Policy and Advocacy Committee Reviews Work, Discusses COVID-19, Medicaid Expansion

AONN+ 2020 Conference Highlights Special Feature —January 4, 2021

With a mission of advocating to protect and promote oncology navigation, the AONN+ Policy and Advocacy Committee is diligent in supporting that objective. Along with providing an overview of the committee’s accomplishments and a primer on advocacy, committee members delved into the impact of COVID-19 on patients with cancer, as well as Medicaid expansion.

Kerri Medeiros, BSN, RN, OCN, ONN-CG(T), explained the fundamentals of advocacy, saying it can be conducted by anyone by:

  • Contacting elected officials
  • Signing coalition letters
  • Voting and helping others to do so
  • Writing newspaper editorials
  • Attending town hall meetings.

“Elected officials are not experts in cancer care, but you are,” Ms Medeiros said. “Find out what you’re passionate about in cancer care and bring that out to your elected officials and to your community.”

Occurring at all levels of government, advocacy can take place around federal issues, such as Medicare, the Affordable Care Act, and the Healthcare Marketplace; it can also encompass state issues, including commercial insurance and state insurance marketplaces.

“No amount of advocacy is too small,” Ms Medeiros added.

With guiding principles of access, equity, affordability, patient-centered care, and patient assistance, the committee’s recent undertakings have included presentations, as well as helping to shape comments for a letter regarding the Oncology Care Model 2.0 and signing letters supporting the committee’s core tenets, with many focused on COVID-19.

COVID-19 and Cancer

Having immeasurable impact worldwide, COVID-19 brought with it the threat of greater mortality for patients with cancer. The directive by the American College of Surgeons and Centers for Disease Control and Prevention for hospitals to cancel elective surgeries during the first months of the pandemic caused less aggressive cancer surgeries and other treatments to be delayed, according to Michele M. Hubert-Fiscus, MSN, RN, CCM. In addition, pandemic-related delays in care resulted in reductions in early cancer detection and restricted the ability to screen persons of average risk for colorectal and other cancer types. Colorectal cancer testing is of particular concern, with screenings already seeing a downturn and the pandemic further reducing screening by 80%, she said.

Along with facing an increased risk for contracting COVID-19 because of immunosuppressive treatment effects, patients with cancer have dealt with the conundrum of choosing whether to go to medical appointments and take a chance with getting the virus. Additional stressors, such as children being home-schooled, loss of employment and health insurance, transportation concerns, isolation, and possible lack of assistance because of reduced nonprofit revenues, only exacerbate the situation. The resulting psychosocial distress adds to the burden.

These issues became personal for Ms Hubert-Fiscus when her uncle was battling cancer, she said.

“For someone who was elderly and was really not sure what was going on, it was crucial for someone to be with him,” she said, adding, “So many people would not have had access to care if not for telehealth.”

Advocating for these patients includes working to ensure the elimination of copays for COVID-19 testing, reimbursement for telehealth, helping patients access additional financial assistance for those impacted by cancer and COVID-19, and having COVID-19 vaccination covered as a preventive service, among other efforts, Ms Hubert-Fiscus said.

Helpful for guiding patients with cancer through the pandemic is the new AONN+ COVID-19 Navigator Toolkit. Other ways to be an advocate for patients are to:

  • Encourage healthy lifestyle
  • Educate on prevention and screening recommendations
  • Empower patients and promote informed decision-making
  • Identify and address barriers to care
  • Transition them into survivorship programs when appropriate.

Medicaid Expansion Update

Part of the provisions of the Affordable Care Act, Medicaid expansion has thus far been adopted in 40 states, including Washington, DC, according to Debra Kelly, RN, BSN, OCN, ONN-CG. A boon for patients with cancer, Medicaid expansion is associated with fewer disparities in cancer outcomes, reducing the number of patients presenting with metastatic disease and increasing the receipt of treatment, resulting in longer median survival.

Looking beyond cancer, Ms Kelly cited studies showing Medicaid expansion has saved more than 19,000 lives over a 4-year span through regular checkups, early diagnoses, more prescription fills, and surgeries aligned with clinical guidelines. In addition, states with expanded Medicaid are better equipped to contend with COVID-19 and the accompanying recession, she said, adding that more than 650,000 uninsured essential workers could gain Medicaid coverage if states that have yet to do so adopted Medicaid expansion.

“They just tell me it’s not the political climate,” Ms Kelly said of holdout states. “The trick is just getting it on a referendum. Most people want it.”

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Last modified: January 20, 2021

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