Thursday, October 31, 2019

State universities get $4 million federal grant to create hub for entrepreneurial innovations in health care

Health-poll breakdown shows regional differences on drugs, syringe exchanges, statewide smoking ban, dental care

The Foundation for a Healthy Kentucky has released regional breakdowns of the Kentucky Health Issues Poll, which was conducted last fall. Each breakdown outlines respondents' answers to various questions and compares regional responses to statewide findings.

The poll focused on substance and tobacco use, access to health care, and issues around health insurance. The responses were comparable across the state as a whole, but there were a few key differences in each of the regional breakdowns.

Eastern Kentucky: About 22 percent of Kentuckians live in this 46-county region where fewer adults reported having dental insurance (53%) than the rest of the state (60%)  and more of them (34%) reported that they or a member of their household delayed needed dental care in the past year due to cost compared to the rest of the state (26%).

More adults in Eastern Kentucky also reported that they had family members or friends with a prescription-drug problem (38%) than adults statewide (30%) or a methamphetamine problem (29%, vs. 22% statewide).

They were also less likely to support a statewide smoking ban, with only 59% of them favoring such a ban compared to 66% statewide. And more of them opposed syringe exchanges for intravenous drug users, to control the spread of disease, than in the rest of the state: 48% and 40% respectively.

Greater Lexington: This 17-county region, which has about 18% of the state's population, had one big difference from the state as a whole: support of syringe exchanges. Fifty-seven percent of adults in the region supported them, compared to 49% statewide.

Greater Louisville: This seven-county region, with 23% of the state's population, had the most adults reporting that they had dental insurance, at 71%. Concurrently, it had fewer adults delaying needed dental care due to cost (19%) compared to the statewide number of 26%.

The poll found more adults in Louisville supported a statewide smoking ban than the state as a whole, 76% and 66% respectively; and more support syringe exchanges, at 59% compared to 49% statewide.

Among those who said they knew a friend or family member with a drug problem, more in Louisville reported that they did not enter treatment compared to the rest of the state: 55% and 44%, respectively.

Northern Kentucky: The poll found that the 10% of Kentuckians living in this eight-county region were more likely to knew someone who used heroin compared to the rest of the state (36% and 20%, respectively) and to know of someone with a drug problem who had entered treatment because others had intervened (55%, compared to 36% statewide).

Northern Kentuckians were about evenly divided on syringe exchanges, with 46% of them favoring and 43% opposing such programs. Because of the poll's error margin, that is no statistical difference.

Western Kentucky: About 27% of Kentuckians live in this 42-county region. Their knowledge of someone who had experienced problems with heroin was less than the rest of the state: 12% and 20%, respectively. They were also about evenly divided on syringe exchanges: 45% for, 42% against.

In Western Kentucky, adults in low-income households were also less likely than elsewhere in the state to report that they were in excellent or very good personal health, with only 17% of them reporting such health, compared to 30% statewide.

The Kentucky Health Issues Poll is sponsored by the health foundation and Interact for Health, a Cincinnati-area foundation. The poll surveyed a random sample of 1,569 Kentucky adults via landline and cell phone. The statewide results have an error margin of plus or minus 2.5 percentage points for each result. The regional error margins are higher and can be found in the regional reports.

Sunday, October 27, 2019

Open enrollment for federally subsidized health insurance (Obamacare) begins Friday, Nov. 1 and runs through Dec. 15


Insurance Department maps, adapted by Kentucky Health News; click on either for a larger version.
Open enrollment for federally subsidized health insurance in Kentucky next year will begin Friday, Nov. 1 and run through Dec. 15.

Plans will cost more or less than this year, depending on the insurer and the type of plan. And many consumers will have more choices.

Policies offered on the federal insurance exchange by Anthem Health Plans of Kentucky will be an average of 9.7 percent higher than last year. Plans from CareSource Kentucky will average 4.5 percent less than this year. CareSource is serving an expanded area, covering 83 counties. That means 56 of the state's 120 counties will have more than one insurer to choose from on the exchange.

"The actual rates charged will vary based on individual plan selection and factors," the state Department of Insurance noted in a August news release. Detailed rate filings are at http://insurance.ky.gov/ratefil.

CareSource will offer 12 individual plans on the federal exchange, which must be used to get the tax credits for premiums. "These plans vary in levels from catastrophic to gold, and include nine different silver and bronze options," the release said. Silver and bronze plans are in the middle range for premiums and deductibles under the 2010 Patient Protection and Affordable Care Act, commonly called Obamacare.

Anthem will offer 13 individual plans, under different network and service area options. "The Anthem Pathway HMO service area includes seven approved plans. These plans, with a broad provider network, will be offered in 77 counties," the release said. "The second option is the narrower Anthem Pathway Transition HMO, and includes six different plans available in 17 counties." The areas overlap only in Hardin County.

The Insurance Department says that before enrollment opens, consumers should work with an agent, do their own research or contact the department to understand their options. “It is critical to review the details for each plan to minimize the potential for surprises later on,” Adkins said, “and ensure individuals purchase the plan that best suits their individual needs.”

If you fail to enroll by Dec. 15, the only way to enroll in a federally subsidized health plan is during a special enrollment period. To qualify for special enrollment, you must have a qualifying life event such as a change in family status (for example, marriage, divorce, birth, or adoption of a child), change in residence, or loss of other health coverage (such as loss of employer-based coverage, or loss of eligibility for Medicare or Medicaid).

Saturday, October 26, 2019

Health Literacy Month reflects why Kentucky Health News exists; attention must be paid to health issues, including drug abuse

By Al Cross
Editor and Publisher, Kentucky Health News

Kentucky Heath News is in the business of health literacy: helping Kentuckians understand how to maintain and improve their health, and understanding the health-care system. But somehow we failed to notice that October is Health Literacy Month. Maybe we've been too busy with our work. But that prompts me to write a bit about KHN, why it exists, and what we hope you get from it.

The idea was conceived at a Kentucky Chamber of Commerce meeting about nine years ago. I sat down at a table with Robert Slaton, a health-care consultant and former state health commissioner, and Susan Zepeda, then the president and CEO of the Foundation for a Healthy Kentucky. Robert said, "Al, you ought to ask Susan for some money."

The obvious follow-up question was "What for?" and I had the answer. For five years, I had been publishing The Rural Blog, a daily digest of events, trends, issues and journalism from and about rural America, as director of the Institute for Rural Journalism and Community Issues at the University of Kentucky. The institute's mission is to help rural journalists define the public agenda in their communities, through strong reporting and commentary, especially on broad issues that have local impact but few if any good, local sources.

From the time Al Smith and others conceived it, one of the institute's main issues has been health, because it is a chronic problem in rural areas, and especially in Kentucky, where people's overall health status is one of the worst in the nation. So, when Robert made his suggestion, I already had the answer to the "For what?" question: a service that would help Kentucky news media help their audiences live healthier lives and understand the health-care system.

The foundation got us started, and has been increasingly supportive of our work, allowing us to have a reporter, former nurse Melissa Patrick, who works 25 hours a week doing original stories and excerpting others. Many in news outlets have also supported our work by publishing it, but we wish more did so. Our stories appear with some regularity in many newspapers, but not in most, despite our weekly emails to every paper in the state (and to the Kentucky Association of Broadcasters).

This is understandable to those of us who have worked at small-town radio stations or have been editors of rural newspapers, which exist to provide local news and information. Most Kentucky Health News stories aren't local, but they do touch on issues that matter to local audiences. Some newspapers pick up on such stories and use them as the basis for their own stories or editorials.

Many times, though, certain information about local health doesn't reflect well on the community that the newspaper serves, so it's not reported. In community journalism, there is often a reluctance to make an effort to report such news; there may be plenty of bad news already, and the role of community cheerleader is a long-established one in rural journalism.

That used to show up in Kentucky papers' treatment of the annual County Health Rankings, which rank every county in every state on its health outcomes and the factors that affect those outcomes. For the first few years that the rankings were issued, the better your county's ranking, the more likely you were to read about in your local Kentucky newspaper. And the worse your county's ranking, the less likely you were to read about it. The papers were declining to print bad news.

But that has changed. A couple of years ago, we found that there was no longer any correlation between a county's ranking and its publication in the local newspaper. A poor ranking was just as likely to be published as a good one. This is just one example, and the trend varies from year to year, but we'd like to think that our work has made many rural journalists in Kentucky realize that health is an important local issue that needs attention.

Now we hope they realize something else needs attention: the epidemic of substance abuse that is plaguing Kentucky, and the means of fighting it, as individuals and communities. This is primarily a health issue, but in rural news media is usually presented as a criminal-justice issue. The lack of coverage of it as a health issue is an obstacle to solving the problem, according to research by Oak Ridge Associated Universities.

To reduce that obstacle, ORAU and the institute will hold Covering Substance Abuse and Recovery: A Workshop for Journalists, in Ashland, Ky., on Nov. 15. Journalists from weekly and daily papers will join health experts and public officials to explore the subject, and we hope for a good turnout that will make some headway in rural communities. Space is limited; the registration fee until Nov. 1 is $50; it will be $60 through Nov 8, when registration will close. Get details and register here.

This probably isn't your cup of tea; it's a difficult subject, but attention must be paid. That's one of the best-known lines from the play Death of a Salesman: "He's not the finest character that ever lived. But he's a human being, and a terrible thing is happening to him. So attention must be paid. He's not to be allowed to fall into his grave like an old dog. Attention, attention must finally be paid to such a person." Let's pay attention to these people and their problem, and help solve it.

Friday, October 25, 2019

As 'vaping' devices evolve, new potential hazards emerge

By Carmen Heredia Rodriguez
Kaiser Health News

The smokeless tobacco industry that began with low-voltage cigarette look-alikes has evolved to include customizable, high-wattage machines capable of generating enormous clouds of vapor or aerosol ― and potentially toxic substances.

As the technology continues to change, researchers are finding more evidence that the way vaping devices and e-liquids interact could harm consumers. High-powered devices may overheat vaping liquids to produce toxic chemicals, tobacco experts warn, and the aerosol that is inhaled may be contaminated with dangerous metals from the device.

Although researchers say they still don’t have enough data to know whether vaping devices are less dangerous than cigarettes, Stanton Glantz, a professor of medicine and the director of the Center for Tobacco Control Research and Education at the University of California-San Francisco, said the scientific evidence convinced him that vaping is far from a harmless substitute.

“Nobody knows what’s in any of these products,” said Glantz. “What you’re actually exposing yourself to is not in any way, shape or form standardized.”

Electronic cigarettes (Photo by Justin Sullivan, Getty Images)
Many consumers credit vaping and electronic cigarette products with helping them kick their cigarette habit. But as the technology has changed, so have e-liquids. Formulas today can deliver the same amount or more nicotine than a cigarette in the same number of puffs, researchers say.

("Vaping" is a term used by manufacturers, sellers and users of electronic cigarettes, but many devices do not produce a vapor, which has liquid particles suspended in the air. They produce an aerosol, which has liquid and/or solid particles suspended in a gaseous medium.)

Liquids and devices are being scrutinized by the Centers for Disease Control and Prevention to identify what is causing the outbreak of vape-related illnesses. As of Oct. 15, the CDC had identified nearly 1,500 lung injuries related to vaping. Thirty-three people have died, according to the agency.

Investigators suspect many of the injuries are related to bootleg cartridges laced with THC, the psychoactive ingredient in marijuana. This point is frequently played up by the vaping industry and its advocates to defend products created and sold by reputable businesses.

However, the ingredients and materials that make up these products are often a mystery, even when they are made by legitimate manufacturers. Researchers like Thomas Eissenberg, a professor of health psychology and co-director of the Center for the Study of Tobacco Products at Virginia Commonwealth University in Richmond, said published cases of e-cigarette-related illnesses preceded the latest outbreak.

“Clearly, there’s something strange about these … cases popping up all at once,” said Eissenberg. “But I suspect we’ve been seeing numerous cases of these kinds of diseases ever since e-cigarettes were first sold.”

“Cigalikes” represent the earliest form of e-cigarettes. The disposable gadgets were typically prefilled and often resembled cigarettes. They also contained modest amounts of nicotine and were not very effective in delivering that to consumers.

Then, vape pens entered the market. They were refillable and packed more power than the cigalikes to heat up the e-liquid. The pens also tended to contain more nicotine.

The third generation of devices ― mods ― proved to be a technological and cultural leap for vaping, said Ana MarĂ­a Rule, an assistant professor who researches e-cigarettes at Johns Hopkins University in Baltimore. Consumers could personalize their gadget by altering the battery, heating elements and e-liquid. The device inspired the creation of groups like “cloud-chasers,” vape users who compete at events around the country to make the largest cloud of aerosol.

“They completely changed the scope and the whole culture of vaping,” Rule said.

This type of vaping means consumers are inhaling larger volumes of the aerosolized chemicals, and that might mean more toxic chemicals, researchers say.

Then Juul hit the market in 2015. The rechargeable device resembles a flash drive, could not be customized and has generally lower voltage than its mod predecessor.

But what Juul lacked in technological innovation, it made up for it in its e-liquid. Each pod contains a concentration of nicotine equal to a pack of cigarettes, which concerns public health officials and researchers because nicotine is addictive. The company cut the nicotine with benzoic acid to reduce irritation, making it more palatable. It ultimately became a runaway success ― particularly among youth.

Yet, nicotine is far from the only harmful substance a consumer could be inhaling. Studies have found that overheating an e-liquid could cause “thermal degradation,” a process where the ingredients start breaking down. In some cases, this dismantling can create toxic chemicals like formaldehyde, a cancer-causing agent, said Eissenberg.

Overheated or burnt e-liquid can taste bitter, he said, but typically consumers have no way to detect a problem. “It’s important to realize it doesn’t always taste bad when that thermal degradation has occurred,” Eissenberg said.

Aerosol from e-cigarettes can also be laced with harmful metals that cause pulmonary and neurological health problems. A study Rule co-authored collected e-liquid samples from 56 e-cigarette devices owned by daily users, and found that the fluid sitting in the device and inhaled by the consumer had markedly higher levels of metal than the liquid in the refillable dispenser.

The authors suggest that the device’s heating element could be introducing toxic metal substances like chromium, nickel and lead into the e-liquid.

Despite the worrisome findings, tobacco researchers say the verdict is still out on the danger of e-cigarettes versus traditional cigarettes. There’s simply not enough data, they say.

However, the lack of evidence hasn’t stopped states from reacting to the cases of vaping-related illnesses by cracking down on the industry. Massachusetts has temporarily banned the sale of all vaping products in the state, but the ban is being challenged in court. Selling flavored e-cigarette and vaping products has been temporarily halted in a handful of other states and local jurisdictions, too.

Some vaping advocates view these state actions as fear-mongering. Gregory Conley, president of the nonprofit American Vaping Association, emphasized that the vast majority of sickened patients reported using bootleg cartridges that contained THC.

“The U.S. is in the middle of a moral panic right now, and good public health policy rarely flows out of moral panics,” said Conley, a New Jersey lawyer.

Conley acknowledged that stricter regulations could have helped keep Juul out of the hands of teens. The Food and Drug Administration, however, did not regulate e-cigarettes until 2016. A court order requires the companies that had products on the market as of August 2016 to turn in applications by May 2020 for FDA approval.

As the agency rolls out those regulations, researchers stress that e-cigarette companies still have wide latitude to sell their product without federal oversight.

E-cigarette and vaping products are “not regulated in terms of quality control, market control, anything right now,” said Bonnie Halpern-Felsher, a professor of pediatrics who researches tobacco-use prevention at Stanford University in California. “It is completely wide open.”


Trump may back off planned e-cigarette flavoring ban and allow mint and menthol, to the pleasure of tobacco companies

President Trump’s campaign manager has warned him that his plan to ban most flavored electronic cigarettes "could backfire in the 2020 election," placing Trump’s re-election campaign in the middle of a governmental debate over a major public-health issue," report Michael Scherer, Josh Dawsey, Laurie McGinley and Neena Satija of The Washington Post.

"The political lobbying effort comes as the Trump administration is considering whether to continue allowing menthol- and mint-flavored e-cigarette products, according to three people familiar with the deliberations,"  the Post reports. "Allowing these sales would mark a major retreat from a proposed ban announced in September on 'all non-tobacco' flavors. Government data shows that nearly two-thirds of high schoolers who use ­e-cigarettes use mint or menthol flavors."

Trump tweeted this after his campaign manger raised concerns.
Campaign manager Brad Parscale has polling that indicates "Trump supporters who use e-cigarettes could abandon the president if he follows through on a ban, according to a person familiar with the effort who spoke on the condition of anonymity to discuss internal deliberations," the Post reports. "Instead, this person said, Parscale has suggested reframing the issue away from flavors to other steps that the government can take to prevent youth use of the products, including a ban on sales of e-cigarettes to anyone under 21, a requirement that stores limit access by locking the products up, and stiffer penalties for selling to underage consumers."

The White House is deliberating whether to allow menthol and mint flavors, which "would benefit the largest e-cigarette producer, Juul Labs," the Post notes. Another option is allowing only menthol "on the theory that it is less sweet and the sole flavor permitted in cigarettes, said two people familiar with the deliberations."

That prospect angered anti-tobacco activists and health groups.

“Excluding menthol would be huge; it means that kids will buy menthol,” Desmond Jenson, an attorney with the Public Health Law Center at the Hamline School of Law in St. Paul, Minn., told the Post. “If you give them one flavor, that’s what they will buy. It doesn’t solve the problem.”

Trump’s first Food and Drug Administration commissioner, Scott Gottlieb, "said Friday that the harm to youths of allowing mint and menthol flavors outweighs the benefit to adults of having flavored options," the Post reports.

“If mint and menthol e-cigs remain on the market, the biggest beneficiaries are tobacco companies like Altria and Reynolds which mass-produce these products, harming kids who are largely using these brands,” Gottlieb said. “Data suggests that adults who use e-cigs to successfully quit smoking aren’t using these same products.”

Juul Labs, "the largest e-cigarette company, has removed all flavors from the market except tobacco, menthol and mint, and it said recently that it was reviewing whether to suspend sales of the latter two," the Post notes. "Mint and menthol accounted for almost 60 percent of Juul’s $3.3 billion in retail sales in the United States last year, according to a Wells Fargo analyst report from last month." Altria Group, the leading maker of traditional cigarettes, owns 35 percent of Juul.

Greg Conley, president of the American Vaping Association, told the Post that mint and menthol aren't big sellers at vape shops, and keeping them on the market wouldn't save retailers.

The Post notes that the president's wife and daughter, Melania and Ivanka Trump, "have been helping to lead the push for a crackdown on youth use of e-cigarettes." The first lady attended the Sept. 11 Oval Office announcement by Health and Human Services Secretary Alex Azar and acting FDA Commissioner Norman “Ned” Sharpless about the proposed ban.

Azar said at that event, citing recent research, “The youth are drawn to flavored e-cigarettes, including mint and menthol.”

"Parscale reached out to President Trump after that event to say that the decision was being made too quickly and that Trump needed more data, according to a person familiar with the conversation," the Post reports. "Trump released a cryptic tweet on Sept. 13, which suggested the possibility of a different approach than the one Azar had announced."

“While I like the Vaping alternative to Cigarettes, we need to make sure this alternative is SAFE for ALL!” Trump wrote. “Let’s get counterfeits off the market, and keep young children from Vaping!”

The Oval Office announcement surprised the electronic-cigarette industry. It fought back, and found allies close to Trump. "Senior White House adviser Kellyanne Conway suggested to reporters Friday that menthol could be viewed as a type of tobacco flavoring," the Post notes, quoting her: “I recognize that menthol tastes like tobacco. Many adults like menthol.”

“Flavors are vaping. Vaping is flavors,” said Grover Norquist, the president of Americans for Tax Reform, an anti-regulation group. He wouldn't tell the Post whether he or his group have gotten money from the e-cigarette industry. The Post adds, "Conservative activists and trade groups organized a protest by e-cigarette users at a recent Trump rally in Dallas."

Thursday, October 24, 2019

Albany doctor's weight-loss clinic sees big results with old-fashioned methods: eat better food, less of it, and exercise

Dr. Carol Peddicord holds a model representing
five pounds of body fat. (Clinton County News photo)
A doctor and a pharmacist in rural Albany are seeing big results in the fight against obesity after opening a weight-loss clinic. Since The Doctor's Health and Weight Loss Clinic opened in January, its 433 patients have lost a collective 4,079 pounds, and most have maintained their weight loss, Brett Gibson of the Clinton County News reports.

Dr. Carol Peddicord and pharmacist Arica Collins of Dyer Drug Co. came up with the idea for the clinic after seeing how many patients came in looking for a quick fix to lose weight. But the best way to do that is to live a healthier lifestyle, not through a pill or a crash diet, the News reports.

The emphasis is on healthier, Peddicord told the News: "We don’t want people to be skinner, we want them to be healthy and live longer." Obesity is a significantly bigger problem in rural areas than in suburban and urban areas, according to the Centers for Disease Control and Prevention. Among adults, 34.2% of rural residents are obese, compared with 28.7% in metropolitan counties. Kentucky has the fifth highest adult obesity rate in the nation, at 36.6%, and the third highest rate for youth 10 to 17, at 20.8%,

Though the duo first conceived of the clinic because they were worried about children's health, most of their patients are women between 35 and 58. There are a few high schoolers, though, and they're starting to see more men coming in. That's good, Peddicord told the News, because men typically have heart disease earlier in life.

Albany, in Clinton County (Wikipedia)
The clinic, which takes insurance, offers individually tailored wellness plans for patients, depending on whether they have high blood pressure, diabetes, and/or heart disease. They offer diet plans and will soon have plans for meal replacements such as shakes, the News reports.

Though Peddicord was glad to note that the clinic's patients had lost 680 pounds last month, she told the News that pounds aren't the only thing that matter. Patients have seen other "non-scale victories" such as being able to stop taking insulin for diabetes. "People are losing weight, feeling better and are able to exercise," she said.

U.S. Rep. Hal Rogers of Fifth District gets first Humanitarian Award from Mothers Against Prescription Drug Abuse

Rep. Hal Rogers
U.S. Rep. Harold “Hal” Rogers of Somerset was honored in Washington Oct. 23 by Mothers Against Prescription Drug Abuse, a non-profit, chaired by his former House Republican colleague Mary Bono and founded by mothers who have lost children to the opioid epidemic.

Rogers, who represents Eastern Kentucky's Fifth District, was the first recipient of MAPDA’s Humanitarian Award.

“Hal was the first in Congress to recognize the threat to our country, our communities and our families,” Bono said in a press release. “His leadership is second to none when it comes to addressing the opioid epidemic.” The release said Rogers:
  • Helped establish a program in 2001 to fund prescription-drug monitoring programs, which help doctors and pharmacists spot and prevent prescription drug abuse and are now used in 49 states.
  • Launched Operation UNITE, a 2003 initiative in Southern and Eastern Kentucky that battles drug abuse through law enforcement, treatment and education and is "a national model to combat the epidemic." In 2012, UNITE and Rogers started the Rx Drug Abuse & Heroin Summit.
  • Started the Congressional Caucus on Prescription Drug Abuse with Bono in 2010.
  • Championed laws that have provided billions of dollars "to battle the epidemic through prevention, treatment, enforcement and research."

Three cases of whooping cough have been reported in Lexington high schools this year; the best defense is vaccinations

Two cases of whooping cough have occurred in less than a month at a Lexington high school, and another Lexington high school reported a case earlier this month.

Two cases were reported at Paul Laurence Dunbar High School and one at Frederick Douglas High School, reports Valarie Honeycutt Spears of the Lexington Herald-Leader.

Health officials told Honeycutt that this is the ninth confirmed case in Lexington in 2019 and the third for Fayette County schools for the 2019-20 school year.

Kentucky has had an estimated 164 confirmed cases of whooping cough in 2019, with the following counties having at least five cases this year: Boone, Bullitt, Fayette, Jefferson, Oldham and Warren. Those affected ranged from less than 6 months in age to 79, according to the Cabinet for Health and Family Services.

Whooping cough, known medically as pertussis, is a highly contagious respiratory infection spread by coughing, sneezing or close contact. Infected people are most contagious up to about two weeks after the cough begins.

Early symptoms of whooping cough look like a common cold, including runny nose, sneezing, mild cough and low-grade fever. After one to two weeks, long coughing spells develop, which often occur in explosive bursts, sometimes ending with a high-pitched whoop and vomiting. This can go on for up to 10 weeks or more, according to the Centers for Disease Control and Prevention.

"Pertussis is most dangerous for babies," says the CDC. "About half of babies younger than 1 who get the disease need care in the hospital."

Vaccination is the best way to prevent the spread of whooping cough, says the CDC. The childhood vaccine is calld DTaP. The whooping cough booster vaccine for adolescents and adults is called Tdap. Both vaccines protect against whooping cough, tetanus and dipthieria.

Infants should receive a series of DTaP immunizations at 2, 4, and 6 months, with boosters at 15-18 months and 4-6 years. Children should then get a single dose of Tdap vaccine at 11 to 12.

Pregnant women should receive a single dose of Tdap during every pregnancy, preferably at 27 through 36 weeks.

Parents of infants and anyone who provides care to an infant should also be immunized against whooping cough. It is recommended that the infant's family members receive a one-time dose of Tdap if they have not already done so.

And although the vaccine is effective, immunity tends to decrease over time, which is why the boosters are so important, says the CDC.

Health officials told Honeycutt that they are working with Fayette County Public Schools to make sure parents are aware of the threat of pertussis. They also recommend preventive antibiotics for high-risk students who were exposed.

High-risk students are those with a chronic illness or weakened immune system and those who live with a family member with a chronic illness or weakened immune system, an infant or a pregnant woman.

Honeycutt reports that school-age children with symptoms of pertussis should stay home from school and go see their health care provider, even if they have previously been vaccinated.  Students with probable or confirmed pertussis should remain out of school until they finish their antibiotics.

A county-by-county annual student immunization report shows that 93.5 percent of Kentucky's Kindergarten students have received four or more doses of the DTaP vaccine, with 60% of counties reporting 95% or greater compliance, which lines up with the Healthy People 2020 target measures.

The report found that 92.3% of the state's seventh graders had received one dose of the Tdap booster, with 92.5% of counties reporting 80% or greater compliance; 93.4% of 11th graders were up to date on their Tdap booster, with 92% of counties reporting 80% or greater compliance; and 94.2% of 12th graders had received one dose of the booster, with 95.7% of counties reporting 80% or greater compliance.  The Healthy People 2020 goal for the upper grades is 80% or greater for one dose of Tdap.

In Fayette County, 96.8% of its Kindergarten students are up to date on their whooping cough vaccine, as are 89.5% of its 7th graders, 92.5% of its 11th graders and 93.1% of its 12th graders

Last year in Kentucky, preliminary data shows that Kentucky had 193 cases of whopping cough, which is 4.33 cases per 100,000 people.

Lawmaker files two bills aimed at e-cigarettes; some want to ban flavors, but sponsor says that should be left up to federal officials

By Melissa Patrick
Kentucky Health News

A Louisville legislator has pre-filed two bills to combat the surge of youth use of electronic cigarettes in Kentucky, but some say they don't go far enough.

Rep. Jerry Miller announces his pre-filed vaping bills, aimed
at rampant teen use of electronic cigarettes. (WLKY-TV image)
Louisville Republican Rep. Jerry Miller's most recently pre-filed bill would require all retailers or manufacturers of vapor/aerosol products that come with "enhanced cartridges" to register with the Department of Alcoholic Beverage Control and pay a $500 annual licensing fee per location annually.

It would also prohibit retailers and manufacturers from selling such products online, by catalog or by phone; prohibit home delivery by outside vendors; require real-time age verification for purchase through an electronic third-party source no later than Jan. 1, 2021; and call for fines on any person under the age of 18 who tries to purchase electronic cigarettes or related products.

WLKY-TV reports that representatives from the Foundation for a Healthy Kentucky and officials from the Jefferson County Public Schools and Greater Louisville Inc., the regional chamber of commerce, attended a press conference at Eastern High School in Louisville to support the bills.

But not all health advocates support the bill as written, largely because it doesn't include language to prohibit flavored e-cigarettes, a proposal that is supported by President Donald Trump.

"Anything short of bold and immediate action by the state to prohibit the sale of all flavored tobacco products, including mint and menthol, fails to protect the health of Kentucky’s kids," says a statement from the American Heart Association, American Lung Association, Campaign for Tobacco-Free Kids and Kentucky Voices for Health. "We urge Rep. Miller to amend his bill to adequately address flavored tobacco products and protect our youth.”

Juul Labs, which has the most popular brand of electronic cigarettes among teens, announced Oct. 17 that it would stop selling fruit-flavored e-cigarettes in the U.S., while continuing to sell mint and menthol products.

The Campaign for Tobacco Free-Kids said in a separate statement that Juul not taking its mint and menthol products off the market shows the company "isn't serious about preventing youth use" of e-cigarettes since they are well aware that preliminary data from the 2019 National Youth Tobacco Survey shows that 64% of high school students who "vape" say that menthol and mint is their second most popular flavor behind fruit "and this number is growing all the time."

According to the Kentucky Incentives for Prevention survey, 26.7% of the state's high-school seniors reported they had vaped in the past 30 days in 2018, up from 12.2% in the 2016 survey. Use by sophomores, or 10th graders, increased to 23.2% from 11.3%; use by eighth graders jumped to 14.2% from 7.3%; and sixth-grader use increased to 4.2% from 2.3% over 2016.

Miller told Bailey Loosemore of the Louisville Courier Journal that he recognized the lure of the flavored products to teens and doesn't oppose a ban on them, but said that such a ban needs to take place on a federal level.

"If Washington wants to ban it, fine, that's their deal," he said. "In terms of Kentucky, how we're going to reduce teen vaping, I see it as more effective to regulate it."

("Vaping" is a term used by manufacturers, sellers and users of electronic cigarettes, but the devices do not produce a vapor, which is liquid particles suspended in the air. They produce an aerosol, which has liquid and/or solid particles suspended in a gaseous medium.)

Miller has also prefiled a bill that would impose a 27.5% excise tax on electronic cigarettes and related devices.

On top of the youth e-cigarette epidemic, the cause of related lung injuries is still unknown. And such injuries have disproportionately affected young people.

As of Oct. 15, 1,478 vaping-related lung injury cases have been reported to the Centers for Disease Control and Prevention, and 33 deaths have been confirmed in 24 states. The CDC reports that 15% of the cases were in patients younger than 18 years old, 21% of them were in patients between the ages of 18 and 21 and 18% were in patients between the ages of 21 and 24.

In Kentucky, 28 cases are under investigation, with six of them probable, two of them confirmed and four of them ruled out.

The CDC adds that while they haven't found the exact cause of the lung injuries, "national and state data suggest that products containing THC, particularly those obtained off the street or from other informal sources are linked to most of the cases." THC stands for tetrahydrocannabinol, the psychoactive ingredient in marijuana.

The CDC just released a report that analyzed 79 Utah patients who had suffered from what is now called EVALI, for "e-cigarette, or vaping, product use-associated lung injury." The report found that almost all of the patients reported using THC-containing vaping cartridges and most of the THC-containing products contained vitamin E acetate.

The study showed evidence of vitamin E acetate in 17 of 20 THC-containing cartridges, which were provided by six of 53 interviewed patients. The report notes that national data suggests that vitamin E acetate is now a common dilution ingredient, or diluient, in THC cartridges.

"The potential role of vitamin E acetate in lung injury remains unknown; however, the identification of vitamin E acetate among products collected from patients in Utah and elsewhere indicates that the outbreak might be associated with cutting agents or adulterants," says the report. "Ascertaining the potential contribution of diluents to the current outbreak will require data from multiple states and analysis at the national level."

Among the 849 lung-injury patients with information on the substances they used in their electronic cigarettes, the CDC reports that about 78% of them used THC-containing product, with 31% of those only using THC. About 58% of them reported using nicotine-containing products, with 10% of those reporting that they only used nicotine.

The CDC recommends that at at this time, all persons should not use e-cigarettes or vaping products containing THC. And because the cause or causes of these lung injuries is still not known, "persons should consider refraining from use of all e-cigarette or vaping products."

Wednesday, October 23, 2019

Nursing home's volunteer program disbands due to dwindling numbers; only 19% of Kentucky seniors volunteer, worst in U.S.

Sunrise Manor volunteers used money from fees to buy items that residents could use. Here, Tickle Ragland, second row at left, and Rebekah Okeson, second row at right, are pictured with some residents sporting sweatshirts the organization purchased as a Christmas gift for every resident.
After 38 years, a volunteer program at the Signature Healthcare nursing home in Hodgenville has disbanded, Ron Benningfield reports for the LaRue County Herald-News.

The Sunrise Manor Volunteers were known as the "Redcoats" for the jackets they wore, Benningfield reports, noting three of the program's earliest volunteers.

He writes that the volunteers helped the nursing-home residents with a wide range of things, from making sure they got to planned activities to polishing their nails -- but most importantly, they spent time with them.

“One of the most important roles, though, was just to be there to give them a hug, a pat on the back, and let them know you cared about them,” said Ruth Ann Brown, one of the early volunteers.

Volunteers also paid membership fees to purchase items for residents, including Christmas presents. “Some of the residents didn’t have any living family and some had no one to visit them, so we wanted to make sure that every one of them knew we hadn’t forgotten them,” longtime volunteeer LaDean Self told Benningfield.

The volunteers, dressed in their red jackets, also sat as a group at many residents' funerals or lined up outside the church or funeral home as a post-service honor guard for the deceased.

Ragland told Benningfield that the program was once voted the best nursing-home volunteer group in Kentucky, but its numbers have dwindled from more than 100 to less than 50, with only 16 attending the last membership meeting.

The seasoned volunteers told Benningfield that lack of time and a dwindling desire to help old, sick people were reasons for their dwindling numbers.

Sonya Turner, quality of life director at Sunrise Manor, told Benningfield that Signature has its own volunteer program, and volunteers are still needed. And "just to set the record straight," she said, the Redcoat group did not disband because of Signature.

Turner said, “Being a volunteer doesn’t mean every day--just an hour or two once a week would be a blessing. We all know that love is spelled T-I-M-E.”

Seniors make great volunteers

AARP
, formerly known as the American Association of Retired Persons, recently released a report saying that volunteers should be recruited among seniors, largely because they have the time to do so.

AARP graphic
The online survey of 1,522 adults looked at the behaviors and interest surrounding adult volunteering activities. It found that adults 65 and older were more likely than younger adults to volunteer frequently, with 32 percent volunteering weekly and 20% doing it monthly.

Seniors also volunteered more hours on a regular basis than younger adults, at an average of 10 hours per month, compared to nine hours for those 18-34 and eight hours for those 35-64. The main reason given by seniors for not being able to volunteer was health problems.

Only 18.9% of Kentucky's seniors volunteer, worst in the nation, according to America's Health Rankings. Kentucky's seniors rank 49th in health.

The AARP survey found that 69% of adults in the U.S. volunteer in some capacity. Of those, 29% said they helped a person in need and 23% said they helped an elderly person, but only 6% said they volunteered in a clinic, hospital or health-care facility.

Younger adults cited time constraints as their main reason for not volunteering, with work (25%) and family (22%) listed as the top two reasons. Among all adults, 21% volunteer weekly and 24% monthly.

The survey noted that volunteers tend to be more optimistic and engaged in their communities than non-volunteers: 45% and 27%, respectively. Volunteers were much more likely than non-volunteers to read newspapers: 62% and 34%, respectively.

It also found that a personal connection or a personal request was the best way to find more volunteers, with 23% in the survey reporting they volunteered with an organization because they knew someone who volunteers with that organization.

That said, a challenge for nursing homes seeking volunteers is that about half of adults say they're looking for ways to volunteer that don't involve personal engagement. The survey found that 52 % were very or somewhat interested in volunteering from home and the same percentage were interested in only volunteering small increments of time.

Be wary of the complex pros and cons of Medicare Advantage plans during open enrollment through Dec. 1, columnist advises

By Trudy Lieberman
Community Health News Service

Along with crunchy leaves and pumpkins, fall brings a slew of advertising for insurance plans that fill the gaps in Medicare coverage.

Misleading and confusing messages continue to reach beneficiaries and those nearing Medicare age. To take myself as an example, I’ve received an invitation to a Medicare Advantage plan informational meeting. I’ve gotten a solicitation from my physician’s medical group offering a “zero-cost, no obligation way to review coverage” online or over the phone. The “review” is likely to bring a sales pitch for a plan.

A mailer from another plan offered “a friendly, money-saving Medicare Advantage Plan” that seemed to promise the moon: savings of up to $2,380 a year, maximum dental coverage of $1,500, and a $750 hearing aid allowance, a drop in the proverbial bucket considering the average cost of two hearing aids is about $4,500. One seller seemed to think I was on both Medicare and Medicaid and pitched a “special needs plan.” Since I wasn’t a candidate for such an arrangement, was the insurer trying to get in the door to sell a regular Medicare Advantage plan?

Too many people fall for those kinds of pitches during Medicare's open enrollment period, which runs through Dec. 1. Shopping to cover the gaps in Medicare is a task no one should take lightly. The stakes are too high.

Medicare is a fine program, but it was never meant to cover everything. It’s based on the old Blue Cross model of insurance common in the 1960s, where the company paid 80 percent of the medical bill and the patient paid 20 percent. An industry selling "Medigap" policies sprang up to cover the 20 percent, and deceptive sales practices plagued the business for years.

Congress ended that and standardized the coverage into 10 plans (now 11, including a high-deductible option) that give people a broad choice for covering what Medicare does not pay. If people bought Plan F or Plan C as their supplemental insurance, they were pretty much covered for most illnesses.

Beginning next year, however, new Medicare beneficiaries – those who turn 65 on or after Jan. 1, 2020 – won’t be allowed to buy Plan F or C. Congress wants more beneficiaries in Medicare Advantage plans, so it eliminated the option to buy the most comprehensive plans. Lawmakers wanted seniors to pay more for their care.

They can still buy Plan G, which offers the same protection as F except that it doesn’t cover the Medicare Part B deductible, which is $183 next year. People already on Medicare can still buy Plans F or C.

The goal is to push more people into Medicare Advantage plans, a private alternative that is a step toward privatizing the entire program. To move the process along, the government has overpaid insurers to provide the care, which enables them to offer inducements to join. About one-third of Medicare beneficiaries have moved to MA plans, so that strategy seems to be successful.

But does it come at a cost?

Serious questions have arisen about the overpayments the government has made using taxpayer dollars– overpayments that allow plans to offer gym memberships and even Apple watches, as monitoring devices, to new enrollees as one plan is doing. In September six Democratic senators wrote to the Centers for Medicare and Medicaid Services, noting that taxpayers have overpaid Medicare Advantage plans more than $30 billion over the last three years and that CMS has “taken little to no action to correct” the overbilling and overpayments.

Even more troubling, the letter also says that several other government agencies such as the Office of the Inspector General in the Department for Health and Human Services have raised “serious concerns” about Advantage plans that fail to meet needs of older adults and those with disabilities.

The letter raises questions about the kind of care beneficiaries are actually receiving, and notes that Medicare’s own audits have found “widespread and persistent Medicare Advantage performance problems related to denials of care and payment” that “threaten the health and safety of their members.”

Those are government watchdogs raising a red flag about problems getting care when you’re really sick and need good insurance.

Medicare Advantage plan advisers note that traditional Medicare does not put a limit on the amount a beneficiary must pay out of pocket each year, while Advantage plans do – $6,700 for in-network providers and $10,000 for those out of network. They usually don’t mention that a good Medigap policy will cover those amounts, but the premiums may be higher than for an MA plan heavily subsidized by the government.

The trade-off becomes what it does with all insurance: Pay now in the form of higher premiums, or pay later in the form of higher expenses if the worst happens. Insurers seldom mention that tough trade-off when they host those informational meetings for Medicare shoppers.

Tuesday, October 22, 2019

Weekly editor-publisher, one of several speakers at Nov. 15 workshop on Covering Substance Abuse and Recovery, tells why and how she covers it, and why you should too



Sharon Burton has been getting national attention for her series "The Cost of Addiction" in her weekly Adair County Community Voice in Columbia, Kentucky. On Nov. 15, in Ashland, Ky., she will discuss with journalists how to cover a subject that can be difficult and many don't want to cover.

"It's something that's affecting everyone's lives, and we need to be talking about it and we need to be looking for solutions," Burton says in a video interview with Al Cross, director of the Institute for Rural Journalism and Community Issues, publisher of The Rural Blog. IRJCI is sponsoring the workshop with Oak Ridge Associated Universities, where research has shown that the stigma attached to drug abuse inhibits news coverage and community conversations about it.

Burton, who has a local competitor, says in the video that she understands rural journalists' reluctance: "It's not a pleasant thing to discuss, and I think a lot pf people feel embarrassed because they're talking about their loved ones. . . . A lot of times, they're talking about themselves." However, people have mostly been cooperative when approached for a story, she says: "They want to help other people. . . . They want to share their experiences and help others."

Burton says rural newspapers contribute to the stigma of drug abuse when they cover it only as a criminal-justice issue: "We as newspaper people have probably been some of the most cynical when it comes to, you know, 'Put em in Public Record and throw 'em in jail' kind of attitude."

She says the problem is primarily a health issue, but also also affects the general public through higher jail costs and difficulty of employers and prospective employers to find drug-free employees.

At Covering Substance Abuse and Recovery: A Workshop for Journalists, Burton says, "I hope to encourage them" to help their communities: "If nothing else, to say its worth the effort." For details on the workshop, registration and accommodations, click here. The fee is $50 until Nov. 1 and $60 until Nov. 8, when registration will close. Space is limited.

Monday, October 21, 2019

Citing legal problems encountered by Kentucky and Arkansas, Arizona suspends its plan to add work requirements to Medicaid

Section 1115 waivers are the device being used to add work and other "community engagement" rules.
Arizona has indefinitely suspended its plan to add work requirements to its Medicaid program "due to legal uncertainty caused by several court rulings that have blocked other states from implementing the policy," including Kentucky, James Romoser reports for Inside Health Policy.

Arizona is one of 10 states where the Centers for Medicare and Medicaid Services allowed work requirements, and it is the first Republican-led state to reverse course, Romoser reports.

Kentucky, led by Republican Gov. Matt Bevin, was the first state to be approved, but a federal judge in Washington, D.C., blocked its plan twice, and stopped a similar plan that had already taken effect in Arkansas. A three-judge appellate panel appeared skeptical of both plans in a hearing Oct. 11.

The panel is expected to rule within a few months. Bevin is seeking re-election Nov. 5 against Democratic Attorney General Andy Beshear, who has pledged to drop the plan if elected because "This is paperwork and it is intended to tear health care away from people," as he said in an Oct. 15 debate with Bevin.

Bevin told Beshear, "This isn't about people being, having anything ripped away from them. What I propose is that people work and or volunteer and or go to school or be in training or take care of someone in exchange" for their benefits.

Bevin's original proposal estimated that in five years, Kentucky's Medicaid rolls would have 95,000 fewer people than they would without the plan, largely because of noncompliance. Academic health experts said in a friend-of-the-court brief that a more likely range was 175,000 to 297,500. Medicaid covers 1.4 million Kentuckians, around 450,000 of them under the expansion.

Studies have indicated that most people who would be affected by the work rules are already meeting them. One study based on polling found that 97% were already meeting the requirements; another, based on claims data, showed that 64% were.

Sunday, October 20, 2019

Over 1/3 of Ky. students in violation of rule requiring hepatitis A shots; other immunizations fall short; report has county figures

Photo illustration from NaturalHealthNews.com
More than a third of Kentucky school students are in violation of the year-old state law requiring them to be vaccinated for the liver disease hepatitis A, according to the annual report by the state Department for Public Health on student immunizations.

"While hepatitis A rates were the lowest of all required vaccines, they reflect a broader trend: Kentucky students still aren’t getting the required number of shots," reports Alex Acquisto of the Lexington Herald-Leader. "Kindergartners, who have the highest compliance rates to meet, failed to meet state standards in all categories."

Only 65 percent of students in kindergarten, seventh grade and the 11th and 12th grades had received at least two doses of the hepatitis A vaccine. Only kindergartners, at 84.3%, came close to "meeting the state’s target compliance rate of 85%," Acquisto notes. "Rates were lowest among high school seniors, at 46 percent, followed by high school juniors at nearly 50%, and seventh graders at 76%."

Among high-school students, Hickman County was the only one that met the 85% hep-A standard; it also was the only one where juniors met the target compliance rates for all immunizations. Nearby Ballard County was the only one to meet all of the target compliance rates for seniors.

In Johnson County, only 9 percent got two hepatitis A shots, and the county was out of compliance with every immunization requirement for high schoolers, according to the county-by-county report.

In adjoining Magoffin County, where 21% of high school seniors and 14% of juniors got two hep-A shots, School Supt. Scott Helton told Acquisto there isn't a sense of urgency. “When it’s change, it’s always hard at first,” Helton said. “Most people seem to think it won’t happen to them.”

The state required hepatitis A vaccination for the current school year after an outbreak of the disease, which began in late 2017 and has infected 4,943 Kentuckians and killed 61. "One health official says initially low rates of compliance are normal, even in the face of a public-health crisis," Acquisto reports, quoting Dr. Sean McTigue, a University of Kentucky infectious disease pediatrician.

“Anytime there’s a vaccine that’s added to school requirements there’s some hesitancy among parents, even though this is not by any stretch of the imagination a new vaccine,” McTigue said, adding that it will take “at least two years,” to get close to 85%, because immunization requires two shots six months apart and the school year lasts nine to 10 months. "Most children and teens get vaccines from their pediatricians, who they might only otherwise see once a year," Acquisto notes.

Stigma is also an obstacle, because other strains of hepatitis "are spread primarily by sharing needles for injection of drugs," Acquisto reports. Unlike blood-borne hepatitis C, hepatitis A "is spread primarily through contact with an infected person, or through consumption of fecal material, usually by way of unclean food or water."

Reporting and exemptions

In addition to the lack of vaccinations, there is a lack of reporting, Acquisto notes: "State law requires immunization records to be filed within two weeks of when a student begins attending school, but the report shows 796 high school seniors didn’t provide vaccination records to their schools at all, along with 1,087 11th-graders, 674 seventh-graders, and 1,696 kindergartners — 8%, total.

"Some counties reported significant numbers of students who had no vaccination certificate on file. In Robertson County, 23 percent of high school seniors had no immunization record on file. The same went for 25 percent of Wolfe County kindergartners, 10 percent of Magoffin County seventh-graders, and 15 percent of Clark County juniors."

The report does not include the estimated 19,250 students who are home-schooled, because the state law requiring immunization does not apply to them.

In 2017 the state made it easier to claim a religious exemption from the immunization law. "Roughly 4%, or 2,040 students, claimed a religious exemption, while 2.3%, or 1,175, claimed a medical exemption," Acquisto reports. "Carlisle County had the most high-school seniors, 6%, who claimed a religious exemption, followed by 3.4% of Jessamine County eleventh graders, 5.5 percent of Clinton County seventh graders, and 5% of Crittenden County kindergartners.

Public-health experts worry that the exemptions and the anti-vaccination movement threaten "herd immunity," which occurs when enough people have been immunized against a disease to protect others who are not immunized. (Some can't get vaccinations because their immune systems are too weak to allow them to get shots, or because they are too young.)

The report quoted research that has found high immunization rates are “particularly difficult” to maintain “as populations become more sophisticated and more likely to question recommendations. Unless direct communication about the social benefits of vaccinations are relayed to parents, there will continue to be increases in ‘free-ride’ or reliance on herd immunity to avoid vaccination within school settings. Therefore, more education needs to be provided to parents about the public health impacts vaccinations have within schools, especially for the protection of vulnerable students who are immunocompromised.”

Saturday, October 19, 2019

Kentucky legislators have pre-filed bills to cap the cost of insulin for some; advocate describes the 'real cost' of diabetes

By Melissa Patrick
Kentucky Health News

While legislators and health advocates work to control the surging cost of insulin, a mother with two children and a husband with Type I diabetes points out that the cost of diabetes care far exceeds the actual cost of the drug -- and that the latest, most efficient life-saving technologies and treatments should not be considered a luxury.

Lisa Middleton, patient advocate
Insulin pumps and continuous glucose monitors aren't luxuries, Lisa Middleton, an advocate for patients and affordable health care, said at the annual Health Watch USA 2019 Patient Safety Conference Oct. 17 in Lexington.

Insulin pumps are small, computerized devices that deliver insulin throughout the day, or variable amounts when a meal is eaten, similar to the way the body delivers insulin when it's working properly.

Continuous glucose monitors track glucose levels throughout the day and night, and send alerts to designated cell phones when a person's blood sugar fluctuates, allowing for immediate treatment.

"Things like insulin pumps and things like CGMs shouldn't be considered a luxury," Middleton said. "They should be considered the standard and therefore the standard needs to change. And the same goes for insulin."

Middleton offered an example of how a continuous glucose monitor recently alerted her when her daughter's blood sugar dropped to around 20 or 30, which is dangerously low. She said normal blood sugar levels for her family are 80 to 150.

"So, in my opinion, this right here is the absolute most important thing other than insulin," she said.

What are the "real costs"?

Middleton said that with insurance, her family paid nearly $8,000 out of pocket for one insulin pump, which has a retail cost upwards of $15,000. She said glucose monitors run around $1,800 with insurance, and that require a sensor that has to be replaced every 10 to 14 days and costs about $80. And there are other costs.

Middleton showed receipts from one family that pays $1,092 a month for insulin, and said there have been times when her family has had to pay around $1,300 a month. "And it's non-negotiable," she said, "so you do whatever you have to to make that happen."

She said insulin pens, which make measuring and delivering insulin easier, cost a maximum of $73 in other countries, but $700 in the United States, and around $400 with insurance.

In 2016, Americans with Type 1 diabetes spent $5,705 on insulin, according to an analysis of health-care claim data by the Healthcare Cost Institute.

Middleton provided a long list of supplies that make treatment expensive, such as blood-glucose meters, test strips, lancets and syringes. She pointed out a life-saving medication called glucagon, which is used when a person's blood glucose drops dangerously low, that comes in a one-time use emergency kit that in the past has cost her $300 -- with insurance.

She also pointed to a page-long list of other costs to consider, such as more expensive food to accommodate a person's blood sugar fluctuation, the cost of transportation and time-off-work for doctor's appointments, and the ongoing costs of tapes, adhesives and ointments to name a few.

Dealing with these financial barriers

High costs associated with a Type I diabetes diagnosis can lead to medical bankruptcy, significant credit-card debt or even death, Middleton said. She listed the names of 11 people who have died since 2017 because they couldn't afford their insulin.

To overcome some of the financial barriers, some people are traveling to other countries to get their insulin, she said. Some are moving to other states that offer special insurance coverage for kids with Type I diabetes, and several other states are working to cap the co-payment, as Colorado has.

She said many ration their doses, some eliminate the use of insulin pumps and continuous monitors, and some use equipment longer than it is intended. Some use cheap Walmart insulin, which she said is often not preferable, but is all many can afford.

And some who need the drug have taken to trading their insulin and other needed supplies on social media, Bailey Loosemore reports for the Louisville Courier Journal.

Louisville Courier-Journal screenshot from Facebook
"High deductibles, lack of insurance or inadequate insurance have forced people to pay more for their prescriptions," Loosemore writes. And when they can't afford the life-saving drug Marybeth Lacy of Morgan County, who has lived with Type I diabetes for 43 years, and others told Loosemore they have "hoarded insulin, skipped doses and even traded medications with friends or on social media," which Loosemore notes is "technically illegal."

Lacy told Loosemore that she is grateful that her insurance covers all the cost of her prescribed insulin, which would otherwise cost more than $1,000 a month, but it's not the type of insulin that works best for her. Sometimes, she said, the insulin that is not covered and costs her more than $300 for a two-week supply, is the only drug that will work to control her blood sugar.

In her closing PowerPoint slides, Middleton said that she has been told that some will suggest that people with diabetes need to switch to a more affordable "multiple daily injection" therapy, which requires the person to self-inject insulin several times a day as well as constantly self-monitor their blood sugar.

To this suggestion, they said "I should not have to choose between being financially stable and staying out of debt and having the best treatment for my diabetes. The standard of care for diabetes needs to be updated so that insulin pumps and CGM are affordable and available to everyone. The long term benefits to better coverage for the technology will drastically reduce the financial impact of treating complications that arise from improperly managed diabetes throughout life."

What's Kentucky doing?

Two Kentucky legislators are working to fix that. Rep. Danny Bentley, a Republican from Russell who is a pharmacist, pre-filed a bill to cap the cost-sharing price, or co-pay, of insulin at $100 for a 30-day-supply; Sen. Phillip Wheeler, a Pikeville Republican, has pre-filed a bill in the Senate. So far, Colorado is the only state to have passed such a bill; it will go into effect in January.

Wheeler's bill would also require insulin manufacturers and wholesale distributors to issue all customers a rebate for expenses over $100.

Angela Lautner, founder of the advocacy group Kentucky Insulin 4 All, told Loosemore that such a cap could benefit people who receive insurance through state insurance plans or the state-federal marketplace, but it would not help those who are insured through self-funded plans by multi-state employers, because those plans are governed by federal rather than state laws.

During its last session, the legislature passed a Bentley bill to allow pharmacists to dispense insulin and respiratory inhalers in the smallest supply available in an emergency. Kentucky already had a law to allow pharmacists to dispense a 72-hour emergency supply of a prescription medication, but because insulin and most inhalers are not available in doses that small, they couldn't dispense them.

The law is called Kevin's Law for Kevin Houdeshell, an Ohio man with diabetes who died after running out of insulin on New Year's Eve in 2013, despite multiple efforts to reach his doctor to get the refill.

Four students at Grayson County High School taken to hospital after using device to vaporize hashish oil; two arrested

Leitchfield and Grayson County (Wikipedia maps)
Four students at Grayson County High School in Leitchfield were taken to the local hospital Oct. 15, and two were arrested, after inhaling vapor or aerosol from "dab pen" devices, police said.

The Leitchfield Police Department said officers and ambulances were called to the school about after several students became ill after inhaling an "unknown substance" from the dab pens. The four students were treated and released at Twin Lakes Regional Medical Center.

"Dabbing," sometimes called the "cannabis crack," involves "highly concentrated marijuana in a vaporized form," Billy Kobin reports for the Louisville Courier Journal. "According to the Center on Addiction, dabbing often involves inhaling or vaping a Tic Tac-sized drop of butane hash oil, a gooey liquid which contains a high concentration of tetrahydrocannabinol (THC), the psychoactive ingredient in marijuana.

At least 12 students "had used the dab pens and were experiencing the same symptoms, according to Leitchfield police," Kobin reports. "Additional details on the symptoms were not provided. According to the National Institute on Drug Abuse and Center on Addiction, dabbing can result in symptoms that include rapid heartbeat, loss of consciousness and psychotic reactions like paranoia and hallucinations."

After searching a Leitchfield residence, police said they located more of the substance found in the dab pen, Kobin reports: "Two juvenile suspects were arrested and charged in connection with the dabbing incident, according to Leitchfield police. The charges include 12 counts each of first-degree wanton endangerment and trafficking in a controlled substance, with additional charges pending."

Kobin notes, "The Grayson County incident comes as health officials have reported over 1,000 cases nationwide of a lung illness that has been linked to vaping devices and e-cigarettes and has killed over two dozen people."

Friday, October 18, 2019

Bevin and Beshear hotly debate governor's Medicaid work rules, their effect and their cost; and their stands on health insurance

Gov. Bevin and Attorney General Beshear debated Oct. 15. (Photo by Ryan Hermens, Lexington Herald-Leader)
By Melissa Patrick
Kentucky Health News

A key difference between Kentucky's gubernatorial candidates is that one wants to require most able-bodied adults on Medicaid to work or participate in other "community engagement activities" in exchange for their health insurance, while the other says he would immediately dismiss such a proposal if elected because it's designed to kick people off of the Medicaid rolls.

Republican Gov. Matt Bevin and his administration have tried to add such requirements through a waiver of traditional Medicaid rules. It would require, among other things, most of the state's able-bodied adults who gained coverage through the expansion of Medicaid (to people who earn up to 138 percent of the federal poverty line) to work, go to school or take job training 80 hours a month unless they are medically frail or must care for children.

A federal judge in Washington, D.C., has blocked the waiver. On Oct. 11, an appeal was heard by judges who indicated they are unlikely to revive it. Bevin has said he expects the Supreme Court to decide the issue. He has issued an executive order that would end the Medicaid expansion six months after a final ruling against his plan.

The televised debate at the University of Kentucky Oct. 15 was the first time Bevin and Attorney General Andy Beshear had locked horns over this issue and it was a lively exchange.

Bevin said, "I am a strong proponent of able-bodied, working-aged men and women who do not have dependents and have the capability of going to work, to go to work in exchange for that which is provided for them by people who do go to work."

The governor said he has empathy for such people, telling his oft-told story of how he was raised poor and no health insurance until he joined the Army.

"I also know that it is an amazing degree of bigotry that allows people to assume that someone like myself had no opportunity, needed to be babied, needed to be put in a position where I was given things as opposed to opportunity and an expectation that I seize that," he said. 

Bevin said expanded Medicaid should be "available for those who need it and the medically frail and women with children," he said.

Beshear disagreed. After calling health care "a basic human right" he declared that if he was elected Nov. 5 he would drop the waiver, which would require those covered by the community-engagement rules to report their hours monthly and be locked out of the program for non-compliance.

"This is red tape. This is paperwork and it is intended to tear healthcare away from people," Beshear said. "I will always stand up against that, and I'm going to rescind that Medicaid waiver in my first week of office."

Beshear noted that after Arkansas implemented Medicaid work requirements,where 18,000 people lost their coverage before the same judge who got Kentucky's case blocked the program,  "The vast majority of people who lost their coverage were already working," he said.

Harvard University researchers have found that most of those affected by the Arkansas work requirements were already working and likely lost coverage because of a "lack of awareness and confusion about the reporting requirements," Phil Galewitz reports for Kaiser Health News. "They also found that there was no evidence they had either secured jobs or other insurance coverage."

Studies indicate that if appellate courts allow the Kentucky waiver, most who would be affected by its work rules are already meeting them. One study based on polling found that 97% are already meeting the requirements; another, based on claims data, shows 64% are.

Numbers, oversimplified

Beshear added, "Governor Bevin's plan will rip 95,000 people off health care that have it for the very first time and I think that's wrong."

That line had some over-simplifications. Some people on the Medicaid expansion have had health insurance in the past, and the numbers cannot be individualized because tens of thousands of people go on and off Medicaid each month due to changes in their eligibility.

The 95,000 number comes from Bevin's original proposal, which estimated that in five years, Kentucky's Medicaid rolls would have 95,000 fewer people than they would without the waiver. Academic health experts said in a friend-of-the-court brief that a more likely range was 175,000 to 297,500. Medicaid covers 1.4 million Kentuckians, around 450,000 of them under the expansion.

Bevin replied to Beshear, "This isn't about people being, having anything ripped away from them. What I propose is that people work and or volunteer and or go to school or be in training or take care of someone in exchange." Further, he said if a person is already meeting the requirements, as was a person Beshear cited as an example, they have nothing to worry about.

Beshear also noted a recently published report by the General Accounting Office, the investigative arm of Congress, which found that Kentucky has budgeted $272 million in fiscal years 2019 and 2020 to pay for the technology and administrative costs of Bevin's plan, an amount roughly twice the combined expense of four other states that are also working to implement similar requirements.

"And his plan is going to cost $272 million of our taxpayer dollars," Beshear said. He did not note that 87 percent of the money comes from the federal government.

Talking over each other, Bevin pushed back and suggested that  Beshear and "the people who wrote your comments" didn't bother to read the report, saying it would not cost that much.

The report says the budget is based on 620,000 Kentuckians being affected by the new Medicaid requirements, which is a much larger number than has been previously reported but apparently includes people who would qualify for exemptions because of children, frailty or other reasons.

Asked about access to care, Beshear said he would fight to keep "federal health care reform" -- otherwise known as the Affordable Care Act or Obamacare -- and its expansion of Medicaid, which he said is "absolutely critical" to the survival of rural health care and rural hospitals.

"With the current lawsuit that threatens the very future of expanded Medicaid, rural health care is on the line," Beshear said. "Everybody should be able to get the health care coverage they need in their hometowns," he said.

Answering the question about access, Bevin said it is a "form of bigotry" to assume that people can't fend for themselves. "It's easy to say that health care is a right," he said, "but the reality is it's one that costs money."

Requiring insurance for pre-existing conditions

The two candidates also had a noisy discussion about whether Bevin supports taking away  protections for pre-existing conditions.

This stems from his support of association health plans (AHPs), a type of insurance that makes it easier for small employers to band together, free of many of the requirements of the ACA.

Bevin says he doesn't support any plan that denies coverage for pre-existing conditions because the  U.S. Department of Labor clearly says AHPs "may not charge higher premiums or deny coverage to people because of pre-existing conditions."

Beshear says AHPs have loopholes that allow them to deny coverage. For example, AHPs do not have to cover all the essential benefits required by the ACA, such as maternity, mental health or prescription drugs, allowing them to create benefit packages that are of limited use to people with certain health conditions. AHPs are also allowed to vary premiums based on age, gender, industry and geography, which are factors that can be used to predict or anticipate pre-existing conditions.

"You can go to the doctor and learn you have a chronic disease, but it's not covered," Beshear said. "Your kids may get the flu . . . but pediatrics isn't covered. You might get home and find out that you're expecting a child, but maternity is not covered," Beshear said. "This governor supports health care that doesn't cover anybody's basic needs."

Bevin pointed to the Labor Department ruling and said, "These are scare tactics and lies. Nothing I have ever proposed offers any of these things that he is saying. . . .  So everything that you are threatening is not true and the things that you are saying I said are not true."

Pre-existing pool for pre-existing conditions?

Beshear also pointed out that Bevin said we should go back to how pre-existing conditions were treated before federal health reform. To which Bevin said, "I never said that."

Beshear's campaign said he was referring to Bevin's comment that he would support going back to high-risk pools for people with pre-existing conditions, which Kentucky used before the ACA.

Problems with the high-risk pool, called Ky Access, were numerous. It never enrolled more than 4,837 people, cost almost $14,000 a year in 2013 and had a $2 million lifetime cap per enrollee, Lisa Gillespie reported in 2017 for Louisville's WFPL.

"Costs to both the state and individuals rose so much because there weren’t any young, healthy people to balance out all the high medical costs," Gillespie reported. "That’s according to Advocacy Action Network executive director Sheila Schuster. She helped oversee the rollout of KY Access."

“It was essentially a conglomeration of people with high-risk, chronic conditions that were going to be very costly,” Schuster told Gillespie. “The premiums were very high, but it was the only game in town.”