Kids First is set to sunset at the conclusion of FY 2023. To build on the program’s success in accelerating childhood cancer research, a bipartisan group of lawmakers introduced the Gabriella Miller Kids First Research Act 2.0 (H.R. 3391) (795). In addition to reauthorizing Kids First through FY 2027, the Gabriella Miller Kids First Research Act 2.0 would nearly double funding for the program to $25 million annually. The House passed an earlier version of the Gabriella Miller Kids First Research Act 2.0 in July 2022, but insufficient support in the Senate and a limited Congressional calendar prevented the legislation from moving forward. Fortunately, lawmakers from both parties have reintroduced the Gabriella Miller Kids First Research Act 2.0 in Congress, breathing new life into this important vehicle for improving the lives of the nation’s youngest patients with cancer. Aside from medical research, health care coverage remains an important issue for children facing cancer. Nearly half of all children in the U.S. have health insurance coverage through Medicaid or the Children’s Health Insurance Program (CHIP) (796). However, millions of children face the prospect of losing their insurance coverage as flexibilities permitted because of the COVID-19 pandemic expire. Since March 2020, the federal government has provided state Medicaid offices additional Medicaid funding in exchange for ensuring continuous coverage of Medicaid enrollees and suspending eligibility determination processes. These emergency coverage protections for Medicaid enrollees ended on April 1, 2023, and the federal government has allowed state Medicaid agencies up to 14 months to redetermine the eligibility of enrollees, including children. While outcomes of the redetermination process will vary from state to state, an estimated 6.7 million children could lose their coverage and face prolonged periods without insurance (796). These coverage losses would be especially devastating to children undergoing cancer treatment and their families. Thus, it is crucial for policymakers to ensure that state Medicaid agencies have the guidance and resources available to limit coverage losses and connect children who have lost Medicaid or CHIP coverage with new coverage options. Building Health Equity by Addressing Cancer Disparities As described in the AACR Cancer Disparities Progress Report 2022 (13), systemic disadvantages greatly contribute to poorer health outcomes for medically underserved communities. Centuries of discriminatory policies that restrict housing, education, and employment opportunities for racial and ethnic minorities have led to lower health insurance coverage rates, lower utilization of preventive health services, poor nutrition, and inadequate access to quality health care. Additionally, the lack of high-quality health care facilities in low-income neighborhoods and rural communities results in a lower quality of care even for those who can afford it. Eliminating cancer disparities will require a long-term, multipronged approach that supports individuals, communities, health care centers, and federal agencies, as well as local, tribal, and state governments. Recent policy developments related to cancer screening, nutrition, and health insurance have demonstrated that work in addressing health disparities is underway, but there is still more progress that must be made (see Sidebar 3, p. 18). Routine cancer screenings are necessary to detect precancerous and cancerous lesions as early as possible in cancer development; however, variability in cancer screening contributes to cancer disparities. Unfortunately, follow-up care is less likely to occur for patients from rural areas or from racial and ethnic minority backgrounds for many historic and systemic reasons, including being uninsured or underinsured, decreased access to care, health care system bias, and miscommunication with health care providers (see Suboptimal Uptake of Cancer Screening, p. 61). Several additional initiatives organized by NIH, NCI, the National Institute on Minority Health and Health Disparities (NIMHD), and CDC are designed to address cancer disparities. For example, NIH’s All of Us program aims to improve precision medicine research by building one of the largest and most diverse health databases. To date, over 661,000 people have joined the research program. The NCI Community Oncology Research Program is a national network that brings cancer clinical trials and care delivery studies to people in their own communities. Additionally, the NCI Center to Reduce Cancer Health Disparities supports disparities research within NCI and reinforces training a diverse cancer research workforce. NIMHD is NIH’s core institute to support research on the many factors that contribute to disparate health outcomes, including socioeconomics, politics, discrimination, culture, and environment (see Figure 2, p. 19). This work needs to continue and be adequately funded to urgently address cancer disparities. All research and clinical trials should be conducted with consideration for every patient. This means reaching out to and involving individuals in previously neglected regions of the country. In June 2023, NCI awarded $50 million to create five new Centers for Cancer Control Research in Persistent Poverty Areas under the Persistent Poverty Initiative, which aims to address the factors behind persistent poverty in the context of cancer (797). AACR Cancer Progress Report 2023 163 Advancing the Future of Cancer Research and Patient Care Through the Adoption of Evidence-Based Policies
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