Monday, February 20, 2017

With Obama gone, emphasis is on 'care,' not him; Rep. Guthrie says voters want a replacement 'that creates a better opportunity'

"With President Barack Obama out of office, the debate over 'Obamacare' is becoming less about 'Obama' and more about 'care,' greatly complicating the issue for Republican lawmakers," writes Jonathan Martin, national political correspondent in the Washington Bureau of The New York Times. "Polling indicates that more Republicans want to make fixes to the law rather than do away with it. President Trump, who remains popular on the right, has mused about a replacement plan that is even more expansive than the original."

That's a contrast with the last seven years, when "few issues have animated conservative voters as much as the repeal of the Affordable Care Act," Martin notes. "As liberals overwhelm congressional town hall-style meetings and deluge the Capitol phone system with pleas to protect the health law, there is no similar clamor for dismantling it." Republicans in Congress told Martin that there is "significantly less intensity," as he puts it, among Obamacare opponents now that Obama is no longer president.

Rep. Brett Guthrie, R-2nd
Rep. Brett Guthrie of Bowling Green and Kentucky's 2nd District, who is on two health subcommittees in the House, said “I was here in 2009 and 2010, and we’re not getting the anti-Obamacare calls like that. I think people are going to hold us accountable for making sure we not only repeal, but we have a law in place that creates a better opportunity for people.”

Martin writes, "The demands from conservative-leaning constituents in districts like Mr. Guthrie’s are plainly shifting. In a nationwide CBS News poll last month, 53 percent of Republicans said they wanted to change the law to make it work better while 41 percent said they wanted to abolish it. Overhauling the law, however, is far more politically complicated than simply scrapping it."

The law passed with no votes from Republicans, and they have campaigned against it ever since. Now that they control the government, except the lack of a filibuster-proof majority in the Senate, the debate has "shifted from the theoretical to the tangible," Martin reports.

"It was easy for conservatives to rally against a law identified with a president they despised when he was capable of vetoing any repeal," he writes. "Now that he is gone and the law’s benefits appear to be on the chopping block, the people who stand to lose the most are the most vocal."

The "wild card" in the process is President Trump, who "has said multiple times that he is uneasy about depriving anybody of health insurance, and he may bridle if Democrats attack any Republican plan that may lead to that," Martin writes. "As Democrats note, Mr. Trump owes his victory in part to voters who have benefited from the law."

Kentucky is an example of that. More than half a million Kentuckians, the great majority of them on expanded Medicaid, are among the 20 million Americans who gained coverage under the law. By some measures, the state has had the largest percentage decrease of people without health insurance.

Senate Majority Leader Mitch McConnell said Friday that Republicans will have to repeal and replace the law without Democratic help or votes. “It’s clear that in the early months it’s going to be a Republicans-only exercise,” he said. “We don’t expect any Democratic cooperation on the replacement of Obamacare. . . . Clearly this is not one of those bipartisan ‘Kumbaya’ moments.”

But Republicans may still need Democrats. The GOP can pass budget- and tax-related measures with a simple majority, under budget-reconciliation rules, but it remains to be seen how that can be done with the rest of the law.

Friday, February 17, 2017

State Senate panel OKs bill to deny most taxpayer dollars to Planned Parenthood; Ky. affiliate gave up funding in 2015

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – A bill that would effectively deny most tax dollars to Kentucky's Planned Parenthood locations in Louisville and Lexington passed out of a state Senate committee Feb. 17.

Senate Bill 8 would create a three-tier system to direct how federal family planning dollars are distributed in the state, with money first going to community health departments and federally qualified health centers, followed by private organizations that provide comprehensive primary and preventive health services, with Planned Parenthood third in line.

In 2015 Planned Parenthood's Kentucky affiliate stopped accepting its federal funding of about $300,000 per year, but Wise said the law is still necessary because "there is currently nothing in law that should prohibit them from in the future needing access to Title X family funds."

The bill would prohibit Planned Parenthood from receiving state or local funds, but it could still be paid by Medicaid, which is mainly funded by the federal government. Federal money does not pay for abortion.

Sen. Max Wise
The bill passed 8-3 along party lines out of the Senate Veterans, Military Affairs and Public Protection Committee, though Sen. Julian Carroll, D-Frankfort, said his vote was a "reluctant no" because of concern that it would reduce women's access to health services.

Texas, Kansas and Ohio have similar laws. The legislation wouldn't take effect until Congress repeals a regulation that prohibits family planning money from being allocated through a tiered structure. The U.S. House has already scheduled a vote on that, said Sen. Max Wise, R-Campbellsville, the bill's lead sponsor. It passed the measure Thursday.

“I come before you today thankfully more optimistic about the prospects of protecting unborn life than I was last year when the committee heard this similar bill,” Wise said.

Opponents of abortion have stepped up efforts to defund Planned Parenthood, which performs abortions but not in Kentucky, since undercover videos released in 2015 purported to show that it sells unborn baby parts for profit.

Wise cited the videos as a reason to support the bill, but they have been found to be heavily edited and misleading. FactCheck.org, a nonpartisan service of The Annenberg Center at the University of Pennsylvania, says, "The full, unedited video they cite as evidence shows a Planned Parenthood executive repeatedly saying its clinics want to cover their costs, not make money, when donating fetal tissue from abortions for scientific research." Experts also said the amount of money mentioned in the videos was not enough to create a profit.

Tamarra Wieder, director of external affairs at Planned Parenthood Advocates of Indianan and Kentucky, said in an interview after the meeting. "The ultimate agenda here is not women's health, it's about outlawing abortion and restricting people's ability to choose what's right for them."

Wise said another reason to withhold funding from Planned Parenthood is because it has a "vested, financial interest" in directing women toward abortion, noting that in 2013-14 the organization had provided 323,653 abortions and made 1,880 adoption referrals.

Federal and state law does not allow tax dollars to be used to pay for abortions, but Wise suggested that it is difficult to ensure that this money isn't crossing over for abortion services: "Under Title X grants, abortion providers can pro-rate expenses such as staff and waiting rooms, carving a portion of the fixed cost of the abortion related staff and facilities."

Opponents of SB 8 (L-R) Dr. Mary Sterrett, Sage Martin and
Tamarra Wieder speak to committee (Photo by Melissa Patrick)
The committee chair, Sen. Albert Robinson, R-London, chairman of the committee, had six opponents of the bill to speak for a little over 15 minutes before Wise presented it.

Wieder told the committee that as a military wife, she was referred to Planned Parenthood because the base was unable to care for her gynecological needs.

"As one of the state's leading and most trusted providers of comprehensive reproductive health care, Planned Parenthood in Kentucky serves more than 7,000 patients a year, a vast majority being low-income women of childbearing age," she said.

Sen. Denise Harper Angel, D-Louisville, the only woman on the committee, voted no and said, "With all the serious issues facing Kentucky, I don’t understand why we spend our time just taking away services for the women of Kentucky."

Wise said that if women need family-planning services, they could go to their local health department or federally qualified health center. But Wieder said, "They say you can go to the health department for this care ... and that's not true. Louisville and Lexington, there is no family planning services from the health department, they contract out. . . and that's not unique to just Louisville and Lexington."

The Louisville Metro Health Department confirmed that, and said it contracted with Planned Parenthood until it stopped taking Title X money. It now sends patients to Family Health Centers, which is a federally qualified health center.

Wieder said the FQHCs in Louisville often refers patients to Planned Parenthood for reproductive health services because "they are inundated with patients seeking other services and they don't have experts in the field that can manage that care, so we do get a lot of referrals from the FQHCs throughout the state, and specifically in Louisville and Lexington."

Thursday, February 16, 2017

Tobacco ban for public-school properties and activities heads to the House on 25-8 Senate vote

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The state Senate passed a bill Feb. 15 to ban the use of tobacco products and electronic cigarettes on public-school properties and during school activities, but not without debate about local control and overreach.

Senate Bill 78 would prohibit use of tobacco products by students, faculty, staff and visitors in schools, school vehicles, properties, and activities, and give one year to adopt, implement and enforce the policy. It passed 25-8, with two pass votes and now heads to the House for consideration.

Sen. Ralph Alvarado
The sponsor, Sen. Ralph Alvarado, R-Winchester, told the committee that the bill "is a beginning attempt to help reduce our youth smoking rates in Kentucky," which at 17 percent ranks third in the nation. "A strongly enforced tobacco free school policy can prevent or delay students from using tobacco. Some studies have shown up to a 30 percent reduction in student smoking."

Despite earlier comments by Alvarado that he didn't think others would "dare" oppose a bill to decrease Kentucky's youth smoking rates, several legislators voiced concerns about local control, overreach, unintended consequences and enforcement.

Sen. Paul Hornback, R-Shelbyville, acknowledged the bill's good intent and noted that Shelby County school district was smoke-free, but he also pointed out that the ban doesn't just concern students, "but also concerns the school bus drivers at the school bus garages and places where there aren't even any students around."

"So, I'd urge the members to think about this," Hornback said. "You know, we are in favor of local control until we are not, and this is one of those things where we want to come down and mandate to the local school boards what they need to do, rather than letting them decide like they are doing right now."

Hornback, who was a prominent tobacco farmer before becoming a senator, also wanted to know if a person would be in violation of the law if they had tobacco in their personal vehicle while on school property.

Alvarado replied, "If you would be on school property, you would be in violation, according to this. Again, the enforcement on the policy would be up to the local school boards."

Alvarado, a physician, said he changed the bill at the behest of the Kentucky School Boards Association and superintendents to allow school districts to develop their own enforcement policies.

Just over half of Kentucky's public-school students are in school districts with tobacco-free policies: 62 of the state's 173 districts, covering 654 schools.

Sen. Robin Webb, D-Grayson, said she also appreciated the intent of the bill, but had concerns about its overreach and enforcement, noting that as written, the bill would not allow volunteers or chaperones to use tobacco products in the privacy of their own hotel room on a school-sponsored trip.

"I just think it is a little far-reaching. I don't think it's enforceable," Webb said. "I don't know what the enforcement would be unless it would go back to that local control. I think there are some portions of this bill that are a little vague, undefined and extends beyond the scope of the intention of the bill."

Webb passed on the vote. So did Sen. Johnny Ray Turner, D-Prestonsburg, a basketball coach at a smoke-free school. He voiced concerns about the financial impact of the bill on schools if attendance decreases at outdoor sporting events because people can't smoke. He said tobacco policy should be a local decision.

Besides Hornback, senators who voted against the bill were Republicans Joe Bowen of Owensboro, Tom Buford of Nicholasville, Stan Humphries of Cadiz, John Schickel of Union and Wil Schroder of Wilder, and Democrats Julian Carroll of Frankfort and Perry Clark of Louisville.

Mark Pyle, Christian County health director, is named state's deputy commissioner of public health

Mark Pyle
The director of the Christian County Health Department in Hopkinsville will be the new deputy commissioner of the state Department for Public Health.

Mark Pyle will serve as the state's chief liaison with Kentucky's 63 district, county and independent health departments. The job was briefly held by Randy Gooch, who returned to his old job as health director in Jessamine County, saying it suited him better.

Pyle has headed the Christian County department for nine years, and led it to national accreditation. "Although national accreditation was a crowning achievement, it was not the most important," he told the Kentucky New Era. "The most important achievements were the development of community partnerships, implementing evidence based/population based health programs and forming a culture of above-the-line performance."

Legislature moving bills targeting fentanyl sales, shortening length of most opioid prescriptions to three days

The General Assembly is moving bills to increase penalties for the sale of fentanyl and put a three-day limit on prescriptions of other high-potency painkillers, in an effort to stem the state's opioid epidemic.

Kim P. Moser
"This is a public-health crisis," freshman Rep. Kimberly Poore Moser, R-Taylor Mill, a former nurse who reminded the House Judiciary Committee that Kentucky has the nation's third highest rate of deaths from opioid overdoses.

Her legislation would raise the penalty for selling any amount of fentanyl, "a powerful synthetic opioid," reports Bruce Schreiner of The Associated Press. "Current law allows lesser felony charges, with lighter penalties, for people convicted of trafficking less than 2 grams."

"The bill would create a new crime of trafficking in a misrepresented controlled substance, a felony punishable by one to five years in prison," Schreiner writes. "It's aimed at drug dealers who sell fentanyl to buyers who think they're getting less-potent painkillers, with sometimes deadly results."
Read more here: http://www.kentucky.com/living/health-and-medicine/article133010659.html#storylink=cpy

Rep. Robert Benvenuti, R-Lexington, said at the House Judiciary Committee's Feb. 15 meeting, "We have people in this commonwealth who are actively marketing something that is the equivalent to shooting somebody. And we've got to have strict penalties for that. . . . And if it means longer terms of incarceration, there's one way not to get into that situation – don't traffic in this stuff."

The bill would also "direct licensure boards overseeing doctors and others with prescriptive authority to write regulations setting guidelines to generally limit a patient's supply of painkillers to three days," Schreiner reports. "There would be exemptions in cases of chronic pain, end-of-life and cancer care and if a provider believes there's a medical necessity for a longer prescription."

Gov. Matt Bevin told the committee, "We've got to make it harder to get addicted." Schreiner reports, "Bevin said no amount of government money or rehabilitation programs will fix Kentucky's drug woes until action is taken to reduce the state's acute drug addiction rate."

The committee approved the bill on a bipartisan vote. The day before, the state Senate passed and sent to the House a bill to toughen penalties for people caught trafficking smaller amounts of heroin or fentanyl.

About 3/4 of the Kentuckians getting free exams and screenings via Medicaid are covered by its expansion, study finds

More than three-fourths of the Kentuckians who got free medical screenings through Medicaid last summer were covered by the expansion of the program under the Patient Protection and Affordable Care Act, according to a study done for the Foundation for a Healthy Kentucky.

Likewise, almost three-fourths of Medicaid substance-abuse treatments were for people included in the expansion of the program to people with incomes up to 138 percent of the federal poverty level, $16,394 for an individual or $33,534 for a family of four.

Medicaid covered more than 44,000 dental exams, 10,143 screenings for breast cancer, 6,319 colorectal cancer screenings, 6,153 hepatitis C screenings and 4,495 diabetes screenings for non-elderly Kentucky adults during July, August and September 2016. It also covered 7,039 births, 22 percent of which were for for expansion patients.

"The dramatic growth in preventive health screenings for low-income Kentucky adults is one of the most meaningful benefits of Medicaid expansion in Kentucky," said Ben Chandler, CEO of the foundation. "Getting recommended tests such as colorectal cancer screenings, mammograms or dental exams gives Kentuckians the chance to either prevent chronic disease or get earlier treatment. These screenings can quite literally save lives. They can also lead to significant savings for Medicaid and other programs that pay the cost of caring for Kentuckians who otherwise would put off medical visits and just get sicker."

Since the Medicaid expansion began in January 2014, people covered by it have had 224,720 dental exams, 15,692 screenings for diabetes, 59,529 breast cancer screenings, 38,190 colorectal cancer screenings, 24,157 hepatitis C screenings and 53,465 substance-abuse treatments, according to the study by the Health Access Data Assistance Center at the University of Minnesota.

Wednesday, February 15, 2017

State Senate committee approves bill to remove insurance-company barriers to smoking-cessation treatments

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Kentuckians could get treatments to help them quit smoking without facing obstacles from their insurance companies, under a bill that a state Senate committee approved unanimously Feb. 15.

Sen. Julie Raque Adams
Senate Bill 89 would require all insurance policies sold in Kentucky to cover all smoking-cessation medications and counseling approved by the U.S. Food and Drug Administration "with no barriers to access," said Sen. Julie Raque Adams, the bill's sponsor. "The choice is simple: If Kentuckians want to quit smoking, they will have true access to the necessary tools. If they don't, no money or effort is expended."

The Patient Protection and Affordable Care Act requires all insurance policies to cover smoking-cessation treatment, but Adams said that doesn't mean they are readily available. The Louisville Republican said many insurers have barriers to treatment such as co-payments, prior authorization, limits on length of treatment, annual and lifetime limits on attempts to quit, and step-therapy requirements that dictate the order in which physicians can prescribe treatments. SB 89 would provide barrier-free access to all U.S. Preventive Services Task Force-recommended smoking cessation treatments in all Kentucky health plans, including Medicaid.

Dr. Shawn Jones, senior physician in the Ear, Nose and Throat Group at Baptist Health Paducah and past-president of the Kentucky Medical Association, said in a telephone interview that he runs into these barriers "all the time."

"A lot of times we will want to try certain medications, whether it is a medication that has been out for a long time, like Wellbutrin or [a newer one like] Chantix, and a lot of insurers won't pay for that, even though the studies say they are much more effective than the nicotine-replacement-therapy that the patient may have already tried over-the-counter, and that doesn't count because it wasn't from a prescription from the physician," he said.

Asked if he ran into annual limits on quit attempt barriers, Jones laughed and said, "I haven't been able to get a whole lot of people covered the first time, so I haven't had the trouble of getting them covered the second time. My experience has been more with the Medicaid population and it's very difficult to get them the treatment they need."

Dr. Shawn Jones
Jones, who spoke in favor of the bill at the Senate Health and Welfare Committee meeting, said smoking costs the state $1.92 billion in annual health-care costs, of which $590 million goes to Medicaid (most of which is federally funded), and kills almost 9,000 Kentuckians a year. The state leads the nation in smoking; 26 percent of Kentucky adults smoke.

"If we are going to use the word crisis with respect to the opioid epidemic in Kentucky, and I think we should, then we must do the same with regard to smoking," he said, noting that smoking kills many more people. "Smoking in Kentucky is nothing short of a catastrophic pandemic of gargantuan proportions, and that does not do it justice."

Jones said 70 percent of U.S. smokers say they want to quit, and 34 percent of those try to quit, but only about 10 percent are successful. "It's not easy to quit smoking," he said. "Many smokers simply cannot quit without true, barrier-free access to the treatments prescribed by their doctors, and physicians play a critical role in helping people quit."

Jones wrote in an op-ed in the Lexington Herald-Leader that the insurance companies' set of obstacles "makes it extremely difficult for smokers to stay motivated to quit."

Erica Palmer Smith, speaking on behalf of the American Cancer Society Cancer Action Network and other patient advocacy groups, told the committee that insurance companies' barriers to access "cause confusion among providers and patients about the availability of treatment, meaning fewer Kentuckians don't attempt to quit smoking."

Adams said after the meeting that the bill has the support of the state Cabinet for Health and Family Services, and noted that the state Department of Insurance estimated the financial impact of SB 89 to be minimal, $1.10 a year for the average policyholder. She said it will save insurance companies and Medicaid money in the long run.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, applauded the committee's vote. "If anyone wants to quit smoking, we ought to help them do it, instead of throwing up roadblocks," he said in a news release. "Senate Bill 89 will improve health in Kentucky and save taxpayer money."

Ky. uninsured rate has dropped significantly under Obamacare, but many struggle with maintaining stable coverage

By Melissa Patrick
Kentucky Health News

Many more Kentuckians have health insurance because of the Patient Protection and Affordable Care Act, but more than one in five Kentucky adults under 65 say they still don't have stable coverage, according to the latest Kentucky Health Issues Poll.

The Sept. 11-Oct. 19 survey found that 12 percent of Kentuckians aged 18 to 64 were uninsured. Another 9 percent reported they had health insurance, but had been uninsured at some point in the past 12 months.

"Health insurance is still an iffy proposition for more than one in five Kentucky adults who are 18 to 64," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll. "While the ACA has ensured coverage for over 355,000 Kentuckians from 2014 through 2015, there's still a significant number of Kentucky adults who can't rely on getting routine preventive and wellness care, let alone effective treatment for chronic conditions, because they can't rely on insurance to cover the cost."

The poll also found that the number of Kentuckians 18 to 64 on public insurance has dropped, while the number with employer-sponsored health insurance was about the same as last year.

Public insurance, such as Medicaid or military benefits, was reported by 29 percent of Kentucky adults under 65, down from 35 percent in 2015. Forty-five percent of Kentucky adults said they had employer-sponsored coverage in 2016, compared to 41 percent in 2015. The latter difference is not statistically significant, because the poll's error margin is plus or minus 2.5 percentage points, but chances are that fewer Kentuckians had such coverage.

The uninsured rate for Kentuckians 18 to 64 has dropped by more than half since the 2014 implementation of the ACA. The report notes that 97 percent of all Kentuckians 65 and older have health insurance.

Among Kentuckians aged 18 to 26 who reported having health insurance, 24 percent said they were covered on a parental plan, made possible by the ACA.

Chandler said, "As the Commonwealth moves forward to transform Medicaid, the foundation is working to help policymakers understand who has health insurance coverage and who doesn't. KHIP is one piece of the foundation's ongoing work to help sustain the gains Kentucky has made while identifying gaps we still need to fill."

The poll was conducted for the foundation and Interact for Health, a Cincinnati-area foundation, by the Institute for Policy Research at the University of Cincinnati. It interviewed a random sample of 1,580 adults on both landlines and cell phones.

Humana says it will pull out of government health-insurance exchanges next year

Humana Inc. announced Feb. 14 that it would stop selling health insurance through the government marketplaces created by federal health reform. That made the Louisville-based company "the first major insurer to cast a no-confidence vote over selling individual plans on the public exchanges for 2018," The New York Times noted.

The company said its early analysis of Obamacare enrollment for this year showed “further signs of an unbalanced risk pool,” meaning too many "customers with expensive medical conditions continued to enroll as compared with healthy people," Reed Abelson explains for the Times.

The change will mean relatively little to Kentucky, since Humana was selling on the federal exchange in only nine counties (Bourbon, Bullitt, Clark, Fayette, Jefferson, Jessamine, Oldham, Scott and Woodford) and off the exchange in nine (Boone, Bullitt, Campbell, Gallatin, Grant, Jefferson, Kenton, Oldham and Pendleton).

"Humana is not a major player in the individual exchanges and is among the national insurers, like Aetna and UnitedHealth Group, that have struggled to make money in the market," Abelson notes. Humana and Aetna abandoned their planned merger after a federal judge ruled it would violate antitrust laws.

On the Obamacare exchanges, "The company has steadily scaled back its presence, selling policies for 2017 in just 11 states," Abelson notes. "The company’s main focus has been selling private insurance under Medicare," under the brand Medicare Advantage.

Tuesday, February 14, 2017

Study analysis by Ky. critic of hospital safety estimates more than 200,000 preventable hospital-associated deaths each year

An analysis of two well-controlled studies estimates that the number of preventable hospital-associated deaths are over 200,000 each year, argues a commentary in the Journal of Patient Safety.

In an online review, Dr. Kevin Kavanagh, the lead analyst, acknowledges that critics of such studies will say the data is flawed because they often include older and sicker patients.

However, he adds they also don't include diagnostic errors, deaths that occur after the patient goes home from the hospital, or don't include data about patients whose deaths are imminent. Thus, he concludes, the number of deaths in these studies are more often underestimated, not overestimated.

"The onus is on the facilities to provide better data," he said, adding that his analysis looked at the two studies with the most rigorous data sets.

"We calculated an annual rate of 163,156 preventable deaths and when combined with diagnostic errors, non-captured events and deaths after hospitalization can be projected to approximate 200,000 preventable deaths annually," Kavanagh, a retired physician and chairman of HealthWatch USA, said in an e-mail.


The report says that despite having the knowledge to prevent many adverse events, "many health systems do not adequately invest in patient safety to put well-known safety improvement strategies in place." The report offers as an example resistance to mandatory nurse-to-patient ratios, which have been proven to decrease falls, pressure sores, urinary tract infections and decrease medication errors.

"Advocates are not calling to prevent problems for which solutions are not known, but calling to implement known solutions to prevent all too common problems," the report says. "What ties the occurrence of preventable adverse events and mortality together is the willingness and determination of facilities to adopt a culture of safety and to invest in patient safety."

It also points out that data from countries with nationalized health care systems and "well-defined and near-uniform implementation standards" cannot be compared to the United States' combination of non-profit, for-profit and government-systems.

Kavanagh said that even if the preventable hospital mortality rate from medical errors "is not the 163,156 that we have projected, but is as low as the 25,000 per year based on the United Kingdom's NHS data, that equates to approximately 5 potentially preventable deaths per year, per hospital in the United States, or one every two to three months.

"In addition, one could argue that this figure should be doubled by accounting for deaths from diagnostic errors," Kavanagh writes. "In what other industry would such a record be tolerated, let alone defended? Would the airline industry and public ever tolerate even a single preventable airline crash? We can and must do better."

Monday, February 13, 2017

KET examines successful recoveries from opioid addiction, airs a forum to discuss Kentucky's opioid crisis

Kentucky Educational Television is airing "Journey to Recovery," a documentary that looks at Kentucky's opioid epidemic and explores the state's available treatment options through personal stories of recovery.

The program, narrated by Grammy-winning recording artist and Kentucky native Sturgill Simpson, first aired Monday, Feb. 13. It will be air again Wednesday, Feb. 15 at 2 a.m. ET. KETKY will show it Feb. 16 at 3 p.m.; Feb. 18 at 2 a.m.; Feb. 27 at 11 a.m.; and March 8 at 10 a.m. (all ET). Go to http://www.ket.org/health/opioids for archived KET and national programs addressing the growing opioid epidemic.

Opioids, including heroin and many prescription painkillers, killed more than 33,000 people in the United states in 2015, according to the Centers for Disease Control and Prevention. In Kentucky, 1,248 died from drug overdose in 2015, up from 1,071 in 2014, according to a report from the Kentucky Office of Drug Control Policy. 

The documentary examines both abstinence-only programs as well as medication-assisted treatment programs. In addition to interviews with recovered addicts, the program also has interviews with several of the nation’s top addiction experts, including Dr. Nora Volkow, director of the National Institute on Drug Abuse and Dr. Robert DuPont, a former NIDA director and founding director of the Institute for Behavior and Health.

After the documentary's initial airing, Renee Shaw hosted an "Inside Opioid Addiction Forum" to discuss ways to battle the opioid crisis. Panelists included Justice Secretary John Tilley and Health Secretary Vickie Yates Brown Glisson.

The forum is available online and will air on KETKY Feb. 14 at 6 p.m., and on KET Feb. 15 at 3 a.m. It will also air on KETKY Feb. 15 at 5 a.m. and 11 a.m.; Feb. 16 at 4 p.m.; Feb. 18 at 3 a.m.; Feb. 27 at noon; and March 8 at 11 a.m. (all ET).

Sunday, February 12, 2017

Republicans will not only keep the Medicaid expansion, they will broaden it, says Lamar Alexander, Senate health panel chair

Sen. Lamar Alexander (Photo by M. Scott Mahaskey, Politico)
Republicans in Congress will not only keep the expansion of Medicaid, but will broaden it, says U.S. Sen. Lamar Alexander of Tennessee, a former governor who is a familiar figure to many Kentuckians and is close to Senate Majority Leader Mitch McConnell of Kentucky.

That's what Alexander told reporters Burgess Everett and Jennifer Haberkorn of Politico, which headlines their story by saying that he could be "the stealth Republican force behind Obamacare repeal" and replacement. But other senators may disagree and have more leverage.

The Patient Protection and Affordable Care Act allows states to expand Medicaid to people earning up to 138 percent of the federal poverty level, $16,394 for an individual or $33,534 for a family of four. Democrat Steve Beshear did that as governor in 2014, adding 440,000 people to the rolls; Republican Gov. Matt Bevin is trying to reduce the cost, now that the state has to pay a small part of it: 5 percent this year, which would rise to the current law's limit of 10 percent in 2020.

Alexander told Politico that Republicans need to first fix the subsidized insurance markets the ACA created, "which are suffering from high premiums and low competition, even if they represent just 4 percent of those insured in the United States," the reporters write. "From there, he wants Republicans to turn to Medicaid expansion — which Republicans will keep and potentially even broaden, he says — before eventually addressing problems with the country’s patchwork of employer-sponsored health care plans. In essence, Alexander is trying to triangulate an approach that can become law."

President Donald Trump campaigned on a promise to repeal the law soon after taking office, but said recently it might be next year before that happens. "Daily Senate Republican lunches regularly erupt in disagreement over strategy," Politico reports. "It’s now mid-February without a clear path forward, after years of Republican show votes to repeal the law. . . . Conservatives inside and outside Congress have already grown frustrated with the GOP’s plodding pace."

Alexander is not as conservative as other Republicans. but he is chairman of the Senate Health, Education, Labor and Pensions Committee, which makes him a major player in the discussions. He "was one of the first lawmakers to call on Republicans not to scrap Obamacare until a replacement is ready to go," the reporters note. "That’s now the GOP’s mantra."

"If there’s a softer side to Republicans’ plans to gut the law, it’s best represented by Alexander, a lawmaker who so loves cutting a deal that he voluntarily left the top ranks of Republican leadership to better work with Democrats," Everett and Haberkorn write. "The folksy Tennessee senator is quietly prevailing upon Republican lawmakers to take a deep breath. . . . His goal, in a nutshell: to reassure millions of Americans that Republicans aren’t trying to snatch away their health insurance."

Alexander "repeatedly stressed" in the Politico interview that he is on the same page as Trump and House Speaker Paul Ryan, the reporters note. "Those relationships have given other Republicans confidence in Alexander’s role." Sen. John McCain (R-Ariz.), told them: “That’s the key guy.”

But Finance Committee Chair Orrin Hatch of Utah, whose panel has jurisdiction over taxes, insurance subsidies and Medicaid, told Politico that Alexander “doesn't have much to do with it. He takes a great interest in it, and I’m glad he does, and I want to get his best ideas.” The two disagree, for example, on taxes that fund the subsidies; Hatch wants to repeal them quickly, but "Alexander urges caution: If Republicans repeal taxes now, how can they be sure they’ll have the revenue needed to pay for their replacement plan?"