Saturday, July 23, 2016

Latest sign of IV drug spread: Hepatitis C cases among Ky. women of childbearing age more than tripled from 2011 to 2014

Hepatitis C among Kentucky women of childbearing age more than tripled from 2011 to 2014, while the national rate among that group was rising only moderately, the federal Centers for Disease Control and Prevention said July 22 in a report that "offers further evidence of growing problems in the state from intravenous drug use," Bill Estep writes for the Lexington Herald-Leader.

In 2011, the hepatitis C infection rate among Kentucky women aged 15-44 was 275 per 100,000. In 2011, it was 862 per 100,000 -- an increase of 213 percent. The national increase during the period was only 22 percent.

The CDC highlighted Kentucky because "the state had the highest incidence of acute hepatitis C infections from 2011 through 2014," Estep reports. "The report found that the rate of infants born to women diagnosed with hepatitis C went up 124 percent in Kentucky in that time."

But those numbers likely understate the problem, Estep notes: "The figures were based on data from a large commercial laboratory called Quest Diagnostics and birth certificates. The report said that having to rely on data from one lab means the figures might not represent the reality across the country or in Kentucky. The numbers for Kentucky are likely low, the report said. Official figures for 2015 are not yet available. However, health department officials said early indications suggest the trend will continue for 2015."

Health officials also told Estep that the statistics make a good argument for needle exchanges where IV drug users can get clean syringes instead of sharing dirty ones and transmitting diseases such as hepatitis or HIV, the virus that causes AIDS.

There is also a financial argument, Estep notes: "One course of the drug needed to treat hepatitis C costs more than $80,000, and the lifetime cost of treating HIV can be hundreds of thousands of dollars, health officials said. Hepatitis C is the top cause of expensive liver transplants, according to the CDC."

Estep reports, "Most people with hepatitis C don’t have physical symptoms, but of every 100 people infected with the virus, 70 or more will develop chronic liver disease and as many as five will die from cirrhosis or liver cancer, according to a CDC fact sheet. . . . The agency said people born between 1945 and 1965 should talk with a doctor about being tested for hepatitis C, and that people with risk factors such as IV drug use should be tested. It also recommends that health care providers assess all pregnant women for risk factors and test those who might be at risk."

Justice Dept. sues to block Aetna's takeover of Humana

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The U.S. Department of Justice has filed lawsuits to block the sale of Louisville-based Humana Inc. to Aetna Inc. and of Cigna Inc. to Anthem Inc., on grounds that consolidation of the health-insurance market will reduce competition and hurt consumers. Observers expect a protracted court battle, involving negotiations with the department's anti-trust division, reports Grace Schnieder of The Courier-Journal.

"Of the two deals, analysts and investors see Aetna and Humana as having a slight chance to reverse the decision," report Caroline Humer and Carl O'Donnell of Reuters. Aetna "faces a tough but not impossible legal battle." Also, "Aetna may also gain some leverage if the Anthem-Cigna deal breaks up first, according to some antitrust experts."

The Justice Department's major focus in the Humana-Aetna case is Medicare Advantage, the alternative insurance for seniors. "The two companies now compete in more than 600 counties, nearly 90 percent of the counties where Aetna offers Medicare Advantage plans," Schneider notes. "That fierce competition has led to lower premiums, better benefits, better provider networks and improved coordination of care, the suit said." It also said smaller insurers "lack the scope and scale" to compete.

Reuters reports, "Aetna will argue in court that the Justice Department defined the market for Medicare Advantage too narrowly, which has caused it to see competition issues where they do not exist, Chief Executive Officer Mark Bertolini said in an interview. The government has failed to take into account that seniors can not only choose between Medicare Advantage plans sold by private players, but also have the government-run Medicare program as an option. . . . The Justice Department has already rejected that argument. However, Aetna will use evidence that the Obama administration envisioned Medicare and Medicare Advantage as direct competitors as it sought support for the Affordable Care Act passed in 2010."


Friday, July 22, 2016

Lexington baby tests positive for Zika virus but shows no effects

A baby born in Lexington showed antibodies for the Zika virus but no apparent effects of it, the Lexington-Fayette County Health Department announced Friday. It is Kentucky's 10th confirmed case of Zika, which can cause birth defects such as an abnormally small head and brain.

Health Director Kraig Humbaugh said the mother had traveled early in her pregnancy to an unspecified area known to have been affected by the virus. "Health officials say the infant's mother never described symptoms of illness," Victor Puente of WKYT-TV reports.

While the baby showed antibiodies for Zika, it showed no other evidence of the virus, and apparently fought it off, Puente reports. Humbaugh said the mother and child present no risk to public health. He said pregnant women, or those planning to become pregnant, should cancel or postpone travel to Zika-affected areas.

Thursday, July 21, 2016

Health advocates, providers and faith leaders voice concerns about Medicaid plan; one says it's based on false assumptions

By Melissa Patrick
Kentucky Health News

FRANKFORT -- Health advocates, providers and faith leaders spoke out against Gov. Matt Bevin's proposed changes to the state's Medicaid program at a news conference July 20, saying it creates barriers to access, is too complex and is based on false assumptions.

"The proposed changes to Medicaid by Governor Bevin and his staff will impact the health and economic wellbeing of hardworking, low-income Kentuckians, families and our most vulnerable citizens across the Commonwealth," said Rich Seckel, executive director of the Kentucky Equal Justice Center.

The news conference was sponsored by KeepKYCovered, a campaign coordinated by Kentucky Voices for Health, an umbrella organization for groups focused on sustaining access to affordable health coverage in Kentucky.

Col Owens, a director of KVH and a retired Legal Aid lawyer, was one of the most vocal opponents of the Medicaid proposal, saying it is based on inaccurate assumptions.

He said the notion that low-income workers don't sign up for health insurance because they don't know how it works is false. He said it "has little to do with understanding insurance and virtually everything to do with affordability." He noted that the costs of health insurance and health care are rising faster than wages, which have remained stagnant for decades, and that fewer employers than ever are offering health insurance: 56 percent, down from 70 percent in 1980.

As for the idea that people need "skin in the game," as Bevin contends, Owens said, "Low-wage workers do not earn enough money to achieve economic stability for their families, and it is simply untrue, demonstrably untrue, that they have enough sufficient disposable, discretionary income in order to pay co-pays, deductibles or premiums."

As for the work requirements, he said, "It is a great fallacy to believe that low-income people must be forced to work by holding out goods or services for things that they need. ... The truth about Medicaid is quite the opposite: it is what allows people to work."

The Kentucky Center for Economic Policy found that more than half of Kentuckians who gained Medicaid through the 2014 expansion by then-Gov. Steve Beshear are working.

Bevin's proposed work and volunteer requirements were particularly upsetting to entrepreneurs and farmers, jobs that require long hours and often the need to work a second job to make ends meet.

“The work requirements of the new proposal feel like a slap in the face to hard-working families like mine,” Oldham Coutny farmer Bree Pearsall said in a prepared statement. “To assume that because I am low-income that I have an inferior investment in my family’s health is an insult. I would like to see the governor act with compassion, instead of creating a culture of shame for families who receive health care coverage through Medicaid.”

Tyler Offerman, 27, of Lexington, who recently started an outdoor-adventure company while working full-time in a restaurant, said the expansion of Medicaid “allowed me to follow the American dream, and it supports other young entrepreneurs in doing the same. To assume people like me are lazy or are mooches to the system is totally offensive. I am an entrepreneur. I am trying to create jobs, to create a living for myself, and the kind of  rhetoric that is coming out of the Bevin administration is very offensive.”

Under Bevin's plan, Medicaid recipients would be required to pay premiums, which initially range between $1 and $15. Non-payment would result in a six month lock-out for those who are above the federal poverty level, though they can re-enroll if they get current on their payments and take a financial- or health-literacy class. Those below the poverty level or who are medically frail and don't pay premiums would shift to a co-payment system and have $25 deducted from their rewards account, which is then suspended.

Father Dan Noll of the Catholic Conference of Kentucky said that the complexity of the plan would discourage access, and strongly opposed the premiums.

"Kentucky cannot sacrifice people because they are poor," Noll said. "Many more lower income individuals and families in Kentucky will lack the resources to meet the financial burdens of their healthcare under Governor Bevin's health-care plan. To these families, an increase in premiums, cost-sharing charges and a lock-out period will be significant barriers to obtaining coverage or seeing a doctor, much less a dentist or eye-doctor."

Dr. Eli Pennington, a family practice physician in Louisville who cares for the poor, said he was "deeply troubled and dismayed" by the plan.

"I had people come to me with tears in their eyes, overjoyed that they were finally able to take charge of their health problems. I had people quit smoking, get their blood pressure and diabetes under control, get much needed glasses, and finally address long-standing dental issues. Many of these patients were able to then enthusiastically rejoin the work force," he said.

"I worry that Gov. Bevin's plan will erase all of this progress and more. We know that premiums tend to decrease overall coverage; we know that co-pays decrease frequency of visits and discourage people from seeking immediate care; lock-outs compromise the management of complex chronic disease and decrease downstream cost, both for the patient and the system as a whole; and impoverished patients... are not helped by complex requirements for extended coverage."

Deacon William Grimes, who runs the New Hope Clinic in Bath County, one of the state's poorer counties, said many of his patients have no income and don't have enough money to pay for a $4 generic prescription.

"If they can't pay a $4 generic, how are they going to pay a co-pay, how are they going to pay premiums, how are they going to pay for anything?" he asked. "Yes, there are some people who this 'skin in the game' might help, but the people I deal with can't afford it."

Foundation for a Healthy Kentucky has many concerns about new Mediciad plan; health officials say current plan is not sustainable

By Melissa Patrick
Kentucky Health News

FRANKFORT -- At a legislative committee meeting July 20, health advocates urged the administration of Gov. Matt Bevin to make sure the final plan is evidence-based and that they fully understand the people it will affect. Administration officials said changes are needed because the 2014 expansion of the program isn't sustainable.

"We are asking, as in any well-designed program, that it starts with an awareness of who are these people we are trying to help, what jobs are available in their communities, what is their education level, are they already working two or three jobs, or not able to find a job, do they have access to a computer?" said Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky.

Bevin's plan calls for participants to pay premiums and have a higher level of involvement in their care, including community engagement and work requirements for able-bodied adults who aren't primary caregivers or dependents -- requirements that Bevin calls "skin in the game," but health advocates call "barriers to care."

"Kentuckians who don't have paid sick leave, reliable transportation or a bank account already face greater barriers to obtaining and keeping insurance coverage and participating in their own health improvement. Their lost wages and time investment are their 'skin in the game'," Zepeda said in a news release. "A Medicaid reform plan that creates more barriers will exacerbate the state's already challenging health statistics and health disparities."

In her testimony, Zepeda praised several aspects of the waiver proposal, including the expansion of substance abuse treatment services, sustaining the behavioral health services in the state, managed care organization reforms and its healthy behavior incentives.

But she also came with a long list of concerns, such as the loss of dental and vision benefits from the core benefit package, denial of services and monetary penalties for nonpayment of premiums, the work requirements, the loss of non-emergency transportation to and from medical appointments, the reduction in smoking-cessation options, and the premiums for all income levels.

Despite provisions for regaining coverage after nonpayment, Zepeda said, "In some ways we liken this to taking a hungry child with a bad tooth ache who is misbehving in school, can't pay attention and kicking that child out of school and then wondering why he or she isn't learning."

Republican Rep. Addia Wuchner of Florence said she supported the requirements for able-bodied Kentuckians to have to earn their dental and vision benefits because it will "help them to be an engaged health-care consumer."

But Zepeda said poor people struggle to save money, especially when they don't make enough to buy groceries or pay the rent. She said many in this population work, and wouldn't have time to peform extra tasks to get dental or vision services.

Wuchner also supported the work and volunteer requirements. "If this would incentivize that individual to take the extra step to gain more education so that there are other jobs available to them, I just say that that is an incentive, not a disincentive," she said.

Gabriela Alcalde, vice president of policy and programming at the foundation, said research does not support the effectiveness of work requirements for the poor. While voluntary skills and education training have been found to have very positive outcomes, mandatory work requirements do not have lasting effects, she said, so once people get out of the program, the effects disappear.

"They also increase poverty in some cases and do not in any way eliminate the barriers to access," Alcalde said. "So we actually have people lose coverage, but not maintain gains with certain strategies."

Zepeda said Bevin's request to the federal government, for a waiver of normal Medicaid rules, would better seek such things as price transparency, which would allow participants to price-shop for their health care; integration of behavioral health, oral health and primary care under one roof; or to deliver care where people are, like schools.

"There are lots and lots of opportunities for care delivery reform that will lift up Kentuckians, make the access to care more equitable and help the state prosper," she said.

Sen. Danny Carroll, R-Paducah, who earlier in the meeting said that the requirement for individuals to be on their employee based health plan if possible would likely add a financial burden to small businesses, summed it up.

"If you have to choose between some requirements and ownership or not being able to serve that population at all, I think it is clear that we have to require the ownership and some input and some investment from these folks to keep the system going," he said. "I think it is a good balance on what we are trying to do without totally doing away with expanded services, but being able to afford it as a state."

Administration defends plan

Medicaid Commissioner Steve Miller said that almost 500,000 people have been added to the Medicaid rolls through the expansion, which allows those with incomes to 138 percent of the federal poverty line to get Medicaid, with no long-term plan to pay for them.

"One of the concerns from the very beginning has been the sustainability of Medicaid expansion as we know it today," he said, noting that the cost to the state between 2017 and 2021 will be $1.2 billion. The federal government pays for the expansion through this year, but next year the state will be responsible for 5 percent, rising in annual steps to the reform law's limit of 10 percent in 2020.

The Steve Beshear administration said the expansion would pay for itself by creating health-care jobs and tax revenue, but the Bevin administration has said that hasn't happened. No one has offered definitive figures.

"The funding will just not be available," Miller averred. He said Medicaid's budget has been increased by approximately $600 million over the next two years, while the consensus revenue projection is that new revenue coming into the state during the same time frame will be $585 million.

"Medicaid consumes every new dollar of revenue that comes into the state over the next two years," without change, Miller said, and that will continue in the following budgets. That means that paying for Medicaid will crowd out all other initiatives, like pension funds, education, and corrections, he added.

The administration estimates that the waiver would reduce total Medicaid spending over five years by $2.2 billion dollars, but only $331 million of that would be state money, as a result of lower enrollment and less use of the program.

Adam Meier, Bevin's deputy chief of staff, said the new plan's goals are to improve participants' health, to instill personal responsibility, to move people into commercial health insurance plans, to empower people to seek employment and to achieve fiscal sustainability.

Wednesday, July 20, 2016

Study finds no link between tighter controls on prescription opioids and increased use of heroin; some researchers disagree

National overdose-death rates for heroin (red) and prescription opioids (blue)
By Al Cross
Kentucky Health News

Soon after Kentucky cracked down on "pill mills" where prescription painkillers were easily available, officials noticed a jump in heroin arrests and overdoses, and many presumed that one helped lead to the other. A study published in the New England Journal of Medicine found no link between the two, at least on a national scale, but some other experts disagree.

The study was conducted by physician William Compton of the National Institute on Drug Abuse, pharmacy Dr. Christopher Jones of the Department for Health and Human Services and public-health specialist Grant Baldwin of the federal Centers for Disease Control and Prevention.

They wrote, "It appears that the shift toward heroin use among some non-medical users of prescription opioids was occurring before the recent policy focus on prescription-opioid abuse took hold." They note that heroin use began to increase by 2007, and that a pill-mill crackdown in Florida, similar to Kentucky's, was followed by only a small increase in heroin overdoses.

"The results of these studies consistently suggest that the transition to heroin use was occurring before most of these policies were enacted, and such policies do not appear to have directly led to the overall increases in the rates of heroin use," the researchers wrote. "Although the majority of current heroin users report having used prescription opioids non-medically before they initiated heroin use, heroin use among people who use prescription opioids for non-medical reasons is rare, and the transition to heroin use appears to occur at a low rate."

They said the shift from prescription opioids to heroin is most prevalent among "persons with frequent non-medical use and those with prescription opioid abuse or dependence," and is driven mainly by cheaper, purer and more accessible heroin.

Those conclusions drew a letter to the journal from researchers who have concluded otherwise. Theodore Cicero and Matthew Ellis of the Washington University School of Medicine in St. Louis wrote, "A growing body of research has shown direct associations between the introduction of reformulated OxyContin and increases in rates of heroin use." The reformulated drug was much harder to inject; the federal researchers looked at the possible effect of the change and discounted it.

The critics didn't mention state crackdowns, but wrote, "It would be unwise for the agencies that the authors represent to ignore unanticipated negative aspects of efforts to limit supply, such as a shift to heroin in some persons, even if they represent a small part of the total heroin problem."

The federal researchers concluded their report with lines few could disagree with: "Fundamentally, prescription opioids and heroin are each elements of a larger epidemic of opioid-related disorders and death. Viewing them from a unified perspective is essential to improving public health. The perniciousness of this epidemic requires a multi-pronged interventional approach that engages all sectors of society."

"The last sentence is the most important," said Van Ingram, director of the Kentucky Office of Drug Control Policy. "Prescribing regulations are more about slowing the creation of new people obtaining an opioid-use disorder. If we keep prescribing at the same rates this country has been this problem never gets solved."

Young diabetes coalition coordinator forms partnerships to uncover and fight the disease in five Eastern Kentucky counties

By Mallory Powell
University of Kentucky

Growing up in Hazard, Brittany Martin was familiar with diabetes. Many of her older relatives had been diagnosed with the chronic condition, and her younger family members were starting to develop it as well. In a state with one of the highest rates of diabetes — 11.3 percent of adults had a diagnosis in 2014 —Martin’s family wasn’t out of the ordinary, but she found the status quo unacceptable.

Since she graduated from the University of Kentucky in 2014 with a dual degree in biology and sociology, Martin’s family history and her interest in health have converged in her current role as coordinator of the Big Sandy Diabetes Coalition, where she serves as an AmeriCorps Vista volunteer.

Brittany Martin administers a diabetes screening. (UK photo)
The coalition, based at Big Sandy Health Care in Prestonsburg, aims to improve detection, prevention and treatment of diabetes through screening and connection with local resources; it serves Floyd, Johnson, Magoffin, Martin and Pike counties, the Big Sandy Area Development District.

Diabetes is especially prevalent in the region, with 13 percent of adults diagnosed with it. In Pike County, the rate is at least 16 percent.

The rates are based on surveys that ask people if they have been diagnosed with the disease. An estimated 138,000 Kentuckians are thought to be living with undiagnosed diabetes.

As diabetes coalition coordinator, Martin juggles many responsibilities, from hosting community screenings to planning board meetings and writing a regular newsletter. It didn’t take her long to observe that irregular screenings, a lack of follow-up, and shortage of robust data inhibited diabetes prevention and care at both individual and community levels.

“We decided we wanted to set up more systematic screenings, instead of opportunistic screenings, and eventually set up a diabetes registry and keep track of participants,” Martin said.

She is now leading a project to determine whether regular community screenings and targeted follow-up can help to identify undiagnosed cases, measurably improve health, and reduce the emotional and economic burden of diabetes through connection with local resources.

"Brittany’s important work, receptivity to our input, and unparalleled enthusiasm have made her a stellar CLIK participant," said Nancy Schoenberg, co-director of community engagement and research for the CCTS. "She is an ambassador for UK, the CCTS and CLIK, sharing her expertise and her commitment to the health of residents of the commonwealth."

Martin, a registered phlebotomist, has personally screened 586 people since she began working with the coalition in August 2015. At each initial screening, she gathers baseline data and provides diabetes education. She then follows up with people who are diabetic or pre-diabetic to connect them with local resources and encourage them to come back for screening in six months.

Much of Martin's work has been supported by grants and training from the University of Kentucky Center for Clinical and Translational Science, which facilitates interdisciplinary and community-engaged health research with a focus on Appalachia. A CCTS community engagement grant provided funding for a pilot study of diabetes screening at a senior living center in Pike County.

Martin, 25, has since received further funding and research training through the CCTS Community Leadership Institute of Kentucky, which aims to enhance the capacity of local leaders to address health challenges.

Through CLIK, Martin received training on evidence-based interventions, data mining for research, and data collection and analysis — essential skills to assess the impact of a project. Equipped with this additional expertise, she is now researching the effectiveness of her diabetes screening system in Martin County.

The opportunity to work in several Appalachian counties, especially Kentucky's two easternmost, has enlightened even a native of the region about its diverse needs and challenges.

“People speak of Appalachia as a whole, but Martin County has so much less than Pike County,” she said. “Martin County doesn’t have a hospital. They have such a lack of access to care. They have one grocery store. It was very hard for me to find the resources to give them.”

Depending on the month, Martin hosts up to 10 community screenings across the five counties served by Big Sandy Health Care.

The results alarm her. “It’s actually kind of scary. Roughly 24 percent of people are pre-diabetic and 25 percent are diabetic. That’s roughly half of my sample in the red zone,” she said.

Martin sees particular challenges for individuals who face multiple health issues and dire socioeconomic circumstances. “Sometimes we’ll go do screenings in the homeless shelter. Imagine being homeless and diabetic. Sometimes people are also recovering from addiction. Really, can you imagine being homeless and diabetic and recovering from an addiction?”

At some of the community screenings, people have been surprised to learn that they’re diabetic or at immediate risk. In a screening at Big Sandy Community and Technical College, she said, many students “learned that they had pre-diabetes, and they were in their early 20s. It was scary for them. One person was diabetic and didn’t know it. At all ages we’ve screened, there’s been at least one person who’s said ‘Oh my god, I didn’t know, I didn’t know the signs.’”

However, the data she has gathered encourages her about the potential impact of systematic community screening with targeted follow-up.

Her initial screening study in Pike County found that 50 percent of people who received follow-up information and returned for their six-month screening had lower A1C levels, the essential measurement for a diagnosis of diabetes.

Martin's demonstrated success has also yielded nearly $20,000 in outside funding to pay for community screenings and upcoming educational classes. The Anthem, Aetna and Passport health plans have provided a total of $11,000 in sponsorships for screenings. It costs about $7 to screen one person.

Martin also recently received a $9,000 grant from Marshall University in West Virginia to support diabetes education classes in Big Sandy communities, with “gentle yoga” exercises for their clients in order to increase movement and activity, especially for individuals who are wheelchair-bound or have trouble exercising.

“There are a lot of positive health effects of gentle yoga,” she said. “We work with the aging population, and as they age we want to keep them moving. Safe, slow movements, even if someone is wheelchair-bound, can help keep away chronic effects of things like diabetes.”

Martin is developing yet another partnership to integrate retinopathy eye screenings at some community-outreach events. Over the course of nearly 600 diabetes screenings, Martin observed the a great need for eye care, and engaged both UK and the new Kentucky College of Optometry at the University of Pikeville to provide retinopathy screenings at some of her events.

When Martin isn’t busy with her full-time (and mostly unpaid) work as the diabetes coalition coordinator, she works at least 30 hours a week as a waitress. She is also studying for the Medical College Admission Test and the Optometry Admission Test, with plans to apply to medical and/or optometry school at Pikeville. Her ultimate goal is to become a practicing physician in a rural community.

She has a demanding portfolio of responsibilities, and says she sleeps about five hours a night but doesn’t tire of her work: “I’m right where I’m supposed to be.”

Tuesday, July 19, 2016

Ky. leads nation in cancers that are caused by a virus for which there is a vaccination, but most kids don't get the vaccinations

By Melissa Patrick
Kentucky Health News

Kentucky has the highest overall rate of cancers associated with the human papillomavirus, and among females is tied for highest with West Virginia, while at the same time falling in the bottom 10 states for vaccinations that can keep the virus from causing cancers, according to a federal Centers for Disease Control and Prevention report.

"Kentucky faces many challenges when it comes to encouraging parents, adolescents and providers to understand the importance of the HPV vaccine," Dr. Ardis Hoven, infectious-disease specialist for the  state Department for Public Health, said in an e-mail to Kentucky Health News.

Speakers at a recent HPV conference in Lexington placed most of the blame for the poor uptick of HPV vaccinations on physicians, because many of them still don't strongly recommend it. They cited a study showing that a "clear, same-day recommendation" from a physician to a parent is the most important factor in whether children get vaccinated.

The speakers offered several reasons for the lack of such recommendations: The vaccination isn't required by law, many physicians don't realize its importance, some falsely believe that it takes too much time to explain, and the vaccine treats diseases that pediatricians don't deal with. They also noted that the vaccine's greatest obstacle is that it is associated with a sexually transmitted disease.

“In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer,” Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center in Columbus, told HealthDay News. “Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe,”

HPV is most commonly transmitted through sexual intercourse, but it can also be transmitted through any skin-to-skin contact.

The three-dose HPV vaccine was approved by the federal government 10 years ago and is recommended for 11- and 12-year-old boys and girls, though it can be given through age 26 for females and age 21 for males. It is recommended at an early age because adolescents have the best immune response to the vaccine, are more likely to keep coming in for annual visits and most are not yet sexually active and therefore not likely to have been exposed to the virus.

HPV infections cause more than 90 percent of anal and cervical cancers and 70 percent of vaginal, vulvar, penile and middle throat cancers, and two of the HPV strains are associated with more than 90 percent of anal and genital warts.

The CDC report found that there were almost 39,000 annual cases of HPV-related cancers in the country between 2008-12, a 16 percent increase from the previous five year period. Most of these cases were oral cancers in men and cervical cancers in women, 12.638 and 11,771 respectively.

The data showed that almost 80 percent of the cancers were caused by two strains of the virus that are covered by all of the commercially available vaccines and 10 percent were caused by five other HPV strains that are covered by the newer nine-valent vaccine.

In Kentucky, only 37.5 percent of its girls and 13.2 percent of its boys aged 13 to 17 were vaccinated as of 2014. Nationwide, fewer than half of girls and only one-fifth of boys are getting immunized, and vaccination coverage did not increase substantially from 2011 to 2014.

Hoven said that Kentucky is working to improve its HPV vaccination rates. She noted such efforts as its HPV initiative team, which has created a comprehensive statewide plan to prevent and control HPV infections; a statewide media campaign last summer to encourage parents to get their children vaccinated; ongoing outreach to universities and colleges about the need to immunize students; and a current survey of knowledge among teens and adults about the importance of HPV vaccinations.

The state health department "has taken up the challenge of improving vaccination rates in the state, and will continue this effort going forward," Hoven said.

Kentucky's 40% surcharge for smokers on Obamacare plans probably scared some away, hasn't encouraged them to quit

Allowing insurers to charge smokers extra for Obamacare health insurance appears to have discouraged them from getting it, "undercutting a major goal of the law," Carolyn Y. Johnson reports for The Washington Post. "The surcharges, of up to 50 percent over nonsmokers' premiums, also showed no sign of encouraging people to quit." That's according to a study at the Yale School of Public Health, published in Health Affairs.

"To explain how the surcharge works, Friedman and colleagues provided this example: Take the case of a 49-year-old with an income at 150 percent of the poverty level. If that person were a nonsmoker, he would pay only $60 per month for a particular health plan, because the tax credit would pay the rest," Johnson writes. "But the premium surcharges that smokers face are not eligible for tax credits. So a smoker would — based on an analysis of 43 states that allowed surcharges in 2014 — pay a median $70 surcharge on top of that premium, doubling their out-of-pocket costs of insurance."

26.5 percent of Kentuckians smoke, second only to West Virginia.
Kentucky was one of those states, allowing surcharges of up to 40 percent. It has the nation's second-highest smoking rate, 26.5 percent.

The researchers found that in 2014, the number of U.S. smokers with insurance rose to 76 percent, from 70 percent in 2013, but "estimated that if the surcharges did not exist, that number would have risen to 80 percent," Johnson reports. "The effects were especially noticeable for smokers under 40 years old. In 2014, 65 percent of the smokers in the sample had health insurance, but 75 percent would have enrolled if the surcharges were eliminated, the researchers estimated."

Scaring away younger smokers backfired. "Younger smokers tend to have health-care costs similar to other young nonsmokers, so their participation in the marketplaces helps balance the risk and makes insurance work," Johnson notes. "Second, stopping smoking when people are younger can have big, long-term health benefits for individuals and in helping to prevent costly chronic conditions."

A spokeswoman for the Centers for Medicare and Medicaid Services noted that before the health-reform law, insurance companies could refuse to cover smokers. And the law required insurance plans to pay for smoking-cessation programs and medications.

The authors of the study said states could reduce or eliminate the surcharges, or (and this would be harder to administer) eliminate them for people who enroll in smoking-cessation programs. "A separate concern that Friedman raised was that the rules could lead people to lie about whether they smoke, to avoid the surcharge," Johnson reports. "If that also led to patients lying to their doctors, it could have real public-health consequences."

Kentucky College of Optometry about to open in Pikeville

Artist's rendering of Kentucky College of Optometry, Pikeville
The University of Pikeville says it is about to open the nation's largest optometric college in terms of floor space, the Kentucky College of Optometry.

"Dr. Andrew Buzzelli, vice president for optometric education and the college’s founding dean, said that, at 130,000 square feet, KYCO is the largest optometry college in the country," Josh Little reports for the Appalachian News-Express in Pikeville. "The cost to build the college is $55 million, plus $9 million for equipment."

Students at the college will perform optometric services for local residents, under the supervision of doctors of optometry. "Pikeville Medical Center will still continue to be the main provider in the area, but they only have two providers, so the care is in here," Buzzelli said. "In the other schools around the country, care is all around the city, that’s not true here. ... This will be for our specialty clinics, such as laser surgery." He said The college will offer electrophysiological tests, which now require residents to travel to Lexington or Huntington, W.Va.

The university is already home to the School of Osteopathic Medicine.

Monday, July 18, 2016

Hearing loss can lead to cognitive decline or even dementia, but is often unaffordable, and financial aid for it is shrinking

By Trudy Lieberman
Rural Health News Service

Nearly two-thirds of adults over age 70 have hearing loss that doctors consider “clinically meaningful.” In plain English that means as people age, they are likely to become hard of hearing. Many of those people, however, don’t get the help they need, often because they simply cannot afford it.

“The prevalence of hearing loss almost doubles with each age decade of life,” says Dr. Frank Lin, an otolaryngologist at Johns Hopkins University, but for older people, he adds, “there are multiple barriers that prevent individuals from getting their hearing loss addressed.”

Lin spoke about the subject to a group of journalists in a recent phone conference sponsored by a Washington, D.C., advocacy group the National Committee to Preserve Social Security and Medicare. He is a co-author of a June report issued by the National Academies of Sciences, Engineering, and Medicine that recommends better access and support for treating hearing loss.

Lin told the group that although hearing loss is a normal part of the aging process, “hearing care is inaccessible” to many seniors. He said studies over the last five years have shown that such loss “can increase the risk of cognitive decline.”

Using data from a longitudinal study (one that tracks data from the same people repeatedly over many years or decades) that began in 1958, Lin and his colleagues at Johns Hopkins found that those with hearing loss had a higher probability of developing dementia. The more severe the loss, the more likely the dementia.

Photo from howmanyarethere.net
That isn’t the only problem. Hearing loss is also associated with a greater risk for falls and other accidents because a person can’t hear traffic or a smoke alarm in their home. Furthermore, those with hearing loss often feel isolated and shun normal social contacts because they can’t hear others speak. That’s a blow to productive aging, the goal promoted by the late Dr. Robert Butler, a well-known gerontologist who fought against ageism.

So why, then, is hearing care so inaccessible? Cost may be the major barrier. Nearly all expenses for hearing care must be paid out-of-pocket, and for many seniors on fixed incomes, that’s sometimes hard to do. Lin told me the average cost of two hearing aids is $4,700 and rarely covered by insurance.

Medicare doesn’t cover hearing exams, hearing aids, or exams for fitting hearing aids. It does cover diagnostic hearing and balance exams, but only if your doctor orders those tests to see if you need medical treatment. In that case, if a person has traditional Medicare and a Medicare supplement policy, often called a Medigap, he or she has to pay 20 percent of the approved amount for the exam. Some Medicare Advantage plans may include hearings tests as part of the extra benefits they offer.

The National Committee and other advocacy groups are campaigning to add a hearing benefit to Medicare’s benefit package. Their campaign is bucking a trend in Washington to cut Medicare benefits by raising the age of eligibility, making richer seniors pay more, and requiring those with traditional Medigaps to have more skin in the game.

Politicians have already begun redesigning Medigap policies to make seniors pay more out of pocket for their care. Beginning in 2020, for example, insurers will not be allowed to sell Medigap policies that cover the deductibles for Medicare Part B that pays for physicians’ services, lab tests and hospital out patient care. The theory behind this shift is that seniors will pay more and the government less, thus helping to save Medicare money.

I asked Dan Adcock, the National Committee’s policy director, about the chances of adding benefits to treat hearing loss, or for that matter vision and dental care, when the focus has been on cutting benefits of all kinds. He said one major source of funds to pay for hearing aids could come from lowering the price of what Medicare pays for drugs. The 2003 legislation that gave seniors a drug benefit also prohibited the government from negotiating prices for the drugs it buys. Drug makers strongly oppose such negotiations.

Adcock said he remains hopeful. If better hearing means a decrease in dementia, falls and accidents, fewer people would need treatment for those conditions. The savings could potentially “pay” for the hearing aids, he said.

For now, though, seniors and their families are on their own. The National Academies offer an "Action Guide for Individuals and Families" that suggests actions people can take to prevent hearing loss, and strategies for families to cope with it when it occurs. It’s available at www.nas.edu/hearing.

What experiences have you or a family member had with hearing loss and obtaining treatment? Write to Trudy at trudy.lieberman@gmail.com.

Ben Chandler, who as AG filed lawsuit that led to creation of Foundation for a Healthy Kentucky, will be its president and CEO

Ben Chandler (AP photo)
Ben Chandler, who as state attorney general filed the lawsuit that led to the creation of the Foundation for a Healthy Kentucky, was named president and CEO of the foundation Monday.

Chandler, 56, was state auditor in 1992-95, attorney general in 1996-2003 and Sixth District representative in Congress from 2004 to 2012, when he lost a bid for re-election. He lives near Versailles and has been executive director of the Kentucky Humanities Council.

As attorney general in 1997, Chandler sued Anthem Blue Cross Blue Shield of Kentucky to recover the charitable assets Anthem received after merging in 1993 with non-profit Blue Cross. In 1999 Anthem Inc. agreed to put $45 million into an independent, charitable foundation that would address the unmet health needs of Kentuckians. The Foundation for a Healthy Kentucky was created and had its first board meeting in 2001.

Chandler succeeds Susan Zepeda, who has been president and CEO since 2005 and announced last year that she would retire at the end of the year. Zepeda came to Kentucky after serving as CEO of The HealthCare Foundation for Orange County in California, and before that as head of the health agency and hospital in San Luis Obispo County.

Chandler said in a press release, “Having fought so hard for a healthier Kentucky during my time as attorney general, I am beyond thrilled to be invited to build on the good work of Susan Zepeda and her team and to lead the foundation to even greater impact. The health challenges in our state are very real, but so is the commitment to a healthier future for all our citizens.”

Foundation Board Chair Chris Roszman, who chaired the search committee, said, “Ben’s past experiences as a bipartisan leader in championing health policies through collaboration and effective consensus-building will serve the foundation well as we continue to address the unmet healthcare needs of Kentuckians.”

Search committee member Robert Slaton, a former state health commissioner who chairs the foundation’s Community Advisory Committee, said in the release, “Sixteen years ago Ben had a vision. To welcome him to continue that vision today is very exciting.”

The nine-member search committee consisted of business and health leaders from across the state, the press release said. All were current or former members of the board or the Community Advisory Committee. "In an extensive, six-month process, the search embraced a broad array of potential contenders from across the commonwealth and from 21 other states and the District of Columbia," the release said.

Chandler earned both his B.A. and J.D. degrees from the University of Kentucky. He studied at the University of London and Trinity College in Dublin, including an internship in the British Parliament. He practiced law with Brown, Todd & Heyburn, specializing in health-care law, and later with Reeves & Graddy in Versailles. He and his wife, Jennifer, have three children, live on the family farm and attend Pisgah Presbyterian Church, where he is a trustee.