brought up for debate by Senate Majority Leader Mike Gronstal. It now seems almost certain that the Legislature will not pass legislation establishing an exchange this year.

Luckily we also have some good news!

(1)  The K-12 tobacco-free school requirement is part of the Senate education reform bill.  This bill will likely end up in conference committee where we will urge members to include it.

(2)  A number of House and Senate leaders have pledged that funding for tobacco prevention and cessation will be restored in Health & Human Resources appropriations bill. We are hopeful that will happen and will continue to work to see that it does.

(3)  Sixty high school students from across the state came to the Capitol on Tuesday and made their voices heard on tobacco-related issues. All costs associated with this youth advocacy day were covered by the Iowa Tobacco Prevention Alliance. The kids did a great job. They were articulate advocates for public investment in tobacco prevention and cessation!

As always, feel free to contact me directly with any questions or concerns - peggy.huppert@cancer.org.