Hon. Phil Murphy, Governor

New Jersey State House

Trenton, NJ 08608

Dear Governor Murphy,

On behalf of the 543,190 cancer survivors in New Jersey I am writing to formally request that you ensure that the adopted 2020-2021 state budget is one that continues New Jersey’s commitment to reducing our state’s cancer rate, helps identify cancers at their earliest- and often most treatable- stage, and ensures that cancer patients are adequately supported as they battle this devastating disease.

I first want to personally take this moment to wish you well in your own battle with cancer. The American Cancer Society and the American Cancer Society Cancer Action Network are here for you if there is anything that you need.

The COVID-19 pandemic has upended lives and the economy. But as this disease grips the nation, cancer is ever-present; 1 in 2 men and 1 in 3 women in the United States will be diagnosed with cancer in their lifetime. Cancer patients have long faced significant barriers to accessing care. COVID-19 has magnified these barriers, with 46% of cancer patients and survivors reporting a change in their ability to pay for care due to the pandemic, and 79% experiencing delays in active treatment. The pandemic has also shone a spotlight on health disparities across populations. Individuals from racial and ethnic minority groups are more likely to be uninsured, increasing the likelihood they will be diagnosed with advanced cancer. The 5-year relative survival rate is lower in Blacks than in Whites for every stage of diagnosis in the four most common cancer sites.

The American Cancer Society estimates that 53,340 new cases of cancer will be diagnosed in New Jersey and 15,710 cancer deaths will occur in the state in 2020,i making it the second leading cause of death in the state. While policymakers are addressing acute needs related to COVID-19, cancer patients need changes that promote innovation, expand access, and drive towards health equity to relieve suffering during the pandemic and beyond. Eliminating cancer relies as much on public policy as it does on scientific discovery and innovation. To reinforce New Jersey’s commitment to the fight against cancer ACS

CAN recommends the following be included in the 2020-2021 state budget.

Budget Recommendation #1: Protecting all New Jerseyans from the predatory tactics of Big Tobacco and a lifetime of addiction by supporting a $1.65 per pack cigarette tax increase and dedicating additional funding to New Jersey’s tobacco control program.

The number one cancer killer is lung cancer. Smoking is responsible for 26.7% of cancer deaths in New Jersey,ii while almost 12,000 people die each year from smoking-related diseases of all types, and 143,000 kids under 18 who are alive today will ultimately die from smoking if we don’t not act urgently to intervene.iii Page 2 of 5

Investing in Tobacco Prevention and Cessation Programs

According to established standards and best practices for state tobacco control efforts,iv New Jersey has never adequately financed its tobacco prevention and cessation program. While the Centers for Disease Control and Prevention (CDC) recommends that New Jersey spend $103.3 million annually in 2021 on tobacco prevention and cessation, New Jersey has never spent more than $7 million annually.

Budget cuts in the last decade to New Jersey’s tobacco program have been among the deepest in the nation. The program’s state funding was eliminated in 2012, and the fiscal year 2018 budget saw a $500,000 restoration. In 2018, legislation was signed into law to dedicate one percent of the state’s cigarette and tobacco tax revenues to the implementation of a comprehensive tobacco control program. The amount appropriated from that law was approximately $7 million. The program will continue to operate at a greatly reduced impact until it is fully funded. As a direct result, New Jersey ranks near the bottom of the nation in funding tobacco control programs.v

New Jersey’s inadequate funding of tobacco prevention and prevention and cessation programs is of concern because it pales in comparison to the huge amount tobacco companies spend each year to market their deadly and addictive products, and the numbers are alarming. Tobacco companies spend an estimated $175.5 million a year advertising their deadly products in New Jersey.vi New Jersey is no different than other states in the sense that ample revenue streams are already in place to provide life-saving tobacco control funding. In fact, New Jersey received approximately $700 million last year in tobacco tax revenue alone, but only a small fraction of that amount was specifically dedicated to comprehensive statewide programs that prevent and reduce future tobacco usage. This failure by the state to adequately fund tobacco prevention and cessation programs contributes to preventable chronic disease, suffering and death in New Jersey, and furthermore undermines the nation’s efforts to reduce tobacco use – still the leading cause of preventable death in the nation. Tobacco use furthermore takes a terrible toll on New Jersey’s finances, costing the state an estimated $4.06 billion in health care bills annually, including $1.17 billion in Medicaid payments alone.vii

While we recognize the challenging fiscal situation that the COVID-19 crisis has presented New Jersey, investing in tobacco control is a proven successful investment. For every dollar spent on tobacco prevention, states can reduce tobacco-related health care expenditures and hospitalizations. California saw a $55 to $1 return on investment between 1989 and 2008.viii Tobacco control programs in Massachusetts and elsewhere have been proven to reduce youth smoking and help people who currently use tobacco to quit.

To further support New Jersey’s commitment to tobacco control, ACS CAN recommends that you increase the state’s cigarette tax by $1.65 per pack to raise the rate to $4.35 per pack. It has been 11 years since New Jersey has increased its cigarette tax and this proposal, if passed, will put us on par with states like New York and Connecticut, as well as the pursuit of tax parity among other tobacco products, including e-cigarettes.

We estimate the proposed tax increase will reduce youth smoking by 17.2% and help 46,300 people who currently smoke, to quit. Low-income adults, youth, and pregnant women are especially likely to quit or reduce their smoking with such a tax increase. Lower smoking rates translate into fewer smoking-related cancers and premature deaths, reduced spending on smoking-related health problems, and more productive workers.

It’s estimated that if New Jersey raises its cigarette tax by $1.65 per pack to $4.35 per pack, 23,700 youth under 18 will be kept from becoming adults who smoke, 18,700 premature smoking-related deaths will be prevented and $103.73 million in new annual revenue will be generated while saving the state $1.44 billion in long-term health care costs from the declines in adult and youth smoking rates.

While New Jersey is not yet going to reach the CDC recommended level of $103.3 million per year,ix we feel strongly that the state should continue to dedicate at least 1% of its cigarette tax revenue or $7 million to tobacco prevention and cessation programs for FY 2021. Page 3 of 5

ACS CAN requests that you include in your 2020-2021 budget an increase in the state cigarette tax by $1.65 per pack and, in accordance with the 2017 law, dedicate 1% of the total revenue generated for tobacco control and prevention. In 2020-2021 we ask that you maintain a minimum of $7 million in funding of revenue from tobacco sales for tobacco control and prevention initiatives. As the cigarette tax increases in the future, we look forward to the continued allocation by the state of 1% of the increased revenue for tobacco and control initiatives therefore bringing the total amount dedicated to tobacco control and prevention closer to the CDC recommended level

Budget Recommendation #2: Identifying cancers early, maintain funding for the New Jersey Cancer Education and Early Detection Screening Program (NJCEED).

NJ CEED offers a critically important service to men and women who lack health insurance – screening for breast, cervical, colorectal and prostate cancer at no cost to the patient. Detected early, these cancers are more effectively treated. Failing to have these cancers detected early can lead to deadly consequences. Program services are provided through 21 contracted lead agencies; each county in NJ has at least one lead agencyx.

Cancer screening saves lives. Detecting cancer early increases the chances of successful treatment, improves survival rates, and saves New Jersey overall on medical costs. For example, research shows that the earlier breast cancer is treated and detected, the better the survival rate. When breast cancer is diagnosed at an early stage while still confined to the breast, the 5-year survival rate is 99%.

Published research on the success of the National Breast and Cervical Cancer Early Detection Program, which partially funds and guides the state screening program, demonstrates a substantial impact on reducing mortality from breast cancer in medically uninsured, low income women. These evidence-based findings justify the state’s investment in NJCEED and the early detection of cancer. With thousands of New Jerseyans out of work and at risk of losing their health coverage, it is more important than ever that we continue these life saving cancer screening programs.

ACS CAN requests that you maintain the current level of funding for the NJCEED program so the lead agencies can adequately serve their existing patients and outreach to the eligible population to the extent possible. Total combined state and federal support for this important program is currently approximately $12 million. We recommend that state funding for this program be maintained at $9.5 million.

Budget Recommendation #3: Find cures and new therapies by maintaining the $2 million in funding for the NJ State Commission on Cancer Research (NJCCR).

Since 1983, NJCCR has funded promising cancer research in New Jersey. NJCCR promotes significant and original research in New Jersey into causes, prevention, treatment and palliation of cancer and serves as a resource to providers and consumers of cancer services. Throughout its 30-year history, the NJCCR has awarded over $40 million to over 800 peer reviewed cancer research grants and student fellowships. NJCCR is the only statewide institution that provides peer reviewed scientific cancer research grants to all eligible institutions in New Jersey, and this merit-based system has a strong track record of funding the best new scientists who engage in ground-breaking basic research. Last year’s final adopted budget included a $2 million appropriation for this program.

The merits of cancer research are undeniable, and the benefits are vast. An independent study of NJCCR grant recipients shows that these researchers leverage $10 in federal funding for each $1 of NJCCR funding. All eligible institutions in New Jersey can apply for cancer research funding grants. In the past, grants have been awarded to researchers at Rutgers Cancer Institute of NJ, Rutgers School of Biomedical and Health Sciences, Rutgers School of Dental Medicine, Princeton, Rider, and Rowan Universities.

With the $2 million in funding, the Commission will be able to fund 16 cancer research fellowships to scientists conducting basic cancer research in New Jersey this year. Additionally, the Commission will be able to award five bridge grants, providing funding to promising and productive New Jersey investigators who faced short term interruption in funding for research projects focused on cancer prevention, diagnosis, treatment and survivorship. Page 4 of 5

Researchers funded by an NJCCR grant have discovered life-saving scientific breakthroughs, including the recent discovery by Princeton and Cancer Institute of NJ researchers of the gene, Metadherin, a gene critical to breast cancer metastasis.

New Jersey’s cancer research enterprise extends beyond the laboratory and campus: NJCCR research and funding augments NJ’s reputation as the world’s medicine chest. The state has one of the highest concentrations of pharmaceutical and biotechnology firms in the nation: a $25 billion industry. The ability of the pharmaceutical industry to tap NJ’s cancer research talent and scientific breakthroughs bolsters their strength and in turn the NJ economy.

ACS CAN requests that you maintain the program’s base appropriation of $2 million and add to it the revenues generated by the current taxpayer filer and license fee programs.

To conclude, ACS CAN’s mission is to support evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. With that objective in mind, we appreciate your commitment to the fight against cancer. With your support of the above-mentioned budget priorities in 2020-2021 you can reduce New Jersey’s cancer rate; help identify cancers at their earliest- and often most treatable- stage and ensure that cancer patients are adequately supported from the public policy standpoint as they battle this devastating disease.

While COVID-19 may have stopped many things in our lives, as you know firsthand cancer hasn’t stopped. So, neither have we. We look forward to standing by your side in the fight against cancer.

Sincerely,

Michael Davoli

New York City & New Jersey Government Relations Director

American Cancer Society Cancer Action Network