Sunday, May 21, 2017

Ky. is a national leader in hepatitis C, but many counties at risk shun syringe exchanges that could prevent disease outbreaks

"Growing intravenous drug use by people sharing syringes to inject heroin and other substances" has helped make Kentucky a national hotbed for cases of hepatitis C, "which ultimately could mean a staggering cost to taxpayers to treat people with the disease," Bill Estep reports for the Lexington Herald-Leader.

"Giving addicts clean needles can help stem the spread of the disease, but many Kentucky counties considered at greatest risk for an outbreak have not approved such programs," Estep notes. His story has a map of syringe exchanges and the Kentucky counties that the federal Centers for Disease Control and Prevention considers most at risk for an outbreak of HIV or hepatitis C due to IV drug use. Of the 220 counties identified, Kentucky has 54, almost half its total number of counties.
Lexington Herald-Leader map
"The programs have only been legal in Kentucky since 2015, when the legislature authorized them in the face of mounting IV drug use," Estep notes. Now there are 33, nine of which are not in operation yet. They are run by local health departments with approval of the county fiscal court and the city where the exchange is located.

"Despite the documented problems, more than 30 of the counties the CDC identified as being at high risk for a disease outbreak have not set up needle-exchange programs," Estep reports. "Some local officials said they’ve faced concerns from residents of their culturally and politically conservative counties that giving needles to drug users condones or perpetuates drug abuse."

Russell County Judge-Executive Gary Robertson "said he had much the same reaction when the idea first came up but changed his mind after learning more," Estep writes. "Drug addicts will find needles and use drugs with or without a local needle-exchange program, but the program can help reduce the spread of expensive diseases, Robertson said."

Studies show that people who use exchanges are much more likely to get drug treatment, Estep notes. "Other studies have shown that exchange programs don’t encourage people to start taking drugs or increase how often users inject drugs; that they don’t increase crime; and that they help reduce the problem of drug users disposing of dirty needles improperly."

Read more here:

Read more here:

Read more here:

Read more here:
The CDC said recently "that in 2015, Kentucky was among seven states where the incidence of new hepatitis C cases was more than twice the national rate," Estep reports. "Kentucky, West Virginia and Massachusetts had the highest rates, the May 12 report said. The problem has been building for years, according to the 2017 update to the Kentucky Department for Public Health’s state health assessment. The update, released in March, said Kentucky had the highest rate of new hepatitis C infections in the nation from 2008 through 2015, the last year with available data." Kentucky also has the second highest rate of babies born to mothers with the disease, trailing only West Virginia.

Those mothers need to be identified and treated before delivery, said Dr. Ardis Hoven, an infectious disease specialist with the state health department.“We have an epidemic, and we need to continue to deal with it,” she told Estep.

Treating hepatitis C is expensive, Estep notes: "In the last full fiscal year, Kentucky’s Medicaid program spent $69.7 million on pharmacy claims to treat 833 beneficiaries, or $83,735 apiece, according to the Cabinet for Health and Family Services."

This week, Sen. Mitch McConnell can start making decisions about what Senate Republicans will put in their health bill

U.S. Sen. Mitch McConnell's role in the national health debate "will come into sharp relief this week," Burgess Everett and Jennifer Haberkorn report for Politico. "He will decide the contents of the Senate’s plan, most likely behind closed doors. And he is on the hook for getting something through a sharply divided Senate Republican Conference in the midst of an increasingly imperiled presidency."

The first shoe will drop Wednesday, when the Congressional Budget Office delivers "a highly anticipated report on the House health-care bill that is expected to show it would cause huge coverage losses," Politico notes. "That will provide a new round of ammunition to Obamacare supporters, even as it allows the Senate to truly start writing its own plan."

McConnell, who as majority leader named a 13-member working group to come up with the outlines of a bill, has been meeting with senators "without making substantive progress, according to attendees," Politico reports. "In the coming days, McConnell will have to move to break the impasse."

Sens. Lamar Alexander and Mitch McConnell (Getty Images)
The Kentuckian has given no clue to what he might do in concert with Sens. Lamar Alexander of Tennessee, Orrin Hatch of Utah and Mike Enzi of Wyoming, chairs of the key committees that will handle the bill publicly once it is drafted privately.

“Mitch right now is listening very carefully. He’s being very careful not to weigh in, thinking that this needs to come from the membership,” an unnamed GOP senator told Politico. “He’s not trying to force a particular point of view.”

"Only the faintest outline of a plan is taking shape," Politico reports. "Senators are working to make the House bill's tax credits more generous and to find a way to wind down Obamacare’s Medicaid expansion more slowly," instead of 2020. "The Senate is expected to repeal many Obamacare regulations but not go as far as the House did in rolling back protections for people with preexisting conditions." The House bill would give the states power to do that.

"The idea, according to several lawmakers, is that if the relatively ideologically diverse working group can agree to get behind a bill, that would get the GOP close to 50 votes," the point at which Vice President Mike Pence would break the tie in favor of Republicans. But it would be up to McConnell to get to 50, and that will be difficult.

“It’s pretty easy to put together 46 or 47,” said Sen. Roy Blunt (R-Mo.). “It’s getting to 50 that’s a challenge.” One obstacle may be Kentucky's other senator, Rand Paul, who is out of the Senate mainstream, saying the House bill didn't go far enough.

Senate Majority Whip John Cornyn of Texas said there will be a vote on the bill by late July, before the August recess, but "Some doubt that aggressive timeline," Politico reports. "Some Republican senators were privately hoping it would never reach this point. They would have preferred that the House bill fail, to spare them having to take up a measure they believe would cause too many people to lose insurance and do too little to lower premiums."

Kentucky's only Democratic member of Congress, Rep. John Yarmuth of Louisville, said recently that McConnell would not allow a health bill to come to a vote in the Senate, for fear of political repercussions in the 2018 elections. But Politico reports, "McConnell wants to have a vote on an Obamacare repeal bill, whether it passes or not, so the Senate can move on to tax reform and spending bills."

It would be unusual to bring a bill to a floor vote without a guarantee of passage, but that seems possible in this case. “We’re on a track to write a bill and vote on it,” Alexander told Politico; whether it will be successful, “I can’t say.”

Trump budget will include big cuts to Medicaid, maybe work rules

The detailed budget that the Trump administration will release Tuesday will contain big cuts to Medicaid, reflecting the approach of the health bill that House Republicans sent to the Senate this month, The Washington Post reports.

"Trump’s decision to include the Medicaid cuts is significant because it shows he is rejecting calls from a number of Senate Republicans not to reverse the expansion of Medicaid that President Barack Obama achieved as part of the [Patient Protection and] Affordable Care Act," Damian Paietta writes for the Post. "The House has voted to cut the Medicaid funding, but Senate Republicans have signaled they are likely to start from scratch."

"Trump offered a streamlined version of the budget plan in March, but it dealt only with the 30 percent of government spending that is appropriated each year," Paietta notes. "Tuesday’s budget will be more significant, because it will seek changes to entitlements — programs that are essentially on auto­pilot and don’t need annual authorization from Congress. The people describing the proposals spoke on the condition of anonymity because the budget had not been released publicly and the White House is closely guarding details."

The budget plan "also will call for giving states more flexibility to impose work requirements for people in different kinds of anti-poverty programs," Paietta reports. The story does not mention work requirements for Medicaid, but the opportunity for states to set such rules would not be a surprise, since it is in the House bill, and the proposed Medicaid plan for Kentucky includes them and was drafted by Seema Verna, the director of the Centers for Medicare and Medicaid Services.

National committee studying health impacts of surface coal mining in Central Appalachia to have first meeting in region Tuesday

A national committee studying the health impacts of surface coal mining in Central Appalachia will have its first public meeting in the region Tuesday, May 23 at Chief Logan State Park near Logan, W.Va.

The committee of the National Academies of Sciences, Engineering, and Medicine had a meeting in Washington on March 7, and has another one scheduled there for July 11. The site of a fourth meeting, set for Aug. 21, has not been announced. The study focuses on  West Virginia, Kentucky, Virginia and Tennessee.

At Tuesday's meeting, representatives from West Virginia Bureau for Public Health, the West Virginia Department of Environmental Protection, the West Virginia Coal Association and several environmental groups will participate in panel discussions form 12:45 to 3:45 p.m. From 6:30 to 9 p.m., a town hall meeting will allow community members will have an opportunity to address the committee. For a detailed agenda, click here.

The study is funded by a $1 million grant from the federal Office of Surface Mining Reclamation and Enforcement. It is examining research, primarily done by Indiana University's Michael Hendryx when he was at West Virginia University. Another study, by the National Institute of Environmental Health Sciences, is in process.

Saturday, May 20, 2017

Paul tells doctors and officials at Ashland hospital, a beneficiary of Medicaid expansion, that the country can't afford to keep it

Sen. Rand Paul at the hospital. (Daily Independent photo by Rachel Adkins)
The nation can't afford to continue the expansion of Medicaid, U.S. Sen. Rand Paul told doctors and officials Friday in Ashland at King's Daughters Hospital, which has benefited greatly from the expansion.

"We don't have any money; we have a printing press," said Paul, a Bowling Green eye surgeon. "And we borrow $500 billion a year. And there is the question: Could we ultimately destroy the country with that much debt? I call it the big-hearted, small-brain syndrome, which is very, very prevalent in Washington. They are sympathetic, they want to help people. We all do. But the thing is, if you destroy the country helping people, would you be better off or worse off?"

Before the Patient Protection and Affordable Care Act, Medicaid paid for "about 17 percent of patients in the King's Daughters Health System," Adam Beam reports for The Associated Press. Now that the law has added 470,000 Kentuckians to the rolls, "Medicaid pays for 23 percent of patients at the hospital system on the Kentucky-Ohio border."

The health bill sent to the Senate by the House would end the Medicaid expansion after 2020. Not having the expansion "would be the difference between staying open and not staying open," Chief Medical Officer Richard Ford told Beam.

King's Daughters' share of uninsured patients fell to 2 percent from 11 percent after Medicaid was expanded in 2014. "But despite the hospital's dependence on Medicaid, the amount of money the hospital made from each of those newly insured patients fell, too," Beam reports. "Ford says the system struggles to make a profit."

"It was more of a redistribution from one patient to the next more than it was helping us with covering our own expenses," Ford told him.

"Paul's solution to fix all of this is to make the health care system more market-based," Beam reports. "He wants to make it legal for people who don't get health insurance from their employer to join together with others in nationwide "health associations" to increase their bargaining power. Imagine, he said, if the National Rifle Association's more than 5 million members were able to join forces and negotiate with health insurance companies as a group instead of individually."

Garfield Grandison, a gastroenterologist, told Paul that he and other senators should consider more factors than cost. "Grandison and a local social worker said they’re concerned patients suffering from mental health and substance abuse problems could be hurt by the ACA replacement," because those would no longer have to be covered by health insurance, Andrew Adkins reports for the Ashland Daily Independent.

Paul said that would make premiums go down, and "said the fundamental question is based, for instance, on if a 72-year-old should be forced to pay for special procedures for others, such as pregnancy, in a free society," Adkins reports.

Grandison replied, "Should I be forced to drive on every single road my taxes pay for, or use every park my taxes help pay for? I understand from the standpoint of cost, where you’re going. You’ve made a good argument on cost, but there are other aspects that should be considered and part of the debate."

Study of Ind. Medicaid, proposed model for Ky., finds more than half of enrollees missed paying a premium and thus lost coverage

By Melissa Patrick
Kentucky Health News

Kentucky's plan to change Medicaid would require poor people to pay small, income-based premiums for coverage. That creates a barrier to health care, says a study of Indiana's similar plan allowed by a federal waiver.

“During the first 21 months of the waiver program, 324,840 (55 percent) of the 590,315 people eligible to pay didn’t make a required payment at some point. All of them were then kicked off of Medicaid or were left with inferior coverage," the liberal-leaning Kentucky Center for Economic Policy said on its policy blog.

Indiana's program requires enrollees to pay between $1 and $100 a month, depending on income, to participate in the plan with the most benefits, including dental and vision. This is the only plan available to Hoosiers above the federal poverty line.

If the enrollees fail to make a payment, those above the poverty line are disenrolled and locked out of the program for six months, while those in poverty are moved to a more limited plan that requires co-payments for all services, has lower service limits and limited drug benefits, and does not include dental and vision benefits.

Under Kentucky's proposed waiver, those who fail to pay would face a six-month lockout unless they pay back three months' worth of premiums and take a financial or health literacy class. Kentucky's plan does not include dental or vision benefits, though these benefits can be earned through a rewards program. This plan is expected to be approved in June, and to go into effect Jan. 1.

Kentucky's plan is modeled after Indiana's. Both were designed by Seema Verma, the new administrator for the Centers for Medicare and Medicaid Services. She has recused herself from the decision on Kentucky's plan, but it's expected that under her leadership other states will be allowed to impose similar monthly fees.

The proposed premium requirements in Kentucky's waiver plan, called Kentucky HEALTH, are based on income and the length of time a person is enrolled, if above the poverty line.

Premiums would be $1 to $15 per month, based on income, and would rise in incremental limits for those above the poverty line after the second year to a limit of $37.50. The federal poverty line for an individual is annual income of $12,060.

The Indiana plan, which took effect in 2015, was evaluated by the Lewin Group, a health-care consulting firm, using almost two years of data.

Among the 55 percent who had missed a premium payment, most (57 percent) were at or below the poverty level, which allowed them to drop to the lower-tier plan instead of being locked out.

"We can expect large numbers of Kentuckians to be left without coverage if the waiver is approved by the federal Department of Health and Human Services," KCEP said. "The assessment of the Indiana waiver confirms that both the cost and process of paying premiums is a barrier to coverage for low-income people."

The report, which was limited to Indiana, and the KCEP did not estimate how many Kentuckians might regain coverage by getting premiums up to date and taking a health or financial literacy course.

The report found that almost half of those who were kicked off the Indiana program or never made an initial payment did have insurance, mostly through an employer, "but that means that 53 to 59 percent were without health-care coverage of any kind," said KCEP.

The most common reasons enrollees gave for not paying premiums were that couldn't afford it, they were confused about the payment process, or didn't know they were required to make a payment.

The report also looked at access to care and found that people who were kicked off coverage or never enrolled were less likely to make appointments for care or fill a prescription in the previous six months.

Kentucky's plan is expected to save $2.2 billion over the next five years, of which the state's portion would be $331 million, according to the state's waiver request. It estimates that after five years, the state's Medicaid rolls would have 86,000 fewer people than an unchanged program would have. About 30,000 people a month go on and off Medicaid in Kentucky as their circumstances and incomes change.

Beshear joins lawsuit to defend Obamacare cost-sharing subsidies; D.C. appeals court to consider request Monday

By Melissa Patrick
Kentucky Health News

Kentucky Attorney General Andy Beshear and 15 of his counterparts have filed a motion aimed at maintaining cost-sharing subsidies for health insurance for low-income people under the Patient Protection and Affordable Care Act. The attorneys general want a federal court to let them directly defend the subsidies, about which the Trump administration has been ambivalent.

In 2014, House Republicans sued the Obama administration over the legality of these cost-sharing subsidies being paid to insurance companies because Congress never appropriated the funding for them. A district court ruled in favor of the House, but the Obama administration appealed the ruling. The subsidies were allowed to continue pending the appeal.

When Obama left office, the Trump administration became the defendant in the lawsuit. The administration is scheduled to inform the U.S. Court of Appeals for the District of Columbia Circuit on Monday, May 22, how it wants to proceed with the appeal.

Harris Meyer of Modern Healthcare reports, "The state attorneys general claim their states' interests would be gravely harmed if the payments stop because many insurers would exit the individual insurance market, premiums would spike, many of their residents would be left uninsured, and state and local governments would face heavy costs in paying for medical care for the newly uninsured people."

Beshear said in a news release, “Thousands of Kentuckians who purchase health insurance from the federal exchange are at risk of losing access to affordable health care coverage. The loss of federal funds and the financial uncertainty threatened by the case would lead to higher health insurance costs for Kentuckians and to insurers abandoning the individual health insurance market.”

The Kaiser Family Foundation projects that without the cost-sharing subsidies, premiums would increase by an average of 19 percent on ACA "silver" plans, the most popular, and higher in states that have not expanded Medicaid. The subsidies are available to people with incomes between 100 and 250 percent of the federal poverty level -- between $24,300 and $60,750 for a family of four.

Kentucky has extended its deadline for filing 2018 Obamacare plans to June 7, from the original May 17, "to allow insurers more time to obtain relevant data, including enrollment and claims data for the beginning of 2017, for use in developing assumptions utilized by actuaries to determine necessary plan pricing," Ronda Sloan, spokeswoman for the state Department of Insurance, told Kentucky Health News in April.

During the 2017 open enrollment period, 81,155 Kentuckians enrolled for coverage through the exchange and four out of five of them received a subsidy to help pay for their premiums, according to the Kentucky Center for Economic Policy. 

Both the ACA and the House-passed health bill, called the American Health Care Act, include subsidies, but use different formulas. The ACA takes family income, local cost of insurance and age into account, while the AHCA bases its tax credit only on age, with a phase-out for individuals with incomes above $75,000. It would continue the cost-sharing subsidies until 2020, "but would not appropriate those funds, leaving insurers uncertain whether they would receive the payments," Modern Healthcare reports.

Subsidies to low-income consumers who sign up for insurance on the exchange are estimated at $7 billion this year, according to the Congressional Budget Office.

Politico reports that Trump has told his advisers that he wants to end the Obamacare subsidies to force Democrats to the table to negotiate an Obamacare replacement.

The states seeking to intervene in the case are California, Connecticut, Delaware, Hawaii, Illinois, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, New Mexico, New York, Pennsylvania, Vermont and Washington, as well as the District of Columbia.

Friday, May 19, 2017

Second town in tobacco-loving Grayson County goes smoke-free; local Population Health Committee's efforts helped

Clarkson, in Grayson County (Wikipedia map)
By Melissa Patrick
Kentucky Health News

Two of the three towns in Grayson County now have smoke-free ordinances, partly as a result of a campaign led by the CEO of the local hospital.

Clarkson, with an estimated population of 900, became the second city in the county of 26,000 to enact a city-wide smoking ban. Leitchfield, the county seat, population 6,900, became smoke-free Jan. 1.

The Clarkson City Commission approved the ordinance by a 3-2 vote at a special called meeting May 1, Theresa Armstrong reports for the Grayson County News-Gazette.

Twin Lakes Regional Medical Center CEO Wayne Meriwether, a smoke-free advocate who leads a local Population Health Committee, said in a telephone interview that Clarkson's ordinance will take effect immediately and is stronger than Leitchfield's ordinance because it not only includes all public places, as Leitchfield's does, but also workplaces.

“Those commissioners that were in favor of it . . . wanted to send a message that their community was progressive and that they wanted to do what was in the best health interest of their community. So they took a strong stance on it,” Meriwether said.

Clarkson Commissioner Ed Schott voiced concern at the meeting about the distance smokers must stand from an establishment's door under the ordinance, Armstrong reports. “The front porch of the funeral home is not 15 feet from the door in any direction, and, at the ball field, the concession stand is not 15 feet away,” Schott said. “I would like us to remove this restriction from the ordinance.”

Schott and Mayor Bonnie Henderson, at the March 13 meeting, told the commissioners that the general consensus of the city's local businesses was that most of them were already smoke-free, but didn't want a law telling them how to run their businesses, Armstrong reported in March.

Despite these concerns, the ordinance passed. Schott, who originally supported the ordinance, and Henderson, who had always opposed it, voted against it; Commissioners Bob Vincent, Joyce Bell and Kay Gibson voted in favor of it.

The Population Health Committee, which is made up of representatives from the hospital, local schools, the health department, city government, local industries and other interested citizens, has led smoke-free efforts in Grayson County, where tobacco was once the main cash crop and its heritage remains strong. The county's estimated smoking rate is 34 percent; the state rate is 27 percent.

Initially the committee worked to pass a countywide ban, but that effort died last year for lack of a second reading in the Grayson County Fiscal Court, despite strong local support and a survey that found 82 percent of the people in the county wanted it.

Meriwether said the committee decided to advocate for smoke-free laws "community by community" after the county-ban failed. Caneyville, estimated population 620, is the only incorporated community left in Grayson that hasn't passed a ban.

“That's been the goal all along: Leitchfield, Clarkson and then Caneyville,” Meriwether said. “That would be the biggest part of our county, if we can get all three communities to have ordinances.”

He added, “We have their packets all ready!” The committee has prepared information packets that include facts about the dangers of second-hand-smoke and the results from the countywide survey.

Hospital CEO Wayne Meriwether and Ellen Hahn, director
of the Kentucky Center for Smoke-Free Policy (UKNow photo)
Leitchfield and Meriwether were recently honored at the Kentucky Center for Smoke-Free Policy's annual conference for their efforts in promoting smoke-free workplaces.

Leitchfield city leaders were presented with the "Smoke-Free Indoor Air Endeavor" award and Meriwether was honored with the "2017 Lee T. Todd, Jr. Smoke-free Hero" award for his advocacy of smoke-free ordinances and getting rural hospitals to push for them, reports the News-Gazette.

“I was really happy to see Leitchfield was recognized," he said. "It took a lot of courage for them to be the first one and their city council took some heat, but they did the right thing and they listened to their constituents that wanted it, which was the majority of them.

“And I appreciated getting an award, but that really should go to all of our Population Health Committee members and others that advocated for the ordinance -- a lot of people did.” he said.

Meriwether said his interest in the subject was spurred by concern for children. “We moved from Leitchfield from Henderson, Kentucky, about five years ago. . . . Henderson went smoke-free about 10 to 12 years ago and my children had, didn't remember any place where people smoke. The first restaurant we went to when we moved to Leitchfield, we walked in, and my daughter said, 'What's that smell?' And I said, well, they allow smoking in here. And she said, 'I didn't think anyplace allowed smoking.'

“The point is, in just a few years you can make such a difference and change so many lives. So my kids were never exposed to cigarettes, they weren't allowed anyplace, and so they both grew up as nonsmokers. And that is the kind of effect an ordinance can have.”

The Population Health Committee came out of the hospital's Community Health Needs Assessment, which is required every three years under the Patient Protection and Affordable Care Act.

In addition to its smoke-free advocacy work, the committee actively works on initiatives around nutrition and obesity, increasing opportunities for physical activity and improving community awareness about health and wellness.

"We felt like it was a responsibility for us to try to make a difference," Meriwether said of the committee. "I think it is a real model for hospitals to follow to try to make a difference in the communities that they serve."

He stressed the importance of community partnerships to improve the health of its citizens.

"We may have initiated the committee," he said. "but it takes a lot of people to make a difference."

Thursday, May 18, 2017

Low-income adults in Medicaid expansion in Kentucky and Arkansas report better health and medical care, study finds

By Melissa Patrick
Kentucky Health News

Two states that expanded Medicaid through the Patient Protection and Affordable Care Act showed a 41 percent increase in the number of enrollees with a regular health-care provider and a 23 percent increase in the share who report excellent health, according to a three-year study of Kentucky and Arkansas.

The study also found that low-income adults with chronic diseases in the two states were more likely to report that they had better health, were getting regular care and were able to afford their medications.

Kentucky and Arkansas and Kentucky both expanded Medicaid to people who earn up to 138 percent of the federal poverty line, but in different ways. Kentucky expanded Medicaid while Arkansas used federal Medicaid funding to provide private insurance to its low-income adults. The study compared them to Texas, which did not expand the program.

The report said that while Arkansas and Kentucky took different approaches to Medicaid expansion, the benefits to enrollees were nearly equal between the states.

“The Affordable Care Act is leading to substantial improvements in health care for low-income adults in Arkansas and Kentucky, and people report that their health is better too,” Dr. Benjamin Sommers, lead author of the study, said in a news release. “In contrast, many low-income adults in Texas continue to lack insurance and more frequently have to skip needed health care due to cost concerns.”

The study, published in Health Affairs, found that when compared to Texas, enrollees in Kentucky and Arkansas reported "substantially" better health, fewer emergency-room visits, increased access to care and medications, and cost savings.

                                                        graphic from report 
Kentucky has 1.4 million people on Medicaid, with 470,000 of them covered through the expansion. As of Jan. 1, Arkansas had 310,951 low-income people enrolled on its "private option" plan funded by Medicaid.

Not surprisingly, low-income adults in Arkansas and Kentucky were much more likely to have health coverage than their counterparts in Texas. Researchers found that by the end of 2016, the percentage of people in Arkansas and Kentucky without coverage had dropped 20 percentage points more than in Texas. In 2016, the uninsured rates were 7.4 percent in Kentucky, 11.7 percent in Arkansas, and 28.2 percent in Texas.

The study found that low-income adults who had gained coverage in Arkansas and Kentucky under the ACA had:
  • A 41-percentage-point increase in having a usual source of health care
  • A 58.6-point drop in reports of trouble paying medical bills
  • A 74.7-point decline in skipping needed health care because of costs
  • A 28-point drop in the likelihood of having an emergency-room visit
  • A 23-point increase in the share who reported they were in excellent health
  • $337 less in medical out-of-pocket spending per year
It found similar results among low-income adults with chronic illnesses who had gained coverage under the ACA, including:
  • 56 percentage points more likely to report having regular care for their chronic condition than were chronically ill adults in Texas
  • 51 points less likely than those in Texas to skip medications due to cost
  • 20 points more likely to report being in excellent health
The study was conducted by the Harvard T.H. Chan School of Public Health. It surveyed a random sample of 10,885 adults aged 19 to 64 in November and December from 2013 to 2016 via land lines and cell phones. The study includes a demographic breakdown of the full samples in each state.

“This study, along with others, makes it clear that the Affordable Care Act’s Medicaid expansion has helped states make substantial gains in coverage while ensuring people can get and afford the health care they need,” said Dr. David Blumenthal, president of The Commonwealth Fund, which funded the study. “Repeal efforts that end the expansion threaten the health and financial security of the 12 million people nationwide who benefited from it. We must hold on to these gains and continue to work toward affordable and accessible health care for everyone.”

The House-passed health bill, called the American Health Care Act, would largely phase out the Medicaid expansion and limit federal funding of the program, reducing federal spending on it by an estimated 24 percent over 10 years. If people enrolled in the expansion went off it, they could not get back on. About 30,000 Kentuckians a month go on and off Medicaid.

Gov. Matt Bevin has said Kentucky can't afford to pay for its share of the expansion costs (5 percent this year, rising to the ACA's 10 percent limit in 2020) and has applied for a waiver that would let the state charge small, income-based premiums and would require "able-bodied" recipients to either work, volunteer, go to class or take job training, among other things.

The waiver request estimates that the changes would make the state's Medicaid rolls have 86,000 fewer people in five years than without the waiver. The waiver is expected to be approved in June and to go into effect Jan. 1.

Tuesday, May 16, 2017

Liberal-leaning group says that if Senate passes House health bill, or big parts of it, results will be dire for millions in rural America

People who have health insurance through the Medicaid expansion are at great risk of losing their coverage if the Senate passes the House health bill, a decision that would greatly harm rural America, says a Center on Budget and Policy Priorities report.

Republican senators have said they are "starting from scratch" and writing their own bill, but that is misleading, said Shannon Buckingham, spokesperson for the liberal-leaning group. "Make no mistake, the House bill's core provisions remain firmly at the center of Senate discussion."

Nearly 1.7 million rural Americans have health insurance through the Patient Protection and Affordable Care Act's expansion of Medicaid to those who earn up to 138 percent of the federal poverty line, about $33,000 for a family of four. Of the 470,000 who have coverage through the expansion in Kentucky, an estimated 224,000 are in rural areas.

The report says the House health bill, called the American Health Care Act, would "effectively end" the Medicaid expansion because "beginning in 2020, states would receive only the regular federal Medicaid matching rate . . . for any new enrollees under the expansion instead of the permanent expansion matching rate of 90 percent." The matching rate for Kentucky is 70 percent, so the state would have to pay 2.8 times more than under current law for each new enrollee, the report said.The bill also allows states to stop enrolling people in expanded Medicaid.

For people who don't qualify for Medicaid, the House bill would raise health-care costs by reducing tax credits that help low income people pay for premiums and out-of-pocket costs; would allow states to take away protections for pre-existing conditions; and cut taxes by more than $600 billion over 10 years, mostly for the top 1 percent of income earners.

The detailed CBPP report, which offers state-level details on many measures, found that in at least eight expansion states, including Kentucky, more than one-third of expansion enrollees live in rural areas.

Gov. Matt Bevin has said Kentucky can't afford to pay for its expansion population and has applied for a waiver that would let the state charge small, income-based premiums and would require "able-bodied" recipients to either work, volunteer or take job training, among other things. These changes are expected to make the state's Medicaid rolls have 86,000 fewer people in five years than they would otherwise. The waiver is expected to be approved in June and to go into effect Jan. 1.

The report notes that states that expanded Medicaid had the largest drops in rural people without health coverage, from 16 percent in 2013 to 9 percent in 2015. In non-expansion states, the uninsured rate dropped from 19 percent to 15 percent in 2015. Kentucky's uninsured rate dropped to 7.5 percent from 20.4 percent.

"While those numbers may seem abstract, they have tangible impacts on access to care, on health and to financial security," Mary Wakefield, former acting deputy secretary for the U.S. Department of Health and Human Services, said. For example, she said the rural states of Kentucky and Arkansas, which expanded Medicaid, saw a "one-third increase in the share of low-income adults getting regular check-ups and a two-thirds decrease in the share depending on the emergency room for care."

The report adds, "In Kentucky, state data show tens of thousands of low-income individuals have received cholesterol, diabetes and cancer screenings, and preventive dental services," as a result of expanding Medicaid.

Wakefield said Medicaid expansion has reduced people's risk of medical bankruptcy, improved treatment access for people with substance use disorders and dramatically decreased uncompensated care in rural hospitals.

"The House health bill is a threat to rural hospitals," said Jesse Cross-Call, a senior policy analyst at CBPP and co-author of the report. "Over the past few years, closures of rural hospitals around the country have been heavily concentrated in states that have not expanded Medicaid,"

The report says, "Most of the 78 rural hospitals that have closed since 2010 are in Southern states that haven't expanded Medicaid" and "uncompensated care costs as a share of hospital operating budgets fell by about half between 2013 and 2015 in expansion states."

The House bill would partially restore the Disproportionate Share Hospital payments that helped rural hospitals make up for the uncompensated care before Medicaid was expanded," but that would fall "far short of the revenues hospitals would lose," according to the American Hospital Association and others, said Aviva Aron-Dine a senior fellow at CBPP.

Cross-Call added that the expansion had created a "pathway to health coverage where before the ACA one often did not exist," noting that people who live in rural areas often have lower incomes, have more contract work and are less likely to have an employer that offers health coverage, than non-rural areas.

Tara Straw, senior policy analyst at CBPP and co-author of the report, said rural Americans will be harmed if the new health plan removes the ACAs "generous and flexible" tax credits and replaces them with credits that would be worth much less.

Straw said ACA tax credits are often higher in rural areas because the cost of insurance tends to be higher, due to low population density, a limited number of providers and little competition among insurers. She also noted that people who live in rural areas tend to be older and have lower incomes.

"Because the ACA's credit is based on the cost of an actual plan, and not a fixed dollar amount, it helps protect people from premium increases," she said. For example, the AHCA tax credit for a West Virginia enrollee would be less than half of what an ACA credit would be, $7,400 compared to $3,100, for a plan that covers less, she said.

The House bill would provide a flat tax credit varying only by age: $2,000 for people under 30; $2,500 for people age 30 to 39; $3,000 for people age 40 to 49; $3,500 for people age 50 to 59; and $4,000 for people age 60 and older.

Straw explained that while the House bill allows for a tax credit for a 60 year old to be twice as high as for a young adult, it also allows older adults to be charged five times as much.

The House bill would also repeal the ACA's cost-sharing subsidies, which are available to people with incomes below 250 percent of the poverty line and allow them to purchase coverage with lower deductibles and covers other out-of-pocket costs.

McConnell says all Senate Republicans are working on health bill, invites Democrats to join them

McConnell used a graphic on the floor to drive home his point.
Senate Majority Leader Mitch McConnell said Tuesday that all Republican senators are working on a health bill, and invited Democrats to help them.

“Can our Democratic colleagues, who promised more choice under Obamacare, really be okay with the continuing failures of Obamacare? The status quo under Obamacare is simply unsustainable and unacceptable,” McConnell said in a speech on the Senate floor. “That’s why the entire Senate Republican Conference is working together on the best way forward to bring much-needed relief to the families who’ve been left behind by Obamacare’s continuing failures. I hope our Democratic colleagues will join us in working to do so. They just sent me a letter last week where they acknowledged that Obamacare hasn’t lived up to its promises and where they effectively conceded that the status quo is unsustainable.”

McConnell recently appointed a working group of 13 Republican senators to work on a health bill and was criticized because they were all men. Since then, he has said no senator will be left out of the drafting process. Last week Democratic Rep. John Yarmuth of Louisville said McConnell wouldn't let a health bill come to a vote before the 2018 elections for fear of political damage.

Click on the chart to view a larger version of it.
McConnell prefaced his remarks by citing the headline on the latest Gallup poll, taken May 3-7: "Health care surges as top problem in U.S." The story said, "Americans became much more concerned about health care this month, with 18 percent naming it as the most important problem facing the U.S. Mentions of health care tie with mentions of 'dissatisfaction with government/poor leadership' at the top of the most-important-problems list. This is the highest percentage mentioning healthcare since November 2013, amid the troubled rollout of the government healthcare exchanges."

Gallup chart of top problems in poll during the last three months
McConnell said, "It’s not hard to see why so many Americans feel this way. They turn on the TV and hear that there will be even fewer options on the Obamacare marketplaces in state after state. They pick up the newspaper and see that even more double-digit premium increases are being proposed for too many of the Obamacare plan options that still remain. . . . It’s troubling news, especially given that so many states, like mine, have already experienced insurers fleeing the Obamacare marketplace leaving families with limited options. This year . . . 49 percent, nearly half of the counties in Kentucky, have only one insurer to choose from. And of course, having only one option is really no choice at all."

McConnell said nothing in his speech about Medicaid, the expansion of which under Obamacare covers about 470,000 Kentuckians, according to the latest figures from the Cabinet for Health and Family Services. About 80,000 people in Kentucky are covered by private Obamacare policies.

Foundation's $3 million program is helping seven counties become healthier in several ways, independent evaluation says

A initiative focused on children's health is helping the Foundation for a Healthy Kentucky change community policies and environments, improve physical activity and nutrition, and strengthen health coalitions in seven Kentucky communities, according to an independent evaluation released by the foundation today.

The grants in the five-year, $3 million "Investing in Kentucky's Future" initiative are also providing useful lessons for place-based grantmakers, said the evaluation by the Center for Community Health and Evaluation, a research center of the Kaiser Permanente Washington Health Research Institute.

The initiative is aimed at reducing the risk that today's school-aged children will develop chronic disease later in life. It has made matching grants for community health coalitions in Breathitt, Clinton, Grant, Jefferson, McCracken, McLean, and Perry counties. All are focused on preventing and reducing childhood obesity except the Louisville coalition, which is working to foster resiliency in children facing traumatic events and other experiences that can lead to toxic stress in childhood and chronic health conditions in adulthood.

"The real value of the Investing in Kentucky's Future initiative is that it's fostering the ability of these seven Kentucky communities to keep improving their residents' health long after the grant period ends," Charlie Ross, chair of the foundation's board of directors, said in a news release. "Yes, the grants have helped build some beautiful walking trails and playgrounds and ensure healthier foods at park concessions, but they've also created lasting partnerships, changed school and community policies, and developed the skills of a cross-sector coalition of people committed to making a healthier future for their children."

The evaluation listed five lessons from the initiative:
  1. Community-Driven Grant Approach: Allowing community health coalitions to study and determine their own health priorities and the solutions they would employ is leading to greater grantee engagement, but also to more diverse strategies.
  2. Coalition Approach: Requiring grantees to use or create a coalition of partners from a variety of sectors is helping build community support for the work. School engagement has been particularly important for the initiative, which focuses on school-aged children.
  3. Planning Phase to Promote Equity: Recognizing that communities have various levels of ability to compete for and implement grant programs, the foundation included funding for a required a planning phase during which grantees would develop a structured business plan to address their selected issue. The planning phase made the grant more accessible to communities with fewer resources.
  4. Sustainability Elements: Grant requirements that were focused on sustainability ─ the planning phase, a 50 percent cash match, a focus on changing policies in the community, and an evaluation ─ have given coalition members skills and experience to them continue to improve the health of their communities.
  5. Shorter-Term Evaluation Measures: The foundation recognized that significant changes in complex health issues take more than five years to see, so it focused its evaluation on shorter-term changes that have been proven to lead to longer-term health improvements.
Investing in Kentucky's Future is entering its fourth year, but some communities' grants will extend into 2019 because they started later than others. The grantees are: Partnership for a Healthy McLean County, Purchase Area Connections for Health (McCracken County), Fitness for Life Around Grant County, Breathitt County Health Planning Council for Children, Perry County Wellness Coalition, Clinton County Healthy Hometown Coalition, and the Bounce Coalition (Jefferson County).

A copy of the evaluation, "Toward a Healthier Kentucky: Lesson Learned from Evaluating Place-Based Community Health Improvement," is available here

Monday, May 15, 2017

Rich-poor divide grows in oral health; Ky. ranks 2nd in seniors with no natural teeth; what's your county's toothless rate?

The rich-poor divide is causing many impoverished rural residents to forgo oral health care, or resort to having teeth pulled rather than pay for costly fixes, Mary Jordan and Kevin Sullivan report for The Washington Post. The rate of Americans who have lost all their natural teeth is higher in rural areas in every age group and 20 percent of all Americans over 65 do not have a single real tooth remaining. (CDC graphic: National Health Survey 2010-12 results of of people who have lost all their natural teeth)
Toothless rates among those 65 and older are especially high in the South. According to Kaiser Family Foundation data from 2014, 33.6 percent of West Virginia residents 65 and older had no natural teeth. Kentucky was second, 23.9 percent, followed by Mississippi and Oklahoma (22.5), Tennessee (22.4), Alabama (22.2), Arkansas (22) and Louisiana (20.5). (CDC graphic: Where people 65 and older have lost all their teeth)
More than 50 million Americans "live in areas officially designated by the federal government as Dental Health Professional Shortage Areas," reports the Post. "A great many of them are working poor. In these rural areas, even the water can work against people." Many people rely on well water that is not fluoridated, which helps reduce tooth decay. The Centers for Disease Control and Prevention says 25 percent of Americans are not connected to a fluoridated water system. Another problem in rural areas is a shortage of dentists.

For the percentage of adults in your county who are missing six or more teeth, go to, click on your county and ask for its health outcomes.

While rich people can afford the luxuries of the best oral health care, poor people often resort to standing in line at free clinics, reports the Post. "High-end cosmetic dentistry is soaring, and better-off Americans spend well over $1 billion each year just to make their teeth a few shades whiter. Millions of others rely on charity clinics and hospital emergency rooms to treat painful and neglected teeth." The problem is that emergency rooms are not typically equipped to fix dental problems. That means they prescribe painkillers, which can lead to addiction, which destroys teeth, and dry mouth, which leads to more cavities.

Sunday, May 14, 2017

The Zika virus has come to Ky. through travelers, and could spread at any time, but few people know or do much about it

This species of mosquito carries Zika.
By Melissa Patrick
Kentucky Health News

As temperatures and travel increase, so does the possible threat from the Zika virus, which can cause dangerous or even deadly birth defects, but many potential victims are uninformed and unprepared.

The best prevention for now may be vigilance by property owners against standing water where mosquitoes breed. Experts say those who travel to Zika-affected areas such as Florida and Texas should use insect repellents after they return to keep local mosquitoes from picking up the virus, which causes no symptoms in some people.

Nearly two out of five people who had traveled to an area affected by the Zika virus hadn't heard or seen any information about how to protect themselves or others from it, and even those who knew how to protect themselves didn't always do so, according to a recent poll.

A senior research scientist at the Harvard T.H. Chan School of Public Health presented the poll results at the 2017 Zika Conference in Lexington May 11. Dr. Gillian SteelFisher said the results emphasized the need for more preventive education, noting that many people don't realize that it "just takes one bite" to become infected.

A Kentucky study of 55 women of childbearing age who had traveled to Zika-affected areas found a similar need for more information, especially among Spanish-speaking women with less education under the age of 30, said Kristen Heitzinger, a Centers for Disease Control and Prevention fellow at the state Department of Public Health.

State Health Secretary Vickie Yates Brown Glisson called on the more than 400 conference attendees to go back to their communities and become "unwavering" in their efforts to get and deliver a simple, easy-to-understand message about Zika, its dangers and how to fight it.

Dr. Ardis Hoven (file photo)
State infectious disease specialist Dr. Ardis Hoven told the conference that local health departments will educate community leaders about the virus. For an 86-second audio clip of her remarks, via Stu Johnson of WEKU, click here.

"Our research tells us that not nearly enough pregnant women in particular, or those who are of the age to become pregnant, know about the Zika virus and what they should do to protect themselves and their unborn baby, or a potential unborn baby," Glisson said. "Overwhelming evidence has shown a link between Zika and dangerous birth defects that cause delayed development and sometimes even death in infants."

Zika is spread mostly by the bite of an infected mosquito, though it can also be transmitted through sex, and from a pregnant woman to her fetus. It circulates in many parts of the world where Kentuckians vacation, do mission trips or work.

So far, only Florida and Texas have had locally transmitted infections in the U.S., but Kentucky has the mosquito that is known to carry it. Click here to see the locations where Zika is a risk.

The virus can cause microcephaly, a condition where a baby's head is smaller than normal because the brain does not develop properly, and other birth defects in infants born to women infected during pregnancy.

It is also associated with adult Guillain-Barre syndrome, a rare disorder in which the body's immune system attacks its nerves.

The most common symptoms of Zika are fever, rash, joint pain and red or burning eyes, though many who are infected have few if any symptoms, which can be so mild they go unrecognized.

There is no vaccine to prevent Zika, and no antiviral treatment for it.

According to the CDC, 5,000 cases of Zika have been identified in the U.S. and its territories including 37 in Kentucky and 1,367 in pregnant women. Among those women, 65 gave birth to babies with some type of Zika-related birth defect.

Of the 37 Kentucky cases, four were pregnant women whose children have had no complications, but are still being monitored. All the Kentucky cases were a result of travel to Zika-affected areas or through having sex with someone who had traveled to those areas.

The state health department has adopted the tag line "Dress, Drain and Defend -- to Fight the Bite Day and Night" to help Kentuckians remember to be vigilant about mosquito control:
  • Dress in light-colored, long-sleeved shirts and pants;
  • Drain all standing water where mosquitoes can breed, such as birdbaths, tires, buckets, gutters and anything, however small, that may act as a vessel for rainwater;
  • Defend against mosquitoes with approved insect repellents for outdoor activities at all times.
Luke Mathis, the environmental health supervisor at the Lexington Fayette County Health Department, said citizens must do their part to make sure Kentucky doesn't have a Zika outbreak.

"We could work ourselves to exhaustion, we could spend every dime of money, and it would have little effect on the mosquito population," Mathis said. Instead, he said it would be more effective to "have every homeowner check out their yard for a few minutes every couple of weeks and kick over those buckets or get rid of those tires."

"We need to begin changing people's attitude to make it socially unacceptable to breed mosquitoes in and around their property," Brown said. "It's going to take decades."

The state health department has advice for those considering travel to Zika-affected areas:
  • Pregnant women and their partners should not travel to Zika-affected areas;
  • Consult with a health-care provider prior to travel if you are pregnant or planning to conceive;
  • Couples who are planning to become pregnant should postpone conception for six months after travel to a Zika-affected area, and should discuss plans for pregnancy with their health provider
  • Follow steps to prevent mosquito bites: Dress and defend!
  • Wear a condom every time you have sex, including vaginal, oral and anal sex, or practice abstinence, while in a Zika-affected area.
Advice for those who have been to a Zika-affected area after they get home:
  • Women who have been exposed to the virus should use condoms or abstain from sex for at least eight weeks after symptom onset or last possible exposure.
  • Men who have been exposed to the virus should use condoms or abstain from sex for at least six months after symptom onset or last possible exposure.
  • Male travelers with pregnant partners should wear condoms throughout the pregnancy.
  • Travelers to Zika-affected areas who have symptoms within two weeks of their return to Kentucky should contact their health-care provider.
  • Travelers returning from Zika-affected areas should wear mosquito repellent for three weeks after returning, so they won't infect other mosquitoes that could bite others.
  • Remember that these precautions are necessary because many infected people have no symptoms.
Dr. Grayson Brown, professor of entomology at the University of Kentucky and director of the Public Health Entomology Laboratory, said many people are concerned about the safety of insecticides, but that they shouldn't be. He said "insecticide technology has changed" in the last 50 to 60 years and that products today are "nontoxic to humans and other vertebrates, but so powerful against mosquitoes."

"If we don't use them," Brown said, "the suffering is going to be absolutely enormous." He said South Florida officials averted a crisis last summer by using insecticides to kill Zika-carrying mosquitoes. Without that, there could have been "hundreds of thousands of cases, and thousands of micrcocephalic babies. . . . They avoided a serious, serious public-health crisis."

Kentucky sprays for mosquitoes each year, but Brown said the spray in mosquito trucks kills very few Zika-carrying mosquitoes, which require a different product that is hand-applied under bushes and brush.

For further information or to sign up for health alerts, visit or the CDC website at The UK College of Agriculture, Food and Environment website also offers Zika updates.

Saturday, May 13, 2017

Yarmuth says McConnell won't let a health bill get a Senate vote for fear it would backfire on Republican senators

Majority Leader Mitch McConnell says the U.S. Senate is working on its own health-care bill, but Kentucky's only Democrat in Congress said Friday that McConnell won't bring the bill to a vote in order to protect his fellow Republicans from retribution by voters, Ronnie Ellis reports for CNHI News Service.

Yarmuth (WDRB image)
“I’m convinced that Mitch McConnell will not allow anything to get out of the Senate because he doesn’t want any one of his members to have to take a vote on health care,” Rep. John Yarmuth of Louisville told Together Frankfort, a civic-engagement group. “At least a half-dozen could be vulnerable if they have to cast a tough vote on health care.”

Republicans have 52 Senate seats to Democrats’ 48, including two independents who vote with Democrats, Ellis notes. In the 2018 elections, only eight seats now held by Republicans are up, putting Democrats on the defensive. "But Democrats are feeling increasingly optimistic about their 2018 prospects – especially in the House, where they need to pick up 24 seats to gain control — in the aftermath of constituent unhappiness over the House healthcare vote and Trump’s rocky first three months in office," Ellis reports.

McConnell spokesman Robert Steurer "didn’t directly address Yarmuth’s comments, instead pointing to a floor speech McConnell gave earlier this past Wednesday in which he said the ACA continues to fail “'the American people and keeps getting worse'," Ellis reports. "He went on to say Democrats have indicated a willingness to work with Republicans on 'common-sense reforms' and said he welcomes Democrats’ input."

"With control of the White House and both chambers of Congress, Republicans are scrambling to make good on their promises while trying to preserve popular provisions" of the Patient Protection and Affordable Care Act, Ellis writes. "After a failed attempt earlier this year, House Republicans narrowly passed the American Health Care Act, which has prompted angry protests at congressional town halls. Critics say the measure will cut Medicaid by $880 billion over 10 years, weaken or eliminate the prohibition on denial of coverage due to pre-existing conditions, and ultimately cost 24 million people health-care coverage."

McConnell has named 13 Republicans to write a bill that Republicans "hope to pass on a simple majority vote through what is known as the reconciliation process," Ellis notes. "Such votes can only be taken on legislation which pertains to the budget and the federal deficit and the Senate parliamentarian must rule on whether legislation qualifies for such a vote. Otherwise, Republicans would need 60 votes to avoid a Democratic filibuster."

Yarmuth said Republicans have realized “they have no place to go on health care,” and that the only acceptable alternative to "Obamacare' is a single-payer system. “I’m convinced that within 10 years there’s going to be a major push for Medicare for everybody and it’s going to come from corporate America,” he said.

Friday, May 12, 2017

Financially strained KentuckyOne Health to sell most Louisville-area facilities, shift focus to Central and Eastern Kentucky

"KentuckyOne Health, the once-dominant hospital system across the state, announced Friday that it will sell off Jewish Hospital and many other high-profile facilities in Louisville as it refocuses on Central and Eastern Kentucky," Grace Schneider reports for The Courier-Journal. "Besides Jewish, its flagship hospital, the health system will sell Frazier Rehab InstituteSts. Mary & Elizabeth HospitalMedical Centers Jewish East, South, Southwest and Northeast; Jewish Hospital ShelbyvilleSaint Joseph Martin and KentuckyOne Health Medical Group provider practices in Louisville and Martin," a small town in Floyd County.

"The great change and great uncertainty in the health care industry has strained our financial health," said Ruth Brinkley, KentuckyOne's president and CEO. “We understand this will bring change and questions to our employees and community partners. We have an extensive transition program underway to ease the change and ensure focus on our priories to our patients and our partners."

The sales will leave KentuckyOne with this footprint: Our Lady of Peace, a behavioral-treatment hospital in Louisville, Flaget Memorial Hospital in Bardstown, Saint Joseph Hospital and Saint Joseph East in Lexington, Saint Joseph Jessamine in Nicholasville, Saint Joseph Mount Sterling, Saint Joseph London and Saint Joseph Berea, and affiliated provider practices.

"The announcement comes 10 days after The Courier-Journal reported the health system was severing ties with doctors in the Louisville area," Schneider notes. Last month, the system announced it was trimming about 250 employees to cut costs, including the layoff of 150 workers. Others were transferred to the University of Louisville Hospital under the split between KentuckyOne and U of L Medical Center or took voluntary retirement offers. KentuckyOne has run day-to-day operations of the University of Louisville Hospital and the James Graham Brown Cancer Center under an arrangement with U of L, but the University Medical Center is to resume management July 1.

Louisville adds electronic cigarettes, hookahs to smoking ban

Electronic cigarettes and hookahs are now included in the smoking ban of Kentucky's largest city. The Louisville Metro Council voted 15-6 Tuesday night to expand its anti-smoking ordinance.

“Neither e-cigs or hookah can be deemed safe or healthy for human consumption,” said Council Member Vicki Aubrey Welch, the legislation's sponsor. Welch, a Democrat, said council members compromised with local business owners who were concerned "about the measure’s likelihood to reduce retail activity," Jacob Ryan reports for WFPL.

"Consumers can still sample electronic cigarette flavors, under the measure, and certain hookah lounges will be exempt from the regulations," Ryan reports.

Mayor Greg Fischer, a Democrat up for re-election next year, asked in February for the expansion of the ban enacted in 2008. Opposition was bipartisan.

Council Member Kevin Kramer, a Republican, "said he’s been provided with little evidence that hookah products are detrimental to users’ health," Ryan reports. Council Member Mary Woolridge, a Democrat, "called the ordinance an overreach of government regulation."

“I don’t know where all this concern is, when we have to breathe the air in West Louisville and Rubbertown,” Woolridge said, referring to chemical plants on the west side of the city. Neighboring Council Member Jessica Green, another Democrat, called the move a Fischer "publicity stunt."

The move drew praise from the Foundation for a Healthy Kentucky. "These products emit dangerous toxins into the air that are known to cause cancer and other debilitating illnesses," said Ben Chandler, president and CEO of the foundation. "While the expanded ordinance includes some regrettable exemptions that will leave some Louisvillians unprotected, this is a step in the right direction toward cleaner air and reduced health disparities."

At town hall in Benton, U.S. Rep. James Comer defends and explains his vote for House Republican health-care legislation

UPDATE, May 21: The Washington Post's Chico Harlan has a more detailed report on Comer's town halls in Benton, Albany, Edmonton and Calhoun.

U.S. Rep. James Comer in Benton (M.C. Daily photo)
"The atmosphere was, at times, tense as constituents gathered from around the First Congressional District of Kentucky to participate in a town hall meeting with U.S. Rep. James Comer Wednesday at the Marshall County Courthouse in Benton," Mary Garrison Minyard reports for the Marshall County Daily.

Comer, a first-term Republican from Tompkinsville, acknowledged that he had been criticized for supporting a Republican health bill that did not have a Congressional Budget Office analysis, but "said lawmakers had little choice in passing the bill," Minyard reports.
Comer told the crowd that 31 of the district's 35 counties "only have one insurance carrier," and noted that the main carrier for such counties in Iowa is pulling out of Obamacare. "I think we’re going to see more of that if a health care bill is not passed," he said.
"Comer said constituents needed a bill that would protect its most vulnerable residents – those with pre-existing conditions and those on Medicaid – but would lower premiums and deductibles," Minyard writes. "He said he voted for the bill because he felt it would do those things. Still, some concessions had to be made."
Minyard reports Comer said it would be "a budget breaker" for that state to pay "10 percent of the health insurance bill for almost half a million people in Kentucky," which is what the state would pay in 2020 for people covered by the 2014 Medicaid expansion. This year it is paying 5 percent.
"Comer said he supported the core concept of Medicaid, which was to provide health care assistance for poor children, low income single parents and pregnant women and the 'truly disabled.' Comer said many had taken advantage of the system, however," Minyard writes.
The biggest issue in passage of the bill was coverage of pre-existing conditions. "Comer told attendees that the bill failed on its first run several weeks ago because ultra-conservative Republicans wanted complete ACA repeal, while others wouldn’t budge on protections for pre-existing conditions," Minyard reports. The new bill lets states allow insurance companies to charge higher premiums to people with such conditions but allocates "$130 billion to set up high-risk pools to help states cover those most expensive to insure," but critics have said that is inadequate.
Jennifer Smith, a two-time cancer survivor from Paducah, said the funding would be inadequate. She told Comer, "You stated your commitment to protecting all of us with pre-existing conditions, our access to insurance and health care, but instead on May 4 you reneged on that promise and voted for the horrendous bill the AHCA. In response to the outrage from your constituents you stated on your Facebook page that the bill protected pre-existing conditions and that those protesting and distorting the truth were far left liberals like the DNC and Planned Parenthood. … The radical left wing organizations that you say are against you include the American Cancer Society, Komen, the National Patient Advocate Foundation and over 25 other cancer and health advocators, the American Medical Association, the American Nurses Association … and the AARP have also come out strongly against the bill. All the organizations have cited the catastrophic impact this will have on those of us pre-existing conditions and every other consumer of health care."
"You also neglect to mention the states have the right to opt out, so that’s almost a certainty that Kentucky’s Governor Bevin would take that option," Smith said. "The reality is that this bill will drive up cost for the poor and those with health issues to the point that there is no access, because we will not be able to afford to pay the premiums or out-of-pocket expenses."
Other constituents at the meeting objected to the provisions. "Some lay on the courthouse lawn prior to the meeting with tombstones at their heads and feet and signs that read 'I had a pre-existing condition'," Minyard reports.
Comer said "Kentucky still has a funding mechanism that other states don’t" for high-risk pools. "They don’t have to worry about getting the General Assembly to pass … it’s already in there." A 1 percent fee on insurance policies funded a high-risk pool that stopped taking new enrollees when Obamacare was implemented. The state kept the fee to pay for a health-insurance exchange that has been largely abolished, but the fee remains in place.
"Here’s the bottom line," Comer said. "If nothing is done, people with individual insurance plans and group plans are going to continue to have to pay more and more insurance costs and it’s just putting people [where] they’re choosing health care costs over food. They’re not buying medicine because they’re spending all their money on health-care premiums.”