Tuesday, January 31, 2017

Kentucky pastor uses his experience to offer advice to caregivers

Paul Prather
(Photo from the Herald-Leader)
As a minister for more than three decades, Paul Prather has sat with more than his fair share of people who are sick or dying.

But the pastor of Bethesda Church near Mount Sterling says nothing prepared him for the experience of taking care of his wife Renee as she struggled with cancer from 2000 to 2005.

"Caregiving is the hardest thing I’ve ever done. Nothing else comes close. Unless you’ve held that job, you have no idea how you’d fare," Prather wrote in his Sunday column in the Lexington Herald-Leader.

About 40 million Americans are caregivers, most of them unpaid, Prather notes. An American Association of Retired Persons study from 2015 estimates the economic impact of caregivers' work at $470 billion annually.

Prather used his own experiences, as well as a New York Times article by Dr. Dhruv Khullar and a Herald-Leader column by Robin Hamon, to offer advice to caregivers:

"You are not the only one. ... You’re one of 40 million." Whatever you're feeling is normal. He notes insight that a counselor once gave him: Emotions are neither good nor bad; they just are. Sometimes emotions jump from rage to fear to grief to numbness and everything in between, and that's OK, he says.

Don't beat yourself up. "You must be pretty decent or you wouldn’t be sacrificing your life for someone else," Prather writes. "Quit berating yourself for your shortcomings. Be merciful to yourself. Do your best on any given day, and leave it at that."

Remember to take care of yourself. Prather encourages caregivers to arrange for a sitter once or twice a week in order to have some time away. He also encourages healthy eating and exercise.

Ask for help. He suggests asking doctors for tips and seeking out information from books and websites.

Vent your frustrations. "You might not be able to talk candidly to the person you’re taking care of. But you might have a trusted sibling, friend, minister or adult child to whom you can speak honestly and safely," Prather writes.

Keep it in perspective. It's important to remember that this tough situation won't last forever, he says.

Prather also offers advice to those who know someone who is caring for a loved one:

"Look for the cracks," he notes. "When the sick person isn't within earshot, ask the caregiver is she's struggling."

Ask specifically what help is needed, but don't impose your agenda. Prather says most caregivers don't want to impose and will likely say, "Nothing," when asked what they need. Be specific with your questions, such as, "Would it help if I brought you a meal?" He warns, however, not to push what you think is needed onto the caregiver. Don't simply announce your plans to bring over a meal without asking.

Also, withhold judgment. "Never judge a caregiver for how she’s handling the situation," Prather writes. "Is she surly? Has she lost her faith? Is she praying that Mama will just go on and flipping die, like, today? Don’t delude yourself that you’d do better. God might let you find out."
Be a source of encouragement. Prather says that caregivers need to hear that they are doing a good job and that their work is noticed. Offer support and reassurance; it just might help him or her get through a rough day.

Caregivers can find additional resources through AARP here.

1/4 of Kentucky adults, 2/5 of those 18-45, have used e-cigs

By Melissa Patrick
Kentucky Health News

One in four Kentucky adults have ever tried electronic cigarettes, with the largest percentage of those reporting use between the ages of 18 and 45, according to the latest Kentucky Health Issues Poll.

The poll, taken Sept. 11 to Oct. 19, found that almost 40 percent of Kentuckians 18-45 had tried e-cigarettes, compared to 23 percent between 46 and 64 and only 6 percent of those 65 and older.

E-cigs are battery-powered devices that deliver nicotine through a vapor by heating a solution of propylene glycol or vegetable glycerin, flavoring and other additives. The use of such products is commonly called "vaping."

Vaping more than doubled among Americans 18 and 24 from 2013 to 2014, the latest data available, according to a December report from the Office of the Surgeon General, its first on e-cigs, which it called a "major public health concern." It said the brains of youth and young adults are more vulnerable to the negative effects of nicotine exposure, including addiction, reduced impulse control, deficits in attention and learning and mood disorders.

"Research suggests that e-cigs may be a gateway to using other forms of tobacco, and they can be just as harmful," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. "They expose users to toxic chemicals, including nicotine, which long has been proven to be addictive and responsible for a wide range of health issues. E-cigs are simply not a safe alternative to smoking, especially for young adults and nonsmokers."

The poll found that e-cig use was highest among current smokers, at 61 percent. Seven percent of lifetime nonsmokers and 21 percent of previous smokers reported they had ever tried them.

It also found that e-cig use was 74 percent higher in Kentuckians with lower incomes, with 33 percent of those at or below 200 percent of the federal poverty level saying they had ever used them, compared to 19 percent of those above this level. Cigarette smoking is also higher among lower-income Kentuckians.

The poll also asked about the safety of e-cigs compared to tobacco cigarettes and found that 45 percent of Kentucky adults thought there was no difference; 29 percent thought they were safer; 19 percent thought they were less safe and 7 percent didn't know.

Advocates for e-cigs claim they are a way for smokers who don't plan to quit to smoke in "smoke-free environments," that they are safer because they have fewer chemicals and carcinogens in them and that they can help smokers quit, but this claim has not been proven.

"In our product you have nicotine or no nicotine, PEG, and some flavoring. In cigarettes you have nicotine, PEG, and 4,000 chemicals and 43 carcinogens," CraigYoungblood, president of the InLife e-cig company, which makes no health claims, told WebMD. "There are 45 to 50 million people already addicted to nicotine. Should they have the choice to satisfy their addiction by other means? ... I am a proponent of harm reduction. People have rights and choices and should be allowed to make them."

But the U.S. Food and Drug Administration, along with many health experts, say there hasn't been enough research done on the long-term health effects of these products to determine their safety and that research, to date, does not support that they help people quit.

The Kentucky Center for Smoke-free Policy says e-cigs have known carcinogens in them, including nitrosamines and formaldehyde. It also notes in its e-cig fact sheet that the lack of regulation on these products hinders research about safety and efficacy because the products keep changing. The FDA is working on regulation requirements for them.

The health foundation's news release about the poll notes that the number of Kentuckians who have ever tried e-cigs remains statistically unchanged from the last time the poll asked the question, in 2014.

The poll was funded by the foundation and Interact for Health, a Cincinnati-area foundation. It was conducted by the Institute for Policy Research at the University of Cincinnati. It surveyed a random sample of 1,580 Kentucky adults via landlines and cell phones. The margin of error for results involving the whole sample is plus or minus 2.5 percentage points, and larger for smaller samples.

Saturday, January 28, 2017

Republican senators scale back statewide smoking-ban efforts to schools, where local officials 'don't want to be tobacco police'

Two Republican state senators who couldn't make progress toward a statewide smoke-free law are shooting for a lesser goal: a ban on use of tobacco products on public school property or at any school-sponsored activity.

“It’s the first time to be presented to the legislature, but we are optimistic that it will become law,” Sen. Ralph Alvarado, a Winchester physician, told the Lexington Herald-Leader. His co-sponsor is Sen. Julie Raque Adams of Louisville, chair of the Senate Health and Welfare Committee.

Alvarado told reporter Jack Brammer that he still prefers a statewide ban on smoking in workplaces, but doubts it can pass. Gov. Matt Bevin has said smoking bans should be a local issue, but hasn't addressed the idea of a statewide school ban. His office "and the Kentucky Education Association did not respond to requests for comments on Alvarado’s bill," Brammer reports. Many teachers smoke.

Senate Bill 78 "would prohibit use of tobacco products by students, school employees and visitors in schools and school vehicles and at school-sponsored activities, beginning no later than the 2018-19 school year," Brammer writes. "It also would require that signs be posted at schools, declaring them smoke-free areas."

Kentucky has the third highest youth smoking rate in the nation, with 17 percent of its high school students smoking. An estimated 3,200 of Kentucky's youth under the age of 18 will become daily smokers, according to Erica Palmer Smith, government relations director for the American Cancer Society in Lexington.

“This is an important step in reducing our highest-in-the-nation youth smoking rate of 16.9 percent,” Palmer Smith told Brammer. “Everyone has the right to a healthy smoke-free area. That certainly should be the case in our schools.”

Status as of August 2016; additional districts may have acted since
About 70 of Kentucky’s 173 school districts already ban tobacco products on school property, and all limit smoking, but the policy varies from district to district, according to Brad Hughes, a spokesman for the Kentucky School Boards Association. "For example, he said, a district might not allow use of tobacco products on school property but might not enforce the policy at an outside football game," Brammer reports. "Alvarado said his bill would ban tobacco use at all school events, but he will leave it up to school boards to set the penalties. . . . His initial bill outlined punishments for violating the measure, ranging from suspensions and expulsions to a public offense action."

The School Boards Association hasn't taken a position on the bill, but Hughes told Brammer, “Some superintendents have said they do not want to be tobacco police.”

Alvarado said, “Some school officials got heartburn over my original bill. They want local control by school boards as much as possible. I’ll negotiate with them on that, but we will police every school district. The goal is to see the reduction of the youth smoking rate in Kentucky. Most people who smoke start in their teen years because of peer pressure. They dramatically shorten their lifespan.”

Tom Shelton, executive director of the Kentucky Association of School Superintendents, said his group is “working with the sponsor currently and continuing to review the bill with the proposed changes to determine our level of support.”

Brammer reports, "The proposal has the strong support of the Kentucky Chamber of Commerce," quoting Ashli Watts, the lobby's vice president of public affairs: “We very much wanted a smoke-free Kentucky law, but if we can’t get that, making tobacco products off-limits on school property is a good step.”

And what about the tobacco industry? "Altria Group Inc., one of the world’s largest producers and marketers of tobacco and the parent company of Philip Morris USA, is 'monitoring' Alvarado’s bill and does not advocate youth smoking, spokesman David Sutton said," Brammer reports, quoting him: “Our view is that kids should not smoke or use tobacco products. As manufacturers of products intended for adults, Altria’s tobacco companies have an important role to play in preventing underage tobacco use. We agree that there are places where smoking should not be permitted, such as schools and day-care facilities. We also support restrictions on the use of e-cigarettes in schools and other places meant for children.”

Is sugar our nutritional enemy? New book claims it is

For about a decade as the century started, more and more Americans appeared to obey the U.S. Department of Agriculture's advice to eat less sugar.

But that trend of improvement has leveled off, according to statistics released Thursday by the federal Centers for Disease Control and Prevention. The data show that about half of American adults drink at least one sugar-sweetened beverage daily and the average adult consumes about 150 calories from sodas or other sugary drinks each day.

Gary Taubes
(Photo from Twitter)
That's a big problem, says Gary Taubes, author of The Case Against Sugar. The book points to sugar to explain why two-thirds of American adults are overweight or obese, one in seven is diabetic and about one in five will die from cancer, Jere Downs writes for The Courier-Journal.

The book makes sugar the villain in "metabolic syndrome," a term coined by medical researchers as early as 1987. Metabolic syndrome is the name for a group of risk factors that raises a person's risk for heart disease and other health problems, such as diabetes and stroke, according to the National Institutes of Health. Risk factors are traits, conditions, or habits that increase the likelihood of developing a disease.
Taubes's book points to sugar as the culprit
behind obesity, diabetes, and other lifestyle-
related diseases. (Photo via garytaubes.com)

"If you are overweight with a thickening middle and especially if you are approaching middle age or older, chances are good your body is wrestling with the effects of prolonged exposure to too much sugar," Downs notes.

The body manufactures insulin, a hormone that unlocks sugar's energy at the cellular level, in response to consuming sugar. Insulin can be elevated in the blood for years before the onset of Type 2 diabetes, as the pancreas produces more of the hormone to cope with the excess sugar. Even if the pancreas remains strong and diabetes does not develop, elevated insulin turns up blood pressure and levels of triglycerides, Downs writes. Such disturbances create and aggravate inflammation and hardening of the arteries.

Taubes's book, like others before it, attempts to dispel the myth that all calories are created equal, whether they come from candy bars or carrots. Straight sugar and highly refined carbohydrates, like white bread, trigger metabolic syndrome, which tells the body's cells to hoard fat, which in turn keeps a person overweight and sick, Downs notes.

"Remove the sugar and the insulin resistance improves, and weight is lost," Taubes told Downs.

However, there has been no definitive proof of sugar's role in metabolic syndrome, obesity, diabetes, and other illnesses and it is not likely to come soon. There are only a handful of small, limited clinical trials underway exploring sugar’s direct role in metabolic disease in the U.S., Taubes told Downs. Long-term lifestyle studies are expensive and face opposition from the sugar industry and other lobbies.

As far back as 1977, some Department of Agriculture researchers were so convinced of sugar's role in diabetes and heart disease that they called for Americans to reduce consumption by 60 percent, Downs writes. The average American today consumes 100 to 130 pounds of sugar a year; the estimates vary with the source of information.

In an effort to help combat the problem, new food labels emphasizing "added sugar" in packaged products are supposed to become mandatory on July 26. Whether the Food and Drug Administration will continue the Obama-era mandate under the new Trump administration is unclear.
Percentage of adults 20 and older who consumed sugary beverages on a given day, 2011-14 (Source: CDC)

Study says older adults with arthritis need 45 minutes of moderate activity per week, much less than federal guidelines recommend

Daily Mail photo
Older adults with arthritis need 45 minutes of "moderate activity" a week to maintain functional independence, a study has concluded.

That's about one-third the amount called for by federal guidelines, which say people need 150 minutes of moderate activity per week. Only one in 10 older Americans with arthritis in their knees meet that guideline, says the news release from Northwestern University, where the research was conducted.

“Even a little activity is better than none,” Dorothy Dunlop, the study's lead author, said in the release. “For those older people suffering from arthritis who are minimally active, a 45-minute minimum might feel more realistic.” Researchers said more than 20 minutes of exercise a day is "daunting" for people as they age, especially with arthritis.

The study found that approximately one-third of people in the study improved or had higher function after two years of increased exercise, and those who had at least 45 minutes of moderate activity, like brisk walking, had the best results: 80 percent of them were more likely to improve or sustain a high level of functioning over two years, compared to those who did less.

The study, published online in the journal Arthritis Care & Research, used movement-monitoring equipment to measure the physical activity of 1,600 adults who had pain, aching or stiffness in their bones, knees or feet.

The federal guidelines say 150 minutes a week of moderate activity, in sessions last at least 10 minutes, is good for cardiovascular health. This study found that if the goal is to maintain functionality, the 45 suggested minutes of moderate activity could be spread out and did not have to be done in 10-minute sessions.

“We’re looking for an older population who can be functionally independent,” Dunlop said. “And we were interested in seeing what kind of physical activity might be beneficial to promote good function down the road. We found moderate-intensity activity rather than light activity, such as pushing a grocery cart, to be more valuable to promote future function.”

Friday, January 27, 2017

New long-acting treatment for opioid-use disorders, tested at UK, is one step closer to submission for FDA approval

Clinical trials of a long-acting therapeutic treatment to treat moderate to severe opioid-use disorders were shown to be effective, making the treatment a good contender for submission to the Food and Drug Administration for approval, according to a University of Kentucky news release.

Dr. Michelle Lofwall, holding
implantable medication to treat
opioid-use disorder. (UK photo)
The trials, led by researchers at UK's Center on Drug and Alcohol Research, compared the performance of long-acting weekly and monthly buprenorphine therapy, called CAM2038, to the current standard of care, a daily dose of buprenorphine/naloxone, or Suboxone.

Suboxone is a "medication-assisted treatment" for people addicted to heroin or other opiates that acts by blocking the effects of opiates while relieving the symptoms of opiate withdrawal, but it too can be abused.

The trial established that CAM2038 was considered "non-inferior" to the current daily treatment, but a "key secondary outcome" was that the drug was "superior" to current standards of treatment because it couldn't be used illegally, says the release.

“If approved, the CAM2038 weekly and monthly injectable buprenorphine medications can improve how we treat opioid addiction and decrease the stigma associated with the medication that is in large part due to concerns about non-adherence and diversion,” Dr. Michelle Lofwall, lead researcher, said in the release.

The news release said the weekly injection would be appropriate for induction and initial stabilization of the patient, and the monthly injection would be conducive for stabilized patients. Together, they would allow for "flexible and individualized dosing that is critical for optimal patient outcomes and recovery from a deadly disease."

Lofwall said, “Together with the six-month buprenorphine implant, these new long-acting medication delivery systems would allow us to administer a proven medication to the patients directly, ensuring adherence, leading to improved medication efficacy as demonstrated in this trial as well as avoiding the potential for missed or stolen doses, diversion or accidental pediatric exposure, which are significant public health concerns.”

Opioid overdoses cause more than 30,000 deaths every year, and 2.6 million Americans suffer from an opioid-use disorder. Stateline reported in March that Kentucky had the fourth-highest rate of painkiller prescriptions, at about 130 for every 100 people. As of May 2016, Kentucky had 1,248 overdose deaths, up from 1,071 in 2014.

Lofwall, who sees patients struggles with opioid-use disorders in clinical practice, stressed the need for progressive and practical therapies to treat opioid addiction, says the release.

The therapy was developed by Braeburn Pharmaceuticals and Camurus.

Former Gov. Steve Beshear warns Republicans that Americans won't respond well to having Obamacare coverage taken away

By Melissa Patrick
Kentucky Health News

Former Gov. Steve Beshear told a national TV audience that Republicans have done nothing about replacing Obamacare except talk about it, and said they should remember that Americans will react politically if their coverage is "yanked away."

"The insurers know, just like I know, that all they've ever given 10 minutes of thought to is repealing. They haven't given 10 minutes thought to replacing," Beshear told Craig Melvin of MSNBC. "They are like the dog that has caught the car, now they don't know what to do. All they know is that they've got to do something. And boy, are they scrambling."

Beshear, who embraced Obamacare as governor, was on the liberal-leaning channel to reply to President Donald Trump's address to congressional Republicans at their annual retreat in Philadelphia.

Trump commented that he had considered doing nothing about Obamacare, saying it would eventually "explode" and cause Democrats to beg for action, but "We have to take care of the American people immediately. So we can't wait."

Asked about that, Beshear said, "If it wasn't so serious, it would be laughable," adding that the ACA "for the first time" is working to provide health insurance to every American,  and if Republicans can come up with something better, "That would be wonderful."

Republicans haven't yet agreed on how to replace the Patient Protection and Affordable Care Act. Trump has said he wants to provide coverage for everyone and cover pre-existing conditions, but also supports changing Medicaid into a block-grant program, which critics say would erode coverage.

Beshear pointed out that 20 million Americans, including 500,000 Kentuckians, have benefited from the reform law, and "most of whom like what they have."

"But every plan that they are talking about right now is really just going back to the way things were," he said, adding later, "Everything that they are talking about so far is basically going to take that health care coverage away from all of those people. And that's unconscionable."

Melvin asked Beshear what he thought about a proposal by Sens. Bill Cassidy, R-La., and Susan Collins, R-Maine, that would allow states to opt in or opt out of Obamacare and the Medicaid expansion.

Beshear said, "Well, if you look at how the ACA works, you have to have that marketplace out there that has got to include everybody. So, dividing it up and saying, 'Oh, do it if you want to' . . . they know what will happen, they know that no insurers will participate on that kind of basis."

Because the law requires insurance companies to cover everyone, regardless of pre-existing conditions, and no longer allows them to set yearly or lifetime limits on coverage, companies must have a large enrollment with a large portion of healthy people who don't use many services in order to cover their costs.

Beshear wrapped up with a warning to Republicans about the possible political repercussions of taking away people's health insurance: "There are 22 million Americans out there who are going to look at them and make sure that they continue to have as good of coverage as they have right now, and if they think that politically they can get away with yanking that away, I think they've got another thing coming."

Thursday, January 26, 2017

Republicans want to block-grant Medicaid but can't agree on how

Most Republican lawmakers and President Donald Trump support a plan to turn Medicaid into a block-grant program, which would limit spending and give each state a set amount of money each year to care for its poor and disabled citizens largely in the way it sees fit, but they remain divided on just how to do it, Burgess Everett, Rachael Bade and Rachana Pradhan report for Politico.

One of the Republicans' challenges is that Trump has said he wants to keep covered the roughly 11 million people who gained coverage under the Patient Protection and Affordable Care Act's Medicaid expansion program, including 440,000 in Kentucky, while also supporting block grants.

These two ideas are "fundamentally at odds with each other because block grants are widely viewed as likely to result in sweeping cuts in government-subsidized health insurance for the poor," which is making it hard for lawmakers to "coalesce around a plan," Politico reports. In total, Medicaid covers roughly 70 million Americans.

Sen. Steve Daines, R-Mont., whose state expanded Medicaid under Obamacare, told Politico that he wants to make sure his constituents keep their coverage: “I’m not seeing any proposal or discussion around a replacement that doesn’t address the fact that we’ve got to take care of these folks that have expanded Medicaid."

But House Budget Vice Chairman Todd Rokita, R-Ind., a strong advocate of block grants, said: “Medicaid is among the top three drivers of our debt. It’s unfair for the citizens of tomorrow to bear the burden through our debt load for the health care of today’s poor, and it’s especially not fair for them to pay for [able-bodied adults] who otherwise should be making their own way.”

But Republicans remain divided on whether to support fixed-rate block grants, which would cause "steep cuts to the program" or one that provides funding based on the number of people who qualify for it, rather than a fixed cap, often called "per beneficiary" or "per capita" payments, Politico reports.

Sen. Bill Cassidy, R-La., who supports the per-beneficiary plan, told Politico that straight block grants don't account for demographic or population changes or variances in health-care costs from state to state.

Rodika, a strong conservative, supports the fixed grants because "limiting a resource, like block grants do, always increases innovation and efficiency," adding that the per-beneficiary approach would be expensive and keep the federal government too involved the program.

House Speaker Paul Ryan's “Better Way” agenda last year proposed that states be allowed to choose which option they prefer.

Critics, especially Democrats, say block grants would put coverage for millions of low-income people at risk. "They’re unlikely to support either plan," Politico writes.

“I can’t conceive of any way in which a block grant would not put vulnerable people at risk,” Sen. Ron Wyden, D-Ore., told Politico. Republicans want, he said, “an ideological trophy — the repeal of [Obamacare] — and then maybe down the road we’ll talk about poor people.”

Despite their differences in opinion, Republicans are working to find a way to include Medicaid reforms into the fast-track Obamacare repeal bill, which is expected to pass both chambers in March or April. If they can figure this out, they won't need Democratic help, but if they can't, they will need at least eight Democrats to get the 60 needed votes in the Senate, which is "likely to prove impossible," Politico reports.

Medicaid expansion had more impact in rural areas, study says

Medicaid expansion under the Affordable Care Act greatly increased access to health care for Americans, especially in rural areas, says an Indiana University study published in The Journal of Rural Health. Researchers, who used data from the Census Bureau's American Community Survey from 2011-15, found that expansion "increased the probability of Medicaid coverage for targeted populations in rural and urban areas, with a significantly greater increase in rural areas, but some of these gains were offset by reductions in individual purchased insurance among rural populations."

Medicaid covered almost 636,000 adult Kentuckians in the second quarter of this year, with the great majority of enrollees covered under Medicaid expansion, and almost half of them young adults, according to a report done for the Foundation for a Healthy Kentucky.

The report found that 493,199, or 78 percent, of the 635,747 adult Kentuckians covered by Medicaid were covered by the Patient Protection and Affordable Care Act's expansion of the program to those who earn up to 138 percent of the federal poverty level. The remaining 142,548 were covered by traditional Medicaid.

IU researchers found that Medicaid expansion increased the probability that low-income people would have health coverage, and it increased Medicaid coverage more in rural areas than in cities. There was some evidence that in rural areas, the expansion was accompanied by some shifting from individually purchased insurance to Medicaid.

The study suggested "that rural childless adults, compared to urban childless adults, experienced a 1.9-percentage-point larger increase in the probability of having Medicaid as a result of the expansion," says the study. "Rural childless adults experienced a 1.5-percentage-point larger decline in the probability of having individual purchased insurance. (Indiana University graphic)

Wednesday, January 25, 2017

Bevin asks Congress to get rid of Obamacare and, if Medicaid expansion continues, limit it to those who are in poverty

By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin has taken a stronger stance against Obamacare than his fellow Republican governors, urging Congress to repeal it "in its entirety" and saying that if Medicaid expansion under the reform law must continue, then only those under the federal poverty line (FPL) should get it.

Gov. Matt Bevin
“Medicaid was always intended to be a poverty program, and anyone above FPL should be eligible for gradually decreasing subsidies to the extent Congress decides to keep premium subsidies and cost-sharing reductions," Bevin wrote House Republicans in a letter dated Jan. 6.

The FPL is $11,880 for an individual and $24,300 for a family of four. The Medicaid expansion is for those who earn up to 138 percent of the FPL: $16,394 for an individual and $33,534 for a family of four. Before the expansion of Medicaid, only people in households with incomes of 69 percent or less of the FPL were eligible for Medicaid in Kentucky.

Kentucky is one of the states that has benefited most from the expansion, with its uninsured rate dropping by more than half from 2013 to 2015, from 14.3 percent to 6 percent respectively. The state has about 1.3 million Kentuckians on Medicaid, with about 430,000 qualifying through the expansion.

Bevin said the expansion is "unaffordable and harmful, threatening to eat up the state’s budget and undermine Kentucky’s ability to provide care for the poorest residents." The federal government paid the full expansion cost through last year; this year states are paying 5 percent of it, an amount that would rise in annual steps to the law's limit of 10 percent if that provision is not repealed. Bevin estimates Kentucky's cost at $1.2 billion over the next five years.

"We need a more sustainable solution, focused less on mere enrollment and more on actually improving health outcomes," Bevin wrote. "At a minimum, the Medicaid expansion population should be converted to a block grant program, possibly encompassing the Children's Health Insurance Program "in order to promote family coverage across those who are at or below the poverty line."

As a candidate in the 2015 primary, Bevin pledged to end the expansion and other elements of Obamacare, but backed off that as the Republican nominee, and as governor has only asked for a waiver from federal rules that would allow the state to charge income-based premiums and require able-bodied recipients who aren't primary caregivers to work or prepare for work. The Lexington Herald-Leader said in an editorial that "emails to Bevin's spokespeople, asking whether he still supports his Medicaid plan . . . or again wants to repeal the expansion produced no replies Wednesday," Jan. 25.

Bevin's comments contrasted with those of other GOP governors, such as Ohio's John Kasich, who said Congress should preserve Medicaid expansion, as well as several consumer protections in the law, Deirdre Shesgreen reports for USA Today. Bevin also asked for "maximum flexibility" for states to create their own plans.

Several governors urged simultaneous repeal and replacement of the law, but Bevin did not, Shesgreen notes. The letters came in response to House Majority Leader Kevin McCarthy's request for governors to offer input about the ACA and their suggestions for replacement.

Eastern Kentucky has some of the nation's highest cancer mortality rates, study finds

Eastern Kentucky has some of the highest cancer rates in the U.S., says a study by researchers at the Institute for Health Metrics and Evaluation at the University of Washington published in the Journal of the American Medical Association. While cancer mortality rates declined 20.1 percent from 1980-2014, death rates in poor counties with high rates of obesity and smoking, such as Eastern Kentucky, rose by about 50 percent. (UW map: Mortality rate for cancer and other neoplasms for both sexes, by county, in 2014)
Researchers used data from the National Center for Health Statistics, the Census Bureau and the Human Mortality Database from 1980 to 2014 for 29 cancers. During that time, there were 19.5 million cancer deaths in the U.S.  From 1980 to 2014, the cancer mortality rate declined from 240.2 to 192 per 100,000.

"In counties with the highest 2014 cancer death rates, six of the top 10 were in Eastern Kentucky," Lindsey Tanner reports for The Associated Press. "Six of the 10 lowest rates were in the Colorado Rockies. For lung cancer deaths, four of the five counties with the highest 2014 rates were in Eastern Kentucky, with rates up to 80 percent higher than in 1980." (Map: Percent change in mortality rates for cancer and other neoplasms, 1980-2014)

"Three of the five counties with the lowest 2014 rates were in the Colorado Rockies, where rates dropped by up to 60 percent," Tanner writes. "Death rates for breast and colorectal cancers increased in Madison County, Mississippi, and in 2014 were at least five times higher there than in Summit County, Colorado, where the rates fell."

Researchers found that "for many cancers, there were distinct clusters of counties with especially high mortality. Clusters of breast cancer were present in the Southern belt and along the Mississippi River, while liver cancer was high along the Texas-Mexico border, and clusters of kidney cancer were observed in North and South Dakota and counties in West Virginia, Ohio, Indiana, Louisiana, Oklahoma, Texas, Alaska and Illinois."

Tuesday, January 24, 2017

Sedentary older women who don't exercise are 'biologically older' than active women, study of their chromosomes shows

Photo from Center for Advancing Health
By Melissa Patrick
Kentucky Health News

A study has found that older women who sit for more than 10 hours a day and also have low physical activity have "biologically older" cells than those who are less sedentary, suggesting the importance of exercise all through life.

And Kentucky's seniors need to get up and take notice, because they are ranked third in the nation for physical inactivity, according to America's Health Rankings.

The researchers found that older women who have less than 40 minutes of moderate-to-vigorous physical activity per day and are sedentary for more than 10 hours a day are biologically eight years older than women in the study who were more active. Future studies will examine how exercise relates to biological age in younger populations and in men, says a news release about the study.

“Our study found cells age faster with a sedentary lifestyle. Chronological age doesn’t always match biological age,” said Aladdin Shadyab of the University of California San Diego Health Sciences, lead author of the study report.

Researchers determined the biological age of the older women by measuring the tiny caps found on the ends of their DNA strands, called telomeres, which protect chromosomes from deterioration and progressively shorten with age. The sedentary women in the study had shorter telomeres.

"As a cell ages, its telomeres naturally shorten and fray, but health and lifestyle factors, such as obesity and smoking, may accelerate that process. Shortened telomeres are associated with cardiovascular disease, diabetes and major cancers," says the release.

About two out of every seven Kentucky seniors are obese, almost 28 percent, and 12.4 percent of Kentucky seniors smoke, putting the state in the top five. The national average is 8.8 percent. Kentucky also has some of the highest rates of heart disease, diabetes and cancer in the nation.

The study, published online in the American Journal of Epidemiology, included nearly 1,500 women, ages 64 to 95. It was part of the larger Women's Health Initiative, a national, longitudinal study that investigates the causes of chronic disease in older women. Data was gathered from questionnaires and a device worn for seven days that tracked their activity.

“We found that women who sat longer did not have shorter telomere length if they exercised for at least 30 minutes a day, the national recommended guideline,” Shadyab said. “Discussions about the benefits of exercise should start when we are young, and physical activity should continue to be part of our daily lives as we get older, even at 80 years old.”

Monday, January 23, 2017

Judge blocks Humana-Aetna merger; appeal in doubt; Aetna's 'leverage' attempt jeopardized Obamacare exchanges

A federal judge blocked Aetna Inc.'s bid to buy Louisville-based Humana Inc. on grounds that it would reduce competition for consumers in Medicare Advantage markets, because it would ultimately affect the price of coverage. Medicare Advantage plans are privately run versions of Medicare for people who are over age 65 or disabled.

"In this case, the government alleged that the merger of Aetna and Humana would be likely to substantially lessen competition in markets for individual Medicare Advantage plans and health insurance sold on the public exchanges," Judge John Bates of the District of Columbia wrote in his 158-page ruling. "After a 13-day trial, and based on careful consideration of the law, evidence, and arguments, the court mostly agrees."

Tom Murphy of the Associated Press writes that Bates concluded "that federal regulation would probably be "insufficient to prevent the merged firm from raising prices or reducing benefits," and neither new competitors nor an Aetna plan to sell some of the combined company's business to another insurer, Molina Healthcare Inc., would be enough to ease competitive concerns."

Bates also concluded that Aetna had tried to "leverage" its continued participation in the Patient Protection and Affordable Care Act exchanges in exchange "for favorable treatment from DOJ regarding the proposed merger," Kevin McCoy reports for USA Today. Aetna's announcement that "it would drastically scale back" on exchange offerings not only hurt its case but "jeopardized the ACA exchanges," Shelby Livingston reports for Modern Healthcare.

Craig Garthwaite, a health economist at Northwestern University, told Livingston that Aetna's move reduced competition and choice for consumers and gave an “impression to people that the marketplaces are failing” and “that's totally inaccurate.”

Aetna's shares fell about 3 percent to $119.20 and Humana's stock finished more than 2 percent higher at $205.02 on Jan. 23, the day of the ruling.

"We're reviewing the opinion now and giving serious consideration to an appeal after putting forward a compelling case," Aetna spokesman T.J. Crawford said in a statement.

However, several analysts told the investing website Seeking Alpha that any appeal is unlikely to succeed.

The Department of Justice praised the ruling as a win for consumers.

"Today’s decision is a victory for American consumers — especially seniors and working families and individuals,” Deputy Assistant Attorney General Brent Snyder, the head of the department’s Antitrust Division, said in a statement. "Millions of consumers have benefited from competition between Aetna and Humana, and will continue to benefit, because of today’s decision to block this merger."

Aetna, the nation's third-largest health insurer, announced its plan in 2015 to buy Humana for $34 billion and become one of the top providers of Medicare Advantage, Murphy notes. The Justice Department sued to block the deal and won. Click here to read the decision.

The Justice Department has also filed suit to block a proposed merger between Anthem Inc. and Cigna Corp., but this case is still pending, Murphy notes.

If approved, the two deals would consolidate the nation's five largest insurers into three, a list that includes UnitedHealth Group Inc., currently the largest. Murphy notes that the insurers argued that these mergers would help them negotiate better prices with drug companies, hospitals and doctor groups, as well as allow them to spread out the cost of technology investments.

Sunday, January 22, 2017

More students eat lunch and breakfast at schools where number of 'food vulnerable' students qualifies all for free meals

Students eat breakfast (U.S. Department of Agriculture photo)
By Melissa Patrick
Kentucky Health News

A program that offers free meals to all students using federal money has increased lunch and breakfast participation at many schools in Kentucky, but may come under renewed threat in Congress.

The Community Eligibility Program, part of the 2010 Hunger-Free Kids Act, allows schools with more than 40 percent of students qualifying as "food-vulnerable" to offer free meals to every student.

The latest schools to report that the program has more students eating breakfast and lunch are Glasgow High School and the Berea Independent Schools.

Glasgow has seen a 5 percent increase in lunch participation and a 13 percent increase in breakfast participation since December 2015, Jackson French reports for the Bowling Green Daily News.

Before the school joined the Community Eligibility Program, it would provide meals to any student who wanted them even if they couldn't pay on that day, but would place a charge for the meal on the student's account to be paid later.

Principal Keith Hale told French that the program reduces financial burdens on families who struggle to pay for food and also allows students to eat healthier, because healthier foods are often costlier.

This is also the first school year that the Berea schools have participated in the program, Ricki Barker reports for the Richmond Register.

“We are serving approximately 60 more breakfasts and 80 more lunches a day compared to last year,” Supt. Mike Hogg told board members at their January meeting. He added that the school is serving about 1,000 more additional meals to students than they have in the past.

“If you are hungry, then you are not at your optimal learning potential,” Hogg said. “With the program we can feed more students and we know that those students are fed and ready to learn each day.”

This program is one that could be altered in the new Congress by Republicans who have long had issues with the 2010 law, the centerpiece of Michelle Obama's eight years as first lady.

Kentucky Health News reported in May that House Republicans had introduced a bill to raise the program's qualifying threshold to 60 percent. The bill passed out of committee but died for lack of action.

According to the liberal-leaning Center on Budget and Policy Priorities, the change could affect more than 350 Kentucky schools, because only 441 of the 804 schools currently eligible for the program would qualify under the 60 percent guideline.

Saturday, January 21, 2017

Head lice spread in Hopkins County elementary schools; committee of school staff and parents formed to tackle problem

Head lice are becoming a greater problem in elementary schools in Hopkins County, reports The Messenger, which published the numbers of cases reported at each school in the last four years and so far this year.

"A committee of parents and school personnel was recently formed to help educate and support parents who may be combating the problem," Jenny Lee Menser reports for the Madisonville newspaper. "Until now, school policy has been to send a letter home with students who are found to have nits, or lice eggs, to inform parents that their children need to be treated, as national standards only recommend sending children with live bugs home. School officials said they will now call parents to supplement the process and ensure that they are aware."

Hopkins County (Wikipedia map)
Hopkins County Public Health Director Denise Beach told the Messenger that recurring cases in some households are at least partly to blame for the recent increase. In an earlier story, Menser quoted West Broadway Elementary parent Jessica Dockrey as saying, "One mother has a child who has had it nine times since the beginning of the school year," Dockery said. "Another parent had experienced it six times."

Beach told Menser, "If it's found several times, then we do get the registered nurse at the schools involved. They may call the parent and counsel them. We'll send educational information home. We may get the family resource or school office involved. I've even called families myself and talked to them. I've also had families come here to the health department if they have a significant problem with getting rid of them. It's just a team effort. If we have someone who continually has head lice, we all just work to try and make that situation better."

"While many over-the-counter lice treatments claim to kill nits, some entomologists say there is no guarantee, and all nits must be removed from the hair," Menser reports. "Most standards recommend treating everyone in the house; bagging all stuffed animals in airtight bags for several days; laundering all bedding in the house; vacuuming all cloth surfaces -- including the insides of automobiles; removing all nits; sanitizing all hair brushes, combs and accessories; and repeating the process seven-10 days later."

Some cosmetologists recommend white vinegar combined with a few drops of tea-tree oil in a spray bottle to spray on hair, clothing and backpacks to prevent re-infestation, Menser reports. A local pharmacist recommended adding red thyme oil to shampoo and hair conditioner.

"We've had several people use red thyme oil as a preventative," Jerry Rickard told the newspaper. "If you use four drops of red thyme oil per ounce of shampoo, lice really don't like that. For instance, if you have a four-ounce bottle of shampoo, you'd use 16 drops of oil."

Entomologist Neil Brown "said over-the-counter lice shampoos will often only kill live bugs," Menser reports. "He added that lice cannot survive more than a few hours without a host. Therefore, any lice that may be inside a school will not live through the weekend and affect students."

Did Medicaid expansion make people move from non-expansion states to Kentucky? A study suggests it did not

When Kentucky expanded Medicaid and Tennessee and Virginia didn't, did that prompt some people to move from Tennessee and Virginia to Kentucky? A study suggests that it did not.

There is "little to no evidence" that Medicaid expansion under the Patient Protection and Affordable Care Act in 2014 encouraged migration to expansion states from non-expansion states in that year, says the author of a study published in the Journal of Policy Analysis and Management.

"Migration from non-expansion states to expansion states, among those who I classify as being potentially Medicaid-eligible, did not increase relative to migration in the reverse direction," University of Maryland Ph.D. student Lucas Goodman said in a JPAM interview about his study. He noted that the possibility of in-migration and additional taxpayer expense "were often cited by non-expanding states as a reason why they should not expand."

Goodman said he was surprised at his finding, because "Medicaid expenditures in 2014 for the newly-eligible population averaged about $5,500, which is a large amount relative to income for the typical newly-eligible individual. Yet, individuals were apparently not willing to migrate in order to gain access to these benefits."

He added, "The big question is whether migration effects will increase in the longer term, either as individuals in non-expansion states learn about the presence of the expansion in other states or states’ expansion/non-expansion decisions appear to be more set in stone." However, the reform law and Medicaid likely to undergo major changes under President Donald Trump and the Republican Congress.

Friday, January 20, 2017

Health boards support legislative agenda to change how public health is delivered and paid for, to make Kentucky healthier

By Melissa Patrick
Kentucky Health News

At their first-ever statewide meeting, Kentucky's local boards of health voted for their state association to adopt a legislative platform aimed at modernizing the state's public health systems in order to improve Kentucky's overall health.

The "Kentucky's Public Health 3.0" plan calls for local health departments to demonstrate measurable outcomes, a supportive framework of state laws, and secure funding for all the services the law requires them to provide. The goals match the recently launched national Public Health 3.0 initiative.

During the online meeting Jan. 12, former Pendleton County judge-executive Henry Bertram, the president of the Kentucky Association of Local Boards of Health, implored board members to support the plan as a way to improve the health of Kentuckians and to better use taxpayer dollars: "We’re not spending our money correctly.”

"It's a call to action," said Bertram, who has been a member of his local health board for 16 years. He added, “The biggest voice in Kentucky for public health is the board members. . . . And I say that because many of you are elected officials that sit on those boards of health. You're county judges, you're magistrates," and medical professionals. "You've got a voice in your community.”

Bertram went on to say that while Kentucky has some excellent local health directors, "Many of us who sit on local boards of health don’t know what our responsibilities are." He said that when he became judge-executive, he didn’t even know that he was on the health board by virtue of his office.

He said it is the responsibility of health board members to fully understand why Kentucky's health is so poor and be able to explain why change is necessary.

“We’ve got to step up; we’ve got a challenge in front of us and we’ve got to hit it head-on," he said.

The plan has also been endorsed by the Kentucky Public Health Association and the Kentucky Health Department Association.

What exactly is Public Health 3.0?

Georgia Heise, health director for the Three Rivers District Health Department in Northern Kentucky, opened the meeting by stressing that Public Health 3.0 is a "grass-roots initiative" meant to improve the health of Kentuckians, not part of "Obamacare." She said in a telephone interview that such a false perception could cause some people, including legislators, to not even listen to the proposal.

“We have to separate population health, the health of our citizens, from politics. We have to. We cannot continue to do the same old, same old thing and expect different results," said Heise, who is also the president of the National Association of County and City Health Officials.

Graphic from Kentucky Health Departments Association presentation
Heise said people must first realize that "public health is not clinical, medical care," but is grounded in prevention through population-health initiatives.

"The work that has already been done with this initiative can be explained and it can be defended and that is what we need you board of health members to help us do with our legislators," she said.

Dr. Karen DeSalvo, acting secretary for health in the U.S. Department of Health and Human Services, appeared via video recording and commended Kentucky for leading the way with this initiative. She focused her comments on the plans call for health departments to join forces with community stakeholders to address the social determinants of health, because "We know that health is more than health care. . . . Our goal is to change the conversation in this country and get every sector involved in improving health and well-being."

For example, health department officials should be included in planning and zoning meetings to make sure newly developed properties include sidewalks, said Allison Adams, director of the Buffalo Trace District Health Department and the KHDA president. Health officials should advocate for "health in all policies," she said.

Adams noted that social and economic factors, such as education, employment, income, family and social supports, and community safety, contribute to 40 percent of a typical person's health, and "none of those things happen inside the walls of the health department. . . . But it's our job to be conveners of bringing these groups that affect these health factors together and letting them know . . . decisions they make and the things they do, how that influences health and the opportunity to be healthy."

The plan also calls for public-health leaders to be the chief health strategists in their communities; encourages health departments to work toward national accreditation; and calls for increased county-level health data so they can make more informed decisions.

What state law requires each Kentucky health department to do
(Click on image to view a larger version)
At the state level, the plan calls for "enhanced and substantially modified funding" for public health. Adams said it is largely funded programmatically, but departments get "very little funding" for their statutory requirements, the things that state law requires them to do. She estimated a $40 million gap between funding and what it costs to meet the requirements.

"There’s no doubt about it, our funding needs to be modified," Adams said. "We need to figure out a way to spend $1 that affects 10 people, instead of $1 that only affects one person." But she acknowledged, "Change is never easy. There will be difficult decisions to make."

But as she described Kentucky's dismal health statistics, noting that the state ranks 45th for health, she said it's time to do something differently, because what we've been doing isn't working.

"My goal is for us across the state of Kentucky to get as angry about the fact that we are 45th in the nation as we would when our basketball teams fall out of the top 25," Adams said. "I think if we could all get angry about that, we could move mountains here in the state of Kentucky."

Thursday, January 19, 2017

Ky. still pursuing Medicaid waiver; Obamacare repeal could convert the program to block grants, giving states more flexibility

Kentucky will continue pursuing its proposed changes for the expanded Medicaid program even if Congress repeals and replaces the law that authorized the expansion, state Health Secretary Vickie Yates Brown Glisson told Ryland Barton of WFPL in Louisville.

“At this point, the governor has said to me ‘That is my number one priority, you’ve got to get this done in 2017 and have it ready to go on January 1st of 2018’,” Glisson said.

"Last year, Bevin formally asked the federal government for permission to require able-bodied Medicaid enrollees to work or volunteer up to 20 hours a week and pay a monthly fee ranging from $1 to $15 to receive benefits," Barton notes. "The plan also removes vision and dental coverage from the built-in list of benefits. Medicaid recipients would be able to earn credits to purchase vision or dental benefits by participating in volunteer work or taking a health risk assessment."

President Donald Trump and congressional Republicans have talked about converting Medicaid to a block-grant program, in which states would get a certain amount of funding based on current expenses, rather than just paying 70 percent of whatever the cost is.

Block grants typically give states more freedom to set rules for programs, and "Glisson said the state might be able to implement the waiver, or a policy similar to it," if the replacement law authorizes block grants, Barton reports.

“If we get approved, I think it answers a lot of questions that I think other states have had, a lot of things that they put in their waivers and maybe were not entirely approved,” Glisson told WFPL. “If this gets approved, yes, I think it’s really going to really set a tone, I think it’ll be a model for the rest of the country.”

Officials of the Obama administration refused to approve work requirements or fees that would be obstacles to coverage, but they never ruled on Bevin's request. Now approval appears likely because the Centers for Medicare and Medicaid Services will be run by Seema Verna, who shaped the Medicaid waiver in Indiana, on which much of Kentucky's proposal is modeled.

Wednesday, January 18, 2017

McConnell: 'If the goal was to expand Medicaid, that could have been done alone.' But he won't say what's next for it

U.S. Sen. Mitch McConnell "has a particularly thorny road" in guiding Republicans' repeal and replacement of Obamacare because of the program's success in Kentucky, David Lightman of McClatchy Newspapers writes after a 20-minute interview with the Senate majority leader.

But McConnell challenged Lightman's premise. Asked why "he would want to undo a successful program," as Lightman put it, McConnell replied, “It depends on how you define success,” and noted “higher premiums and co-payments and higher deductibles and chaos in the private health-insurance market.”

McConnell added, “If the goal was to expand Medicaid, that could have been done alone. . . . This overreach tried to turn the private health insurance market into a regulated utility.”

McConnell has declined to reveal his plans generally for health-care legislation or specifically for Medicaid, the expansion of which in Kentucky has added 440,000 people to the program and cut by more than half the number of Kentuckians without health coverage. He "will have lots more to say about this issue in the coming weeks," McConnell spokesman Robert Steurer said Jan. 10.

In state Trump won in a landslide after pledging Obamacare repeal, fewer than 1 in 5 said they feared losing coverage

By Melissa Patrick
Kentucky Health News

Fewer than one in five Kentucky adults who have health insurance were concerned about losing their coverage in the weeks after Gov. Matt Bevin proposed changes to the state's Medicaid program and Donald Trump pledged to repeal the Patient Protection and Affordable Care Act, according to the latest Kentucky Health Issues Poll.

Ninety percent of those polled Sept. 11 through Oct. 19 said they had health insurance. They were asked, "Are you concerned that you may lose your coverage within the next 12 months?"

The poll found that 80 percent weren't concerned about losing their health coverage, but responses varied with health status. Almost one-third, or 32 percent, of those who were concerned about losing their coverage said they were in fair or poor health; 11 percent of them said they were in excellent or very good health; and 20 percent said they were in good health.

"The vast majority of Kentuckians just weren't worried about having their health insurance coverage taken away, despite the debate about the potential for repealing the ACA in the months preceding the election," said former U.S. Rep. Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll. "Kentucky, like the nation, remains deeply divided on the health-care law."

Trump got 62.5 percent of Kentucky's vote. An article by Sarah Kliff and Byrd Pinkerton of Vox could help illustrate why many Kentuckians said they weren't concerned about losing their coverage. They went to Whitley County, which had a 60 percent drop in uninsured people due to the law, but is heavily Republican and gave 82 percent of its votes to Trump.

They report that "many" in Whitley County voted for Trump because they didn't believe he would "repeal a law that had done so much good for them." Those interviewed also expressed anger over increasing premiums and deductibles, fewer plan choices and a narrowing network of providers, though they had a "persistent belief that Trump would fix these problems and make Obamacare work better," with some even saying they hoped the expansion of Medicaid might include more people, "offering more of the working poor a chance at the same coverage the very poor receive."

Republicans are pursuing their promise to repeal Obamacare, with the U.S. Senate and House voting last week for a budget resolution, largely along party lines in each chamber, as the first step. Trump recently promised "insurance for everybody" but also endorsed funding Medicaid through block grants to the states and giving the states more leeway to set its rules.

The Washington Post reports that at least 18 million people would lose health insurance in the first year if Republicans repeal the ACA without a replacement plan, according to a report from the nonpartisan Congressional Budget Office. However, President-elect Trump, and others, have said they don't want to see a repeal without a replacement plan in place.

The poll also found that Kentucky adults remain divided on their opinion of the reform law, with 46 percent saying they had an unfavorable opinion of it and 40 percent saying their opinion was favorable, about the same as last year. Those figures were just outside the poll's error margin of plus or minus 2.5 percentage points.

Among the 46 percent who said the law had affected their family personally, half said it had affected them positively and half said it had affected them negatively, the same as last year.

"More than 600,000 Kentuckians have gained health coverage under the ACA, and our own research shows that it has greatly increased the use of important health measures such as cancer and dental screenings, preventive care services and substance use treatment," Chandler said. "Yet nearly half of Kentuckians continue to oppose it."

Under the law, the previous state administration expanded Medicaid to people in households earning up to 138 percent of the federal poverty line. This added about 440,000 Kentuckians, most of them in low-paying jobs that don't offer health insurance. The federal government paid the full cost through 2016, but the state is now paying 5 percent, which will rise in annual steps to the law's limit of 10 percent in 2020 unless the law is changed.

Bevin says Kentucky can't afford to pay the bill and has submitted a plan for a waiver from federal rules, to make "able-bodied adults" pay small monthly premiums depending on income and either work or volunteer to get their benefits, among other changes. It is expected to be approved.

The poll was conducted by the Institute for Policy Research at the University of Cincinnati for the foundation and Interact for Health, a Cincinnati-area health foundation. It surveyed a random sample of 1,580 Kentucky adults via landlines and cellphones.

Tuesday, January 17, 2017

Study of Ohio's Medicaid expansion: Enrollees have better health, more financial security, and say it's easier to keep or find work

By Melissa Patrick
Kentucky Health News

Ohio's Medicaid expansion enrollees say having health coverage made it easier for them to keep or find work, and most said it gave them better health and financial security.

Their experience is part of a report Ohio's legislature ordered to evaluate the impact of Gov. John Kasich's 2014 decision under federal health reform to cover those who earn up to 138 percent of the federal poverty level. Previously, only Ohioans who fell under 90 percent of the poverty line qualified for Medicaid, unless they were disabled or pregnant.

Kentucky, under then-Gov. Steve Beshear, also expanded Medicaid, from a previous threshold of 69 percent of poverty. That added 440,000 people to the program; Ohio added 702,000.

That was the main factor in reducing from 21 percent to 8 percent the share of Kentuckians without health insurance. Among low-income, working-age people, the rate dropped from 38 percent to 13 percent. The Ohio report noted that the state's uninsured rate dropped to its lowest rate ever, 14.1 percent.

Ohio's expansion enrollees "overwhelmingly reported that access to medical care had become easier since enrolling in Medicaid," with 43 percent saying they had fewer unmet health-care needs, the report said.

Group VIII is the Medicaid expansion population. Graphic is from the Ohio report.
The report also found that Medicaid expansion enrollees used hospital emergency rooms less often because they were "better integrated into the health care system." According to the report, 34 percent said they used the emergency department less often, and Medicaid claims data proved it.

Nearly half of expansion enrollees reported that their health had improved; only 3.5 percent that said their health had worsened. Just over a fourth said they had been diagnosed with at least one chronic health condition after obtaining coverage. They also showed fewer instances of high blood pressure and high cholesterol.

"Because they were able to obtain treatment for previously untreated conditions, several of the enrollees stated that they did not think they would be alive today if Medicaid expansion had not occurred," the report said.

Enrollment in Medicaid also made it easier for its participants to work and to seek work, with 75 percent of those who were unemployed but looking for work reporting that Medicaid made it easier to seek employment. And 52 percent of those who were currently employed said having Medicaid made it easier to keep working.

They also reported that having Medicaid made it easier to meet other basic needs, like food (59 percent) or paying the rent (48 percent) or to pay off other debts (44 percent). Also, the share of expansion enrollees with medical debt fell by nearly half since they enrolled in Medicaid, from 56 percent to 31 percent.

In conclusion, the report said,"These results suggest that Medicaid expansion has and will continue to improve the health of low-income Ohioans enrolled."

The assessment was independently developed and carried out by a partnership of the Ohio Colleges of Medicine Government Resource Center, The Ohio State University College of Public Health, Ohio University, and RTI International. The data in the report came from a 7,508-person telephone survey, biometric screenings, medical-records reviews, analysis of Medicaid records, and interviews with Medicaid enrollees and stakeholders.

Sunday, January 15, 2017

Health officials say flu is widespread, urge a vaccination

Photo illustration: affiniahealthcare.org
The state Department for Public Health has raised the state's influenza level from "regional" to "widespread," the highest level of flu activity. The widespread level indicates increased outbreaks or flu symptoms in at least half of the state's regions.

The flu virus can cause fever, headache, cough, sore throat, runny nose, sneezing and body aches and can be extremely contagious.

"With widespread flu activity reported in Kentucky, now is a good time to protect yourself and your family by getting a flu shot," Dr. Hiram Polk, public health commissioner, said in a news release. "We urge anyone who hasn’t received a flu vaccine, particularly those at high risk for complications related to the flu, to check with local health departments or other providers."

The federal Centers for Disease Control and Prevention recommends the flu vaccine for everyone six months of age and older. The CDC strongly encourages certain high-risk groups to get vaccination, including children age 6 months to 5 years and their caregivers, women who are or might be pregnant during flu season, people age 50 and older and their caregivers, obese people, those with chronic health problems, residents of long-term care facilities and health care workers.

Vaccinations can be given at any time during flu season, according to DPH. Flu activity levels are tracked weekly as part of the CDC's nationwide flu surveillance system.

"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," Vickie Yates Brown Glisson, secretary of the Cabinet for Health and Family Services, said in a news release.

For more information on the state's flu levels and what they mean, click here.

Supporters of Obamacare rally in Ky. and protest repeal plans

"The event was billed as a public forum on the consequences of repealing the [Patient Protection and] Affordable Care Act and Kentucky Medicaid expansion. But at times it seemed more like a political rally," Andrew Wolfson reports for The Courier-Journal. "Several hundred people turned out for the session hosted by U.S. Rep. John Yarmuth, D-Louisville, at the Louisville Central Community Center." Protests were also held in Lexington and around the nation, WKYT-TV reports.

State Rep. Attica Scott, state Sen. Morgan McGarvey and U.S.
Rep. John Yarmuth (Courier-Journal photo by Marty Pearl)
State Rep. Darryl Owens, D-Louisville, claimed President-elect Donald Trump is “hell-bent on destroying the lives of Kentuckians and Americans,” and state Rep. Jim Wayne, "another Democrat who has worked 40 years as a psychotherapist, went further, describing the soon-to-be president as 'evil' for vowing to repeal the Affordable Care Act and return to a competitive system for health care that 'didn’t maintain our country’s health'," Wolfson reports. "Yarmuth said Republicans want to dismember the law that has provided health care to 22 million Americans without offering any details on how they will replace it."

“They say they want a free market system, which sounds to me ominously like what we had before the Affordable Care Act – when insurance companies decided who lived and who died,” Yarmuth said. Wolfson notes, "Critics of the Affordable Care Act say it is too expensive and that the requirement to get coverage is an intrusion on individual liberty."

Yarmuth said he expects federal officials to approve the Medicaid waiver requested by Republican Gov. Matt Bevin, which would charge small premiums based on income and the require work, school or similar activities by able-bodied adults who aren't primary caregivers.

The future of the Medicaid expansion, and the rest of the law, are in doubt because there has been no agreement on a plan to replace the law but retain certain core elements such as coverage of pre-existing conditions, which Trump has said he wants to keep. Experts say that requires a mandate to buy insurance, a provision Republicans don't like.

"Speakers beseeched Trump and Republican leaders to replace the law immediately and to keep the features that Yarmuth said provide 'health security' for all Americans," Wolfson reports.

Drug-addicted babies more than twice as likely in Kentucky as in rest of nation, but few facilities accept addicted pregnant women

Amy Kalber of Louisville strokes her infant son, Marty Barkley,
in a family gathering. Her first two children were born addicted,
but the last two were born healthy during her recovery, described
by The Courier-Journal's Laura Ungar (C-J photo: Sam Upshaw)
A baby born in Kentucky is more than twice as likely to be addicted as a typical baby born elsewhere in the United States.

In 2013, the last year for which comparative figures are available, Kentucky had 15.1 cases of addiction per 1,000 live births; the national rate was 7.3, according to a research letter in the journal JAMA Pediatrics.

"Both were up substantially from five years earlier, and Kentucky’s rate jumped another 40 percent the following year," reports Laura Ungar of The Courier-Journal.

“We have mothers who are addicted throughout pregnancy and their addiction is more or less passed down to their babies,” researcher Joshua Brown, of the Institute for Pharmaceutical Outcomes and Policy at the University of Kentucky, told Ungar. “The trend just keeps going up and up and up.”

Addicted babies are one product of the state's issues with drugs, legal and illegal. “We’ve had one of the country’s worst prescription drug problems,” institute director Jeffrey Talbert told Ungar. “We need more treatment providers and more access to care.”

Especially for addicted mothers or mothers-to-be: "Only 30 of the 123 substance-abuse treatment facilities in Kentucky accept pregnant or post-partum women," Ungar reports. "Only eight are long-term residential programs."

"There are signs of progress," Ungar reports. "In 2015, Kentucky became one of 11 states to receive up to $3 million in federal grants to provide expanded treatment to pregnant addicts. That was in addition to $1 million in state funds for transitional care and other services that came from an appropriation in the anti-heroin bill passed that year. And on Wednesday, state officials announced they will apply for up to $10 million in federal ... funding to fight the opioid epidemic, and one of their priorities if they get it will be to help pregnant addicts."

A law co-sponsored by Senate Majority Leader Mitch McConnell of Kentucky "calls for, among other things, spreading proven practices to prevent and treat maternal opioid abuse and recommendations for treating drug-dependent infants," Ungar notes