Thursday, May 3, 2018

Kentucky's gains in health care are overshadowed by greater increases in 'deaths of despair,' driven by drug overdoses

"Kentucky improved its standing in many health measures in recent years but still ranks near the bottom nationally, in part because of a troubling increase in deaths from suicide, alcohol abuse and drug overdoses," known as "deaths of despair," reports Bill Estep of the Lexington Herald-Leader, citing a new study.

In 2013, for every 100,000 people in Kentucky, there were 48.9 "deaths of despair." By 2016, driven mainly use by drug abuse, the rate had jumped 26 percent, to 61.7 per 100,000.

That rate was much higher than the national average of 43.2, according to the report from The Commonwealth Fund, a foundation that says it was created to "promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable and the elderly."

The study ranked Kentucky's health system 42nd in performance, up from 46th in 2013.

The jump in "deaths of despair" overshadowed Kentucky's improvement in 16 of the 37 indicators that the foundation uses to evaluate states' health systems, measuring access to care, quality and efficiency of care, health outcomes and income-based health care disparities. Only six states, led by New York, showed more improvements; Kentucky tied for seventh with Arizona and California.

All but one of the states with the most improvements expanded Medicaid under the Patient Protection and Affordable Care Act, most beginning in 2014. Kentucky led the nation in the percentage-point reduction of people without health insurance, going from 21 percent in 2013 to 7 percent in 2016.

"However, the state may reverse some of that improvement," Estep writes. "Gov. Matt Bevin and others have said Kentucky’s Medicaid expansion is financially unsustainable. Bevin’s administration received approval under President Donald Trump for a waiver requiring able-bodied adult Medicaid participants to complete 80 hours a month of work, education, job training or community service to keep benefits. Another provision of the waiver, which has not yet taken effect, is for Medicaid beneficiaries to pay premiums of $1 to $15 a month at first. Critics say the provisions would be difficult for many Medicaid participants to meet and that many would lose coverage as a result."

The Bevin administration has estimated that Kentucky's Medicaid rolls, now almost 1.5 million, will have 95,000 fewer people in five years than without the waiver.
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