Month: October 2018

Paper details:

I would like the proposal written to the Governor of GEORGIA to cover Breast Cancer screenings and treatment for African American women. The proposal should also include a realistic solution to the problem (ex. the use of lottery funds and/or Medicaid expansion).

Objectives

Provide the following information in the form of a letter:

• Identify and briefly describe one health care issue in the news in the last year or one health care issue of a vulnerable or diverse group.
• Governing body to address: Congress? à Fact based appeal
• Articulate a logical, compelling and professional presentation of the issue along with your concerns and recommendations to a governing body.
• DON’T need cover page
• New York times (1 unscholarly)
• Resources (3): peer reviewed, statistics (CDC, Kaiser health), CINAL
• Recommendation: Suggest that they propose legislation?

Requirements:

1. Review the news and the scholarly literature and write no more than 1 page to address the two objectives. à Font no smaller than Arial 10; Single spacing is expected.
2. Adhere to APA standards for cover page, running head, pagination, seriation, in-text citations, and end references. à In Text (use only 1^st author); Cover and reference pages not included in the page limit.

Grading Criteria

Component	Points
Objective 1 •       Identify and briefly describe one health care issue in the news in the last year or one health care issue of a vulnerable or diverse group	40
Objective 2 •       Articulate a logical, compelling and professional presentation of your concerns and recommendations to a governing body	40
Scholarly writing format •       APA format and references •       An organized and well-written letter that is clear, concise, scholarly, and professional •       References reflect current, valid and reliable sources of information o    Past 5 years •       Adhere to page limit	20
TOTAL	100
Grading Criteria Paper should reflect graduate level analysis, synthesis, and application of the information.

 

 

 

 

 

 

 

 

 

 

 

Sample Letter

April 17, 2012

Stephen Carol

495 Jaybird Lane

Wilmington, TN 59283

 

Tennessee Department of Transportation

Attn: Colin Bennigan, Director

100 Municipal Drive

Nashville, TN 49234

 

Dear Mr. Bennigan,

 

I am a resident of the neighborhood of Birdsong Hills on the outskirts of Wilmington, near the newly completed extension of Highway 14. I am writing with some concerns my fellow residents and I have regarding the high number of trucks that travel this route.

 

We have seen a tremendous increase in truck traffic since the newly completed highway opened, and with it there has been an increase in the deterioration of the existing surfaces, presumably due to the weight of the heavy trucks. In addition, the noise of the trucks that travel through the area late at night has become quite a nuisance to area residents. Another concern is the increased potential for exposure to dangerous goods in the event of an accident involving a truck that might be transporting them.

 

In my opinion, a logical solution to all of these problems would be the establishment of a truck route that would send these vehicles through the more industrial and less populated Highway 79 area. If needed, I can provide testimonials or petitions from fellow residents. Please also let me know if there is any other way in which I can be of assistance. I will call your office in the next two weeks to follow up and see what consideration has been given to this request.

 

Sincerely,

Stephen Carol

 

SENTENCE STRUCUTRE

• Short sentences better than long
• More than 3 lines lon, revise and break it down
• Use active voice (I cared for the patient NOT the patient was cared for by me)
• Paragraphs 4-6 sentences
• Last line of paragraph should be the link to next paragraph
• MEAL:
  • Main point: argument
  • Evidence: supporting
  • Analysis: build your case
  • Link
• Use rubric to structure headings and subheadings for paper
• Turnit in: aim for less than 20%
• APA Style blog

 

Why is it a problem?

• Start with a statistic
  • It has come to my attention that miscommunication between providers has caused up to 80% of avoidable medical errors”
  • I am writing to raise my concerns
  • Try to stay away from 1^st person
• Leading cause blah blah statistics

• Recommendations
  • Can we make it happen? Clear and achievable? Measurable goal?
  • There are many we could make, but highest impact one is this…
  • Zero in on one or two

 

 

 

 

ADVOCACY LETTER TOPIC ISSUE:

• Topic:
  • Vulnerable population: African-American women
  • ISSUE: Access to affordable breast screening/treatment for Uninsured women
  • Concerns: Increased risk for breast cancer
    • Issue is that they’re uninsured and aren’t able to afford screenings or even when diagnosed to be able to afford treatment
  • Who to address? Governor
  • Recommendation: Georgia declined expansion of Medicaid; Federal funding to cover those uninsured
    • Equity? Is this a human right?
    • Tie in my aunt’s story?

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5840870/pdf/nihms945890.pdf
   • BC screening shown to reduce breast cancer morbidity and mortality
   • Use of mammography screening varies by race, ethnicity, and sociodemographic characteristics à shown to reduce disease and death by detecting early, when treatment is most effective
   • Medicaid (low-income beneficiaries and those disproportionately member of minorities
   • ACA of 2010 requires most insurance plans to provide breast cancer screening with no cost sharing
   • Lower screening has been associated with later stage diagnosis and higher morbidity and mortality rates among underserved populations, including Medicaid enrollees
   • Greatest likelihood of being successfully treated when detected early
   • Medicaid is an important source of insurance for low-income beneficiates and racial or ethnic minorities who are less likely to be screened than those with higher socioeconomic status

 

2. https://www.healthinsurance.org/georgia-medicaid/ (Georgia and the ACA’s Medicaid expansion)
   • Nearly half a million would gain coverage if the state were to accept federal Medicaid expansion funding
   • GA did not accept federal funding to expand Medicaid under ACA and program more restrictive than average
   • Non-disabled adults without dependent children are ineligible for Medicaid in GA regardless of how low their income is
   • 9% of GA residents were uninsured in 2016, only 3 states had higher rates
   • Without the expansion, GA is leaving billions of dollars on the table and nearly ½ million without Medicaid coverage
   • Governor Nathan Deal and republican lawmakers claim that expanding will be too costly, however while providing Medicaid coverage to nearly ½ million low-income GA residents would increase state spending by 6.3%, that expense would be offset by savings in other areas including uncompensated medical care
   • Georgia’s decision on Medicaid impacts hundreds of thousands of people, increases the uncompensated care burden for hospitals in the state, and results in a less healthy risk pool for the state’s private market (people with income between 100 percent and 138 percent of the poverty level qualify for premium subsidies to buy plans in the exchange, but if the state were to expand Medicaid, they’d qualify for Medicaid instead; lower income is correlated with poorer health).
   • TheKaiser Family Foundation estimates that 240,000 people are caught in the coverage gap, meaning they earn too much to qualify for Georgia’s Medicaid program, but too little to qualify for subsidies that would help them purchase private insurance through the health insurance marketplace. This is about half of the population that would become eligible for Medicaid if the state were to expand coverage (the rest earn a little above the poverty level, and are thus eligible for premium subsidies in the exchange until if and when the state expands Medicaid).
3. https://www.kff.org/medicaid/issue-brief/the-coverage-gap-uninsured-poor-adults-in-states-that-do-not-expand-medicaid/
   • As of June 2018, 17 states had not extended their programs (GA included)
   • Bc ACA envisioned low-income people receiving coverage through Medicaid, it does not provide financial assistance to people below poverty for coverage options
   • More than 2 million poor uninsured adults fall into the “coverage gap” that results from state decisions not to expand Medicaid, meaning their income is above Medicaid eligibility but below the lower limit or Marketplace premium tax credits
   • Coverage gap 11% GA
   • South has a relatively higher number of poor uninsured adults than in other regions, but has higher uninsured rates and more limited Medicaid eligibility than other regions à 9/10 people in the gap reside in the South
   • Because ethnic minorities more likely to lack insurance coverage and more likely to live in families with low incomes, they are disproportionately represented among poor uninsured adults (23% black)
   • The majority of people in the coverage gap are in poor working families—it is likely that many will continue to lack access to coverage through their job even with ACA provisions for employer responsibility for coverage.¹³Further, even if they do receive an offer from their employer that meets ACA requirements, many will find their share of the cost to be unaffordable. Because this population is generally exempt from the individual mandate, and because firms will not face a penalty for these workers remaining uninsured, they will continue to fall between the cracks in the employer-based system.
   • Decisions not to expand affect people of color, particularly African Americans. As a result, state decisions about whether to expand Medicaid have implications of efforts to address disparities in health coverage, access, and outcome among people of color.
4. https://onlinelibrary.wiley.com/doi/epdf/10.3322/caac.21412 (Breast Cancer Facts by state)
   • Most common cancer diagnosed among US women and is the 2^nd leading cause of cancer death among women
   • 252,710 new cases of invasive breast cancer and 63,410 cases of in situ BC are expected to be diagnosed among Us women in 2017
   • NHW and NHB have higher bc incidence and death rates than women of other race/ethnicities
   • NHB have higher breast cancer incidence rates before 40 and are more likely to die from BC at every age
   • In every state BC death rates are higher in NHB women thant NHW women
   • NHB women are disproportionately burdened with aggressive subtype associated with poor survival
   • Increasing access to hc can further progress the elimination of breast caner disparities BUTTT……

 

Advocacy Assignment: Due 11/16

Outline Structure: (No APA Errors, Grammar errors, clear writing, references within 5 years)

• It has come to my attention that…..

1. Describe a Relevant Health Issue that has been in the news in the past year that involves vulnerable group
   1. Issue: Lack of access to affordable breast cancer screening/treatment for uninsured
   2. Vulnerable group: African American Women
   3. Start with the facts/ statistics
      1. Importance of screenings
         1. BC screening shown to reduce breast cancer morbidity and mortality (1)
         2. Use of mammography screening varies by race, ethnicity, and sociodemographic characteristics à shown to reduce disease and death by detecting early, when treatment is most effective (1)
         3. Lower screening has been associated with later stage diagnosis and higher morbidity and mortality rates among underserved populations, including Medicaid enrollees (1)
         4. Most common cancer diagnosed among US women and is the 2^nd leading cause of cancer death among women (3)
      2. How AA women are more at risk. BUT WHY ARE THEY MORE AT RISK?
         1. NHW and NHB have higher bc incidence and death rates than women of other race/ethnicities (3)
         2. NHB have higher breast cancer incidence rates before 40 and are more likely to die from BC at every age (3)
         3. In every state BC death rate are higher in NHB women than NHW women (3)
         4. NHB women are disproportionately burdened with aggressive subtype associated with poor survival (3)
         5. Increasing access to hc can further progress the elimination of breast cancer disparities BUTTT (NEXT PARAGRAPH)
      3. Present Concerns
         1. Concern: Increased risk for breast cancer because of lack of access to screenings and not being able to afford treatment à Medicaid already has limitations on who/who isn’t covered under the ACA, but with Governor Deal declining expansion of Medicaid coverage à widened the gap for those uninsured (explain how this worsened the problem)
            1. ACA of 2010 requires most insurance plans to provide breast cancer screening with no cost sharing (1)
            2. Medicaid is an important source of insurance for low-income beneficiates and racial or ethnic minorities who are less likely to be screened than those with higher socioeconomic status (1)

• More AA women depend on Medicaid than any other ethnicity making it more difficult but, because expansion declined in GA à threatening issue

1. As of June 2018, 17 states had not extended their programs (GA included)
2. More than 2M poor uninsured adults fall into the “coverage gap” that results from state decisions not to expand Medicaid, meaning their income is above Medicaid eligibility but below the lower limit or Marketplace premium tax credits
3. South has a relatively higher number of poor uninsured adults than in other regions, 9/10 people in the gap reside in the South

• The majority of people in the coverage gap are in poor working families—likely they’ll continue to lack access to coverage through their job even with ACA provisions for employer responsibility for coverage.¹³Further, even if they do receive an offer from their employer that meets ACA requirements, many will find their share of the cost to be unaffordable. Because this population is generally exempt from the individual mandate, and because firms will not face a penalty for these workers remaining uninsured, they will continue to fall between the cracks in the employer-based system.

• Present recommendations on how to alleviate issue
  1. Say access to affordable health care is a human right
  2. Equity
  3. Decisions not to expand affect people of color, particularly African Americans. As a result, state decisions about whether to expand Medicaid have implications of efforts to address disparities in health coverage, access, and outcome among people of color.