Sunday, December 10, 2017

We're in the final few days of open enrollment for insurance on healthcare.gov; automatic re-enrollment might not be the best way

Updated Dec. 11, 2017: This article has been edited to reflect that CareSource's marketplace products are not part of Humana.  

By Melissa Patrick
Kentucky Health News

You have just a few days to enroll in a 2018 health-insurance plan on healthcare.gov. Open enrollment under the Patient Protection and Affordable Care Act ends Friday, Dec. 15.

"The clock is ticking," Whitney Allen, the outreach and enrollment coordinator for the Kentucky Primary Care Association, said in an e-mail. " We encourage anyone that has questions about enrolling in a 2018 health insurance plan to contact their local application assister before Dec. 15!"

And even if you don't need marketplace coverage, Allen says you should remind others, because that seems to be the way most people are hearing about government-subsidized insurance this year.

"It seems word of mouth has been the best advertising, this open enrollment," Allen said.

The state health agency has said it is using direct mail, text messages, phone calls and e-mails to communicate with current policyholders and potential new enrollees about open enrollment because it no longer gets federal funds for outreach.

Allen said most people in southeastern Kentucky who have called for application assistance say they heard about the service from family members and friends who have used it.

Who needs coverage?

Anyone who doesn't have health coverage through a job, Medicare, Medicaid, the Children's Health Insurance Program, or other coverage that meets federal standards, needs to sign up for marketplace coverage or risk paying a penalty.

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, whichever is larger.

If you miss the deadline, and don't qualify for a special enrollment period, you will have to wait another year to sign up, says the healthcare.gov website.

Health advocates have encouraged consumers to actively pick a plan to make sure they are getting the best coverage for the best cost, even if they will be automatically re-enrolled, as around 80,000 Kentuckians could be if they don't pick their own plan.

Stan Dorn, a senior fellow at Families USA, an advocacy group, told Kaiser Health News that auto-enrollment doesn't take premiums or benchmark plan changes into account, which means that even if you are assigned to the same plan, your cost could be different next year.

Kaiser Health News has also reported that it's important to actively choose a plan because "if you don't like the plan you're auto-enrollled in this year you may be stuck with it in 2018, unlike previous years when people could generally switch."

In general, the federal exchange plans are more attractive to individuals and families who earn less than 400 percent of the federal poverty level because they will qualify for subsidized coverage. And those who make too much to qualify for a subsidy are encouraged to connect with a certified health insurance agent or a broker to determine whether an exchange or off-exchange plan is best for them.

CareSource, which is offering exchange plans in 61 Kentucky counties, encouraged consumers to also check to see if their doctors are on their plans network.

"Even if a plan did not include your doctor last year, check again for 2018. Some plans, like CareSource, have recently signed agreements with new provider groups. This means more doctors may be in network beginning on January 1, 2018," CareSource said in a news release.

Anthem Blue Cross Blue Shield is selling plans in the other 59 counties. Here's a healthcare.gov checklist of the information that you need to have available when you sign up for coverage:


Where can I get help?

Application assisters are available in every Kentucky county to help people sign up for coverage, and their services are free. There are also sign-up events throughout the state. To find an event in your county or an assister, go to healthbenefitexchange.gov.

Help is also available through the state call center at 855-459-6328 and the Healthcare.gov customer center at 800-318-2596, which is available 24 hours a day, seven days a week.

Click here for a livestream open enrollment information session that aired Friday, Dec. 8 on the Kentuckians for The Commonwealth Facebook page. The video features application assisters from the Primary Care Association.

Friday, December 8, 2017

Flu and pneumonia, which can result from flu, are 8th largest U.S. cause of death; officials urge all over 6 months to get flu shot

Flu season is here and will last through February or longer, prompting state health officials to encourage Kentuckians to get their flu vaccinations.

“During the holidays families and friends will gather, which increases the potential for exposure to the flu virus," Dr. Jeffrey Howard, the state's acting health commissioner, said in a news release. "We urge everyone who hasn’t received the flu vaccine, particularly those at high risk for complications related to the flu, to check with their regular health care professional, local health departments or other vaccine providers.”

Flu is a "very contagious" disease caused by a virus that spreads from person to person. Symptoms include fever, headache, cough, sore throat, runny nose, sneezing and body aches.

It can also be deadly. Flu and pneumonia are the eighth leading causes of death in the United States, according to the federal Centers for Disease Control and Prevention.

Just this week, Jennifer Earl of CBS News reported that a 20-year-old mother of two in Arizona died unexpectedly and quickly from flu.

Alani "Joie" Murrieta of Phoenix was being treated for the flu with an anti-viral medication called Tamiflu, but her health took a turn for the worse the day after her diagnosis. She was then rushed to the hospital, diagnosed with pneumonia and started treatment, but within two days of when she started feeling ill she was dead.

Murrieta's aunt, Stephanie Gonzales, warned the public to take the flu seriously.

"Don't take life for granted. If you feel sick, go to the doctor. Don't wait until your symptoms are so bad there is no turning back," she told CBS.

Kentucky's flu level as of Friday was classified as "regional," with 104 laboratory-confirmed cases, according to the state's weekly influenza surveillance report. Twelve of the state's 17 regions have had a confirmed case this flu season. As of Dec. 2, there had been no flu-related deaths reported in Kentucky.

NPR reports that the flu season could be "unusually harsh" this year because of several factors.

One is this year's early start to the season, which could make it last longer and infect more people. Another is that Australia had a severe flu season this year and the U.S. typically has a similar experience to what happens in the southern hemisphere.

Australia's bad season stemmed from a strain of the flu virus called H3N2 that tends to make people sicker than other strains, and because the flu vaccine was only about 10 percent effective against that strain this year in Australia. The U.S. is using the same vaccine as Australia, but its effectiveness in the U.S. is still unknown.

Health experts say that even an imperfect vaccine is better than no vaccine because it can help prevent or lessen the severity of the illness and also helps to promote "herd immunity" of the population.

The CDC recommends that everyone over six months of age get a flu vaccination, and especially encourages people who may be at higher risk for complications or negative consequences get one. They include:
• Children age six months through 59 months;
• Women who are or will be pregnant during the influenza season;
• Persons 50 years of age or older;
• Persons with extreme obesity (body-mass index of 40 or greater);
• Persons aged six months and older with chronic health problems;
• Residents of nursing homes and other long-term care facilities;
• Household contacts (including children) and caregivers of children younger than 5, particularly contacts of such children, or of adults 50 and older;
• Household contacts and caregivers or people who live with a person at high-risk for complications from the flu; and
• Health care workers, including physicians, nurses, medical emergency-response workers, employees of nursing home and long-term care facilities who have contact with patients or residents, and students in these professions who will have contact with patients.

Howard added, “You should also follow the advice your parents gave you to prevent flu and other illnesses that tend to circulate at this time of year – wash your hands frequently, cover your mouth when you cough or sneeze and stay home when you’re sick.”

House conservatives oppose McConnell-endorsed efforts to resume Obamacare subsidies to moderate-income people

Wednesday, December 6, 2017

Groups pushing $1-a-pack increase in state cigarette tax make their sales pitch through an infographic


The group promoting a $1-a-pack increase in the state cigarette tax and local ordinances to ban smoking in workplaces has a new infographic to remind Kentuckians of the cost of smoking.

The graphic was created by Kentucky Voices for Health, part of the Coalition for a Smoke-Free Tomorrow, which says making the tax $1.60 per pack and raising other tobacco taxes would raise $266 million a year in revenue for the state. The average state cigarette tax is $1.71 per pack.

"Research shows that a tobacco tax increase in Kentucky must be at least $1 to achieve any health benefits," the coalition said in a news release. "Tobacco companies use coupons and other point-of-sale promotions to soften the impact of tax increases on the price of their products, so the tax increase has to be large enough to overcome those promotions."

"The current tax doesn't begin to cover the high cost of smoking in Kentucky," said KVH Executive Director Emily Beauregard. An extra dollar per pack will put a dent in those costs. More to the point of the coalition's work, it also will save lives and improve health."

Smoking's costs are measured not only in dollars, said Ben Chandler, chair of the coalition and CEO of the Foundation for a Healthy Kentucky, which staffs it. "Nearly 9,000 deaths every year in Kentucky are directly related to smoking, more than alcohol, AIDS, car crashes, illegal drugs, murders, and suicides combined," Chandler said. "If we don't start reducing smoking rates in Kentucky right now, 119,000 of today's youth will die early due to tobacco use."

The release said "5,900 Kentucky babies would be born healthier over a five-year period because their moms would quit smoking if the state enacted a $1 tax increase. The Campaign for Tobacco-Free Kids estimates that a total of 29,400 adults would quit smoking, and 23,200 kids would never start." The second page of the infographic appears below.

Tuesday, December 5, 2017

Providing healthier food for students can require new equipment

Jefferson County Public Schools photo
Almost all Kentucky schools are serving meals that meet federal "standards for strong nutrition, but in order to do this, many of these same schools have to work around equipment and infrastructure challenges," Ashlie Stevens reports for WEKU-FM. A survey by the Pew Charitable Trusts found that 89 percent of the state's school districts "needed at least one piece of new equipment to better serve nutritious foods."

The average cost of that is about $50,000 per school, "which is tough considering how public school cafeterias are funded," Stevens reports. Dan Ellnor, manager of the Nutrition Service Center for Jefferson County Public Schools, told her, “No local tax dollars go to feed kids; it is a completely federal grant program. . . . If we don’t make money, we can’t reinvest in the program.”

The U.S. Department of Agriculture, which oversees the school-meals program, has grant fund to help schools buy equipment, but it is relatively small "because the need across the country is so immense," Stevens reports. Legislation in Congress would expend the program to include loans.

In Jefferson County, “Our main challenge has been refrigeration with the increased fruits and vegetables,” which require "a lot more storage space," Ellnor said. Stevens adds, "The schools also need new combination ovens to roast and steam instead of fry these foods, and sometimes they just need more physical space for food prep."

Monday, December 4, 2017

Speaker uses experiences with depression, suicide to help students in area where suicide and attempts are more prevalent

"When Drew Bergman asked students at a packed Graves County Middle School assembly on Thursday how many of them knew someone who had attempted or died from suicide, half of them raised their hands. That stark reality demonstrates how prevalent suicide is in Graves and several area counties," David B. Snow reports for The Paducah Sun.

Graves County is in the Four Rivers mental-health region, one with a significantly higher rate of 10th-grader suicide attempts (9.3 percent) than the rest of Kentucky (8.2 percent). Among adults, the county "ranked 25th among Kentucky's 120 counties with a suicide rate of 17.88 per 100,000 people," Snow notes. "Carlisle [County] led the state with 28.46, Hickman ranked fifth at 23.4, Marshall was sixth at 23.28, Ballard was 13th at 20.26, Fulton was 14th at 20, McCracken was 15th at 19.61 and Calloway was 81st at 13.94. Livingston County is 56th at 15.23."


Snow notes, "Kentucky Health News reported in November that 1 in 12 of Kentucky's high school sophomores said they had attempted suicide within the previous year. It also reported that teen suicides went from 19 in 2014 to 44 in 2016, more than doubling in a two-year period. With seven of the eight Purchase counties among the state's top 25 in suicide rate," Lourdes Hospital in Paducah invited Minding Your Mind, an organization promoting mental-health education, to send a speaker last year."

That was Bergman, who came to McCracken and Marshall counties last year. He told GCMS students that he had come "from a good family, he and his two siblings were very good students, but underneath what he called the 'country club' facade were things kept out of the public eye," Snow writes. "Bergman said his seemingly successful father was an alcoholic and his parents slept apart for most of his youth because of that. He said his father's addiction was hidden from the children until his father got in a drunken driving wreck when Bergman was in the seventh grade. That was when his parents divorced.

"This perfect childhood that I grew up living came crashing down," Bergman said. "And this is when my entire family began to deal with their own mental health issues for the first time. . . . For the first time, I began to exhibit some symptoms of depression." He attempted suicide that year, and again four years later, at age 16.

"When he was a senior, Bergman told the students at his high school about his depression," Snow writes, quoting him: "The day that I started to talk about what I had gone through is the day that I began to feel better."

Snow writes, "He encouraged the students to talk about how they feel with parents, teachers or trusted adults. He said that people need to talk about mental health issues to help remove the stigma associated with them and to help those going through them. Bergman also encouraged the students who knew someone going through problems to tell an adult, saying he would rather lose that friendship than lose that friend to suicide."

Bergman also discussed treatment for mental illness and how he has treated his depression "through medication and positive coping mechanisms, like listening to music, getting outside, relaxation, and preparing for things like tests or events to remove stress and maintain some control. He encouraged the students not to let the topic end with the assembly, to talk about mental illness with their peers, their parents and their teachers."

Sunday, December 3, 2017

Tax bill would repeal requirement to have health insurance, perhaps boosting efforts to repeal and replace Obamacare

Reporters interviewed Sen. Mitch McConnell between negotiations
on the tax bill. (Associated Press photo by J. Scott Applewhite)
The tax-reform bill the Senate passed early Saturday morning, with Majority Leader Mitch McConnell of Kentucky in the driver's seat, includes a repeal of the requirement that almost all Americans obtain health insurance.

The provision, perhaps the most important part of the 2010 Patient Protection and Affordable Care Act, appears highly likely to remain in the final version of the bill that will emerge from a House-Senate conference committee. That's because it was also in the House bill and would help make up for the budget deficits caused by tax cuts, writes Paige Winfield Cunningham of The Washington Post.

Once the mandate is repealed, Republicans may find it easier to "repeal and replace Obamacare," as they vowed for seven years but have so far failed to do, because "It disposes of a major reason previous GOP measures were projected to result in fewer Americans with coverage," Cunningham notes.

Enactment of the tax bill could also lead to cuts in Medicare. "If lawmakers don’t waive a 2010 rule known as 'paygo,' aimed at keeping government spending in check, that deficit spending would trigger automatic cuts to mandatory spending," limited to 4 percent, Cunningham writes. "Sen. Susan Collins (R-Maine), who generally opposes cuts to entitlement programs," has said that McConnell has promised that Congress will waive 'paygo', "but such a decision is beyond McConnell’s ability to control. Waiving 'paygo' requires 60 votes in the Senate, and it’s not at all clear that Democrats would be willing to help Republicans save themselves from mandatory cuts." Perhaps McConnell believes enough would.

Part of the price McConnell paid for the vote of Collins, who helped kill a repeal-and-replace-Obamacare bill in the summer, was a promise for a vote on legislation to restore the insurance subsidies that President Trump ended recently. That measure, sponsored by Sen. Lamar Alexamder (R-Tenn.) and Patty Murray (D-Wash.), "seems awfully shaky," Cunningham writes. "The Senate is focused right now on the tax overhaul; yesterday House conservatives told The Hill they wouldn't support it (they've labeled it an 'insurer bailout'); and, as conservative policy wonk Chris Jacobs writes over at The Federalist, even if the payments are included in a year-end spending bill, they might not ever get made, due to mandatory sequester cuts."

Cunningham concludes, "Here's the interesting question at play over the next few weeks: Will Congress make two changes to the ACA marketplaces that are contrary to each other? Repealing the mandate undermines the marketplaces by ultimately weakening their risk pools (some healthy people drop coverage without the mandate). Making the subsidy payments (known as cost-sharing reductions) helps lower marketplace premiums, but it's kind of moot if you've already removed the key requirement underpinning the whole ACA."

If Trump signs the individual-mandate repeal into law, health-insurance companies will have to decide whether they want to sell through the Obamacare marketplaces, notes Sarah Kliff of Vox: "Are they comfortable selling in a marketplace where they have to offer all consumers coverage but healthy people can decide not to purchase? Or are they scared off by the prospect of getting swamped with sick customers? . . . By September or October of next year, we'd have a sense of whether there are some places where nobody wants to sell Obamacare. And we'll know if there are places with really high premiums, as insurance plans only their sicker customers to stick around."

Kliff concludes, "If Obamacare does truly seem to be in collapse — insurance plans fleeing the markets, premiums spiking — that might give Republicans the pretext to once again take another shot at Obamacare repeal."

FDA approves new shingles vaccine; may be available in 2018

If you had chicken pox as a child, as 99.5 percent of Americans now over 40 did, you still have the virus, and it can cause a painful rash called shingles, which can sometimes leave victims with permanent pain after the rash disappears. About 1 million Americans get shingles each year, and the Centers for Disease Control and Prevention expect one in three adults to get it.

The good news is that there are vaccines for the virus, and the better news is that the U.S. Food and Drug Administration approved an improved vaccine called Shingrix in October. It may be available in 2018, Clark Kebodeaux, an assistant professor in the University of Kentucky Department of Pharmacy Practice and Science, writes for the Lexington Herald-Leader.

"Patients will need two vaccine shots to be fully protected with Shingrix: the first dose followed by a second dose two to six months later," Kebodeaux  writes. "Clinical trials showed that the new vaccine is effective and longer-lasting than the previous vaccines."

The CDC's American Council on Immunization Practices recently voted to recommend that all healthy adults age 50 and older get Shingrix, including patients who have received Zostavax, an earlier vaccine, Kebodeaux reports.

"The Shingrix vaccine is new and is not yet available to the public, but may will be available in 2018," Kebodeaux writes. "Once available for distribution, the vaccine will likely be available at physician’s offices and pharmacies. Talk to your health care provider or pharmacist to see if it will be appropriate for you."

Saturday, December 2, 2017

U of L opens clinic to treat hepatitis C, a disease for which Kentucky has the nation's highest rate of new cases

The University of Louisville Hospital has opened a new center to treat hepatitis C and expects to have more than 2,000 patient visits in its first year, according to a U of L news release.

“While Kentucky has the highest rate of new hep-C cases in the U.S., few places exist here for treatment,” Barbra Cave, a family nurse practitioner who leads the center, said in the release. “This is a much-needed service in the community.”

In the past, treating hepatitis C involved a year-long therapy that came with multiple side effects, and not everyone was a candidate for treatment. "Doctors found it challenging, and some patients opted to not get treated at all," says the release.

But today, treatment involves one pill, once a day for eight to 12 weeks, and has minimal side effects, according to Dr. Ashutosh Barve, the center’s medical director. The center also uses FibroScan, which allows staff to perform a non-invasive assessment of the liver without a biopsy, says the release.

“This is truly a success story of modern medicine. We went from discovering the basic science of the disease in the late ‘80s, early ‘90s, to finding a cure in 2014,” said Barve, a gastroenterologist.

The treatment is not inexpensive. It runs between $32,000 and $56,000 on most health plans, Dr. John Ward, director of the Division of Viral Hepatitis at the federal Centers for Disease Control and Prevention, said at a conference in Lexington in July.

New cases of hepatitis C are largely driven by intravenous drug use, but many "Baby Boomers" have the disease and don't know it, and both groups should be routinely screened for it. It is estimated that up to half of people with the disease don't know they are infected.

“People may carry the disease for decades before they have symptoms,” said Cave, who specializes in gastroenterology and hepatology.

Hepatitis C is a blood-borne virus that can live on a surface for weeks if not sterilized properly. It can cause major complications if left untreated, including cirrhosis of the liver or liver cancer.

The disease can be contracted from contaminated tattoo equipment, contaminated dental equipment or passed on from mother to baby. Cave says anyone who got a blood transfusion prior to 1992 or older veterans who were vaccinated with a "jet gun" are also at risk.

Friday, December 1, 2017

Two decades of data show Kentucky communities with strong smoke-free laws have 8 percent fewer cases of lung cancer

By Melissa Patrick
Kentucky Health News

Kentucky communities with strong laws against smoking in workplaces have fewer cases of lung cancer, according to a University of Kentucky study that says it's the first to show such findings.

Researchers found that residents of counties with comprehensive smoke-free laws, including those with city-only smoking bans, were 8 percent less likely to be diagnosed with lung cancer than those living in communities without smoke-free laws.

There was no difference in lung-cancer rates between places that don't have smoking bans and those that have moderate or weak laws. The study considered laws to be comprehensive if they covered all workplaces, including restaurants and bars; moderate if they covered indoor public places, but not all workplaces; and weak if they allowed for major exemptions.

The researchers say the findings could encourage more localities to pass smoking bans. Only a third of Kentuckians are covered by such ordinances.


"Local government can play a critical role in preventing lung cancer," Ellen Hahn, the lead author of the study, said in a UK news release. "Elected officials can ensure that all workers and the public are protected from secondhand smoke by passing strong smoke-free laws with few or no exceptions."

Hahn is a UK nursing professor and director of the Bridging Research Efforts and Advocacy Toward Healthy Environments initiative at UK.

The BREATHE researchers looked at 20 years of lung-cancer data for more than 80,000 Kentuckians 50 and older. (Few Kentuckians under 50 have lung cancer.) The state has more cases of lung cancer than any other state, and its death rate from the disease is 50 percent higher than the national average. And not surprisingly, at 25 percent, Kentucky leads the nation in adult smoking.

Jim Waters, president and CEO of the Bluegrass Institute for Public Policy Solutions, a libertarian, free-market think tank, said that while lower rates of lung cancer are "wonderful," correlation does not equal causation and therefore public policy should not be built around it. "You can't attribute deaths directly to a single cause such as smoking," he said, "since many factors usually are involved: hereditary issues, poor diet, lack of exercise and education."

Hahn said the study did take other causes of lung cancer into account. "We used a sound, well-known statistical method to consider the other factors that may have affected new cases of lung cancer, in addition to smoke-free laws," she said. "Even after taking sex, age, smoking rate, and income into account, comprehensive smoke-free laws were associated with fewer new cases of lung cancer."

Hahn said factors that protect Kentuckians from lung cancer were being female, being younger, and living in a county with a lower smoking rate or higher median household income in the county.

Waters said his institute supports education efforts to encourage people not to smoke "without the punitive action of denying individuals the right to participate in a legal practice on private property. . . . Where does that end? We don't believe such reasoning will end with anti-smoking policies."

Hahn replied, "Research shows that simply educating the public not to smoke does not work to lower smoking rates or to reduce disease from tobacco smoke exposure. Smoke-free laws are known to reduce disease," heart attacks and hospital visits for emphysema and asthma, as BREATHE summarizes. "Just as we have laws to prohibit drunk driving (alcohol is legal), smoke-free laws prohibit smoking (legal) indoors where the second-hand smoke can harm workers and the public."

Ben Chandler, CEO of the Foundation for a Healthy Kentucky and chair of the recently launched Coalition for a Smoke-Free Tomorrow, called on Kentuckians to use this research to pass more smoke-free laws.

"We know that the Kentucky communities with smoke-free laws covering every workplace and public building are protecting the freedom of their residents and visitors to breath air untainted by dangerous secondhand smoke," Chandler said. "We know that a secondary benefit of these laws is that they help reduce smoking. But here's solid evidence from more than 20 years of data showing a significant decline in lung cancer."

The latest Kentucky Health Issues Poll on the issue found that 71 percent supported a statewide law to ban smoking in public places and the workplace. The state House passed such a ban in 2014, when it was controlled by Democrats, but the bill died in the Republican-controlled Senate, and Republican Gov. Matt Bevin, who took office in 2015, says smoking bans should be a local issue.

The study was published in Cancer, a journal of the American Cancer Society. An editorial in the journal said the "unique and important" study "has shared an incredibly valuable insight into the impact of smoke-free ordinances on lung cancer mortality" and emphasizes "the need for statewide, not municipal, enforcement for maximum efficacy."

USDA nixes further reduction of salt in school lunches

The U.S. Department of Agriculture announced Nov. 29 that it's halting an Obama-era plan to gradually reduce the amount of salt in school lunches each year. But the new plan would keep current sodium level targets unchanged through 2019. "Those targets are currently not more than 1,230 milligrams per meal for elementary, 1,360 mg for middle and 1,420 mg for high schools," Maria Danilova reports for The Associated Press.

The targets cover only meals served to students at breakfast and lunch, not a la carte items sold during meal times or vending machines and other sources of non-meal food sales. Public schools nationwide require that all such non-meal foods meet the nutritional requirements of the USDA's Smart Snacks Standard, first implemented in 2014. Those standards require that snacks be lower in sodium.

Margo Wootan of the Center for Science in the Public Interest said current sodium levels are too high, and the high-school sodium target is two-thirds of a child's daily recommended intake. "This is locking in dangerously high levels of salt in school meals," she told Danilova. The federal Centers for Disease Control and Prevention backs up this claim, saying that about 90 percent of school-age U.S. children eat too much sodium daily, and that 1 in 6 children have raised blood pressure (which can be lowered partly with a healthy diet that includes less sodium).

In Kentucky, 33.5 percent of children age 10-17 are overweight or obese, compared to 31.2 percent nationwide. A diet high in sodium is strongly associated with obesity.

Agriculture Secretary Sonny Perdue has criticized the sodium restrictions, saying that children won't eat the healthier meals and that food gets thrown away.

The USDA's Food and Nutrition Service is also keeping in place a program that allows school districts to opt out of a requirement to supply whole grains in lunches, if the schools feel they can't procure enough whole-grain products.

Thursday, November 30, 2017

Even if Obamacare automatically re-enrolls you, check out your options; open enrollment ends earlier this year: Dec. 15

By Melissa Patrick
Kentucky Health News

This is the first year that more than 80,000 Kentuckians with a 2017 health insurance plan on the federal exchange will be automatically re-enrolled in a 2018 marketplace plan. But that doesn't mean they shouldn't check out other options before open enrollment ends Dec. 15.

"People should not automatically assume that they are going to get re-enrolled in something that is going to work for them," said Emily Beauregard, executive director of Kentucky Voices for Health. "I think it's important that people still log in, see what their plan options are, make sure that if they have been auto-assigned to a plan that it is going to work for them, and not wait until it is too late."

So far, 27,979 Kentuckians have actively selected a 2018 health plan on Healthcare.gov during the first month of open enrollment, according to the Centers for Medicare and Medicaid Services.

This number includes both new enrollees and returning members who have actively selected a health insurance plan on Healthcare.gov. It does not include those who have been been automatically re-enrolled, nor does it indicate how many re-enrollees have compared plans and decided to stick with their old one.

During the same time frame last year, when there was no automatic enrollment, CMS reported 20,276 Kentuckians had signed up for a 2017 health plan on healthcare.gov.

The Kaiser Family Foundation also has warned people 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.

Whitney Allen, the outreach and enrollment coordinator for the Kentucky Primary Care Association, encouraged people to make an appointment with their local application assister.

Allen said assisters can help ensure that Kentuckians who have been auto-enrolled have been placed in the best plan for them in 2018, and can help people understand that even though their premiums have gone up, so have the tax credits that help them pay for their health insurance -- which she said has caused a lot of "sticker shock" and confusion.

"So a lot of folks are getting plans that are cheaper and with better coverage than their 2017 plan," she said. "But it's actually taking those folks to come in and to schedule an appointment to meet with an application assister to understand that."

Allen added that many people in southeastern Kentucky, where she works, still don't know it's time to sign up for their 2018 Obamacare plan or that open enrollment ends much earlier thus year, which she said is largely because of the "drastic" cuts to advertising and marketing budgets this year.

"If folks aren't reading the notices that they are getting in the mail, then basically they wouldn't know that it is open enrollment," Allen said.

The state's health agency has said it is using direct mail, text messages, phone calls and emails to communicate with current policyholders and potential new enrollees about open enrollment because they no longer get any federal funds for outreach.

Adding to the confusion, some Kentuckians who are enrolled in a plan that will not be available next year will qualify for a special enrollment period that gives them until March 1, 2018 to enroll in a new plan.

John Watkins, the acting executive director of the state's Kentucky Health Benefit Exchange, said in an e-mail that enrollees who have plans that will not be continued next year should have received notice of this in October, and may have received another notification from Healthcare.gov telling them what plan they were placed in.

In other words, it's important that you don't assume that you will qualify for a special enrollment period unless you have been notified by your insurer or healthcare.gov that your plan will no longer continue or was cancelled.

Beauregard encouraged Kentuckians to err on the side of caution when it comes to this year's special enrollment period and to go ahead and sign up before Dec. 15 if they can, and to seek the help of an application assister to help with the special enrollment paperwork if they can't.

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

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 855-459-6328 and the Healthcare.gov customer center at 800-318-2596, which is available 24 hours a day, seven days a week.

Wednesday, November 29, 2017

Study: Combination of a low-salt and heart-healthy diet is as good as drug therapy for many adults with high blood pressure

A new study finds that cutting back on salt and following the heart-healthy DASH diet can lower blood pressure, a disease that affects almost two out of every five Kentuckians.

“Our results add to the evidence that dietary interventions are as effective as—or more effective than—anti-hypertensive drugs in those at highest risk for high blood pressure, and should be a routine first-line treatment option for such individuals,” Dr. Stephen Juraschek, a study co-author, said in a news release. Juraschek is an instructor of medicine at Harvard Medical School and an adjunct assistant professor at Johns Hopkins University School of Medicine.

Previous guidelines defined high blood pressure as 140/90 milligrams of mercury (mm/Hg) or higher, but guidelines released this year have re-defined it as 130/80 mm/Hg or higher. High blood pressure increases the risk of stroke, kidney disease, heart attacks and heart failure.

The four-week study, published in the Journal of the American College of Cardiology, included 412 adults between the ages of 23 and 76 who had high blood pressure or were at risk of having it. They were asked to either stay on a "regular" diet or to switch to the Dietary Approaches to Stop Hypertension, or DASH, diet. DASH limits foods high in saturated fat and sugar, and is high in fruits, vegetables, whole grains, low or fat-free dairy, fish, poultry, beans, seeds and nuts.

They were also divided into three groups that received varying amounts of salt. One was allowed about a half a teaspoon per day, another was allowed about a teaspoon per day and the third group was allowed about 1.5 teaspoons a day. To reduce the risk of heart disease and stroke, the U.S. Food and Drug Administration recommends a maximum of about 2,300 mg of sodium per day, which is nearly one teaspoon of salt.

None of the study participants took blood-pressure medicines. Their baseline systolic blood pressures (the top number) ranged from 120 to 159 and their diastolic blood pressure (the bottom number) was between 80 and 95.

The participants were sorted into four groups: 120–129 mm Hg, 130–139 mm Hg, 140–149 mm Hg, and 150 mm Hg or greater.

The results varied based on which regimen the participants followed.

Those who followed the DASH diet with high sodium and had a systolic pressure of 150 or greater, had an 11-point average drop in systolic pressure. The effect was much less, a 4-point drop, among those whose beginning systolic pressure was less than 130.

The effect was even greater for those who were on the low-sodium DASH diet. Those who started with a systolic pressure of less than 130 had a 5-point drop in pressure; those who started between 130 and 139 had a 7-point drop; and those who began between 140 and 149 had a 10-point reduction.

The biggest impact was among those who followed the low-sodium DASH diet and started out with a systolic blood pressure of 150 or greater. They had an average drop of 21 points.

Juraschek called the findings "huge" and said they suggest that those at highest risk for serious hypertension achieve the greatest benefit from the combination diet.

The researchers said further research is needed to determine how the combination diet affects people with systolic blood pressure of 160 or greater or in persons with prior heart disease or diabetes.

Tuesday, November 28, 2017

Here are some holiday dining tips for people who have diabetes, a disease that affects almost 460,000 Kentuckians

Diabetes UK photo
The food and festivities that are part of the holiday season can make it hard to eat healthy, especially if you are one of the almost 460,000 Kentuckians who have diabetes.

But it doesn't have to be if you make a plan and stick to it, says the American Association of Diabetes Educators. To help make this plan, the association created a collection of "Holiday Season Eating Tips" with strategies to help people with diabetes enjoy the holiday season and maintain their blood sugar levels.

When it comes to eating big meals, the association's tip-sheet suggests: not skipping meals; limiting the number of starchy foods on your plate; choosing fruits and vegetables served raw, grilled or steamed; and sticking to calorie-free drinks. And if you choose to drink alcohol, which can lower blood sugar and interact with diabetes medicines, limit the amount and drink it with food.

If you are the one preparing the food, make sure you include healthy food choices like fruits, vegetables and lean meat; avoid frying or adding extra fat during cooking; and avoid sampling the foods more than necessary while you are cooking.

Another way to control your holiday portions is by using the "diabetes plate method," and foregoing seconds, says an article on The Diabetes Council website that also offers tips on managing diabetes during the holidays.

This method involves filling up half of your 9-inch plate with non-starchy, low carbohydrate vegetables, one fourth of the plate with a lean meat or protein and the other fourth of your plate with a carbohydrate of your choice. This method also allows for two more carbohydrate servings, which could be milk, fruit or a higher carbohydrate dessert.

As for all of those holiday treats, the association's tip-sheet recommends taking small portions, eating slowly and savoring every bite.

Holiday parties provide their own set of challenges when it comes to making healthy food choices, including the opportunity to graze, which can lead to poor food choices and overeating.

The tip sheet emphasizes the importance of not skipping meals, which can lead to overindulgence because you will arrive at the party hungry. It also recommends that you study all of the food options before deciding what to put on your plate, adding that if you choose something you don't enjoy, don't eat it.

And as always choose raw vegetables first, with only a small amount of dip (or skip it entirely); eat chips and crackers in moderation; sip on water or mineral water; and don't hang out near the food table.

The association also reminds people with diabetes to check their blood sugar regularly throughout the holidays, possibly adding a few extra checks in on party days to help guide your choices.

The federal Centers for Disease Control and Prevention offers some additional tips for people with diabetes to "holiday proof" their meal plans.

One of them reminds people with diabetes to make sure they eat close to their usual mealtime to keep their blood sugar steady, and if the holiday meal is to be served later than normal, eat a small diabetes-friendly snack at their usual mealtime and eat a little less when the meal is served.

Others include cutting back on carbohydrates during the main meal to allow for a sweet treat; making sure you are sleeping seven to eight hours per night because sleep loss can make it harder to control your blood sugar and tends to make people eat more and prefer high-fat, high-sugar foods; finding ways to fit in your favorite holiday dishes; and to make sure you keep moving, even if your physical activity is broken up into smaller chunks to fit your busy schedule.

And if you need further help with your diabetes management during the holidays, talk to your diabetes educator.

Sunday, November 26, 2017

Many Kentuckians with Obamacare plans got premium notices that over-estimated costs for 2018; see HealthCare.gov for facts

By Melissa Patrick
Kentucky Health News

With a shortened enrollment period, huge cuts in advertising and in-person assistance, and ongoing efforts to repeal and replace the federal health law, it's no wonder many Americans are confused about whether they can or should sign up for health coverage on government marketplaces this year.

Perhaps the most basic facts are these: The Patient Protection and Affordable Care Act, also known as Obamacare, is still the law of the land; it still requires everyone to have health insurance or pay a penalty; and the Dec. 15 deadline to sign up for a plan is fast approaching.

The requirement to have health insurance is designed to spread the risk and hold down costs. The penalty for not having it in 2018 will be $695 per adult and $347 per child, with a maximum of $2,085 per family or 2.5 percent of the household's income, whichever is larger.

Another possible source of confusion is that many returning Obamacare customers received renewal notices from their insurer that underestimated their 2018 monthly premium estimate. The notices used the customers' 2017 tax credit for the estimate instead of the larger 2018 tax credit, which could be causing "significant -- and misleading -- sticker shock," says the Kaiser Family Foundation.

Tax credits are available to people who earn between 100 and 400 percent of the federal poverty line to help reduce Obamacare premiums. The smaller your income, the larger your tax credit.

The practice of using the previous year's tax credit amount to determine the upcoming year's estimate wasn't as much a problem in the past because there wasn't much change from year to year in premium costs.

Tax credits will be larger in 2018 because they are based on the cost of benchmark "silver" marketplace plans, which have increased significantly in most markets for 2018 as a result of the federal government no longer paying a cost-sharing payment to insurers to keep these costs down. Generally, people who have had little or no changes in income and qualify for a tax credit will get a bigger one in 2018, and that will keep their monthly premium about the same.

Kaiser offered an example of the differences in estimated and actual costs of a 2018 silver plan for a 40-year-old in Louisville with income of twice the poverty level.

Such a person would pay the same $127 per month for a benchmark silver plan after using the appropriate tax credit. But if the 2017 tax credit is applied to the 2018 premium, as some renewal notices did, that calls for a monthly cost of $277, more than double this year's.

Elizabeth Kuhn, a spokeswoman for the Kentucky Public Protection Cabinet, said in an e-mail that between Nov. 1 and Nov. 22, about 9 percent of the calls to the state's Department of Insurance Consumer Protection Division were related to the federal marketplace, HealthCare.gov, including calls about this issue.

"The department representatives have explained that premiums could potentially be lower," she said. "Also, the premium notices sent to policyholders by insurers referenced that the 2018 premiums were estimates."

In Kentucky, Anthem Inc. is offering plans in 59 counties and CareSource, a Humana Inc. plan, is handling the other 61. Fran Robinson, a spokeswoman for CareSource, said its premium-estimate notices used the 2017 tax credit instead of the higher 2018 tax credit.

Robinson said the notices stated that the premium estimate was only an estimate, and encouraged recipients to update their information on Healthcare.gov to get their actual 2018 premium amount. She said they have explained this to any consumers who have called about this issue and encouraged them to update their accounts to get an accurate premium amount.

Anthem did not respond to the same inquiry from Kentucky Health News.

Suzanne Craig, program manager of the Community Access Project for the Green River District Health Department, told WKMS in Murray that "substantial numbers" of people are signing up for their ACA plans and many are fearful that they will lose their coverage.

"We are seeing more than we expected. These enrollments are taking longer because people have more questions," Craig told Rhonda Miller of WKMS, the Murray State University station.

WHAT CONSUMERS NEED TO KNOW, from Kentucky Health News:

Don't assume you can't afford a health insurance plan this year, especially if you got a notice that says your premium will be higher in 2018 than it was in 2017. Instead, to get the most accurate estimate go directly to Healthcare.gov, update your information and view the cost of all the plan options after the 2018 credit is applied.

Remember that help is available in person, by phone and online.

Every county in Kentucky has an application assister, formerly called Kynectors, to help consumers sign up for health coverage. They are 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 regions of the state and 2018 sample scenarios for individuals and families. It also provides answers to a list of frequently asked questions.

Kaiser Family Foundation offers a health insurance marketplace calculator to help consumers estimate their 2018 marketplace costs.

Help is also available through the state call center at 858 855-459-6328 and the Healthcare.gov customer center at 800-318-2596, which is available 24 hours a day, seven days a week.

Saturday, November 25, 2017

Progression of Alzheimer's disease can be slowed, even though its cause isn't known and there is yet no cure for it

People with Alzheimer's disease can do something about it.

That statement may surprise you, because no cure has been developed for the disease, and we aren't even sure what causes it. But that doesn't mean its progress can't be slowed.

"Medications and management strategies may temporarily improve symptoms, and can often slow progression," Dr. Graham Garrison of KentuckyOne Health Neurology Associates wrote for the Lexington Herald-Leader.

Garrison's column touched on many basic facts about Alzheimer's, including:

"As Alzheimer’s disease progresses, it destroys the memory and other important mental functions. Those suffering from the disease may first notice an increase in forgetfulness or mild confusion, but over time, will begin to forget recent memories. Someone with Alzheimer’s disease may find themselves repeating questions, forgetting conversations or appointments, getting lost in familiar places, forgetting the names of objects or family members, misplacing possessions, or having trouble taking part in conversations. Early on, patients may not be aware of the presence or degree of their impairment, which is typically more evident to others. When a loved one is suffering from Alzheimer’s disease, family members may notice changes in their personality and behavior, including depression, social withdrawal, mood swings, lack of trust in others, wandering, change in sleeping habits, loss of inhibitions, irritability and delusions."

Garrison concludes, "If you or someone you know are exhibiting early signs of Alzheimer’s disease, speak to a physician about your condition. A physician can check you for other, treatable causes of these symptoms, or other forms of dementia."

Friday, November 24, 2017

Central Ky. newspapers endorse $1-a-pack hike in cigarette tax; more legislators talking about need to raise more revenue

The Lexington Herald-Leader's editorial was accompanied by an
an X-ray from the American Lung Association showing lung cancer.
Two Central Kentucky newspapers recently endorsed a $1-a-pack increase in the state cigarette tax as a good way to raise needed revenue while discouraging smoking, the leading cause of the state's many health problems.

"How does Kentucky overcome a challenge that seems insurmountable? How can we eliminate a cultural touchstone that seems so ingrained into who we are as a state that some feel it is impossible to remove?" The Winchester Sun asked at the start of its editorial. "Simple," it answered. "We take a stand and implement strong measures that are essentially proven to save lives."

The editorial adopted the arguments of the Coalition for a Smoke-Free Tomorrow, a broad and diverse group that is pushing for the tax increase as a way to discourage smoking, especially among young people, for whom price increases would be more significant.

"This proposal makes sense financially as well," the editorial said. "The $1 increase is projected to generate more than $266 million in new revenue, which would address the state’s budget shortfall and provide much-needed funding to save the state’s pension systems without breaking past promises.. . . . The time for talking has passed. We need firm action. Kentuckians deserve it. The health of our state depends on it."

The Lexington Herald-Leader's editorial noted that the state raised its cigarette tax "by 27 cents in 2005 and by 30 cents in 2009 to reach the current 60 cents a pack, one of the nation’s lowest. . . . Unless the per-pack increase is $1 or more, it would just be a tax on poor people, doing nothing to protect Kentuckians’ health."

It added, "A significant increase in the price of cigarettes, on the other hand, is the most effective way to combat the addiction that has cursed Kentucky with the nation’s highest rates of cancer and cancer deaths and overall ill health. In only West Virginia does such a high percentage of adults smoke."

Read more here: http://www.kentucky.com/opinion/editorials/article185110303.html#storylink=cpy

The prospect of major budget cuts and the need for pension financing are making more legislators consider raising taxes in the regular session that begins in January, Ronnie Ellis, Frankfort correspondent for Community Newspaper Holdings Inc., said on KET's "Comment on Kentucky" Friday night.

"The public may finally rise up and say enough's enough," when it comes to cuts, Ellis said. "I am somewhat surprised by the number of lawmakers who will ... privately talk about 'We're gonna have to do something in the session to bring in more revenue, or we'll bring up tax reform'," unlike a few weeks ago.

Wednesday, November 22, 2017

State health department declares outbreak of hepatitis A, a liver disease that is often transmitted due to poor sanitary practices

State and local health officials are working to contain an outbreak of hepatitis, comprising 31 cases in 13 counties, largely in the Louisville area but also from Paducah to Hyden.

The state Department for Public Health has declared an outbreak of acute hepatitis A, it said in a Nov. 21 news release. The number of cases is "a 50 percent increase above the average of 20 cases per year reported over the past 10 years," the release said. "Jefferson County has had 19 confirmed cases, most of which have occurred since August. Cases have been reported in Jefferson, Shelby, Bullitt, Hardin, Henry, Anderson, Mason, Christian, Madison, Fayette, McCracken, Hopkins, and Leslie counties."
  
The release added, "Common risk factors of homelessness or drug use have been identified among 12 of the cases in Jefferson County."

No deaths have been attributed to the outbreak, but “Acute hepatitis A is a serious and potentially life-threatening infectious disease,” said Dr. Jonathan Ballard, the state epidemiologist. “We are working to identify anyone who has been exposed to cases associated with this outbreak and urging those experiencing symptoms of the illness to contact their healthcare provider for appropriate evaluation and medical treatment, if necessary.”

Testing has suggested that the strain of hepatitis involved is one associated with outbreaks in California.

Hepatitis A, a liver disease, can be prevented by vaccinations. Children, ages 1 through 18 are recommended to get the vaccine, as well as adults with increased risk factors or certain medical conditions,” Ballard said. Those factors include homelessness; all forms of substance-use disorder; people with direct contact with someone who has Hepatitis A; travelers to countries where hepatitis A is common; men who have sexual contact with men; household members or caregivers of a recent adoptee from countries where hepatitis A is common; and people with clotting factor disorders, such as hemophilia.

"Other than age-appropriate vaccinations, the best way to keep from getting Hepatitis A is to wash your hands using warm water and soap, to handle uncooked food appropriately and to fully cook food," the release says. "Always wash your hands before touching or eating food, after using the toilet and after changing a diaper. When soap and water are not available, use alcohol-based disposable hand wipes or gel sanitizers."

The signs and symptoms of Hepatitis A include yellowing of the skin or eyes (jaundice), dark urine, fatigue, abdominal pain, loss of appetite, nausea, vomiting, diarrhea, gray stools and fever. Not everyone with the virus has symptoms.

"The virus is found in the stool of infected people is usually spread from person to person by putting something in the mouth (even though it might look clean) that has been contaminated with the stool of a person infected with Hepatitis A," the release says. "It is often transmitted when people do not wash their hands properly or by eating uncooked or undercooked food."

Information about Hepatitis A is available from the federal Centers for Disease Control and Prevention at https://www.cdc.gov/hepatitis/hav/index.htm.

Secretary of State Grimes forms group to push for legalization of medical marijuana in Kentucky in 2018 legislative session

Kentucky Health News

A task force to get medical marijuana legalized in Kentucky held its first meeting Nov. 21 and plans to meet again in December to review legislation to be presented to the General Assembly when it convenes in January.

"The group includes members of Kentucky's medical community, including doctors, nurses and medical administrators, as well as representatives from law enforcement and state agencies with regulatory oversight, medical marijuana advocates, and military veterans," said a news release from Secretary of State Alison Lundergan Grimes, who created the group and chairs it.

The group's co-chair, Rep. John Sims, D- Flemingsburg, is having a bill drafted, Lexington's WKYT-TV reports. "The outpouring of support we've seen so far on this issue is very encouraging. There is no doubt in my mind medical marijuana would change the lives of so many Kentuckians for the better," Sims said in the news release. "I am convinced that together this group will produce a piece of legislation that everyone can endorse and eventually vote for. This is about improving the health of Kentuckians who are suffering every day. It's a no-brainer to me." 

The task force continues the lobbying efforts of member Jaime Montalvo, founder of Kentuckians for Medicinal Marijuana and a multiple sclerosis patient. "This issue is about compassion for patients, for the people who live in pain every single day," Montalvo said in the release. "My life depends on it, and so many more. We have to get this done."

WKYT reported that some Republicans have questioned the role of Grimes, a leading Democrat who cannot run for re-election to her current job in 2019. Grimes told the station that she wants to be an advocate for "the hundreds of thousands of folks who are suffering across this state," and "It's something people are looking to leaders like myself to help solve."

The Grimes news release said "Significant evidence exists showing marijuana counters side effects of a large number of illnesses and diseases, including cancer, multiple sclerosis, Alzheimer's disease, Crohn's disease, hepatitis C, and post-traumatic stress disorder." While those effects have been widely reported for many years, they have not been explained by scientific research. However, medical marijuana is legal in 29 states and the District of Columbia, according to the release.

The Kentucky Health Issues Poll in fall 2012 found that 78 percent of adults favored allowing people to buy marijuana for medical purposes if their doctor recommended it.

A February 2014 poll for Kentucky news outlets found that 52 percent of adults supported the legalization of marijuana for medicinal purposes, while 37 percent were opposed, with an error margin of plus or minus 3 percentage points.

Later that month, the state House Health and Welfare Committee voted 9-5 to approve a medical-marijuana bill, which never came to a vote in the full House -- then controlled by Democrats, now by Republicans. The 2014 legislature did pass a law allowing cannabidiol, a marijuana extract, to be used in clinical trials or at the University of Kentucky or University of Louisville.

Sen. Morgan McGarvey, a Louisville Democrat who has proposed allowing marijuana to be prescribed to terminally ill patients, says the issue cuts across partisan lines.

Dan Seum Jr., the son of Republican Sen. Dan Seum of Louisville, is among plaintiffs in a lawsuit in Franklin Circuit Court seeking a judgment allowing medical marijuana in the state. The suit argues that to do otherwise "violates Kentucky residents’ right to privacy in their own homes, and that the state constitution does not allow Kentucky to create laws that are without reason," Lisa Gillespie reports for Louisville's WFPL. "Seum’s father . . . voted in favor of a bill in 2014 allowing the state to study a form of medical marijuana."

Tuesday, November 21, 2017

Kentucky School Boards Association says it will support any legislation to make all schools in state tobacco-free

By Melissa Patrick
Kentucky Health News

Usually opposed to statewide mandates on schools, the Kentucky School Boards Association says it will support any legislation that proposes a statewide tobacco-free school law in the 2018 legislative session, because the majority of its members support such a law.

"We really try to protect local decision-making on these things," Eric Kennedy, director of governmental relations for the association, said in a telephone interview. "But on this, where so many districts have already adopted these policies locally, and I think the health issue for students and staff also being tied into it, this is one of those rare instances where KSBA will support the General Assembly putting in a statewide policy like this."

An August survey of more than 1,000 KSBA members on various legislative issues asked, "Should the General Assembly ban all tobacco products and electronic cigarettes/vapor products on school property?" Among the nearly 300 respondents, 81 percent said yes, Kennedy said, adding that members at 12 regional meetings across the state also voiced their support.

"Because our membership has said they are in such support of it, we will be supportive of any kind of smoke-free school legislation this year," Kennedy said.

Sen. Ralph Alvarado, a physician from Winchester, introduced a bill to require all Kentucky schools to be 100 percent tobacco-free in the 2016 legislative session. It passed easily out of the Republican-run Senate but couldn't garner enough support to be called up for a vote in the House, which was then controlled by Democrats but now has a Republican majority.

Alvarado, a Republican, 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. Kennedy indicated he had been told likewise.

Kennedy said that as of August, 74 of Kentucky's 173 school districts had some form of a tobacco-free policy in place, and KSBA knew of at least two more considering one.

Map from 100 Percent Tobacco Free Schools website
The "100 Percent Tobacco Free Schools" website reports only 68 districts with such policies, because its requirements for inclusion are more stringent than KSBA's. While that number is only 39 percent of districts, those districts have 55 percent of the state's students.

To be listed on the site, schools must ban use of all tobacco products, including vapor products, by staff, students and visitors at any time on school-owned property and during school-sponsored events. The site notes that some schools need to update their policies to meet new vapor-product standards.

“Passing a 100 percent tobacco-free school policy sends a strong message to young people that tobacco use is not normal and not accepted," Elizabeth Anderson-Hoagland, youth tobacco specialist for the state Department for Public Health, said in an e-mail. "We know that students in districts with tobacco-free policies that are strongly enforced are less likely to start using tobacco."

Six school districts have passed 100 percent smoke-free policies in Kentucky this year, compared to 12 in 2016. This year's additions are the West Point and Covington independent school districts and the Nelson, Hopkins, Monroe and Owen county districts.

KSBA recently became a member of the new Coalition for a Smoke-Free Tomorrow, spearheaded by the Foundation for a Healthy Kentucky. The coalition has three goals: to help localities enact comprehensive smoking bans; to educate the public and providers about a new law that requires health insurers to cover all federally approved tobacco-cessation medications and programs; and to raise the state's cigarette tax by $1 or more per pack.

The coalition has said raising the cigarette tax would initially generate $266 million a year for the state, decrease healthcare costs, improve employer productivity, improve the overall health of Kentuckians and would prevent Kentucky's youth from ever starting the habit.

Kennedy said KSBA supports both the health and revenue missions of the coalition.

"We at KSBA for many years have advocated strongly for comprehensive state tax-reform to bring in additional revenue to support our schools, and so it fits perfectly in line with that," he said.

New data from the Youth Risk Behavioral Surveillance System survey shows the number of high school students who are smokers has dropped again, from 16.9 percent to 14.3 percent. The numbers also dropped for electronic cigarettes, dropping from 23 percent to 14.1 percent. The national rate for smoking is 8 percent and 11.3 percent for electronic cigarettes, according to the federal Centers for Disease Control and Prevention.

Sunday, November 19, 2017

Ky. teen suicides more than double in 2 years; one in 12 high-school sophomores say they have tried to kill themselves

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – A recent survey found that one in 12 of Kentucky's high-school sophomores said they had attempted suicide, prompting experts on the topic to discuss what is being done about it. The main solution offered was more family support for teenagers, even those who may be only temporarily troubled.

In a tone of incredulity, Dr. Allen Brenzel, medical director of the state Department of Behavioral Health, Development and Intellectual Disabilities, told the legislature's joint health committee Nov. 15, "Almost 7,000 students in this survey said on a piece of paper that they actually attempted suicide within the previous 12 months."

Brenzel, the last speaker on the topic, noted that there has been an upward trend in teen suicide deaths, both nationally and in Kentucky -- where the total suicides among teenagers more than doubled between 2014 and 2016,  jumping from 19 to 44.

"From 2014 to 2015 we saw an almost doubling in the adolescent suicide completion rate," Brenzel said. "This is very disturbing, very concerning. It led us to re-double our efforts to collect and partner with many agencies to determine what is the nature of this increase, why are we seeing it , what's happening with our youth and what can we do around prevention."

The 2016 Kentucky Incentives for Prevention survey, given at participating Kentucky schools to even-numbered grades from 6 to 12, found that 15.4 percent of Kentucky sophomores said they had "seriously considered" attempting suicide in the 12 months prior to the survey. The national average is 18.3 percent.

The suicide-consideration rate ranged from 12.2 percent in Eastern Kentucky to 18.2 percent in the Communicare mental-health region (the Lincoln Trail Area Development District) and 17.6 percent in the Pennyroyal region (the Pennyrile Area Development District).
"We're not exactly sure we understand why, but we know there is heavy military family presence in those areas, and we do have some concerns about the cumulative effect of multiple deployments, which is a stressor in military families," Brenzel said. He added that the state has allocated extra money toward suicide prevention efforts in those regions to help military families, and such targeting has been proven to work. Fort Campbell, the Army post with the most deployments, is in the Pennyrile district; Fort Knox is in the Lincoln Trail district.

The Pennyroyal and the other two Western Kentucky regions (and the Comprehend/Buffalo Trace region in northeastern Kentucky) had the highest percentages of sophomores saying they had attempted suicide. Statewide, 12.5 percent of 10th graders said they had made a plan about how to attempt suicide, which is called suicidal ideation; 8.2 percent, or one in 12, said they had actually attempted suicide in the previous year.

"A significant number who have ideation progress to an actual attempt," Brenzel said, "so that is why identifying those students earlier and preventing that progression on that continuum is important."

Dr. Hatim Omar, chief of the Division of Adolescent Medicine at the University of Kentucky, said it's time to stop thinking about suicide as a mental-health issue and make it a public-health issue.

He said one-third of teen suicides have nothing to do with mental health, but are the result of a same-day crisis, and that with the proper prevention efforts and supports -- and a lack of access to a lethal method -- these suicides are often preventable.

For example, he said parents shouldn't just dismiss a teen's broken heart or concerns about a failing grade, but take time to commiserate with the child and not simply brush off such events as part of growing up.

"We want parents to wake up and pay attention to their kids, and listen to them and not ignore them," he said. "But we fail in this very basic thing."

Omar emphasized that research shows that a teen will "do fine if they have one adult who cares about them, if they have a safe place to interact with this adult ,and if we actually give them something useful to do. So why don't we do that? It sounds really simple."

He said the lack of adult support is illustrated by youth in his practice who tell him they no longer have family dinners, while 10 years ago they ate with their families about 15 times a month. He added that even when families eat together, it is often with their noses in a smartphone.

"That's our biggest problem. We are losing our families," Omar said "Kids are not feeling supported."

Risk factors and prevention strategies

Risk factors for teen suicide include a prior attempt, substance abuse, being discharged from a mental hospital, having a firearm in the home, and a bipolar disorder or schizophrenia, Omar said. He added that "major depression" is only responsible for 2 percent to 4 percent of teen suicides.

Omar noted the importance of storing guns and bullets in different places. He told the story of a 16-year-old patient who had decided to kill himself: He found a gun in his house, but couldn't find bullets, so he gave up after 30 minutes.

"That's the difference between life and death," Omar said.

All middle- and high-school students in Kentucky are required to receive some form of suicide-prevention education by Sept. 1, and teachers are required to receive at least two hours of self-guided training. The state has also implemented several peer-led "Sources of Strength" programs that promote resiliency and overall health, with plans to broaden this program to all school districts.

Some districts are doing even more to prevent teen suicide.

Lincoln, Boyle, Harrison, Nicholas and Scott counties use the "Stop Youth Suicide" program, which Omar founded in 2000. This program screens every student starting in sixth grade to determine their suicide risk and "most importantly" let them know help is available, Omar said.

Showing data from Lincoln County, Omar noted that when it started the program in 2007, the school district was seeing an average of two suicides per year, but since then there has only been one, last year. He added that the high school has seen higher attendance and graduation rates, and lower dropout and teen-pregnancy rates.

Dusty Phelps, a psychologist in Pulaski County, said its suicide-prevention and mental-health program, called "Kentucky Aware," is a grant-funded pilot program that could become a statewide model.

Among other things, the program integrates school-based mental-health services into the education system; teaches staff how to recognize signs of trauma and how to respond; creates partnerships with mental-health agencies to support students; and teaches students how to be active participants in their own mental-health care.

Lori Price, a psychologist and coordinator of student and family support Services in Pulaski County, said the district has nurses in every school who are "very tied" to the district's family resource and youth service centers.

"We have trained our nurses in youth mental-health first aid and intervention. And many times our youth service centers and our nurses are the ones that recognize what is going on with our youth," she said. "Our family resource centers and our nurses are a very strong component to our mental health services in our school district."

Price said parents need to be aware that there is a "very dark world on social media," which offers suicide as an option.

Sen. David Givens, R-Greensburg, and Rep. Robert Benvenuti, R-Lexington, both said social media promote the fallacy that everyone else has a perfect life and encourages a constant comparison that is not real.

"That is a burden for a young person with low self-esteem to have to carry," Givens said. "So there has got to be a component of technology usage, digital literacy, understanding that these things lie."

Saturday, November 18, 2017

Study finds 1/3 of Americans haven't heard about open enrollment for subsidized health plans, which ends Dec. 15; here's a primer

By Melissa Patrick
Kentucky Health News

About a third of Americans haven't heard anything about open enrollment for federally subsidized health insurance, and nearly half of them say they are hearing less about it this year than last year, according to a recent poll by the Kaiser Family Foundation.

That's a problem, especially in Kentucky, where about 265,000 people had no health coverage in 2016. Of those, 114,000 were eligible for Medicaid and the other 151,000 could have bought a plan on Healthcare.gov -- many with a subsidy to help pay for it, according to Kaiser.

Despite huge national cuts to programs that fund in-person helpers, Kentucky still has application assisters, formerly called Kynectors, in every county who can offer in-person help for free. Here's a short primer of what people need to know to sign up for insurance under the Patient Protection and Affordable Care Act.

What is open enrollment and when is the deadline to enroll?

Open enrollment is a set period of time when people can buy health insurance through the federal marketplace. Open enrollment on Healthcare.gov for 2018 ends Dec. 15. After Dec. 15, you can only sign up for a plan under special circumstances. Coverage for these plans takes effect on Jan. 1, 2018.

But don't plan on shopping on Sunday mornings. Healthcare.gov is shut down for maintenance from midnight to noon Eastern Time  on every Sunday, except for Dec. 10.

Am I required to have health insurance? The Affordable Care Act requires everyone to have health insurance or pay a penalty. And despite all the talk about whether this requirement, called the individual mandate, will remain the law, it still is.

What is the penalty to not have health insurance? The penalty 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.

The Kaiser Family Foundation has encouraged those who are uninsured to look into the cost of a plan because they could pay less in premiums than they would owe as an individual tax penalty for lacking coverage.

How do I enroll? Enrollment is through Healthcare.gov. This website will walk you through your options, including whether you will qualify for a subsidy or not. New users will have to create a user account and complete an online application. Current policyholders will have immediate access to the site's shopping tool. Before you get started, make sure you have all of your tax records and personal information with you. There is also a place on Healthcare.gov to preview 2018 plans and get estimated prices before you log in. Click here.

But can't I just automatically be re-enrolled? If you are one of the 80,000 Kentuckians who already have a plan through the federal exchange, you will be automatically re-enrolled into the most similar plan available. But health experts say make sure you are happy with your plan, because you won't be able to change it in January, as in the past. They also advise that you compare plans and costs, since they have changed since last year.

What is a tax credit? People earning between 100 percent and 400 percent of the federal poverty line will qualify for federal tax credits to help them pay their monthly premiums on plans purchased through Healthcare.gov. The smaller your income, the larger your tax credit. Most people who qualify for a tax credit will find that the cost of insurance in 2018 will be about the same, according to the state's health agency.

What is a cost-sharing reduction? And didn't President Trump end them? Cost sharing reductions are payments that reimbursed insurers for making plans more affordable for people who earn between 100 percent and 250 percent of the federal poverty level.

President Trump did stop these payments, but the two companies offering plans in Kentucky had prepared for this circumstance by increasing their premiums. And because the tax credit that helps pay premiums is based on the average cost of "silver" plans, those who qualify for assistance will get a larger subsidy.

In fact, some people's subsidy will be large enough for them to qualify for a no-cost or low-cost bronze plan, but health experts warn that many of these bronze plans come with very high deductibles or large yearly out-of-pocket costs.

Still, not everyone will benefit from this change. For example, those who make too much money to qualify for a subsidy will likely have to pay more for their plans than in previous years.

What should I do if I make too much money to qualify for any help? Health advocates are encouraging the 20 percent of Kentuckians who don't qualify for any help to look at plans off the exchange, as they could be less expensive.

Kentucky Department of Insurance map shows Anthem
counties in blue, CareSource in pink
Who is offering plans in my area? In Kentucky, Anthem Inc. is offering plans in 59 counties and CareSource is in the other 61.

Where can I get help? Assisters are avialable in every Kentucky county to help people sign up for coverage, and their services are free. There are also sign-up events throughout the state.

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 858 855-459-6328 and the Healthcare.gov customer center at 800-318-2596, which is available 24 hours a day, seven days a week.

What's the takeaway? Advocates say: Sign up early, make sure you compare costs and plans and make an early appointment with your application assister. State officials remind Kentuckians to pay attention to their mail, text messages, phone calls and email about open enrollment, because that is how the state is spreading the word about open enrollment this year.