Friday, November 17, 2017

Kentucky Primary Care Alliance says its accountable care organization saved Medicare nearly $2 million in its first year

By Melissa Patrick
Kentucky Health News

The Kentucky Primary Care Alliance says its Medicare accountable care organization, in its first year, saved Medicare nearly $2 million.

Accountable care organizations were created under the Patient Protection and Affordable Care Act to encourage doctors, hospitals and other providers to work together to provide coordinated patient care as a way to cut back on unnecessary spending. Participants are provided bonuses as a reward for increased efficiency.

"It is really an excellent way of doctors engaging with their patients and making sure they are getting the care they need, all while making sure they aren't getting a bunch of services that they don't need," Barbara Newton, executive director of the ACO, said in a telephone interview.

For example, Newton said, ACOs focus on well-check-ups, prevention and screening, and chronic disease management in hopes of keeping their patients healthy and out of the hospital and emergency rooms.

"What you are really trying to do overall is to improve the health of your patients," she said. "You get patients used to coming in when they aren't near death's door and seeing the doctor and making sure they get the preventive screenings that they need, the vaccines that they need and that they stay healthy."

She added, "We are just trying to make sure that they get taken care of in the right setting at the right time and that they all have preventive healthcare."

Newton said the $2 million in "shared savings" would normally be split between Medicare and the participating providers and clinics, but instead they will use their share to help pay down the Centers for Medicare and Medicaid Services innovation grant that allowed them to create the ACO. She added that the hope is that their portion of the savings is large enough next year to pay off the balance of the grant, with some to spare.

The Kentucky Primary Care Alliance opened in 2016 with 10 clinics that cared for approximately 4,400 Medicare patients. CMS estimated that their annual cost would average around $10,450, but the clinics were able to save $450 per patient, resulting in $2 million of shared savings for Medicare. Eight more clinics joined the alliance in 2017.

Critics of ACOs say such programs could encourage providers to skimp on care to earn bonuses, but Newton said the program is set up to require ACOs to meet 33 quality benchmarks that range from patient satisfaction with shared decision making to cancer screenings and preventive vaccines.

"They have very strict quality measures that you have to meet and report on in order to qualify for shared savings," Newton said. "So you can't get away with not seeing patients or not providing care. You have to really engage the patients."

Out of 432 ACOs that qualified for shared savings in 2016, only 134 of them, 31 percent, generated a shared savings, the Primary Care Alliance said in its release.

"These are all rural health clinics and federally qualified health centers, providing services in rural and under-served areas of the state," David Bolt, COO of the Kentucky Primary Care Association, said in an e-mail. "Their story tells that good quality care at reasonable costs is available in the communities and to the patients they serve."

In 2016, the Kentucky Primary Care Alliance comprised these clinics: Bluegrass Clinic Stanford in Lincoln County; Bluegrass Clinic Liberty in Casey County; Fairview Community Health Center in Warren County; Health First of the Bluegrass in Fayette County; Lewis County Primary Care Center with clinics in Bracken, Fleming, Mason, Lewis, Greenup and Boyd counties; Sterling Health Solutions, with clinics in Montgomery, Bath and Nicholas counties; Pennyroyal Community Clinics in Caldwell and Christian counties; Triad Health Systems in Owen, Carroll and Gallatin counties; Tri-Rivers Healthcare in Crittenden and Livingston counties; and White House Clinics in Madison, Rockcastle, Estill, Jackson and Garrard counties.

Thursday, November 16, 2017

Casey County High School students win award for their smoke-free efforts; 17 percent of Kentucky's youth are smokers

The Casey Youth Coalition won the health foundation's first
Healthy Policy Champion Award for its smoke-free efforts.
A group of 19 Casey County High School students are the first recipients of the Foundation for a Healthy Kentucky's Healthy Kentucky Policy Champion award for their work to change the smoking culture at their school.

"The Casey Youth Coalition has been working for two years to boost adherence to the district's 2015 tobacco-free campus policy, and this award recognizes their unrelenting efforts to change social norms about tobacco use," Ben Chandler, president and CEO of the foundation, said in a news release.

The students' campaign has contributed to a 10 percent decrease in 30-day tobacco use among its 10th graders in 2016, the release said.

"All of us are extremely proud of all we have accomplished because the school's environment has changed," Delaney Sowders, vice president of the coalition, said in the release. "There's no tobacco smell when you enter our school. That has been a long-time problem. It took a lot of our time, commitment, ideas from a diverse group of students, support from our champions and funding, to accomplish this. We still need to work on the community's tobacco use on our campus."

Below is a video created by the Casey County Youth Coalition to instruct other school districts about passing and implementing a 100 percent smoke-free policy in their schools.


Casey County is one of the state's 68 (out of 173) school districts with a 100 percent tobacco-free school policy. As of November 2017, 39 percent of districts have such policies and 55 percent of the state's students are protected from second-hand smoke.

Schools get this distinction if they don't allow tobacco products, including vapor products and alternative nicotine products, by staff, students and visitors at any time on school owned property and during school sponsored events. The 100 percent tobacco-free school website notes that some of the schools need to update their policies to meet the new vapor product standards.

A bill in the 2016 legislative session would have required all Kentucky schools to be 100 percent tobacco-free. It passed quickly out of the Senate, but couldn't garner enough support in the House to bring it to a floor vote. Sen. Ralph Alvarado of Winchester told Kentucky Health News in September that he plans to sponsor the bill again in the upcoming session, and anticipates a similar one to be introduced in the House, where his fellow Republicans gained control this year.

Elizabeth Anderson-Hoagland, a youth tobacco specialist with the state Department for Public Health, said she encourages local school districts to pass 100 percent tobacco-free school policies, despite what happens at the state level.

"It is really beneficial for local communities to take the steps to pass a local tobacco-free district policy," she said in an e-mail. "The process engages students, parents, personnel and community in a discussion about tobacco use and how the community can best protect their young people."

Most Kentuckians support such policies. According to the foundation's 2015 Kentucky Health Issues Poll, 85 percent of Kentucky adults favor tobacco-free schools.

Almost 17 percent of Kentucky's high-school students are smokers and 23 percent of them report using electronic cigarettes, according to the 2015 Youth Risk Behavior Survey. The 2016 national rate for smoking is 8 percent and 11.3 percent for electronic cigarettes, according to the federal Centers for Disease Control and Prevention.

The Casey Youth Coalition is now eligible for the Healthy Kentucky Policy Champion of the Year award, which comes with a $5,000 grant from the foundation given to a Kentucky-based nonprofit of the winner's choice. The winner of that award will be announced next fall. Nominations for the Healthy Kentucky Policy Champion award are accepted at any time. Click here for details.

Wednesday, November 15, 2017

McConnell says he asked nominee for Health and Human Services secretary to make fighting opioid epidemic a top priority

McConnell and Azar (McConnell office photo)
Senate Majority Leader Mitch McConnell met Wednesday with Alex Azar, whom President Trump has nominated to succeed Tom Price, who resigned, as secretary of the Department of Health and Human Services. Azar is a former deputy secretary of HHS and a pharmaceutical manufactiring executive.

“Alex and I had a productive meeting,” McConnell said in a news release. “We discussed his outlook and vision for a department that oversees some of the nation’s most important programs, including Medicare and Medicaid, the Centers for Disease Control, and the National Institutes of Health. I also asked him to make combating the opioid epidemic, which has devastated families across Kentucky and the nation, a top priority.”

Tuesday, November 14, 2017

Republicans in Congress say tax bill will include repeal of law requiring individuals to have health insurance; critics object

Senate Republicans' tax bill will include a repeal of the requirement that almost all Americans obtain health insurance, "a major change as they now try to accomplish two of their top domestic priorities in a single piece of legislation," The Washington Post reports. The House is expected to agree.

Lisa Des Jardins of PBS reports that the repeal "helps them with (conservative) critics demanding some kind of Obamacare repeal and, according to the Congressional Budget Office, the repeal would bring an additional $338 billion in savings, mainly because fewer people would sign up for Medicaid." The government exchanges for tax-subsidized Obamacare policies are also used to enroll in Medicaid.

The mandate in the 2010 Patient Protection and Affordable Care Act is tax-related, because failure to have coverage incurs a penalty on tax returns. The Supreme Court decision upholding the law turned largely on that point.

“We’re optimistic that inserting the individual mandate repeal would be helpful” to the effort to pass the tax bill, something Republicans badly want, Senate Majority Leader Mitch McConnell said. President Trump had promoted the idea, but "Republicans had resisted making the change, worried that injecting health care politics would imperil the tax bill," the Post reports.

Sens. McConnell and Paul (USA Today photo)
McConnell announced the change a few hours after his Kentucky seatmate, Republican Rand Paul, said he would offer an amendment to the tax bill to repeal the mandate and give a greater tax cut to middle-class families. Paul "suggested earlier in the day that Republicans should use the money to help taxpayers who would be impacted by the loss of the state and local tax deduction, which the Senate bill currently eliminates," NBC News reports.

As part of the deal, Republicans will allow a vote on the bipartisan Senate legislation aimed at stabilizing individual markets, Des Jardins reports. "It would fund the subsidies that President Donald Trump said he would end and Congress needed to resolve. Democrats love that bill and it could pass overwhelmingly. It also helps with a certain senator from Maine, Susan Collins, who was a key 'no' vote on the original health-care bill."

"The bills cannot be combined due to strictures imposed by the budget process Republicans are using to avoid a Democratic filibuster," the Post reports. Sen. John Thune of South Dakota, chair of the Senate Republican conference, "said he’s confident the votes are there," Des Jardins reports.

"Repealing the mandate would undermine other key parts of the Affordable Care Act," the Post reports. "The health-care law banned insurance companies from discriminating against people with pre-existing health conditions. But in order to prevent people from waiting to buy insurance until they got sick, the law also imposed financial penalties for individuals who did not maintain health insurance coverage. Health experts say eliminating the mandate would destabilize the individual insurances markets set up by the Affordable Care Act, as they would be full of people with high health care costs but have far fewer of the healthy people that insurance companies bank on. In response, insurance companies would likely either massively raise premiums or pull out of the marketplaces entirely. A powerful group of stakeholders, including the major health insurance and hospital insurance lobbies and two influential doctors’ groups, wrote a letter to leaders from both parties arguing that they should retain the individual mandate."

Kentucky's children improved on several health measures in last year but still lag behind nation; many counties are far behind

By Melissa Patrick
Kentucky Health News

More Kentucky children than ever have health insurance, fewer Kentucky teens are getting pregnant, fewer mothers are smoking during pregnancy, and the state has fewer low-birthweight babies – but that's not the case in every county, according to the annual Kentucky Kids Count report.

The report, released Tuesday by Kentucky Youth Advocates, is part of the 27th annual release of the County Data Book, which provides data on overall child well-being through 17 measures in four areas: economic security, education, community strengths, and health and family.

Instead of ranking counties from top to bottom for each of these measures, as in the past, this year's report shows whether the outcomes have improved or worsened in the last five years.

"Looking at data change over time illuminates areas of progress and areas of needed policy change and investment," KYA Executive Director Terry Brooks said in a news release. “If all of our kids—no matter their families’ income, skin color, or ZIP code—are to grow up to be healthy and productive citizens, their needs must be prioritized.”

Part of Russell County's profile, one of 120 from 
Kentucky available at the Kids Count Data Center
The report also shows how many Kentucky children would be affected if the state or county were able to improve each measurement by 10 percent. KYA's hope is that this will help the state and individual counties see what areas need attention the most.

For example, the report shows Kentucky has seen a 13 percent decrease in the rate of births to mothers who smoked during pregnancy, dropping to 20.6 percent in 2013-15 from 23.8 percent in 2008-10. The national rate is 8.4 percent, according to the 2017 State Health Assessment.

If 10 percent fewer women smoked during pregnancy, 3,533 fewer babies would be exposed to cigarette smoke before birth, which would result in fewer babies with low birthweights. Such babies  (less than 5½ pounds) account for 8.7 percent of Kentucky births.  

Being born too early or with low birthweight increases a baby's risk of health complications, including a 25 percent increased risk of dying in the first year of life.

For example, Lee County has the highest rate of smoking during pregnancy (47.7 percent) and one of the highest rates of low-birthweight babies (12.2 percent). A 10 percent improvement of these measures would result in 11 fewer Lee County babies being exposed to smoke before birth each year, and three fewer babies being born with a low birthweight.

On the other end of the spectrum, only 10.2 percent of mothers smoke during pregnancy in Oldham County, and only 7.4 percent of the babies born there have a low birthweight.

The Foundation for a Healthy Kentucky, which is leading the state's newly formed Coalition for a Smokefree Tomorrow, says it's ready and willing to help counties decrease their smoking rates.

“The foundation is committed to working with advocates and local communities to promote smoke-free ordinances, ensure that expectant mothers have easy access to effective tobacco treatment, and raise the state tax on cigarettes to reduce youth smoking," Ben Chandler, president and CEO of the foundation, said in the news release.

Related encouraging news is that the number of teen births in the state continues to drop, to 34.6 per 1,000 in this year's report, down from 37.9 in last year's report and 48.9 five years ago. The national teen-pregnancy rate is 22.3 per 1,000.

The report says 16 Kentucky counties had teen-birth rates of 60 or more per 1,000 (6 percent), with Wolfe County leading the way at 80.9 per 1,000. Its rate five years ago was 68.2 per 1,000.

Only five Kentucky counties had rates of less than 20 teen births per 1,000 (2 percent). Oldham County had the lowest rate, 8.2 per 1,000.

Other encouraging news is that almost all Kentucky's children (96 percent) have health insurance. The report says at least one in 10 Kentucky children are covered by Medicaid or the Children's Health Insurance Program, called K-CHIP in Kentucky.

The report stresses the importance of making sure Medicaid and CHIP program are sustainable – including the expansion of Medicaid under the Patient Protection and Affordable Care Act to those who earn up to 138 percent of the federal poverty line. It notes, "Children are more likely to have health insurance when their parents do."

The report also says coverage for children "boosts family financial stability due to reduced out-of-pocket costs for health care and increased participation in other supports for which they are eligible, such as Supplemental Nutrition Assistance Program," or food stamps.

The U.S. House of Representatives has passed a bill to fund CHIP for the next five years, but it includes funding provisions that likely won't pass the Senate. A Senate committee has passed a CHIP bill, but without provisions for funding. The deadline for reauthorization was Sept. 30. 

Kentucky will run out of KCHIP money in about five months if CHIP is not renewed. A Kaiser Family Foundation report shows that the federal budget for CHIP was about $14 billion in 2016 and Kentucky's federal share was around $243 million. (For a county-by-county list of KCHIP and Medicaid enrollment, click here.)

The report also called for more outreach and enrollment efforts, and said the state should stop dis-enrolling children for incorrect or missing addresses.

The number of young adults with health insurance in Kentucky is around 77 percent. Robertson County, at 91 percent, has the highest rate; Lee County, at 41 percent, has the lowest.

Other key findings about Kentucky's children in the report:
  • Grandparents and other relatives raise 7 percent, the highest rate in the nation.
  • Almost half live with families that are considered low-income (annual income of $48,072 or less for a family of four).
  • One-fourth live in poverty (annual income of $24,036 or less for a family of four).
  • 12 percent live in deep poverty (annual income of $12,018 or less for a family of four).
  • 20 percent live in food-insecure households, and food insecurity is widespread; only five counties have fewer than 15 percent of children in food-insecure households.
  • In 24 counties, at least a fourth of the children living in a food-insecure home.
  • Only half of Kentucky's children are ready for kindergarten or are proficient readers in the fourth grade, and fewer than half of them are proficient in mathematics in eighth grade.
  • Almost 90 percent graduate from high school on time.
  • 41 per 1,000 are in "out-of-home" care, and the rate increased in 88 counties.
  • 26 per 1,000 are incarcerated in the juvenile-justice system, a 57 percent decrease.
Brooks concluded: “Kentucky kids rely on their state leaders to make decisions and investments that prioritize them. As state agencies, the legislature and governor craft the next biennial budget and prepare for the 2018 session, we are calling on leaders to build a budget that invests in kids’ education, health, economic security, and safety. Our communities and economy can only win when Kentucky kids and their families succeed."

Overall Kids Count chart for Kentucky shows previous and current scores in four major areas
The Kids Count Data Center is also available for a deeper dive into the data. It offers a profile sheet for every county, and allows you to create maps, graphs, and make comparisons.

The 2017 County Data Book was made possible with support from the Annie E. Casey Foundation and local sponsors Passport Health Plan, Delta Dental of Kentucky and Kosair Charities.

Sunday, November 12, 2017

Feds change Medicaid rules to allow work requirements for some, paving way for Bevin's revamping of program, including premiums

By Melissa Patrick
Kentucky Health News

The Trump administration has announced rules changes for the Medicaid program that allow states to require some enrollees to work or volunteer – changes that likely pave the way for Kentucky's new Medicaid plan to be approved.

Seema Verma (US News photo)
"Let me be clear to everyone in this room, we will approve proposals that promote community engagement activities, " Seema Verma, director of the Centers for Medicare and Medicaid Services, said in a speech to state Medicaid directors Nov. 7.

Gov. Matt Bevin proposed changes to Kentucky Medicaid by requesting a waiver from federal rules more than a year ago. The proposal largely targets "able-bodied" adults who qualify for Medicaid under the expansion of the program under the Patient Protection and Affordable Care Act – those with household incomes up to 138 percent of the federal poverty level.

If approved, the plan would require such beneficiaries who are not "medically frail" or primary caregivers to work or volunteer 20 hours a week to keep their coverage. Work requirements for Medicaid recipients have historically not been approved because they didn't line up with the program's mission to provide medical assistance to low-income people; now the rules are different.

Kentucky Medicaid Commissioner Stephen Miller said at the directors' meeting that Kentucky hopes to implement the state's work requirements by July, Lisa Gillespie reported for Louisville's WFPL.

At the Nov. 6 meeting of Kentucky's Friedell Committee for Health System Transformation, Dr. Gil Liu, the state's medical director for Medicaid, said the state will initially implement work requirements in regions that have the most jobs available, and will then figure out how to implement them in other parts of the state where fewer jobs are available.

The plan would also require most Kentuckians on Medicaid to pay small monthly premiums, initially $1 per person to $15 per family, depending on income. People with disabilities, pregnant women, children and caregivers would not have to pay.

"Miller said the administrative costs of collecting those premiums would be higher than the actual amount of premium collected. But he said the point of the change isn’t to make money — it’s to encourage enrollees to transition out of Medicaid and into private coverage," Gillespie reports.

Critics of the plan, called Kentucky HEALTH, say that won't work because employers don't offer health insurance as a benefit nearly as much as they used to, and the state has many working poor who can't afford private insurance. Most covered by the Medicaid expansion work.

Miller said he expects about 200,000 Medicaid enrollees will be affected by the changes, Gillespie reports. The expansion covers about 478,000 Kentuckians; Medicaid as a whole covers about 1.4 million. For a spreadsheet of enrollment by county in June 2017, click here.

If federal officials approve the waiver, as expected, the state estimates that 95,000 fewer Kentuckians will be on Medicaid in five years than if the proposal is not accepted. The state estimates that will save the state and federal government $2.4 billion over the next five years.

The state pays 30 percent of traditional Medicaid costs. The federal government paid all the expansion costs for the first three years, but this year the state is paying 5 percent, and that will rise in annual steps to the law's limit of 10 percent in 2020.

Bevin has said the state cost is "unsustainable," and rejects arguments that the multi-billion-dollar expansion has generated state tax revenue by boosting employment in health care.

Commissioner
Stephen Miller
The governor's lieutenants also make the argument that the expansion hasn't improved Kentucky's health. Miller did that at the Medicaid directors' meeting.

"He said that even though the state’s Medicaid rolls have soared to cover 33 percent of residents, Kentucky still has high rates of cancer, smoking and obesity," Phil Galewitz of Kaiser Health News reports, quoting Miller directly: “We have to try something else. We need to do more than just help people access health care.”

Officials of then-Gov. Steve Beshear's administration said when they expanded Medicaid that it would take several years to change the state's health status, and that it might even decline temporarily as people who hadn't received care for many years were diagnosed with health problems.

Tens of thousands of Kentuckians have used their new Medicaid benefits to get screened for cancer and other health problems, or get treatment for substance abuse or other issues. A three-year study of the expansion in Kentucky and Arkansas found a 23 percent increase in the share of people in federal surveys who reported that their health is excellent.

Emily Beauregard, executive director of Kentucky Voices for Health, an umbrella group of pro-Obamacare organizations, wrote in an op-ed that Bevin's changes are designed to "remove people from the rolls, rather than to promote health and access to affordable care."

Verma, who played an active role in designing Kentucky's waiver request, told the Medicaid directors that the new rules are "ushering in a new day for Medicaid" that will increase states' flexibility while improving accountability and integrity.

"We owe our fellow citizens more than just giving them a Medicaid card. We owe a card with care, and more importantly a card with hope," Verma said. "Hope that they can achieve a better future for themselves and their families. Hope that they can one day break the chains of generational poverty and no longer need public assistance, and the hope that every American, no matter their race, creed, or origin, can reach their highest potential. We will approve proposals that accomplish this goal."

Verma also said, "Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration."

Seven other states — Arizona, Arkansas, Indiana, Maine, New Hampshire, Utah and Wisconsin — have submitted varying requests to CMS that would require non-disabled Medicaid enrollees to either work or provide community service.

Saturday, November 11, 2017

Advocate says keys to passing a local smoking ban are a plan, mobilized citizens, young people and perhaps a dose of luck

Wayne Meriwether at the workshop (Photo by Melissa Patrick)
By Al Cross
Kentucky Health News

MADISONVILLE, Ky. – Two big keys to winning passage of a smoke-free ordinance are a systematic plan and mobilization of citizens, a hospital administrator who has persuaded two towns in his county to enact indoor-smoking bans told Western Kentucky journalists Friday.

It also helped that high-school students were involved and that one of them prompted the county judge-executive at the time to make a controversial remark, Wayne Meriwether, CEO of Twin Lakes Regional Medical Center in Leitchfield, said at "Covering Health: A News Workshop" in Madisonville.

Meriwether said Judge-Executive Gary Logsdon "went berserk" and drew Louisville news coverage that reached Grayson County. He said city officials in Leitchfield and Clarkson "didn't want to be seen as being like the elected county officials" on Fiscal Court, which rejected the ordinance.

Meriwether said he had hoped Logsdon, the recipient of a double lung transplant, would be the "elected-official champion" of the ordinance, but when it came before Fiscal Court, defenders of individual and private-property rights carried the day and a magistrate's motion for an ordinance didn't even get a second.

When a high-school student asked Logsdon, "If it’s not the role of government to protect people, then what is the role of government?" Logsdon replied, "I’m not black and I’m not Obama, and I’m not passing, making you do anything."

Logsdon apologized a few days later, and resigned several months later. But he inadvertently paved the way for passage of an ordinance in the county seat of Leitchfield, population 6,700, Meriwether said.

The Population Health Committee had already taken a poll that showed 82 percent of the people in the "very conservative" county favored a smoking ban, and had prepared booklets for each community showing the potential benefits. So it was ready to mount a campaign to persuade the Leitchfield City Council – where two or three of the six members are smokers, Meriwether said.

"I guarantee they received a lot more calls in favor of a smoking ordinance than against it," he said. The vote on the council was 5 to 1.

"This was amazing, that we could do that," Meriwether said. He said the involvement of Grayson County High School students helped, because "It's harder to say no" to them.

The task was more difficult in the smaller town of Clarkson, pop. 875, where the city commission vote was 3-2. Meriwether said one commissioner told him, "I can't support this. I might make somebody mad. I need this job."

"Those are the kinds of issues that you face in small, rural Kentucky," said Meriwether, who moved to Leitchfield from Henderson five years ago.

Meriwether said the most common objection he hears is "It's my right to smoke." He said he replied, "You have a right to smoke, but you don't have the right to impose your right on someone else when it affects their health."

He shares credit with the hospital's Population Health Committee, which includes the school superintendent, a plant manager, a business owner, the health department director, an extension agent and the tourism director, "A good cross-section of people who care about the community."

The committee decided to tackle smoking, Meriwether said, because "We didn't want to do another 'How much weight can you lose over the next six weeks?' We wanted to do something with a long-term effect."

Besides smoking, the committee's targets are obesity, lack of physical activity and awareness of health issues. He said it is working on a community garden and a permanent location for the local farmers' market.

But there is still work to do on smoking. Meriwether said he is working on an ordinance in Caneyville, pop. 600, and may go back to Fiscal Court because appointed Judge-Executive Kevin Henderson, former police chief in Leitchfield, is more favorable to it than Logsdon was.

"We may wound up with a countywide smoking ordinance yet," he said. "If it can be done in Leitchfield and Clarkson, it ought to be done anywhere in the state of Kentucky."

Ad spending on electronic cigarettes drives up use of product, but don't call users 'vapers,' anti-smoking expert says; it's not vapor

By Al Cross
Kentucky Health News

MADISONVILLE, Ky. – Tobacco companies are "normalizing smoking again" through electronic cigarettes, misleading children and adults about them "in more insidious ways," Kentucky's leading crusader against smoking told Western Kentucky journalists Friday.

Ellen J. Hahn, Ph.D.
Ellen Hahn, a University of Kentucky nursing professor, also talked about efforts against secondhand smoke at "Covering Health: A News Workshop," held in Madisonville by the Institute for Rural Journalism and Community Issues and the Foundation for a Healthy Kentucky, the funder of Kentucky Health News.

"E-cigarette use has risen in an astounding way, and it's exactly correlated with the amount of money companies have spent advertising the product," Hahn told the journalists. She said tobacco companies spend $266 million a year marketing their products in Kentucky, while the state spends $2.4 million on tobacco prevention.

Additional advertising comes from "vapor shops" for "vapers" who use e-cigs, but the words are misleading, Hahn said: "I would discourage you strongly from using the word 'vaping' because that is the word the industry is using."

Hahn explained that e-cigs don't produce vapor, which is diffused matter suspended in the air, but an aerosol, which is a liquid or solid of fine particles in a gaseous medium. She said e-cig aerosols have "at least 10 chemicals known to cause cancer, birth defects or other harm."

There are over 400 types of e-cigs, with lots of flavorings, Hahn said: "That gives some false hope. People say, 'It tastes good. How could it be bad for me?'"

The flavors help attract children, she said. The last health poll of Kentucky high-school students, in 2015, found that 41.7 percent reported using an e-cig and 23.4 percent reported using them in the previous 30 days. Those rates were about the same as national rates. Meanwhile, the percentage of Kentucky high-schoolers smoking tobacco declined to 17 percent, still well above the U.S. rate of 10.6 percent.

Hahn said e-cigs can be a pathway leading children to cigarettes: "It's kind of like a little door, a little opening, to nicotine addiction."

Hahn runs the nursing college's BREATHE (Bridging Research Efforts and Advocacy Toward Healthy Environments) program and its Kentucky Center for Smoke-Free Policy, which campaigns for local ordinances that ban indoor smoking, including the use of electronic cigarettes and the "heat not burn" product that is expected to hit the market soon. She is also part of the campaign for a $1 increase in the state's 60-cents-a-pack cigarette tax, to reduce state's smoking rate, which is the nation's second highest and the cause of many health problems.

Hahn was asked about private-property rights and individual freedom, the main arguments used by opponents of smoking bans. She said Kentucky's heritage of growing tobacco also makes anti-tobacco efforts difficult, even though the state has fewer than 5,000 tobacco farmers.

"This is not about going after farmers in any way, shape or form," and tobacco farmers tell her they don't want their children to smoke, Hahn said. Still, "Politicians are worried it's going to make people mad, it's going to affect them politically. . . . I don't think anyone wants our tobacco heritage to stay in the way of our health."

She said Kentuckians don't know how toxic secondhand smoke is; that it has 7,000 chemicals, 69 of which are known to cause cancer: "It's like a toxic waste dump on fire." Research has estimated that 34,000 Americans a year, 900 in Kentucky, die because of exposure to secondhand smoke, and Hahn said even brief exposure can narrow blood vessels,

She said 67 percent of Kentuckians are exposed to secondhand smoke at work, and restaurant servers and bartenders are more likely to have heart disease and cancer.

Still without health insurance and not eligible for Medicaid? Chances are 4 in 10 you can get a free policy (with big deductible)

By Melissa Patrick
Kentucky Health News

Premiums are higher for health insurance through the Patient Protection and Affordable Care Act, but federal subsidies mean the total cost will be about the same. And many people will qualify for subsidies large enough to completely pay for a low-cost "bronze" plan -- or make it less than the penalty for not having health insurance.

To find an application assister or a sign-up event in
your county, go to www.healthbenefitexchange.ky.gov
For now, the ACA is still the law of the land, despite repeated efforts this year to repeal and replace it, and that means everyone is required to have health insurance in 2018 or risk paying a tax penalty, with some very limited exceptions.

The 2018 penalty is $695 per adult and $347.50 per child, with a maximum of $2,085 per family or 2.5 percent of the household's income.

The Kaiser Family Foundation is encouraging the 10 percent of Americans who are still uninsured to make sure they know what it would cost to sign up for a health plan this year. The foundation says its recent analysis of plans for 2018 found that about four in 10 could be obtained at no cost.

The foundation found that "more than half of the 10.7 million people who are uninsured and eligible to purchase an Affordable Care Act marketplace plan in 2018 could pay less in premiums for health insurance than they would owe as an individual mandate tax penalty for lacking coverage."

It added, "Within that 5.8 million, about 4.5 million (42 percent of the total) could obtain a bronze-level plan at no cost in 2018, after taking income-related premium tax credits into account. "

According to Kaiser, 265,000 Kentuckians were uninsured in 2016. Of those, 114,000 were eligible for Medicaid. The other 151,000 could have bought a plan on Healthcare.gov, and about 77,000 of those would have been eligible for a tax subsidy to help pay for their coverage.

Among the 80,000 Kentuckians with policies on the exchange, about 80 percent will qualify for a tax credit or subsidy to reduce their monthly payments. Though premiums have gone up this year, most people's cost will be about the same because the credits are calculated to offset premium increases.

Many in this group will also qualify for the low- or no-cost bronze plans. so they are advised to compare all of their options before simply re-enrolling in the same plan or allowing the system to automatically re-enroll them.

Bronze plans are likely to have high deductibles and/or co-payments, so health experts stress the importance of looking at the whole plan, not just the premium cost.

In a recent webinar, the Kaiser foundation encouraged the remaining 20 percent of Kentuckians who don't qualify for any help and who will likely see the largest increases in their premiums to look at plans off the exchange, because they could be less expensive.

The foundation offers an easy-to-use individual mandate penalty calculator that lets you compare your penalty for going uninsured to the cost of coverage on the federal marketplace. It also estimates whether you would qualify for several, but not all, of the exemptions to the penalty.

To help with open enrollment, which ends Dec. 15, free application assisters are available in every county. They are also offering sign-up events throughout the state. To find an event in your county or an assister, go to healthbenefitexchange.ky.gov. The site also includes net payment examples for all regions of the state and 2018 sample scenarios for individuals and families. Help is also available through the state call center at 858-459-6328 and the Healthcare.gov customer center at 800-318-2596, which is available 24 hours a day, seven days a week.

Wednesday, November 8, 2017

Weekly newspaper in Woodford County keeps a spotlight on the local drug problem, but also on someone in recovery

The two headlines at the top of last week's front page of The Woodford Sun were a reminder of the depth, breadth and impact of the opioid epidemic: "Woodford County drug overdoses up from last year" and "Recovering addict shares her journey to getting clean." The locally owned Sun has been forthright about covering the problem, publishing a five-part series on it last year.

Angie Stewart (Woodford Sun photo)
Its latest major story spotlights the story of Angie Stewart, 46, who has been in recovery for 12 years. Writer Bob Vlach reports that she started using around the time she dropped out of her senior year in high school, and went into recovery after "nearly dying of an overdose and being arrested for stealing a car. A felony conviction became Stewart's opportunity to get into Woodford County Drug Court - and finally get clean."

The Sun's stories are behind a paywall, but you can download our PDF of the latest two here.

Tuesday, November 7, 2017

Hardin County selling Elizabethtown hospital to Baptist Health, which has managed 300-bed facility for 20 years

Reinforcing its status as Kentucky's largest hospital chain, Baptist Health will buy Hardin Memorial Hospital in Elizabethtown for a price that will be disclosed when the sale closes.

Baptist announced Monday, Nov. 6, that it had signed a letter of intent to buy the hospital and its outpatient facilities. The letter is non-binding agreement, but "follows a two-year long HMH process of exploring potential affiliations and authorizes both parties to move forward with necessary steps to pursue a proposed acquisition," Mary Alford reports for The News-Enterprise. "Following due diligence and the negotiation process, projected to take several months, the terms of the final agreement will be made public," according to a news release.

"The parties are familiar with each other," Alford notes. "For the past 20 years through a series of agreements, Baptist Health has provided management services for the county-owned hospital and its health system."

Hardin County Judge-Executive Harry Berry, chair of the hospital's board, "said the challenge for independent, county-owned hospitals such as HMH, faced with a demanding and uncertain environment of increased costs and declining reimbursements, is to continue to ensure that clinical expertise and capital investment keep pace with local demands for the highest level of health care," Alford reports.

“This transaction will assure HMH will emerge stronger operationally and financially as a regional health care leader,” Berry said in the news release. “This will clearly benefit the 400,000 individuals in 10 counties which our health system has served with quality health care for more than 60 years.”

Alford notes that HMH has 300 beds and "operates more than 45 outpatient facilities, including a cancer center and surgical cen­ter, and "is the third largest employer in Hardin County with 2,389 employees and a volunteer corps of 119."

Sunday, November 5, 2017

Obamacare enrollment is on through Dec. 15; sign up early for assistance and compare plans, experts advise

By Melissa Patrick
Kentucky Health News

Sign up early, make sure you compare costs and plans and make an early appointment with your "application assister."

That was the advice given on an Oct. 31 Kaiser Family Foundation webinar offering open enrollment advice to consumers in Kentucky, as well as in Tennessee and Virginia.

Open enrollment began Nov. 1 for 2018 health insurance plans sold on Healthcare.gov and ends Dec. 15, half as long as in previous years.

"Consumers should start this process early this year," said Jennifer Tolbert, director of state health reform at the foundation. "Waiting to the final week of open enrollment is risky."

In addition to the shorter enrollment period, Tolbert said it's important to enroll early because there is no guarantee the federal government will extend the enrollment date for those who have started the application process prior to Dec. 15, as they have in the past.

Also, the federal government has announced that the Healthcare.gov website will be shut down every Sunday from noon to midnight Eastern Time (except Dec. 10) for maintenance, the foundation reports.

It's also important to pay attention to any mail, text messages, phone calls and emails you get about open enrollment, because this is how the state's health agency is spreading the word about open enrollment this year. The state no longer gets federal funds for advertising or outreach.
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The webinar also reminded Kentuckians that the Patient Protection and Affordable Care Act is still the law. "The law has not been repealed or replaced. Individuals must have health insurance in 2018 or risk paying a tax penalty," the Kaiser foundation said.

The penalty for not having health insurance in 2018 is $695 per adult and $347.50 per child, with a maximum of $2,085 per family or 2.5 percent of the household's income.

Kentucky Department of Insurance map shows Anthem
counties in blue, CareSource in pink.
The 80,000 or so Kentuckians who have a plan through the federal exchange will automatically be re-enrolled into the most similar plan available, but the foundation and other experts advise them to make sure they are happy with their re-enrollment plan, because they won't be able to change it in January, as they have in the past.

In Kentucky, Anthem Inc. is offering plans in 59 counties and CareSource is in the other 61.

The webinar also urged consumers to compare plans and costs, since they have changed since last year.

About 80 percent of Kentuckians enrolled on the exchange will qualify for a tax credit or subsidy to reduce their monthly premiums, and because the credits are calculated to offset premium increases, the cost of insurance in 2018 will be about the same, according to the state Cabinet for Health and Family Services.

The Kaiser foundation also cautioned that while many will qualify for a "bronze" plan with a very low premium or no premium at all, it's important to look at the whole plan because these low or no-cost plans have very high deductibles and co-pays.

The foundation encouraged the remaining 20 percent of Kentuckians who don't qualify for any help and will likely see large increases in their premiums to look at plans off the exchange, because they could be less expensive.

Assisters are available in every Kentucky county to help people sign up for coverage, and their services are free. They will also be offering sign-up events throughout the state.

The webinar encouraged individuals to schedule an appointment with their assister early, noting the shortened sign-up period and that spots traditionally fill up quickly during the last week of enrollment.

To find an event in your county or an assister, go to healthbenefitexchange.gov. The site also includes net payment examples for all regions of the state and 2018 sample scenarios for individuals and families.

Help is also available through the state call center at 858-459-6328 and the Healthcare.gov customer center at 800-318-2596, which is available 24 hours a day, seven days a week.