PLEASE RESPOND TO THESE 3 FOLLOWING POSTS # 1 Patience A Summary COLLAPSE Patience, I am an independent nurse with MassHealth, and I care for patients in the comfort of

their homes. I have been an independent nurse for over two years. I have had the opportunity to work with immigrants at some point during my career and realized that this vulnerable group faces many barriers that cause health disparities, which greatly affect their well-being and subsequently the country's economy. Immigrants make up about 14% of the US population, for a total of 45.5 million individuals who are here legally or illegally. They are a diverse group of individuals who chose to move to the US for different reasons: for work, to reunite with family, or for safety. Immigrants contribute greatly to the economy by opening businesses, which create jobs, and by paying taxes. With all that they are doing to make the US the number one power in the world, immigrants, especially undocumented immigrants, do not have access to quality healthcare. The lack of regular checkups, physical exams, or means of transportation to healthcare centers leads to undiagnosed illnesses, which negatively affect their health. They become stressed, which affects their mental health and their ability to function well. One of my patients migrated here for safety reasons; she left her husband and kids behind. When she got here, she found out she was pregnant. She started prenatal care at a local healthcare center. Unfortunately, she miscarried, in part because of the stress and anxiety related to her status. She is unable to get employment since she does not have documents. Everything is expensive, and she cannot afford to pay for food, rent, and transportation. Bills started piling up, with some being forwarded to collection agencies. Passing a bill for affordable and equitable healthcare for immigrants will help those who cannot afford insurance. Older immigrants will not have to wait five to ten years to qualify for Medicare or Medicaid. We will have fewer comorbidities, fewer emergency visits, and improved health conditions among the individuals in this population. I also think that it will be helpful if funds are allocated for immigrants to borrow from to get them started, which they can start paying back when they get a job. We can call it an immigration loan. It will also serve as an incentive for them to get to work as soon as they can. Passing this bill will also relieve the receiving families, who are saddled with the responsibility of taking care of their loved ones for extended periods. Given the challenges that immigrants face, I will recommend passing the Affordable Healthcare for Immigrants Act and passing a bill to allocate funds for immigrants to borrow from. # 2 Sarah N. Children with incarcerated parents are a vulnerable population that is at high risk for health care disparities. According to Turney, (2019), in 1970, 100 out of 100, 0000 individuals in United States were incarcerated, and today, 500 out of 100, 000 are incarcerated, with most of them being parents. Children with incarcerated parents face challenges including social isolation, stigma, poor school performance, low self-esteem, disturbed sleeping patterns, depression and post-traumatic stress disorders which are likely to cause adverse childhood experiences (Beresford et al., 2020). Studies suggest that children of incarcerated parents are likely to end up in the criminal justice system because of engagement in delinquent behavior, aggressiveness, and antisocial behavior (Poehlmann-Tynan et al., 2021). Policy changes are necessary to implement to mitigate negative effects of parental incarceration. The school system plays an important role in helping these children navigate through the challenges they experience. Educators can help these children and classmates understand that their parent's incarceration is not their fault which can reduce the stigma associated with parental incarceration. Children would also benefit from a mentor to provide guidance and support which promotes resilience in the face of challenges, and improves educational and behavioral outcomes (Turney, 2019). This writer also recommends that the Massachusetts Department of Corrections decreases the restrictive visiting policies placed on visitors which may discourage families from visiting especially those with young children. Visitors who visit incarcerated individuals in facilities go through various screening procedures, there is a barrier to physical contact, and lack of privacy which may strain relationships between children and their incarcerated parents. In person visits with parents create positive adjustment for these children to their parents' predicament, positive sense of family connection, and decreased negative emotions including anger and feelings of alienation (Kremer et al., 2022). In conclusion, children with incarcerated parents face challenges that can impact their wellbeing, but with implementation of the policies recommended above, positive outcomes can be promoted. # 3 Nicole COLLAPSE Attention Members of the Oncology Review Board, my name is Nicole Olsen, a former oncology medical assistant and nurse, and I bring the issue of Cancer Treatment Affordability for Low-Income Individuals to the forefront as a topic of discussion. Low-income individuals are already at risk for disparities such as less job flexibility, inadequate housing, transportation issues and nutritional deficits. Those receiving chemotherapy are at risk for immunotherapy compromises such as severe blood infection, organ failure and death. Together, individuals who are low-income receiving chemotherapy are at a heightened risk for pooper health outcomes and demise. 1 in 3 cancer patients say they have trouble paying for their medical bills in which they are cutting into their savings, visiting family less, cutting back on food and selling their assets, like vehicles and homes, to pay for care. Some are even delaying obtaining care and entering severe depression. Currently, physicians receive monetary compensation for prescribing more expensive chemotherapies. A study by Patlak says that "a generic version of paclitaxel costs about $312 per dose…. [while] physicians can prescribe Abraxane, a brand- named paclitaxel, for $6,000 per dose and receive $3,000 in reimbursement" (Patlak, 2014). Because of this, hospitals must bill insurance companies higher amounts. Patlak says that "the maximum out-of-pocket expense is reached in the first month of treatment and deductibles and coinsurance become irrelevant…... [that] a family of 4 with an annual income of about $47,000 must pay about $10,000 of out-of-pocket costs before they would reach the cap limit” and insurance would take over (Patlak, 2014). This introduces a toxic cycle of unaffordability and disparities for low-income individuals across the United States. With your help, I am proposing a policy statement in the hopes changes are made to help this vulnerable population. Individuals must receive dialog whenever a change from generic to brand-name drugs are considered. Institutions shall lower physician incentives whenever they prescribe a brand-name drug and incentives should be granted for prescribing generic drugs. Lastly, society must focus more on time spent together rather than on capitalism. With these changes, patients may receive more autonomy regarding treatment decisions in a time when choices are slim, and chemotherapy prices may be more affordable allowing for patients to spend more time with family. In a time when healthcare and innovation are at its highest, we must do our best to help all who are suffering so that future generations are set for success. Thank you for your consideration.