National Breastfeeding Week, Aug. 1-7, focuses attention on need for supportive families, friends and employers

World Breastfeeding Week is Aug. 1-7, so the state Department for Public Health is pointing out the importance of providing support for breastfeeding families. “We encourage mothers to breastfeed to ensure that infants are getting the nutrition they need to grow and thrive,” said Health and Family Services Cabinet Secretary Audrey Haynes. “Even the most committed mothers can struggle to successfully breastfeed when they don’t have the kind of support system they need at home, at the workplace and in the community. If we want to send the message that breastfeeding is important and improve our breastfeeding rates, we need to support mothers who choose to breastfeed.”

The World Health Organization, the American Academy of Pediatrics and other medical organizations recommend that babies be exclusively breastfed for the first six months of life, and continue to be breastfed, along with other food sources, for at least a year. The cabinet and the department want fathers, other family members, friends, employers and others to know that, and the importance of support for breatfeeding mothers, especially in the workplace. “Continuing breastfeeding after returning to work is a tremendous challenge,” said Fran Hawkins, director of the state's Women, Infants and Children nutrition program. Public health officials stress that continuing breastfeeding after returning to work is often necessary to meet the recommendations for optimal infant nutrition.

The state says four steps help make workplaces more conducive to breastfeeding: support from managers and coworkers; flexible time to express milk (10 to 15 minutes three times per day); education for employees about how to combine breastfeeding and work; and a designated space to breastfeed or express milk in privacy. Kentucky law protects women who wish to breastfeed their babies in public. This law permits a mother to breastfeed her baby or express breast milk in any public or private location. This law also requires that breastfeeding not be considered an act of public indecency or indecent exposure. For more information, contact Marlene Goodlett at (502) 564-3827 ext. 3612 or marlene.goodlett@ky.gov. Information on breastfeeding can be found here.

What it's like to lack health insurance, and how health reform is changing that: It's a story for every county, with local data

The Kentucky Standard's Randy Patrick deftly shows how the federal health-care reform law is having an effect at the individual level by telling the story of Bonnie Varnell, a Nelson County resident who is uninsured and is more than $65,000 in debt due to her fight against cancer.

For 18 years, Varnell worked at a daycare that didn't offer health insurance. She wasn't able to buy individual coverage because she had pre-exisiting conditions as a result of surgeries. She is only 59, so does not qualify for Medicare, and she didn't qualify for the federal law known as COBRA, which "allows workers to keep their company group health insurance benefits for up to 18 months after leaving their jobs, as long as they pay the entire premium," Patrick explains.

As a result, the bills kept mounting, despite hospitals giving the Varnells reduced rates through charity care. "I've been trying to pay something on every one," Varnell's husband Ed said of the bills he receives and has to delay paying in full. "It's really frustrating. We had never been late a day in our lives."

Now, Varnell has health insurance through a program created under the Patient Protection and Affordable Care Act. "It costs her $315 a month and covers most of her costs after the deductible is met, but the law stipulates that a person with a pre-existing condition must be uninsured for at least six months before she or he can be eligible," Patrick reports.

Varnell's fear now is the program will be taken away if the Affordable Care Act is repealed after the November election. Patrick gives opponents of the law their say. (Read more)

There are stories like Varnell's in every county. Patrick, who recently joined the Bardstown thrice-weekly after editing papers in Nicholasville and Winchester, sets the bar high for how to tell such stories.

Varnell is among the estimated 15 percent of people in Nelson County who didn't have health insurance in 2009, the last year for which estimates are available. Statewide, the census estimate was 16.5 percent. For a list of all Kentucky county estimates, click here. For the Census Bureau website that is the source of the data, go here. 

New health law and aging baby boomers' anticipated strain on the system is about to make chronic doctor shortage worse

Kentucky's persistent physician shortage is hardly new. Almost a century ago, the Frontier Nursing Service came to Hyden on the presumption that doctors wouldn't. A report from the Health Resources and Services Administration in 2005 found that 81 of 120 of the commonwealth's counties were officially health professional shortage areas. Now comes news that areas in the United States with growing and dense urban populations are feeling the considerable pinch of also not having enough doctors to provide care.

New York Times reporters Annie Lowrey and Robert Pear report that with the expansion of insurance coverage and aging baby boomers driving up demand, we shouldn't expect the shortage to get better anywhere before it gets worse everywhere. (NYT chart)


"The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. That number will more than double by 2025," report Lowrey and Pear. "Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000." In addition, Medicare officials predict their enrollment will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year because of the baby boomer demographic hitting their golden years. “Older Americans require significantly more health care,” said Dr. Darrell G. Kirch, the president of the Association of American Medical Colleges. “Older individuals are more likely to have multiple chronic conditions, requiring more intensive, coordinated care.”

Medical school enrollment is increasing, but not as fast as the population. The number of training positions for medical school graduates is lagging. Younger doctors are on average working fewer hours than their predecessors. And about a third of the country’s doctors are 55 or older, and nearing retirement. (Read more)

State insurance exchanges are good for farmers and other rural residents, farmers union president writes

Farmers and rural Americans have much to gain from state health-insurance exchanges under federal health reform, since "Rural residents often have the hardest time getting health insurance," the president of the Wisconsin Farmers Union argues in an op-ed piece in Madison's Capital Times.

People who live in rural areas "are predominantly self-employed and run small businesses, with insurance costs too high because of small risk pools," Darin Von Ruden points out. "They often pay way too much for terrible coverage. Some are uninsurable because of the high-risk nature of farming. Many can't pay high premiums for the current system of individual and family coverage." Insurance exchanges will "broaden risk pools" and bring down the overall cost, he argues. 

Wisconsin has been one of the firmest states against implementing federal health-care reforms, including the exchanges, which will be marketplaces where people can choose from a variety of state-approved health-insurance plans. This month, Republican Gov. Scott Walker said he would not take any action to implement the law until after the November elections. After the U.S. Supreme Court upheld the law, Democratic Gov. Steve Beshear of Kentucky issued an executive order creating a Kentucky exchange. States have the option to run their own exchange or let the federal government do it for them.

Von Ruden said exchanges are "critical" for Wisconsin's farmers and rural communities. "It's disappointing, to say the least, that our legislative majority would be dragging their feet on getting this done," he writes. "I can't imagine why any of them would want to wait on this. Creating our own state exchanges keeps the control in Wisconsin." He concludes, "Every American deserves health care that is comprehensive, affordable and accessible, regardless of occupation or geographic area." (Read more)

Reports show impact of health-care industry in each of Kentucky's 120 counties

It's not often that such detailed data is broken down to the county level, but a new report looks at the economic impact of the local health-care system in each of Kentucky's 120 counties.

The reports, compiled at the University of Kentucky, look at the number of health-care jobs, as well as the revenue and income generated by the local health-care system. In many rural counties, the authors note, health care is the second largest industry, second only to local government.

The most important economic role of the health-care sector is to "keep local health-care dollars at home," the report says. If private insurance, consumer out-of-pocket payments and Medicare and Medicaid transfer payments aren't kept local, an outmigration of health-care services can take place. "This bypass of local health care remains an important issue for many rural health care providers and rural communities."

Conversely, if the local health-care sector can attract patients from outside the area, health care "can act as an export industry," the authors note. Because doctors and other providers can help improve the health and productivity of the local workforce, the health-care sector can also help an area recruit new and retain existing business.

The county reports include a comparison of household income with the state and nation, and indicates how that income is earned. In Boyle County, for example, 55.6 percent was earned through place-of-work earnings, while 22.6 percent was from transfer payments, such as those from Social Security, Medicare and Medicaid. The reports also break down how much income is generated according to industry type, from 2000 to 2008.

Income earned by Boyle County residents working in the health-care sector increased 42 percent in those years, one of the largest areas of gains in the county. In all, health care accounted for 13 percent of industry in Boyle and generated more than $322 million in sales, more than $151 million in labor income and nearly 3,500 jobs in the area.

The report, available here, was compiled by Dr. Alison Davis, director of the Community and Ecomomic Development Initiative in Kentucky, part of UK's College of Agriculture. It was funded by the Foundation for a Healthy Kentucky.

Lyme disease in Ky. probably more common than reported

Nearly anyone who has spent considerable time in the woods this summer has later discovered they carried a visitor back with them — one the size of a freckle who latches on for dear life. Ticks are not uncommon in Kentucky, though Lyme disease, which is spread through the bite of a black-legged deer tick, is not commonly seen in the state.

But those numbers are likely under-reported, Keiara Carr reports for The Courier-Journal, in part because "Current medical guidelines say the disease is so rare in Kentucky that doctors should look for alternative causes for symptoms that might suggest Lyme disease."

Only five cases were reported in Kentucky in each of the past two years and there was just one case in 2009. But it's likely cases went under-reported because doctors don't give the blood test that diagnoses Lyme. They just don't feel it's necessary given the rarity of the disease in the area, Carr reports.

But Mike Gatton of Louisville knows all too well that it's possible. He got bitten by a tick while mowing his lawn two years ago. He developed a rash on his leg but when he went to the doctor he was tested for a variety of diseases, including West Nile, multiple sclerosis and Lou Gehrig disease, but not Lyme. "I was feeling more and more fatigued. I was having severe headaches. I was really concerned," he said.

When he got another tick bite a year ago and had the same reaction he had to the first bite, he put the tick in a vial and brought it to his doctor, who still dismissed the possibility of Lyme. He is now being treated with antibiotics he takes intravenously.

Symptoms of Lyme disease include fever, headache and fatigue. Sometimes, a rash that looks like a bull's eye around the tick bite can develop. Usually, people get better with large doses of antibiotics. If left untreated, "the infection can be painful and debilitating, causing arthritis or spreading to the heart and nervous system," Carr reports.

Guidelines by the Infectious Disease Society of America "to help doctors decide if a patient is eligible for treatment say the patient should have received the tick bite in an 'endemic area," Carr reports, which makes sense according to Paul Mead, a consulting physician for the Centers for Disease Control and Prevention. "For example, a physician in Africa evaluating a child for fever should have malaria at the top of his list; a physician in Kentucky should not," he said. (Read more)

Children's health and education improves in Kentucky, but one in four kids lives in poverty, report shows

New data show one in four Kentucky children live in poverty, a sharp increase since 2005, but the state is improving when it comes to children's health and education. These were the latest findings in the influential Kids Count report by the Annie E. Casey Foundation, as assessment of children's overall well-being in the country.

Compared to national averages, fewer Kentucky children go without health insurance (6 percent compared to the nation's 8 percent) and there are fewer teens who abuse alcohol or drugs (6 percent in Kentucky; 7 percent nationwide).

Though it remains higher than the national average, Kentucky's rate of child and teen deaths decreased considerably from 2005 to 2009 (41 per 100,000 to 32 per 100,000). And the number of babies who are born underweight dropped slightly in Kentucky from 2005 to 2009 (9.1 percent to 8.9 percent), though the number remains higher than the country as a whole (8.2 percent).

These were some of the 16 factors, shown below, that the report used to assess overall child well-being. The factors fell into four main groups: economic well-being, family and community, education and health. Kentucky ranked a somewhat dismal 35th among the 50 states in overall well-being of children. But in education, it was 28th, and in health, 25th.

The report shows the share of Kentucky children living in poverty grew by 18 percent from 2005 to 2010, meaning they lived at or below the federal poverty line. In 2010, that meant "an annual income of less than $22,113 for a family of two adults and two children," Valarie Honeycutt Spears reports for the Lexington Herald-Leader.

The Courier-Journal's Jessie Halladay points out that more children have access to health insurance in part because of a statewide push to get more children enrolled in the federally funded Kentucky Children's Health Program, known more commonly as KCHIP. Now, about 65,000 children are enrolled. "We are clearly making a difference in easing the difficulty these tough economic conditions put on our families," said Gov. Steve Beshear, who launched the effort.

But much work remains to be done, points out Terry Brooks, executive director of Kentucky Youth Advocates. He referred to the fact that while more fourth-graders are proficient in reading than they were in 2005, a whopping 65 percent of them were still not considered reading proficient in 2010. "At one level you want to celebrate us doing well compared to other states, but you can't celebrate too much," Brooks told Halladay. (Read more)

Whooping cough on the rise in Kentucky and nationwide

A resurgence of whooping cough in Kentucky and the nation has officials urging the public to get vaccinated. The state has already had 171 reported cases this year, making it "on track to beat our record from just two years ago," said Dr. Kraig Humbaugh, state epidemiologist with the Cabinet for Health and Family Services.

The Centers for Disease Control and Prevention announced recently there have been 18,000 cases nationwide so far in 2012, double the number of confirmed cases at the same time last year. "At that pace, the number for the entire year will be the highest since 1959, when 40,000 illnesses were reported," Mary Meehan reports for the Lexington Herald-Leader.

Washington and Oregon have been hit hardest. In Kentucky, Madison County has 24 cases. Estill County has 20, while the Northern Kentucky Health Department, which serves Boone, Campbell, Grant and Kenton counties, has reported 61 cases. In Lexington, there have been 15.

Whooping cough is spread by respiratory droplets transmitted person to person through close contact. It is sometimes characterized by a cough that ends with a high-pitched "whoop" sound during the next intake of breath. Immunization against the disease is required for school-age children, but many adults may not have gotten the vaccine or might need to get a booster shot. Officials urge them to do so. (Read more)

Looking for 'a few short-term wins' to start, Kentucky Oral Health Coalition formally reorganizes

By Amy Wilson
Kentucky Health News

LOUISVILLE, July 25 – There was no whitewashing the ruinous state of the state's teeth Wednesday when the Kentucky Oral Health Coalition formally reorganized with the goal of fixing as much as they can as fast as it can. With almost a fourth of Kentuckians over 65 having complete tooth loss and almost half of children between 2 and 4 already having twice the national average of cavities, there is work to be done on every front.

As the state with the 49th worst-looking mouths in the country, explained Andrea Bennett, senior policy analyst for Kentucky Youth Advocates, "What we're looking for is a few short-term wins."

It appears that the top priority, as voted by the coalition's members, is to improve oral health literacy and education. That means that members will be looking for ways – including maybe getting themselves a celebrity spokesperson – to explain what good oral hygiene is and how to get it.

Close behind in priorities will be efforts to expand school-based oral health services, including for those in Head Start and all child-care settings. Members also expressed a desire to increase the number of Kentucky dentists who accept Medicaid, thus expanding the numbers of those who can be treated.

How they do that is under discussion. The group, which existed a decade ago but lost momentum, has decided to revitalize into a more active, more inclusive, perhaps even more legislatively inclined group. It all depends on its new leadership, said Dr. James Cecil, a national leader in public health and a former University of Kentucky dental school professor.

Cecil, who now works with KYA, a nonprofit whose staff will handle a lot of the coalition's workload, explained that funding for the initial work of the group is expected to come from the renewal of a grant from DentaQuest, a continuous source of funding for Kentucky dental projects for three years. New programs, as drawn up by and agreed to by the new executive committee elected Wednesday, will seek other sources of funding through corporations and other grants, Cecil said. In their current treasury is $20,000, left over from the old KOHC.

The coaltion is now chaired by Laura Hancock Jones, Western Kentucky Dental Outreach Program director in the University of Kentucky College of Dentistry's Division of Public Health. A well-known and well-respected practicing pediatric dentist, she is self-described "passionate" advocate for education and literacy about oral health. She runs a program that provides a fluoride varnish on children as young as 2.

"I have seen how much we've done and it's not been enough," Hancock-Jones said. "We have not moved the needle." The answer, she said, is "from the bottom. You have to talk to the kids." In her own health-department experience, she dogged one family for three years, she said, through the school Family Resource and Service Center, social workers, and eventually the judicial system, to get their children care. Eventually, she did and "the kids are" getting care and thinking "It really is a good thing to go to the dentist."
 
Members of the coalition include dentists, dental hygienists, insurance providers, public health officers, school nurses and students. Donna Ruley, executive director of the Kentucky Dental Hygienist Association, was elected secretary of the group Wednesday. She said she believes it's important that her profession is at the table when talking about dental priorities and potential scope of job description legislation. "Our impact on education is huge," said Ruley. "The legislature just recently passed a public-health hygienist role that would allow for a greater number of people to be taught prevention services without a dentist's supervision." That, she added, is a great need in a lot of far-flung rural reaches of the state.

The vice chair of the group is Linda Poynter of the Kenton County Health Department. The treasurer is Dr. Lee Mayer of the University of Louisville dental school.

Bath salts, synthetic drugs change too fast for foes to fight

Bath salts, which mimic the effects of drugs like cocaine
and speed. The Patriot-News photo by Chris Knight.

Though legislators across the country, including Kentucky, have passed laws to ban synthetic drugs like bath salts, there are so many new formulations of the substances the states can't keep up.

Experts estimate there are more than 100 types of bath-salt chemicals. "The moment you start to regulate one of them, they'll come out with a variant that sometimes is even more potent," said Dr. Nora Volkow, director of the National Institute on Drug Abuse.

The drugs, which mimic the effects of drugs like cocaine and amphetamines, are usually sold at small stores "in misleading packaging that suggests common household items like bath salts, incense and plant food," Matthew Perrone reports for The Associated Press. "But the substances inside are powerful, mind-altering drugs that have been linked to bizarre and violent behavior across the country." The products are sold under brand names like "Ivory Wave," "Vanilla Sky" and "Bliss." The American Association of Poison Control got more than 6,100 calls about the drugs in 2011 — up from 304 in 2010 — and 1,700 calls so far this year.

The sticky wicket in controlling the surge of formulations stems from the fact that "U.S. laws prohibit the sale or possession of all substances that mimic illegal drugs, but only if federal prosecutors can show that they are intended for human use," Perrone reports. On almost every packet of these drugs, there is a warning that says they are not fit for human consumption. Be that as it may, "everyone knows these are drugs to get high, including the sellers," said Barbara Carreno, a spokeswoman for the Drug Enforcement Administration.

Kentucky banned bath salts in 2011. In May 2012 Gov. Steve Beshear signed a mandate that "closes legal loopholes by banning classes, not just compounds, of synthetic drugs," reports Jeffery Smith for WFIE-TV in Evansville, Ind. The 2011 law "extends seizure and forfeiture laws to retailers who sell the items, makes sales a felony for a second or subsequent offense, and makes simple possession a misdemeanor," Smith reports.

Still, those fighting on the front lines of the problem said it's difficult to curb. "The problem is these drugs are changing and I'm sure they're going to find some that are a little bit different chemically so they don't fall under the law," said Dr. Sullivan Smith of Cookeville Regional Medical Center in Tennessee. "Is it adequate to name five or 10 or even 20? The answer is no, they're changing too fast." (Read more)

Four pain clinics already closed as 'pill mill' bill takes effect; Beshear says nine more haven't applied, will be investigated

By Tara Kaprowy
Kentucky Health News

Just days after new legislation has taken effect to combat prescription drug abuse, four pain clinics in Kentucky say they will close, Gov. Steve Beshear announced today. "The word is out. Kentucky is deadly serious about stopping this scourge of prescription drug abuse and now we have some of the strongest tools in the country to make that happen," the governor said, adding that nine other pain-management clinics have not applied for licenses and will be investigated.


The law puts more restrictions on pain clinics to prevent so-called "pill mills" from setting up shop in the state. To be licensed, pain clinics must be owned by a licensed medical practitioner, and the law requires licensing boards to investigate complaints immediately.

It also requires doctors who prescribe controlled substances to refer to the state's drug-monitoring system known as KASPER before they write a prescription so they can see if a patient appears to be doctor shopping. The licensing boards have been charged to set up standards to increase oversight and spell out how doctors should be using KASPER (Kentucky All Schedule Prescription Electronic Reporting).

Though changes are still possible, the licensing boards issued those regulations last week, which were more expansive than originally required in the new law. The boards indicated they wanted KASPER to track all Schedule II and III drugs and 15 more Schedule IV drugs. The statute originally only required tracking of Schedule II and Schedule III drugs that contain hydrocodone.

Cracking down on actual pill mill owners, drug abusers and dealers had been difficult up until now since law enforcement couldn't see the data in KASPER without already having a case file opened. In his first four years in office, Attorney General Jack Conway said repeatedly he never got a referral from the Kentucky Board of Medical Licensure saying an investigation should be conducted.

Now when a complaint about prescription drug abuse is lodged with any investigative agency — the attorney general's office, Kentucky State Police, any of the licensing boards or the Cabinet for Health and Family Services — it must be shared with the other agencies within three days. However, the six licensing boards (medical licensure, nursing, dentistry, pharmacy, podiatry and optometry) don't have to share among each other. "This alleviates concerns that the professional organizations would be forced to report information to other boards that have no jurisdiction over the complaint," Beshear said.

If the Kentucky State Police sees there has been a complaint made by another agency, its officers do still need to open "a bona fide specific investigation on that designated individual" before they can request their own KASPER report or see the one used to prompt the complaint, said CHFS spokeswoman Jill Midkiff.

Some critics have said the legislation interferes with the care doctors provide for their patients and threatens confidentiality. To that end, Beshear said people who legitimately need prescription drugs "have nothing to fear. You'll get your medicine." For doctors who are concerned they won't be able to prescribe as they wish, Beshear said provisions have been built into the law to prevent that from happening.

"But if you're doctor-shopping, buying extra pills for recreational use, or prescribing pills for cash, you'd better change your vocation or change your location, because we're coming after you," he said.

As for arguments that checking with KASPER to see if a patient has a questionable prescription history will be too time consuming for providers, "nine times out of 10, it will take as much time as measuring a patient's blood pressure or recording their insurance information," said Mary Begley, CHFS inspector general. CHFS reports 90 percent of KASPER reports are completed within 15 to 30 seconds.

A prescriber or pharmacist can also choose delegates — like a nurse or an aid — to run reports on their behalf, Midkiff said.

The licensing boards have allowed a grace period until Oct. 1 to allow practitioners to time to learn how the new policies will work, according to Beshear's press release.


Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

CBO estimates court ruling will mean 3 million fewer people than predicted will get insurance, saving federal government $84 billion

The Congressional Budget Office estimates 3 million fewer people will get health insurance than expected before the U.S. Supreme Court's decision on the Patient Protection and Affordable Care Act. The CBO forecasts that will reduce the law's estimated cost by $84 billion over the next 10 years.

Fewer people will have coverage because some states will opt not to expand their Medicaid programs up to 138 percent the federal poverty level — an option states now have because of the decision. This runs counter to a report by the conservative American Action Forum that predicted states declining to expand Medicaid would increase the law's cost.

Sarah Kliff of The Washington Post breaks down the nonpartisan congressional agency's calculation: "The CBO estimates that for every person who does not enroll in Medicaid, and because of that goes uninsured, the federal government saves $6,000 in spending by 2022. For the average person who does not enroll in Medicaid, but instead gets subsidized coverage from the health-insurance exchange, the federal government spends $9,000 — $3,000 more than they would have had those individuals been on Medicaid."

Thus, the CBO says it will be more expensive for taxpayers if more people are on Medicaid instead of getting their insurance from the exchanges. With about 6 million fewer people than expected on Medicaid, and only about 3 million signing up for insurance exchanges, leaving 3 million more uninsured than expected, "The projected decrease in total federal spending on Medicaid is larger than the anticipated increase in total exchange subsidies," the CBO notes. Here is its graphic representation:

Doctors shifting from private practice to large hospitals for more security under health-care reform

Associated Press photo by Michael Schennum.

The days of hanging up a shingle and opening shop are becoming more and more unusual for doctors. Afraid of being left without protection in the face of changes caused by federal health-care reforms, doctors are leaving their private practices and moving under the shelter of large hospitals.

The shift is "driven largely by growing regulatory and administrative burdens, rising malpractice costs and declining reimbursements from insurers," reports J.D. Harrison for The Washington Post. In general, large hospitals have more financial security and are more equipped to keep track of new regulations.

In 2000, 57 percent of physicians owned their own firms compared to 43 percent in 2009, research by Accenture shows. The number is expected to fall to 33 percent by 2013. "The classic model of independent, small physician practice still exists today, but it's rapidly becoming a relic of a bygone era," Mark Smith, president of physician-recruiting firm Merritt Hawkins, told the House Small Business Committee last week. "This model is only likely to persist in any numbers in smaller, rural areas where there are few physicians; and even here, physicians will likely need to partner or affiliate with larger entities in some way."

Part of the change stems from the fact that accountable-care organizations are now an official part of Medicare. This health-care model, in which groups of providers "take responsibility for the care for an entire patient group," encourages hospitals to take on physician partners, Harrison notes. "Because of bundled payments and other measures in the law, hospitals want to make sure they have enough primary-care physicians, particularly, as well as specialists that they can have in their accountable care organizations so they can participate," Dr. Jerry Kennett, senior partner at Missouri Cardiovascular Specialists in Columbia, Mo., told lawmakers.

New regulations and non-compliance penalties that are built into the law are also making doctors run for cover. "There is so much more regulation, and the penalties are so great, physicians are very fearful that they'll make an honest mistake and be held financially accountable," Smith said. (Read more)
Hat tip to The Lane Report

After several groups say Pap smears aren't needed every year, ob/gyns recommend an annual 'well-woman' visit

Though several groups have said women don't need a Pap smear every year, obstetricians and gynecologists still recommend an annual "well-woman" visit and annual pelvic exams for all females over 21.

These new recommendations by the American College of Obstetricians and Gynecologists were published Monday. They come a few months after the American Cancer Society, the U.S. Preventive Services Task Force and other groups said most women only need a Pap smear every three years starting at age 21. After the age of 30, they can get them less often if they also get tests for the human papillomavirus, known to cause cervical and other cancers.

The visit "can be used to check blood pressure and weight, update immunizations, counsel patients on healthy lifestyles, screen for sexually transmitted infections and other health problems, perform breast exams and build relationships between doctors and patients," reports Kim Painter for USA Today.

But some critics question if these visits are just a way to make money. "We estimate that about $8 billion a year is spent on preventive yearly physicals of all kinds," said Ateev Mehrotra, a professor at the University of Pittsburgh School of Medicine. "The question is whether we could spend those $8 billion more wisely." (Read more)

Kentucky students will get extra education in nutrition, exercise

Kentucky children will get extra nutrition education at school starting Oct. 1, thanks to a $6 million federal grant intended to instill better eating and physical-activity habits in families eligible for food stamps.

The education will be provided by local health departments. It will encourage students to:
• Fill half their plates with fruits and vegetables; drink fat-free or low-fat milk; and make sure they eat whole grains.
• Increase physical activity and cut down on sedentary behaviors.
• Consume the appropriate amount of calories for their age.

Kentucky students will get more nutrition education
aimed at getting those eligible for the Supplemental
Nutrition Assistance Program to make healthy food
choices. (Photo from The Lane Report)

Details about how many children will benefit from the education and how many minutes of instruction they will receive per week have not yet been ironed out, said Beth Fisher, spokeswoman for the Cabinet for Health and Family Services.

"Sometimes children can be the best teachers, so our hope is that they will pass on to their parents some of what they have learned at school about the importance of nutrition and physical activity," said Teresa James, acting commissioner of the Department of Community Based Services. "If children ask their parents to serve more fruits and vegetables, or take a walk instead of watching TV and the parents comply, this effort can benefit the entire household — just look at the influence children have had on recycling." (Read more)

Cost of long-term-care insurance going up, but it's still a wise investment, depending on your income

Judy Witte says her long-term-care insurance premiums
are going up at a worrying rate. C-J photo by Matt Stone.

Seniors are facing increases in their premiums for long-term-care insurance as insurance companies scramble to deal with increasing longevity of seniors and low interest rates that are "crimping investment returns," Chris Otts reports for The Courier-Journal.

Louisville retiree Judy Witte, 72, said she received a letter from her insurance company recently saying her premiums will go up by 77 percent, from $986 to $1,746 per year.

Her situation is part of a larger trend in which the cost of an average policy has increased by 6 to 17 percent from 2011 to 2012. Long-term-care insurance helps pay for the cost of assisted living, nursing homes, hospice care and home care.

In the Louisville area, assisted living costs about $45,000 per year and nursing homes cost about $72,000 per year and more.

People should buy long-term-care insurance if they can't afford the care they might need without dipping into their savings, Otts reports. "For example, someone who receives $100,000 a year in retirement income but spends only $30,000 might be able to afford an assisted-living center or nursing home," Otts notes. But if that same person spends $80,000 a year, then it would be a wise investment to buy long-term-care insurance because they would not be able to afford the assisted living or nursing home costs.

The right time to buy long-term-care insurance is between age 50 and 60. If Witte had waited to buy hers today, it would have cost her more than $26,000 a year, Otts reports. "To me, it's a precious possession," she said. "It helps me sleep at night to know I have this." (Read more)

Six of 41 child-abuse fatalities show improper follow-up by Cabinet for Health and Family Services, Herald-Leader analysis finds

The way child-abuse deaths are reviewed in Kentucky continues to be problematic. Looking at the 41 child fatalities in 2009 and 2010, Lexington Herald-Leader reporters Beth Musgrave and Bill Estep found at least six cases in which the Cabinet for Health and Family Services "did not do an internal review even though there were previous reports involving the family before the child died."

State law requires the cabinet to conduct such a review when a child dies or nearly dies because of abuse or neglect and the cabinet had prior involvement with the family.

That didn't happen in the case of 2-year-old Derek Cooper, whose father placed his hands over the crying boy's mouth "until the child was silent," a state report said. Cooper's father, Brandon Fraley, had had contact with the cabinet when he was a child himself, and in 2006 there was an allegation of domestic violence against him, Musgrave and Estep report. Cabinet spokeswoman Jill Midkiff said the cabinet doesn't do internal reviews when the contact with the cabinet occurred when the alleged abuser was a child, but Midkiff "provided no explanation about why the 2006 domestic violence investigation of Fraley didn't trigger an internal review," the newspaper reports.

The analysis also showed vast differences in the way internal reviews are conducted in different parts of the state. "Some of the reviews appeared to be thorough, but in others, child-protection workers produced only one-page reports with little detail on what happened to the children and no assessment of potential improvements," Musgrave and Estep report.

"The cabinet for so long has hidden everything it could," said state Rep. Susan Westrom, D-Lexington, who tried earlier this year to pass a bill that would create an external child-fatality review panel. Gov. Steve Beshear has issued an order to create such a panel, whose members will review cases and make recommendations. The panel will not have cabinet staff as members.

Westrom's bill got hung up partly over the cabinet's attempt to impose further restrictions on the sort of information it is required to make public. The newspaper's analysis the result of a long fight the Herald-Leader and The Courier-Journal have waged to make the child-abuse documentation available to the public. C-J lawyer Jon Fleischaker said on KET yesterday that the cabinet continues to redact more information that it should, in an effort to protect its own interests. The fight continues in the appellate courts. (Read more)

Questions about health-care reform law answered in comprehensive Courier-Journal report

Reporter Laura Ungar has put together an excellent primer in The Courier-Journal that appears to answer all the key questions people have about the federal health-care reform law. Reporters would do well to refer to Ungar's report when writing about the Patient Protection and Affordable Care Act.

The piece breaks down how the law will affect adults, young people, senior citizens and business owners. "Experts agree the changes will be sweeping," Ungar reports.

Ungar asks questions like:
• What is the individual mandate? It means everyone must have health insurance by 2014 or pay a fine. By 2016, the penalty will increase to $695 for individuals and $2,085 for families or 2.5 percent of their income.

• Will I become eligible for Medicaid under the new law? That's not yet clear because Kentucky hasn't decided whether or not to expand the program. If it does choose to expand, people who earn up to 138 percent of the federal poverty level will qualify, which means individuals who earn up to $15,415 or a family of four that earns up to $31,809.

• Are there any new taxes under the law? Yes. The individual mandate can be interpreted as a tax. Also people who earn more than $200,000 and married couples who earn $250,000 combined will pay a payroll tax of 2.35 percent, up from 1.45 percent.

• How will I find health insurance? A state health insurance exchange will be set up by 2014 so people who earn up to 400 percent of the federal poverty level — an annual income of about $90,000 for a family of four —can buy health insurance.

• How can young people stay on their parents' health insurance plan? They are eligible under the new law to stay on their parents' plan until the age of 26. So far, 35,600 young adults in Kentucky have gotten coverage this way.

• What if my young child gets married or pregnant? The child will be covered and so would the pregnancy if the parents' plan allows for that. The plan doesn't have to cover the baby, however.

• Will my premiums go up if I get insurance through my job? That's still unclear. "There are provisions that could push up premiums slightly, such as the elimination of lifetime caps on coverage, but there are also provisions that could push them down, such as the influx of many more healthy young people," Ungar reports.

• How does the law affect Medicare coverage? Benefits have not changed, but there will no longer be co-pays for preventive services like mammograms and prostate-cancer screenings, "a provision that has affected more than 1.2 million seniors in Kentucky," Ungar reports.

The report is worth reading in its entirety and could be used as a regular reference about the law. (Read more)

To implement law aimed at prescription drug abuse, licensing boards issue regulations that some say are too expansive

Ambien and Ritalin are among the drugs that will be tracked through the state's drug monitoring system, with medical licensure boards issuing emergency regulations that are more expansive than originally required in a law aimed at curbing prescription drug abuse and so-called pill mills.

Rep. John Tilley, D-Hopkinsville, said "there's an honest debate" about why the Cabinet for Health and Family Services and the boards wish to track all Schedule II and III drugs and 15 more Schedule IV drugs. "The statute only called for tracking Schedule II drugs and those Schedule III drugs that contain hydrocodone," reports Ronnie Ellis for Community Newspaper Holdings Inc.

Among the 15 listed Schedule IV drugs are Ambien, Valium, Librium, anorexic drugs and Soma. Ritalin, usually used to help with Attention Deficit Disorder, is a Schedule II drug and will be tracked for patients who are prescribed it for more than 30 days. Lloyd Vest, the Kentucky Board of Medical Licensure's general counsel, said some parents "doctor shop" to get the drug. The new regulations have prompted "some prescribers to cease prescribing the drug, causing parents and children to scramble for prescriptions before school begins next month," Ellis reports.

Dr. Steven Sack, an emergency room doctor from St. Joseph East in Lexington, said the regulations "have gone well beyond the initial intent" of the legislation and will "result in unnecessary suffering in the commonwealth with patients not getting the care they need."

He said running a report in the drug-monitoring system known as KASPER takes an "enormous" amount of time. He asked why doctors must run reports on, say, an 80-year-old with chronic pain. Ellis reports the average KASPER report can be electronically transmitted in 15 seconds, and Tilley said running a report might "prevent prescriptions which might adversely interact with other medication the patient is taking."

Changes can be made to the regulations before the September deadline and they can be revised in the 2013 General Assembly. Physicians had until last week to sign up for a KASPER account. As of last Friday, there were 17,048 master accounts. In 2011, there were just 879.  (Read more)

Hopkinsville hospital's credit rating downgraded; part of national trend, but only Kentucky hospital nicked by rating agency lately

Following a national trend stemming from a slowly recovering economy, the hospital in Hopkinsville has had its credit rating downgraded, a possibility many Kentucky hospitals may be facing. "This means the hospital may have to pay a higher interest rate if it needs to borrow money in the near future," reports Nick Tabor, senior staff writer for theKentucky New Era.

Loss of business, a small revenue base and lots of debt were among the reasons Jennie Stuart Medical Center's rating dropped from BBB+ to BBB, Tabor reports. Fitch Ratings, one of the global agencies whose ratings guide investors, said uncertainty about the expansion of Kentucky's Medicaid system and how federal health reform will affect the hospital's finances were other reasons for the downgrade. The hospital has lost money in two of the last four years. Last year, it had a 1.9 percent loss.

Tabor explains there are eight ratings above the BBB level. If the facility's rating "were to slip two levels lower, to BB+, it would be on the level of 'junk bonds,' no longer considered investment grade," he reports.

There are three major rating companies in the U.S.: Fitch, Moody's and Standard and Poor's. Moody's expects downgrades of nonprofit hospitals to outnumber upgrades by the end of 2012, reports Jeffrey Young for The Huffington Post. Fitch expects the same will happen, said Senior Director Emily Wong. Smaller hospitals will especially feel the pinch since they "don't have as much ability to offset expense, inflation or reimbursement reductions," Wong said.

Since October 2011, Fitch has reviewed seven nonprofit hospitals in Kentucky. Five were affirmed, one was upgraded and Jennie Stuart was the lone downgrade. The other facilities reviewed were:
• Norton Healthcare, Louisville: affirmed at A-

• Owensboro Medicald Health System: affirmed at BBB+

• Appalachian Regional Healthcare: upgraded BB from BB-

• King's Daughters in Ashland: affirmed at A+

• Baptist Health Systems: affirmed at AA-

• St. Elizabeth Medical Center: affirmed at AA-

AA- and A-rated facilities are reviewed every two years. BBB and BBs are reviewed once a year, and B- and below-rated facilities are reviewed every six months. This type of story can be localized for any hospital. The easiest way to check ratings for hospitals in your area is to get an account at each of the three major rating companies. "These accounts are free and easy to set up," Tabor said. (Read more)

Safety-net hospitals could get hit hardest in Oct. when patient ratings will influence Medicare and Medicaid payments

When hospitals start getting paid based on the perceived quality of care they provide to their Medicare and Medicaid patients, so-called "safety net" hospitals, a last resort for the poor, could be the losers in the equation. That's because a main way of measuring quality will be patient experience ratings, and safety-net hospitals tend to get poorer marks from patients, according ta new study published in the Archives of Internal Medicine.

Since hospitals have had to publicly report their patient experience ratings, the gap between how patients rated these facilities and the scores that other hospitals got widened. "We found that [safety-net hospitals] performed more poorly than other hospitals on nearly every measure of patient experience and that gaps in performance were sizeable and persistent over time," the authors write.

When the Centers for Medicare and Medicaid Services agency starts using the scores to hand out bonuses and penalties, safety-net hospitals could be at a disadvantage, especially since penalties could mean a 2 percent cut on regular Medicare payments. Starting in October, patient experience scores will determine 30 percent of a facility's bonus. "The hospitals that perform best will gain money, while those that lag in scores and improvement over time will end up with less," reports Jordan Rau for Kaiser Health News. (Read more)

Hospitals are not reporting cases of harm to patients; electronic health records may be key to solving the problem

By Tara Kaprowy
Kentucky Health News

Hospitals aren't reporting cases in which medical care harmed a patient, making it difficult for providers to identify problems and fix them, according to a report to be released by the U.S. Department of Health and Human Services.

The report indicates many hospitals are ignoring state regulations by not reporting preventable problems. In Kentucky, there are no mandatory public reporting requirements for hospitals. They must only inform the state Department of Public Health about infectious outbreaks, but the definition of an outbreak varies from facility to facility, based on the number of patients seen in a specific period of time.

Dr. Kevin Kavanagh, a retired physician and chairman of Health Watch USA, said the report points to "the need for greater health care transparency and state government engagement."

The study's lead researcher, Lee Adler, is looking to electronic health records to set things right since "we may be able to prevent events, we may be able to ameliorate events, and (electronic records) may become your surveillance system," he said.

The software can be designed to "catch triggers for potential errors," Kelly Kennedy reports for USA Today. One example could involve a patient that is given an antidote after a medication overdose. The fact that the antidote was used would trigger an alert to a hospital quality control officer, who would them follow up in turn. (Read more)

About half of doctors are using EHRs nationwide, the latest survey from the Department of Health and Human Services shows. "That's a pretty high number, historically speaking," reports Sarah Kliff for The Washington Post. "As recently as 2005, just about a quarter of doctors' offices had gone digital."

In February, Health and Human Services Secretary Kathleen Sebelius said the percentage of hospitals using electronic health records has doubled in two years, Medical News Today reports. The shift at doctors' offices and hospitals stems from a provision in the federal health-care reform law, which gives financial incentives to facilities that switch over to EHRs.

In Kentucky, 723 eligible professionals and 15 hospitals have already been paid their incentives, which totaled more than $155 million as of May. In February, Sebelius said almost 2,000 hospitals and more than 41,000 doctors had received more than $3 billion in incentive payments to use health information technology. The proportion of hospitals that now use EHRs went up from 16 percent in 2009 to 35 percent in 2011. More than 80 percent of hospitals said they intend to advantage of the incentives by 2015.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

More breakthroughs lately in fight against HIV/AIDS

It has been an inspiring season of breakthroughs in the fight to prevent the spread of HIV and AIDS. Earlier this week, the Food and Drug Administration approved the pill Truvada, "a preventive measure for healthy people who are at high risk of acquiring HIV through sexual activity, such as those who have HIV-infected partners," reports Matthew Perrone for The Associated Press.

Just two weeks ago, the agency also approved the first over-the-counter HIV test that can be used at home. "I think the combination of self-testing and a medicine that you can take at home to prevent infection could mean a whole new approach to HIV prevention that is a bit more realistic," said Dr. Demetre Daskalakis of New York University's Langone Medical Center.

In the meantime, a research team at the University of Nebraska Medical Center is making progress to develop a weekly or twice-monthly injection that would help manage patients with HIV. The long-acting injection "would be a substantive improvement over daily and sometimes more complex regimen of pills," lead investigator Dr. Howard Gendelman told research-reporting service Newswise.

"We actually followed the process exactly as we would with a person — and it worked," he said. "This is all very exciting. Although there are clear pitfalls ahead and the medicines are not yet ready for human use, the progress is undeniable." (Read more)

Forums set to explain state insurance exchange and its new opportunities for coverage, little known to most who will be eligible

By Tara Kaprowy
Kentucky Health News

Now that Gov. Steve Beshear has issued the order to create a state health insurance exchange, the state is scheduling public forums to explain it. Rachel Klein, the executive director of Enroll America, said 78 percent of uninsured Americans "have no idea that there is new health coverage coming." 

Klein's nonprofit organization, based in Washington, D.C., is working with local and state groups like the Kentucky Voices for Health coalition to help spread the word that many will be eligible for health care under the exchange, part of national health reform.

Under the exchange, people who earn up to 400 percent of the federal poverty level will be able to buy private health insurance, and most will have their premiums partly paid for through federal subsidies. They will be able to get information about various policies and enroll online.

Officials from the state Department of Insurance and Cabinet for Health and Family Services will hold six educational forums in the coming days to talk about the exchange the federal health-care reform law. Here is the schedule:

• Erlanger: 1-3:30 p.m. July 25, Northern Kentucky University, The METS Center
• Louisville: 1-3:30 p.m., July 26, University of Louisville Shelby Campus
• Prestonsburg: 1-3:30 p.m., July 27, Big Sandy Community and Technical College
• Somerset: 1-3:30 p.m., Aug. 1, Somerset Community College
• Paducah: 1-3:30 p.m., Aug. 16, West Kentucky Community and Technical College
• Owensboro: 8:30-11 a.m., Aug. 17, Owensboro Community and Technical College

Once the exchange is set up, Klein said it will be important for the sign-up process to be easy. States should make the application itself easy to read and be sure there is a lot of help available to those enrolling, she said. "It's hard to underestimate the incredible need for assistance," Klein said. Another key piece is to make sure the exchange's technology "coordinates well with other systems that are already in existence," she said.

The exchange will include the federal-state Medicaid program. Kentucky has the option of expanding its program up to 133 percent of the federal poverty level (with a sort of fudge factor up to 138 percent). Right now, only those earning up to 59 percent qualify. Expansion would cover almost 300,000 more Kentuckians, Democratic U.S. Rep. John Yarmuth of Louisville said last week. The  has not yet released an exact number of how many would be affected.

As of last Friday, Kentucky was the 16th state to commit to an exchange. States have until Nov. 1 to inform the federal government if they intend to set up an exchange, and have until Jan. 1, 2014 to get them up and running.

KVH said it will also help educate the public. Executive Director Jodi Mitchell said she is staying connected with the state to keep abreast of the status of the exchange. "The cabinet is going to do it the way the cabinet is going to do it," she said. "The challenge is for us to keep involved and hold them accountable as they proceed."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Being sedentary is just as deadly as smoking, series finds

Getty Images photo by George Doyle

Physical inactivity is such a problem worldwide it has become as deadly as smoking, a series of studies has found. Lack of exercise causes about one in 10 premature deaths worldwide, in large part because it contributes to heart disease, Type 2 diabetes, breast cancer and colon cancer.

"If physical inactivity could be reduced by just 10 percent, it could avert some 533,000 deaths a year; if reduced by 25 percent, 1.3 million deaths could be prevented," reports Alice Park for Time Healthland.

In a study published in the journal Lancet, researchers "calculated something called a population attributable fraction (PAF), a measure of the contribution of risk factors like physical inactivity to diseases such as heart disease or diabetes, and even risk of death," Park reports. That calculation indicated how many incidences of disease could have been prevented if people started exercising like they should. PAFs were calculated for 123 countries and showed overall that physical inactivity is responsible for 6 percent of heart disease, 7 percent of Type 2 diabetes and 10 percent of breast and colon cancers.

The numbers also showed people living in the Americas have the most physically inactive populations — 43 percent of people don't get enough exercise — while people who live in Southeast Asia are the most active. The Americas' reliance on cars and other vehicles is considered a major factor in their sedentary lifestyles, with just 4 percent of people in the U.S. walking to work and fewer than 2 percent using a bicycle to commute.

Experts say sufficient physical activity is the equivalent of 150 minutes of moderate exercise a week, which could mean 30 minutes of fast walking five times a week.

Another paper in the series pointed to steps people and communities can take to be more active: using signs to suggest taking the stairs rather than the elevator, or free exercise classes at public parks, for example. Maintaining streets and improving lighting can raise activity levels by 50 percent, some studies show. Researchers also discussed an effort in Bogotá, Colombia, where some city streets are closed to cars and vehicles on Sunday mornings and public holidays. Each week, about 1 million people show up to exercise. The effort has spread to Kentucky and been dubbed Second Sunday Kentucky.

Some experts took issue with the comparison with smoking, since "even if smoking and inactivity kill the same number of people, far fewer people smoke than are sedentary, making tobacco more risky to the individual," Park reports. (Read more)

Infant mortality, pre-term birth, teenage pregnancy, children living in smokers' homes all drop even as as child poverty goes up

Nationwide, the rates of infants who die, babies who are born prematurely, teens who are having babies, and the percentage of young children who live in a home where someone smokes have all decreased in the last five years. But the percentage of kids who live in poverty has gone up.

These findings are some highlights of the report "America's Children in Brief: Key National Indicators of Well-Being, 2012," compiled by the Federal Interagency Forum on Child and Family Statistics. The report, which does not break down data by state, looks at children's demographic backgrounds, family and social environments, economic circumstances, health care, physical environment and safety, behavior, education and health.

"This year's report contains good news about newborns," said Dr. Alan E. Guttmacher, director of the Eunice Kennedy Shriver National Institute of Child Health and Human Development. "Fewer infants were born pre-term and fewer died in the first year of life."

Among other findings: In the last five years there has been a five-fold increase in the percentage of teens who have received the vaccine that prevents the most dangerous form of meningitis. Other key findings show:
• A drop in the percentage of children who live in homes that are classified as food insecure.
• A drop in the percentage of teens ages 16 to 19 who don't work and are not enrolled in high school or college.
• A rise in the percentage of children from birth to age 17 who live in counties in which one or more air pollutants were above allowable levels.
• An increase of one statistical point in the average math scores for 4th and 8th graders from 2009 to 2011. For a quick glance at the findings, click here. (Read more)

Beshear says he will expand Medicaid if state can afford it, says 'If we've got a healthier Kentucky, we're all better off'

By Al Cross
Kentucky Health News

Gov. Steve Beshear said today that he would expand Kentucky's Medicaid program under the federal health-reform law if the state can afford the cost.

"If there is a way that we can afford that will get more coverage for more Kentuckians, I'm for it, because if we've got a healthier Kentucky, we're all better off. Our economy's better off, and of course the individuals are better off," Beshear told Jack Pattie of WVLK Radio in an interview on Pattie's mid-morning show. (KET image)

That may have been Beshear's first public statement from his own mouth on the issue. State House Republican Leader Jeff Hoover has said Beshear should not expand Medicaid because it would cost the state hundreds of millions of dollars once it has to start paying part of the cost of covering the new patients, beginning in 2017 and rising to 10 percent in 2020.

The first caller to the show asked the Democratic governor, "How much is this going to cost us?"

Beshear did not reply with a number. He said, "We're gonna analyze that part of the law to see how much it will cost us, how many people we're talking about. I do know the profile of the people we're talking about; they're working adults, they're working families that just can't afford health care because they don't make enough money to be able to pay premiums" for health insurance.

Beshear said he would make "a reasoned and fiscally responsible decision, and there is "no timetable on making it at this point." Republicans are expected to make it an issue in the fall elections, raising the prospect of reduced state services or higher taxes.

Pattie asked the governor, "Is it possible to do all this without a tax increase?" Beshear answered, "I've got to look out into the future, see how our revenues are growing, see how our economy is doing, to make sure we don't put a burden on ourselves that we can't afford."

The 2010 law specified that if states did not expand Medicaid to cover those with incomes up to 133 percent of the federal poverty level, they could lose all their federal Medicaid funds, which in Kentucky covers 70 percent of the program's current cost. The U.S. Supreme Court ruled that threat was unconstitutional, giving the states the option.

Several Republican governors have said they would not expand Medicaid, while Democrats are generally in favor of it, but governors of both parties have said they are undecided. It is possible that federal officials would allow the program to be adjusted in ways that would reduce the cost of the expansion.

Beshear also defended his decision to create a state exchange for health insurance, saying the state's business interests, hospitals, insurance companies and other interests wanted the state to run its own exchange rather than let federal officials do it. "We know better about Kentuckians than the federal government does," he said. He told the first caller that the exchange "would not cost us anything," and explained later that insurance companies would pay the cost.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Are fallacies about health reform becoming accepted wisdom? Former New York Times editor Bill Keller says he fears so

"A number of fallacies seem to be congealing into accepted wisdom" about the Patient Protection and Affordable Care Act, former New York Times editor Bill Keller writes for the paper. The myths, he says, are that (1) the law is killing jobs, (2) it's a federal takeover of the health system, (3) the free market would be better, (4) states can fix the problems with health insurance, and (5) the law is a political loser. Here's a capsule of Keller's counterpoints:

(1) Jobs: While some workers "no longer so dependent on employers for their health-care safety net may choose to retire earlier or work part-time," Keller writes, their jobs will be open for others, and he cites FactCheck.org's latest debunking of the job-killer claim.

(2) Takeover: "The main thing the law does is deliver 30 million new customers to the private insurance industry," Keller writes, with emphasis. "Insurance will be governed by new regulations, and supported by new subsidies . . . but the share of health-care spending that comes from the federal government is expected to rise only modestly."

(3) Marketplace: "To the extent there is a profound difference of principle anywhere in this debate, it lies here," Keller writes. He says giving people tax credits to buy their own insurance and care could reduce wasteful spending, but quotes Karen Davis, president of The Commonwealth Fund: Ten percent of the population accounts for 60 percent of the health outlays. They are the very sick, and they are not really in a position to make cost-conscious choices.”

(4) States: "Some states are too poor to adopt worthwhile reforms. Some are intransigent, or held captive by lobbies," Keller writes, noting that the law "underwrites pilot programs to reduce costs, and gives states freedom — some would argue too much freedom — in designing insurance-buying exchanges."

(5) Politics: Because most of the law won't take effect until 2014, "so there are not yet testimonials from enthusiastic, family-next-door beneficiaries. This helps explain why the bill has not won more popular affection. It also explains why the Republicans are so desperate to kill it now, before Americans feel the abundant rewards," Keller writes, calling on Democrats to "mount a full-throated defense." (Read more)

Beshear issues order to create insurance exchange as GOP legislators carry symbolic vote against lease to house it

As Gov. Steve Beshear issued an executive order to establish a state insurance exchange this afternoon, lawmakers voted along party lines against a lease that would have housed employees of the exchange, once again illustrating the divisive nature of the controversial Affordable Care Act.

Members of the Capital Projects and Bond Oversight Committee voted 4-3 against the nearly $300,00-per-year lease, with Sen. Tom Buford of Nicholasville, Sen. Jared Carpenter of Berea, Rep. Steven Rudy of Paducah— all Republicans — voting no, along with Independent Sen. Bob Leeper of Paducah. Leeper caucuses with Senate Republicans.

Rep. Jim Wayne, Sen. Julian Carroll of Frankfort and and Rep. Jim Glenn of Owensboro, all Democrats, voted yes. Discussion focused on the uncertainty of the cost of implementing provisions in the Affordable Care Act and the state budget.

The committee does not have the power to block the lease permanently, but Beshear will have to go through some additional procedural steps.

The exchange is considered one of the cornerstones of the federal health-care reform law aimed at containing costs by spurring competition among private insurers. It will be a marketplace to shop for different packages of state-approved health insurance and will be available to people who earn up to 400 percent of the federal poverty level. To offset the cost of their premiums, those participating in the exchange will receive subsidies in the form of tax credits. The Medicaid program will also fall under the exchange's umbrella. 

Small businesses with fewer than 100 employees can also qualify for the exchange, a move that is meant to boost their purchasing power.

 
Beshear said, "We will work closely with insurers, providers and consumers and other groups to develop a robust, responsive, and user-friendly portal that will help Kentuckians find the coverage that best suits their needs."

He said the exchange will be in operation starting Jan. 1, 2014 as the federal law requires. The state has already received more than $66 million to plan for the exchange. States had the option to run the exchange themselves or have the federal government do so for them. But Audrey Tayse Haynes, secretary for the Cabinet for Health and Family Services, said Kentucky is better geared to running its own program since it "is more in tune with the unique regional and economic needs of our citizens, as well as the health insurance needs of individuals, Kentucky small businesses and nonprofits." (Read more)

Beshear to have outside panel review cases of children killed or life-threatened by abuse

An independent panel of experts will review cases of children who have been killed or severely hurt by child abuse or neglect, Gov. Steve Beshear announced Monday. The panel will have 17 members and be based in the Justice and Public Safety Cabinet. Its aim will be to assess if the state's child-protection workers did all they could to protect children who died as a result of abuse. It will also determine causes of death.

The Cabinet for Health and Family Services "released thousands of pages of documents Monday that detail the state's involvement with dozens of children who were killed or nearly killed as a result of abuse of neglect," reports Beth Musgrave for the Lexington Herald-Leader. "Still, the cabinet continues to withhold some case files and has redacted large portions of others."

The release is the result of a lengthy court battle between the cabinet and the state's two largest newspapers, the Herald-Leader and The Courier-Journal. The newspapers argued documents pertaining to these cases were subject to open record laws and Franklin Circuit Court Judge Phillip Shepherd agreed. The cabinet released 76 of about 140 files, but with key information omitted. In February, Shepherd ruled the cabinet had 90 days to hand over remaining case files, fined the cabinet $16,000 for withholding the records and ordered it to pay $57,000 in attorney fees for the newspapers.

The cabinet appealed the ruling in the Court of Appeals, but on July 9, the court sided with the newspapers, refusing to allow the documents from being withheld. More than 40 similarily-redacted cases were released yesterday but the cabinet filed an appeal with the Kentucky Supreme Court. "We disagree on how much personal information about the children and private individuals included in caseworker files should be made public," Cabinet Secretary Audrey Haynes said.

Also yesterday, Beshear issued an order to create the panel, which will meet four times a year and will issue an annual report that details issues it finds. "When a child dies or is critically injured because of abuse or neglect, we must carefully review the practices of all government entitites involved to make sure that our system performed as it was supposed to — and if not, that review allows us to take disciplinary action," Beshear said.

Panel members will include law enforcement, prosecutors and medical experts, Musgrave reports. While the meetings will be open to the public, the records consulted during them will not be subject to open records laws. (Read more)

Cabinet for Health and Family Services held in contempt over Medicaid services for Eastern Kentuckians

Hazard Appalachian Regional Medical Center, one of
eight ARH hospitals. Courier-Journal photo, copyright 2000

For taking "practically no steps to a comply" to a request to help thousands of patients transfer their Medicaid services, the Cabinet for Health and Family Services was held in contempt of court Monday.

U.S. Senior Judge Karl Forester said the Cabinet's refused to "process requests by patients to transfer away from Coventry Cares, a managed-care organization, in light of Coventry's impending termination of its provider contract with Appalachian Regional Healthcare," reports Valarie Honeycutt Spears for the Lexington Herald-Leader.

ARH and Coventry, part of Coventry Health and Life Insurance Co., battled it out in court earlier this year when Coventry wanted to terminate its contract in May — six months before its contract was set to expire — with the hospital chain, which covers 25,000 patients. In turn, ARH filed a lawsuit asking for a preliminary injunction to avoid the termination, which was ultimately granted. The injunction states Coventry must continue to pay ARH for services until Nov. 1. But the cabinet was supposed to help facilitate the transfer of patients from Coventry to Wellcare, the only other company that has a contract with ARH, in the meantime. Forester said in his order about 6,000 transfer requests "were being held by the Cabinet," Spears reports.

Mike Wynn of The Courier-Journal reports that 8,400 patients have sought to switch to Wellcare from Coventry since May.

Though Forester said he will decide whether to impose sanctions on the cabinet at a later date, but did not require "the cabinet to process transfer requests with the start of open enrollment only five weeks away," Wynn reports. The open enrollment window is between Aug. 20 and Oct. 19, Spears reports.

Cabinet attorney argued processing transfers was unnecessary since Coventry had been forced to pay for services through the open enrollment period. ARH argued stopping the requests creates confusion.

In response to the ruling, the cabinet praised Forester for acknowledging "the need to allow the Medicaid program to proceed with open enrollment so as not to cause a gap in service or confusion for members."

"Member support is extremely important and the cabinet remains committed to listening to concerns from Medicaid members about their managed-care company as well as medical providers," the statement continued.