Introduction

The purpose of this paper is to describe a health advocacy campaign designed to promote policies that are supposed to improve population’s health in the area of promoting access to cancer care in the US for under insured people. Access to appropriate cancer care is vital. Since, many low-income citizens are not able to obtain the appropriate cancer care, they incur medical, psychological and financial devastating results. Therefore, it is necessary to provide the important aspect of high-quality cancer care and achieve the best possible health outcomes for the American community.

The first part of the paper discusses the existent cancer issues in the United States. It also describes the successful advocacy programs, as well as their attributes suitable for the new health advocacy campaign and a plan for it. The second part characterizes the legal considerations, associated with modifying the already existing law. The third part describes ethical dilemmas that could arise during the advocacy campaign.

Cancer Issues in the United States

Nowadays, cancer diseases are one of the most commonly diagnosed in the United States. According to the American Cancer Society, cancer accounts for nearly 25% of all deaths caused by diseases in the United States (American Cancer Society, 2016). At the same time, death rates of the most common cancer types, such as lung, colorectal, breasts, and prostate, have declined for the last decade (American Cancer Society, 2016). Nevertheless, absolute figures still remain high. For example, the American Cancer Society (2016) forecasts that almost 1,685 thousands of new cancer cases will be diagnosed and more than 595 thousands of Americans might possibly die of cancer in 2016.
Furthermore, high costs of cancer care negatively impact patients and their families. Most people with cancer have high possibility rates for bankruptcy and often experience a lack of financial resources. Despite the significant opportunities to get ill, some Americans disregard health insurance, which could prevent them from the financial problems and be helpful in receiving optimal health care. For example, 10% of American citizens (almost 33 millions) have had no health insurance during the 2014, especially among those with the low education and income (American Cancer Society, 2016). The percentage of citizens with no health insurance ranges from 8% of non-Hispanic whites to 20% of ethnic minority groups, and from 3% in Massachusetts to 19% in Texas (American Cancer Society, 2016). Moreover, patients from ethnic minority groups are usually diagnosed with cancer at a later stage.

The Advocacy Programs

In response to a significant threat of cancer, American society has founded a wide range of advocacy programs. One of the most successful advocacy programs is the Fond du Lac Wiidookaage Comprehensive Cancer Program. The aim of the program was to provide an early detection of breast cancer, using the mammography for American Indian women. As a result, the program has increased an access to mammograms for women (Centers for Disease Control and Prevention, 2009). The other example is the Breast and Cervical Early Detection Cancer Program, aimed to research colorectal cancer screening women’s behaviors in Iowa. The program findings have shown that the primary barriers to early detect this type of cancer are costs of colorectal cancer screening and lack of insurance coverage. As a result, the cancer screening of the colorectal for the recipients with the Iowa Cancer Consortium membership was provided at a little cost (Centers for Disease Control and Prevention, 2009). Further, the Indiana Cancer Consortium decided to address the issue that California insurance companies did not cover the routine patient care costs for cancer patients which have entered clinical trials before 2009. As the result of the advocacy campaign, the ICC Clinical Trials Action Team has been successful in the legislation promotion. The new legislation made it compulsory to cover the routine cancer care costs of patients with the insurance (Centers for Disease Control and Prevention, 2009).

The Attributes that Make Advocacy Programs Effective

There were several attributes that made both of these programs successful. First of all, these programs have used comprehensive media intervention and discussions with policy makers and community leaders (Milstead, 2013). Moreover, the advocacy team members have also used the forums to dialogue with stakeholders and find the features of their life and health management (Centers for Disease Control and Prevention, 2009). A key factor for the program’s success was the development of strong partnership between the local communities (i.e. tribal in Fond du Lac), state and national government (Milstead, 2013). Furthermore, am attribute, that has made these advocacy programs successful, was the proper evaluation of programs’ researches, i.e. participant’s attitudes, knowledge, and behaviors related to cancer screening (Raynor, York, & Sim, 2009). Thereby, advocacy team members were able to draw the appropriate conclusions.

A Plan for a Health Advocacy Campaign

Nowadays, cancer has become the second most common cause of death in the United States. According with the American Cancer Society survey almost 1,630 people will day per day from cancer in 2016 (American Cancer Society, 2016). Moreover, ethnic minorities have greater risk of detecting cancer at a late stage, and therefore lower rates of survival because of the lack of financial help. For example, in 2014, 24% of Hispanics/Latinos and 26% of blacks lived below the poverty line, compared to 10% of non-Hispanic whites (American Cancer Society, 2016). The existing Affordable Care Act has some gaps in its coverage expansions and differences in Medicaid expansion across state. Moreover, 19 states do not expand their Medicaid programs, because it is optional. At the result almost 3 million of citizens with low income falls into the “coverage gap”. This happens because their income is but below the lower limit for Marketplace premium tax credits but above the current Medicaid eligibility (Garfield & Damico, 2016). That is why in response to existent cancer issues in the United States, a new health advocacy campaign should be developed.

The proposed policy solution is to provide access to a usual care provider across the country for all individuals who have lower socioeconomic status, are underinsured or lack health insurance coverage, especially individuals in racial and ethnic minorities. The main objective to be implemented in this policy is to provide an insurance coverage in every state for all individuals with the low income.

Methods of Establishing Support for the Policy

Information about this policy change needs to be announced to many stakeholders. In the case of this policy these stakeholders include: ethnic minority groups, state and federal politicians, national cancer advocacy groups, hospitals and health centers, and private insurance companies (Milstead, 2013). The great importance has the informing ethic minority groups, because in order to make policy change successful the targeted population needs to be engaged in the process.

Raising the Advocacy Program’s Effectiveness

Researched attributes of the effective advocacy programs could also be applied to the proposed advocacy campaign. First of all, a comprehensive media campaign should be provided; for example, in the online sources, television, radio and print media. Furthermore, the representatives of the targeted groups should be engaged in the problem discussion. Thereby, they will be able to more effectively convey information about the program to their relatives and members of their community. Furthermore, it is necessary to build a strong partnership with the national government and ensure the adoption of law, which will oblige clinics to provide free consultations and examinations for patients with low income.

Legal Considerations

Modifying the Existing Law

In order to ensure the proposed policy, the existent limitations of the Affordable Care Act should be removed. For example, the option of providing the Medicaid program should become compulsory for all states. In case 19 states adopt the Medicaid expansion, all of the 3 million adults in the coverage gap and 1.8 million adults with incomes between 100% and 138% of poverty will be able to gain Medicaid eligibility. Moreover, Medicaid coverage should provide lower premiums for recipients with low income than they would face under Marketplace coverage.

The Impact of the Existing Laws or Regulations for the Proposed Policy

During the advocacy process, it is necessary to ensure that this activity is legal for the company. Existent U.S. laws protect the rights of nonprofits organization to engage in advocacy and legislative lobbying, thereby the lobbing and advocacy activity is legal for non-profits organizations in the United States. Many advocacy and lobbing laws and guidelines are specified in the Lobbying Disclosure Act of 1995. For instance, in case a nonprofit organization registers as planning to lobby, it is able to spend up to 20% of its first $500 thousands in annual exempt-purpose expenditures on lobbying. Furthermore, it can spend 15% of the next $500 thousand and 10% of the next $500 thousand. In order to use these advantages, the organization must register and fill in Federal Form 5768 from the National council of nonprofits web site.

Methods of Influencing Legislators and Other Policymakers to Support the Advocacy Policy

Effective advocacy campaign should be based on the Three-Legged Stool, where all three legs are mandatory. The first leg is the Capitol Leg, the second leg is the Community or Grass Roots Leg and the third leg is the Media Leg (Milstead, 2013). According with the method description, the Capitol Leg refers to city or county council, state legislature, and U.S. Congress, or any other place associated with the legislative process. Other appropriate places are those where citizens go to meet with their legislators during the Legislative Session. Therefore, it is necessary to engage full or part-time lobbyists in these places. Moreover, to cover the Capitol Leg advocacy team, members need to think of groups already lobbying in the Capitol, for example, health care professionals, minority organizations and faith communities, since they potentially can provide the necessary support in the promotion of changes to the law.

The Community leg refers to everything that goes on in the community. For example, sponsor community forums and places for community education can become a good platform for finding the associates and promoting the main idea of the advocacy campaign. Furthermore, setting up the telephone trees and email lists is a good method for generating the signatures in support of changes to the bill.

The third Media Leg refers to everything associated with the dissemination of information, for example, traditional media (local radio or local television and newspapers), and non-traditional media (social media, such as Facebook, Twitter or YouTube, online blogs and forums). Furthermore, it is possible to engage the local community college or university existent communication program. The third leg is important for the few reasons; first of all, it ensures that elected officials will pay attention to the existent problem through the traditional or non-traditional media. Secondly, an active media campaign allows informing more people, especially the targeted audience.

The Obstacles Arising in the Legislative Process

There are several obstacles arising in the legislative process of providing the changes in the Affordable Care Act. The first obstacles are organizational barriers. For instance, the bureaucracy of the involved institutions is the organizational barrier. This obstacle enlarges the time for decision-making processes, thus slowing down or hindering the policy campaigns of the advocacy project. Furthermore, the process of meeting with a policymaker is based on navigating with one or more gatekeepers. Thereby, the advocacy first needs to build a relationship with legislative aides, and only after that they become able to meet with the policymaker. Nevertheless, even after the meeting with the policymaker, there are no real guarantees that it will support policy change. The next obstacle is the political polarization, since legislators have different preferences and may deliberately interfere with the promotion of the unwanted law. For example, they can substantiate their opposition to change by the fact that it will have a negative impact on the insurance business, or that it is too expensive for the government budget. Finally, the advocacy team may not have enough financial resources for providing its activity. As the result, its team members will be forced to leave the project in order to earn money for their families. Therefore, during the dealing with policy makers advocacy must, first of all, clearly determine their orders and collect all the necessary statistical information. It is necessary to write a well crafted letter before sending emails to the potential partners. An appropriate idea is to invite the legislator to visit the advocate workplace to consider one as an expert on health care and nursing issues. Therefore, it will be possible to provide a strong relationship with the legislator.

The Ethical Dilemmas that Could Arise During the Advocacy Campaign

There are several ethical dilemmas around providing financial help to ethnically diverse individuals. First of all, nurses in the healthcare organizations must ensure that healthcare insurance coverage is being spent in the most appropriate ways (Goethals, Gastmans, & Dierckx de Casterle, 2010), since many individuals with low-income do not have access to comprehensive health insurance plans. For example, it is evident that cancer diagnosing at the late stage of progression is more expensive and requires more advanced treatment (Karpf, Ferguson, & Swift, 2010). Moreover, nurses should assure that social and economic inequities in health care are addressed (Begley, 2010).
Furthermore, this situation can cause paternalism when low-income ethnic minority groups will allow responsible persons to dictate them both public and private behavior models. According to Zomorodi and Foley (2009), nurses should reduce their paternalism and advocate for the patients. One key factor of reducing paternalism is to remove the language barriers that are in place for many of the targeted individuals. For example, poor knowledge of the language prevents them from understanding mainstream media and previously developed educational materials (Paquin, 2011). Moreover, it is necessary to develop health lectures for individuals from ethnic minority groups (Craig, 2010). Thereby, it will increase their understanding of the insurance options and disease processes.

The Ethics Laws and Reporting Requirements Applicable to the Advocacy Campaign

Nurses need some assistance in understanding how to manage the existent ethical dilemmas (Crippen & Barnato, 2011). In order to make sense of ethical dilemmas presented to them they need to study the American Nurses Association (ANA) Code of Ethics. There are several provisions in the code that are applicable to the ethics around the proposed advocacy campaign.

First of all, nurses need to ensure that in their care of patients, they are the following policies and standards, provided in the provision 7 in the ANA Code of Ethics. This provision describes the nurse practice, connected with the health policy and professional practice standards. According to it, nurses need to understand that their practice is linked to changing health policy and be aware of changing health policies and practice standards.
Considering the proposed advocacy campaign, provision 8 of the ANA Code of Ethics has a great importance. According to it, nurses need to ensure that their care is provided to populations of ethnic diversity, both in the United States and around the world. Thereby, this provision highlights the need to focus on communities and population groups. Moreover, nurses have to advocate for ethnically diverse individuals who have little voice to change their circumstances. These individuals often find themselves living in poverty, without access to health insurance, and are dying at higher rates than other American citizens with the same illness. Despite of this fact, nurses are able to provide the necessary assistance and support.

The next Provision 9 of the ANA Code of Ethics is also necessary for the proposed advocacy campaign, since this provision outlines that nurses need to work towards social reform in the United States. They also have an obligation to address ethical inequities, which occur in the society. Thereby, in order to ensure the success of providing legislation changes, each state needs to implement the new reforms, as mandated within the ANA Code of Ethics.

The Special Ethical Challenges Unique to the Targeted Population

Ethically responsible advocacy campaign in minority populations with low income presents a variety of challenges. First of all, members of advocacy team need to cultivate a trusting and strong relationship with members of the relevant minority community. Moreover, they need to involve the community representatives in consultations, discussion and study processes (Gallagher, 2009). Furthermore, advocacy needs to take into consideration the history of previous distrust among minority populations, for example, American Indians or African Americans. Secondly, it is necessary to design studies with due consideration for language, culture, traditions, lifestyle, and other factors important to the minority group. Finally, they also should avoid stigmatizing in research studies that may have a negative social impact on the minority groups.

Conclusion

The existing situation in the field of promoting access to cancer care in US for the under insured people requires legislative changes. In order to ensure the access to health insurance for the low-income Americans, the Medicaid program should be extended. Therefore, a new health advocacy campaign was proposed. The aim of this campaign is to provide an insurance coverage in every state for all individuals with the low income, especially to individuals in racial and ethnic minorities. In order to ensure this change, the existing law called the Affordable Care Act, should be modified. The proposed policy will produce many benefits or the American society, such as a healthier population and workforce, building a stronger health care system and stimulating economic growth.

There are several obstacles arising in the legislative process, especially organizational and associated with the political polarization. Thereby, in order to effectively influence legislators and other policymakers, the advocacy team needs to use the method of Three-Legged Stool, which covers building the relationship with the legislators and community, and filling the information space though the media instruments. Furthermore, the advocacy team should deal with the ethical dilemmas that could arise during the advocacy campaign; for instance, dealing with the paternalism or ethical discrimination.