Federal shutdown won't stop Obamacare, Ky. insurance exchange

By Molly Burchett
Kentucky Health News

The federal government is on the brink of shutdown after House Republicans refused to pass a budget unless it involved a delay in the health reform law, and both Senate Democrats and the White House have said they will block any such budget resolution. In the event that Congress doesn't reach a compromise, which would lead to a shutdown on 12:01 a.m. on Tuesday, enrollment for Kentucky's online health insurance exchange, Kynect, will still begin as scheduled.

The shutdown drama is heightened since Tuesday is both the start of the federal fiscal year and the first health insurance can be bought on the online exchanges created by the reform law, often called Obamacare. Kynect won't be affected because it is funded by a "permanent appropriation," that isn't subject to annual appropriation, Paul Van de Water, a policy analyst at the Center on Budget and Policy Priorities, told Sharon Begley of Reuters.

The Department of Health and Human Services' contingency plan for a government shutdown makes clear that Obamacare will continue, along with other mandatory programs like Medicaid and Medicare, programs that do not rely on annual appropriations and involve the human life and safety, Cunningham and Nather report. "And that means the staff that carry out mandatory programs like those in the health law can keep working — even if their positions are funded through the annual spending bills."

However, uncertainty about the shutdown could add more confusion to America's lack of understanding of the health law. Many may not realize they can sign up for coverage through the state exchanges even if the federal government is shut down.

The Kaiser Family Foundation's August 2013 Health Tracking Poll showed that roughly four in 10 Americans, 44 percent, either think the law has been repealed by Congress or overturned by the Supreme Court. A recent Pew Research Center poll last week found 53 percent of Americans disapprove of the law, and 42 percent approve.

But most Americans oppose defunding the new law if it means shutting down the government and defaulting on debt, says CNBC's third quarter All-American Economic Survey.

President Obama has said he will not negotiate on his signature legislative accomplishment, and most Senate Republicans have disavowed the House Republican strategy of risking a government shutdown.

The stakes are high for both political parties, writes Noam Levey of the Los Angeles Times. For Democrats, a meltdown of the new system would be politically damaging. For Republicans, "A relatively drama-free rollout of the law this fall could shatter what has been a key pillar of the Republican agenda."

Opinions about Obamacare will not change overnight and the law's effectiveness won't be determined by the first few weeks of the exchanges. The Congressional Budget Office estimates that only about 7 million people will enroll in 2014, but that the number will rise to 25 million by 2018.

There are currently 640,000 uninsured Kentuckians, which 14.9 percent of the state's population, says the Kynect website. About 332,000 will be able get insurance through the exchange, and 276,000 of them can get subsidies to buy insurance coverage through the exchange.  An additional 308,000 Kentuckians will be newly eligible Medicaid, with expansion of the program to people earning up to 138 percent of the federal poverty level.

It is expected that about 147,000 Kentuckians who are newly eligible for Medicaid in 2014 will find coverage through Kynect. That number is projected to increase to about 188,000 by 2021, says a Medicaid expansion report. Open enrollment for coverage runs through March 31, 2014. Beginning Jan. 1, coverage purchased on the exchange will take effect, and most Americans will be required to have health insurance or pay a penalty. Click here for more information about Kynect.

Gov. Steve Beshear and Lt. Gov. Jerry Abramson are appearing at events across the state this week to promote the exchange and enrollment, starting Tuesday morning in Louisville and that afternoon in Hazard. They will visit Ashland, Lexington, Covington and Bowling Green on Wednesday; and Mayfield and Owensboro on Thursday. For details, click here.

Workers, employers blame Obamacare for higher premiums, but experts say the causes are a lot more complicated than that

By Molly Burchett
Kentucky Health News

While the main provisions of the federal health-reform law are only now taking effect, some Americans are already saying it doesn't work and are blaming it for higher insurance premiums and deductibles. But the cause and effect are uncertain.

"The connection between the new benefit plans and the new law isn’t as clear as it might seem . . . because many of the coming benefit changes have been talked about and embraced by companies for years, long before Obamacare became an emotional and political lightning rod," reports Dan Horn of The Kentucky Enquirer.

As they renew or enroll in employer health plans, workers are taking note of unwelcome changes, including new fees and surcharges, more high-deductible plans, bigger penalties for not participating in wellness programs, and the elimination of benefits for spouses, Horn writes.

"The law represents the most profound change to the nation’s health care system in decades, and uncertainty over its provisions has made both businesses and individuals nervous," Horn reports. "With the [employer] mandate on hold, most companies get another year before the Affordable Care Act changes the game."

Nearly one in five Americans believe their health insurance costs have gone up because of Obamacare, says CNBC's third quarter All-America Economic Survey.

Actual health-insurance premiums to cover working Americans rose 4 percent this year, less than in the previous two years, says the Kaiser report. Slow premium growth indicates a slowdown in health benefit costs for U.S. companies, which economists attribute to an overall economic slowdown. And, the tepid economic recovery and decline in personal wealth continues to impact the health sector, says a recent Price Waterhouse Cooper Health Research Institute report.

Shifting costs to employees

While premiums may be rising more slowly for employers, they could be rising more rapidly for workers because employers' insurance plans are shifting more costs to workers. Many companies are moving to high-deductible plans that require employees to pay a larger share of their costs.

The Pricewaterhouse Coopers report said in 2013 that the number of employers offering only high-deductible plans increased 31 percent over 2012, and another 44 percent of employers are considering the move for 2014. Transitions to high-deductible plans can affect health care costs; when consumers pay more for their health care, they often make more cost-conscious choices.

"Businesses have been shifting more of the costs of health insurance to workers through premiums, deductibles and other cost-sharing,” said Drew Altman, Kaiser Family Foundation CEO. “From a consumer perspective, the cost of health insurance just keeps going up faster than wages.”

Over the last decade, premiums have risen almost three times as fast as wages or inflation. The average premium for family coverage has increased 80 percent, and worker contribution has increased 89 percent over the past decade and 14 percent more than in 2009, says the Kaiser report.

A new study by the Kaiser foundation says the economy has had the biggest influence on health care utilization and spending.

It says adjustments to health benefit plans have been slowly occurring over the past decade, well before Obamacare became policy, and economic conditions may influence workers' perception of health insurance costs. “We’re seeing that the continued economic downturn is leading to more burden for employees,” said Gary Claxton, vice president of the foundation.

The economic decline has put pressure on companies to reduce overall costs and pass along the expense of health insurance to the employees, said Claxton. Companies have been trimming benefits and implementing cost-saving and cost-control measures for some time, but many still blame these unpopular measures on Obamacare. “Why wouldn’t you?” he asked.

Proponents of Obamacare say it's actually helping control costs. Even if it isn't now, it will eventually, Claxton told Drew Armstrong of Bloomberg in a conference call. His boss agrees.

"Historically, we have always seen the health-care marketplace respond by lowering costs when there is the threat of impending health reform legislation or government action on costs," Altman wrote in a recent column for Politico. "Now we have not only the threat but the reality,"

Big changes are on the way

The health law builds on employer-sponsored insurance, but since it makes such big changes to the system, some are questioning how it will impact the employers' role in providing insurance. A study by the RAND Corp. says that through state insurance exchanges' putting employees of small firms into a single risk pool, Obamacare could alleviate some of the difficulties faced by small firms that want to offer insurance.

Many people are concerned that the law may cause employers to stop offering health insurance. The RAND study predicts the opposite, saying that the number of workers offered coverage will increase from 115.1 million (84.6 percent of the approximately 136.0 million U.S. workers) to 128.7 million (94.6 percent ) after the reform.

The large increase in coverage will stem from small business coverage, which will be driven by a greater demand for coverage by workers due to individual penalties for being uninsured and the availability lower-cost insurance options, says the RAND study.

However, health plans may look different than those before the health law passed. The state exchanges allow an employer to provide employees with more plan options. The Kaiser report notes that the exchanges encourage employers to deliver health benefits in a lump sum that employees can use to buy insurance through the exchange.

Another trend tied to the law is the proliferation of employee wellness programs. New federal rules for such programs allow employers to have larger financial rewards for employees who participate in them, and allow employers to penalize employees for specific behaviors, such as smoking.

Horn, writing in the Enquirer, says companies have embraced wellness programs as a way to offset costs: "No matter where they stand with the law, companies are constantly looking for new ways to save on health care."

These health-benefit approaches, just like the premiums paid for the plans, will vary with each exchange. Kaiser says the common theme is to give employees choices, along with financial responsibility for those choices. The fact is, as a result of the health law, some Americans will pay more for health insurance and some will pay less.

"Whether this new way of purchasing coverage works for employers and their employees, and how it affects benefits and plan costs, will be among the more important stories for the employer health insurance market over the next few years," says the Kaiser report.

Here are the basics of buying health insurance on the state exchange that opens Tuesday

On Tuesday, Americans can begin buying health insurance through state exchanges created by federal health reform. Journalists have spent months trying to understand the reform law in an attempt to explain it to their readers, but unraveling the act can be a confusing and tiresome process. With open enrollment knocking at the door, Trudy Lieberman of Columbia Journalism Review asked for advice from Elisabeth Benjamin, a vice president at the Community Service Society in New York, which runs an insurance counseling program. She suggests looking at enrollment as a four-step process that she hopes will make the process easier for people. 

Step 1 is looking at the health insurance buying cycle, Lieberman writes. Initial enrollment is from Oct. 1 through March 31, and can be done at HealthCare.gov. Those eligible include anyone who doesn't have employer coverage, Medicare, Medicaid, or the Children’s Health Insurance Plan, also known as children's Medicaid. Kentuckians can also enroll at the state health insurance exchange, Kynect, by clicking here. Questions about the act can be directed to a call center at 1-855-459-6328 from 8 a.m. to 7 p.m. Monday through Friday, and Saturday from 9 a.m to 4 p.m.

Read more here: http://www.kentucky.com/2013/09/29/2850843/answers-to-frequently-asked-questions.html#storylink=cpy

Step 2 is the mechanics of enrolling, which includes having an email account and information about your household, residency, immigration status and income, which will let people know what insurance they qualify for, Lieberman writes. "People with employer-provided insurance may still need to visit the exchange to see if they’re eligible for exchange coverage. Employers with more than $500,000 in annual sales that offer group coverage must give all workers a document that tells them about the existence of the exchanges, and the premium that a worker would pay for the lowest-priced plan the employer offers for single coverage. This form lets workers know if their employer coverage is affordable according to the government. If it isn’t, they can shop in the exchange and receive a subsidy. Their families, however, cannot receive a subsidy."

Once a person has entered the information, he or she will find out how much of a subsidy they can get, Lieberman writes. Subsidies can either be applied to each insurance payment, which means lower monthly costs for coverage, or the purchaser can wait and collect it at the end of the year like a tax refund. Kentucky has five providers: Anthem, UnitedHealthcare, Humana, Bluegrass Family Health and the Kentucky Heath Cooperative. Not every company is offering a policy in every area of the state. Rates will be available starting Tuesday.

Read more here: http://www.kentucky.com/2013/09/29/2850843/answers-to-frequently-asked-questions.html#storylink=cpy

Step 3 is choosing a policy from options given the names of precious metals. "The platinum policies not offered on some exchanges cover about 90 percent of someone’s medical costs; the gold plans 80 percent; the silver 70 percent; and the bronze 60 percent," Lieberman writes. "As a point of reference, the gold plan is basically the old Blue Cross model that most Americans had for the last four decades and was considered good coverage." From there, people have to decide, "Do they want to pay a high premium up front in return for lower co-pays; a set amount for a service; lower coinsurance; a percentage of the bill; or, a lower deductible?"

The premium is calculated on four factors: age, where you live, how many people are on your policy and whether you use tobacco. Depending on the state, tobacco users can face a surcharge of up to 50 percent; Kentucky's is 40 percent.

Read more here: http://www.kentucky.com/2013/09/29/2850843/answers-to-frequently-asked-questions.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/09/29/2850843/answers-to-frequently-asked-questions.html#storylink=cpy

The final step is finding and reading the disclosures, which is something consumers have to take the initiative to find on their own, Lieberman writes. "Shoppers can find out about the policy elements, deductibles (and what they apply to), coinsurance and co-pays for different services (especially common ones like diagnostic tests and outpatient surgery), amounts for different services, and fees. It also spells out some services that are not covered and provides sample charges for common conditions." (Read more)

People who don't sign up for insurance will face a fine of 1 percent of their annual income, or $95, whichever is higher. The fee increases every year. There also is a penalty for not providing coverage for children. (Read more)

Northern Kentucky health board supports statewide smoking ban

The main health board in Northern Kentucky, where local smoking bans have stirred much controversy. has endorsed the idea of a statewide ban on smoking in all places of employment.

"The 32-member board, which represents Boone, Campbell, Grant and Kenton counties, voted to support the ban at its Sept. 11 meeting after Dr. Lynne Saddler, director of the Northern Kentucky Health Department, presented evidence about the dangers of second-hand smoke," The Kentucky Enquirer reported.

The board also authorized the department to promote Smoke-Free Kentucky, the main group advocating smoking bans, and its work in Northern Kentucky.

Efforts to pass a statewide smoking ban have never come to a floor vote in the legislature, but "23 Kentucky communities have passed comprehensive smoke-free laws, covering 34 percent of Kentuckians," the Enquirer noted. "In Northern Kentucky, only Kenton County has a smoke-free law, and it contains exemptions for bars and restaurants." (Read more)

Delaying individual mandate, as GOP now proposes, would wreck exchanges and Obamacare, Democratic aide warns; McConnell says Republicans can't get Democratic votes they need in Senate

The key piece of the latest House Republican legislation to keep the federal government running – a one-year delay of the federal health-reform law and its requirement for individuals to make sure they are covered – "would have serious consequences" for the online health-insurance marketplaces set to open Tuesday, writes the spokesman for the only Democrat in Kentucky's congressional delegation.

"If you require insurance companies to cover everyone regardless of pre-existing conditions and don't require everyone to have insurance, the insurance companies will leave the market," writes Stephen George, communications director for Rep. John Yarmuth of Louisville. "Kentucky tried that in 1994, and the results were devastating: 40 insurance companies left the state, leaving just one private plan and one state-run plan." Supreme Court Justice Ruth Bader Ginsburg noted that in her concurrence to the decision upholding the law, George notes.

Senate Republican Leader Mitch McConnell told Newsmax.com that the House plan "would be a very appealing vote to all Senate Republicans," but they despair of getting any Democrats to join them. "It would require at least five Senate Democrats to agree with that. We’re not going to be able to do anything Republicans-only in the Senate because we have a math problem."

Hinting that the game is about at an end, or at least that he wishes it to be, McConnell said Republicans would target four Democratic senators who are seeking re-election next year in states President Obama lost twice: Mark Begich of Alaska, Mark Pryor of Arkansas, Mary Landrieu of Louisiana, and Kay Hagan of North Carolina.

"There are four Democratic senators who are running for re-election who will have to explain to their constituents why they didn't take the opportunity today to defund, and therefore stop, this overwhelmingly unpopular law," McConnell said. "Our ability to have achieved the defunding is not there, because we don't have enough Republican senators to achieve the goal — and until we have at least four or five Democrats to support us, we can't get that job done." (Read more)

Beshear, writing in The New York Times, defends Obamacare

Ever since he decided to expand Medicaid with money from the federal health-reform law, Democratic Gov. Steve Beshear has been telling opponents of Obamacare to "Get over it." Now, as Republicans have made the law the sticking point in talks to keep the government open and cover the national debt, Beshear has taken that argument to a national audience.

"Get over it, and get out of the way, so I can help my people. Here in Kentucky, we cannot afford to waste another day or another life," Beshear concluded in an op-ed piece in The New York Times on Friday. While not naming Sens. Mitch McConnell and Rand Paul, he took some swings at them.

"Sunday morning news programs identify Kentucky as the red state with two high-profile Republican senators who claim their rhetoric represents an electorate that gave President Obama only about a third of its presidential vote in 2012," Beshear wrote. "So why then is Kentucky — more quickly than almost any other state — moving to implement the Affordable Care Act?"

The real answer is that Beshear is a Democrat and Kentucky law allowed him to expand Medicaid and create a state-based health-insurance marketplace without approval of the legislature, which is divided between the parties. But the governor answered his question another way: "Because there’s a huge disconnect between the rank partisanship of national politics and the outlook of governors whose job it is to help beleaguered families, strengthen work forces, attract companies and create a balanced budget."

Beshear noted that several Republican governors have expanded Medicaid and/or created insurance exchanges, saying they "see the Affordable Care Act not as a referendum on President Obama but as a tool for historic change. That is especially true in Kentucky, a state where residents’ collective health has long been horrendous."

Beshear said health insurance will now be available to the 640,000 uninsured Kentuckians. "Lack of health coverage puts their health and financial security at risk. They roll the dice and pray they don’t get sick. They choose between food and medicine. They ignore checkups that would catch serious conditions early. They put off doctor’s appointments, hoping a condition turns out to be nothing. And they live knowing that bankruptcy is just one bad diagnosis away. Furthermore, their children go long periods without checkups that focus on immunizations, preventive care and vision and hearing tests. If they have diabetes, asthma or infected gums, their conditions remain untreated and unchecked. For Kentucky as a whole, the negative impact is similar but larger — jacked-up costs, decreased worker productivity, lower quality of life, depressed school attendance and a poor image. . . . Frankly, we can’t implement the Affordable Care Act fast enough." (Read more) 

Ky. Health Cooperative, a new kind of insurer, could help hold down rates and reshape the health-care system

By Molly Burchett
Kentucky Health News

FRANKFORT, Ky. -- A little-known but key part of federal health reform created a new kind of health insurance -- a cooperative that is neither public, like Medicare and Medicaid, or run for profit, like traditional insurance companies. And the Kentucky Health Cooperative is offering coverage this week, with the opening of the state health-insurance exchange.

Kentucky is one of 23 states with plans the law designated as Consumer Operated and Oriented, or "co-ops," designed to give for-profit companies more competition and hold down rates. The plans have received more than $2 billion in federal loans to build themselves from scratch, but have been operating largely under the radar.

Janie Miller (Associated Press photo)

"The co-op program is an extremely little known part of the Affordable Care Act," Kentucky Health Cooperative CEO Janie Miller said in an interview with Kentucky Health News. "It's been very difficult to get people to understand what the co-op is and why they should care."

The Co-Op provision was a political compromise in the Affordable Care Act, developed as an alternative to the "public option" of a government-run plan. "It's the closest thing you can probably get to a public option," said Miller. “We [cooperatives] are created to be the non-profit options in most states… specifically for the uninsured and under-insured. ”

But the co-op could also help all insurance buyers, by pushing private insurers to set premiums lower than they would without non-profit competition. "Since we are non-profit, we don’t have to add a profit margin to our products, so our price should be competitive," Miller said. 

"We believe the addition of the Kentucky Health Cooperative will be positive for Kentucky consumers by bringing more competition to the market," said Ronda Sloan, spokesperson for the state Department of Insurance, which approves premium rates. "While Humana is offering a limited service area, both Anthem and the Kentucky Health Cooperative are offering plans statewide."

Development of the co-op

The creation of this new type of insurance began in Kentucky when Joe Smith of the Kentucky Primary Care Association, a lobby for primary-care clinics, got a call from Beam Partners of Atlanta, a consultant to health plans and cooperatives, offering to help create a co-op. Smith, who spent five years organizing health cooperatives in Alaska before becoming executive director of the Kentucky group, recruited other board members and Miller, who was recently secretary of the state Cabinet for Health and Family Services.

The cooperative was the only applicant in Kentucky for the federal loans. It received $11.9 million in start-up loans and is in line for $46.8 million of reserves from the federal government. The reserve money allows the co-op to meet state requirements for solvency and enter the insurance market.

Miller said the application process was community-driven and required a business plan and an extensive feasibility study estimating how many people the co-op would likely insure. It estimates 31,000 in the first year and 65,000 after 20 years.

"That's about 10 percent of the uninsured market that would be eligible for the exchange and not the Medicaid expansion" under the reform law, to people with incomes up to 138 percent of the federal poverty level. The exchange offers tax credits to make its coverage more affordable.

In return for the federal money, and to promote sustainability and accountability, the co-op must reach specific milestone requirements to receive all of the money from the Center for Consumer Information and Insurance Oversight in the Centers for Medicare and Medicaid Services.

"Is it an uphill battle? Absolutely," Miller said.

The co-op has some limits

The law bars the cooperative from using federal loan funds to for marketing and advertising, but it is required to do education and outreach, such as press releases and community presentations, and it has hired a Louisville public-relations firm, New West, to raise its profile.

"We are finding that a lot of people, especially people who did not have insurance, don't necessarily value having health insurance every month like we do," Miller said. "But they see the value when they need health services . . . so we are doing a lot of education about what the patient protections are and about the new affordability programs" in the law, including the cooperative. Insurance from the co-op can be bought on the state health-benefits exchange, branded as Kynect, directly from the co-op website and from many brokers and agents in Kentucky..

Kentucky Health Cooperative is modeled after other successful cooperatives, such as the Group Health Cooperative of Seattle, which was founded in 1947 and has evolved from a single clinic to an organization that delivers higher-quality, affordable coverage and care to more than 650,000 members, the group's executive director of public policy said at a Co-Op Federal Advisory Board public hearing.

In preparing to launch plans on the Kentucky exchange, Miller said, the cooperative's biggest challenge has been time constraints.  The co-op has outsourced its claims processing and call center, but will have 55 employees when fully staffed by Dec. 1, Miller said. It has partnered with ProCare Rx for prescription benefits.

Since the cooperatuve is new, it had no historical data about specific claims and collections, so it contracted with Milliman, an actuary with access to millions of claims for new carriers entering the market, to ensure that health plans were adjusted for a pool of members whose risks might be higher than usual.

The cooperative's business plan projects that about 75 percent of its sales will cover individuals directly, and 25 percent will cover employees of small businesses.

What's really different?

The cooperative is a non-profit, consumer-governed health plan, where consumers can become engaged and have a say in the health plan's affairs, says Miller. "There's something about health care that says it shouldn't all be for profit."

Smith said the co-op "provides an opportunity for a value-based system that goes beyond the bottom line."

The co-op will be directly responsible to its policyholder-members because it they will govern it. By January 2016, all of its board members will have been elected by co-op members, said Miller. “Not only that, but if we collect revenues above expenses, that money goes back to our members in the form of better benefits or lower premiums,” she said.

Miller said there's another inherent possibility in the co-op's consumer governance design to engage consumers and educate them. If the ownership is truly educated, the whole design of health care can be shifted from "treat them and street them" to a focus on quality care. Members "can start putting demands on the institution that they own to start being a true health care system. That's the dream, that's the goal," said Smith.

Kentucky, Louisiana, South Carolina and Tennessee are the southern states with cooperatives. Click here for the complete list and funding totals.

Almost 1/4 of Ky. inmates have mental-health issue; lockups are becoming the 'new asylums,' Wall Street Journal says

Almost a fourth of the inmates in Kentucky's prisons and jails have a mental-health issue, and it's part of a growing national problem. "America's lockups are its new asylums," Gary Fields and Erica Phillips report for The Wall Street Journal. "After scores of state mental institutions were closed beginning in the 1970s, few alternatives materialized. Many of the afflicted wound up on the streets, where, untreated, they became more vulnerable to joblessness, drug abuse and crime."

The reporters quote Esteban Gonzalez, president of the American Jail Association, a lobby for jail employees: "In every city and state I have visited, the jails have become the de facto mental institutions." Of the 22 states that responded in detail to the reporters' survey, which as a whole have most of the nation's prisoners, "their mental-health patient ratios ranged from one in 10 inmates to one in two," the ratio reported in Oregon and Iowa.

Of Kentucky's 12,300 prisoners, 24 percent have a mental-health issue, according to information the reporters received from the state Department of Corrections.

The situation is a return to the times of a century or more ago, when knowledge of mental illness was rudimentary at best and the mentally ill often would up behind bars. State-run mental institutions were developed, but gave way to community-based treatment. "The weaknesses of that concept—a lack of facilities, barriers created by privacy laws and tightened local and state funding—has brought the picture full circle," the Journal reports.

Watch out for specious claims about health-reform law in highly politicized debate; Sen. Paul among those found off base

The biggest story in the state and nation is about to be Tuesday's opening of online health-insurance marketplaces, or exchanges, under the federal health reform law. "Obamacare" has been politicized from the start, and the current debate has featured several specious claims that journalists should be on the lookout for as they report, edit, present and choose commentary (including letters to the editor and person-on-the-street interviews) on the subject.

"There’s plenty of fodder for fact-checkers in Sen. Ted Cruz’s looong attack on Obamacare, and in President Obama’s defense of it," says FactCheck.org, the oldest of the nonpartisan political fact-checking services. It says the Texas Republican falsely claimed that spouses of United Parcel Service employees will be “left without health insurance” and forced into “an exchange with no employer subsidy.” UPS is dropping coverage only for who can get insurance with their own employer.

Conversely, "Obama greatly exaggerated when he credited the health care law for bending the cost curve on health care spending," FactCheck says. "Experts say the down economy is the overwhelming reason that national health care spending has been growing at historically slow rates in recent years."

FactCheck also took on Cruz ally Sen. Rand Paul (R-Ky.) for saying “everybody is going to pay more” for health insurance under the Patient Protection and Affordable Care Act. "The fact is, some will pay more and some will pay less," the service says. "Some currently uninsured Americans will pay little or nothing because of the law’s expansion of Medicaid."

As usual, FactCheck has a detailed accounting for its analyses, with plenty of references, here.

Clinics in 9 Appalachian counties will offer high-tech eye screenings to head off common ailment that blinds diabetics

Kentucky has one of the nation's highest rates of diabetes, but half the diabetics in rural Kentucky don't have annual eye exams – even though nearly 30 percent of diabetics over 40 have diabetic retinopathy, the leading cause of blindness among diabetic adults.

To stem that threat, units of the University of Kentucky are using a three-year federal grant to bring diabetic eye screening to diabetics in nine Kentucky Appalachian counties. Diabetic retinopathy can be treated, or avoided altogether, if the disease is detected early enough.

While studies have found that 90 percent of diabetics consult their doctor about their disease, about half the diabetics in rural Kentucky do not have annual eye exams. The grant will make technologically advanced exams available at clinics in Bath, Carter, Elliott, Estill, Jackson, Madison, Menifee, Rockcastle and Rowan counties, sending digital images of the eyes to UK's Department of Ophthalmology.

The specialists will screen the images for cataracts, glaucoma, macular degeneration, and other retinal abnormalities that can lead to vision loss and blindness. They will also enter the results into the patient's electronic medical record, for reference by other health-care providers. Currently, only a fraction of the results of community-based eye exams are imported into such records.

The partnership between the UK ophthalmologists, the university's Kentucky TeleCare, and primary care centers where the screenings will be done, is called the Appalachian Eye Network. It will reach nine counties with a combined population of 206,000. All the counties have diabetes rates higher than the national average. The project is expected to screen 4,860 people over the three-year term of the grant.

"Our goal is to reach patients with diabetes and those with high risk factors for diabetes who do not get annual eye exams and help uncover potentially devastating eye disease so it can be treated before the patient loses their vision," said Rob Sprang, director of Kentucky TeleCare. "I believe we have the opportunity to save people’s vision and change lives."

Using food labels and other guidance helps you control weight and reduce risk of cardiovascular disease, FDA study finds

Food labels and dietary guidance help consumers make healthier choices and lose weight, according to a study for the U.S. Food and Drug Administration.

The FDA's Joanna Parks used data from the National Health and Nutrition Examination Survey to estimate the effect of labels and guidance on the intake of 18 nutrients. She found that people who used the Nutrition Facts panel on food labels consumed about 120 fewer calories per day, enough to explain at least an 11-pound difference in body weight between them and those who didn't use the information.

Parks also found that using health claims, ingredient lists and serving-size information appears to reduce risk of cardiovascular disease, including high blood pressure, and help weight-control efforts; and using the MyPyramid meal panel decreases the average daily intake of cholesterol.

"Unfortunately," Parks writes, "it appears that many individuals only use these tools and information once they have developed diet-related diseases that necessitate changes in diet and lifestyle." A PDF of her paper can be downloaded here.

Weekly newspaper in Jessamine County localizes the changes coming to health insurance and health care

The Jessamine Journal did a story this week that every Kentucky newspaper can do, spotlighting the local impacts of Medicaid expansion under federal health reform and federal tax credits for private insurance through the state health benefits exchange that opens Oct. 1, and comparing the local percentages to the rest of the state.

This graphic by Jonathan Kleppinger illustrated the story.

"A larger percentage of low-income people in Jessamine County than in most Kentucky counties have been uninsured and will be able to receive free health coverage through the Affordable Care Act," Kelly McKinney began her story. She noted that only 21 counties in the state have a higher
percentage of people who have no health insurance and will be eligible for Medicaid when it expands Jan. 1.

McKinney went to a local expert for an analysis and wrote, "Having health insurance will mean better health care for the estimated 3,535 low-income Jessamine Countians who haven’t had insurance, said Randy Gooch, public health director for the Jessamine County Health Department." Gooch also mentioned some potential problems: the lack of enough health-care providers to handle the influx of people entering the regular health-care system, and a reduction in services by health departments because they can't bill insurance companies for services.

McKinney's story is an example of how to put these topics into local terms and give readers information they need about changes coming to health insurance and health care. For a while, it was the most-read story on the weekly paper's website. To read it, click here.

Kentucky poverty rate is fifth highest in U.S., but a larger share of Kentuckians had health insurance in 2012 than in 2011

By Molly Burchett
Kentucky Health News

In 2012, as U.S. incomes remained lower and poverty rates higher than in 2007, the year before the recession, Kentucky poverty rates increased and one in four Kentucky children were living in poverty, according to estimates released Thursday by the U.S. Census Bureau. However, the percentage of Kentuckians with health insurance increased.

Kentucky had the fifth highest percentage of residents living in poverty (19.4 percent) in 2012, up from 18.8 percent in 2011. It ranked behind Mississippi (24.2 percent), New Mexico (20.8), Louisiana (19.9) and Arkansas (19.8). However, it was statistically tied with the last two states for third place because the error margin for the estimates is plus or minus 0.5 percentage points. Nationally, 2012 was the second straight year that the U.S. poverty rate had failed to improve. It remained at 15 percent, with 46.5 million people earning at or below the federal poverty line. Click here for an interactive poverty rate map from Stateline.

These findings highlight the challenges that Kentuckians face regarding economic security relative to the rest of the country. The high poverty rate should also act as a warning since it presages troubles with education, health and other areas, Terry Brooks, director of Kentucky Youth Advocates, told Chris Kenning of The Courier-Journal.

The figures are three-year rolling averages from the American Community Survey, a continuing poll of Americans. It estimated that 595,260 Kentuckians were uninsured in 2012, indicating an uninsured rate decline to 13.9 percent, from 14.7 percent. Overall, the U.S. uninsured rate dropped from 15.7 in 2011 to 15.4 percent in 2012, with the number of the uninsured statistically unchanged at 48 million. Insured rates tend to rise as employment rises.

Among the estimated 1 million Kentucky households earning less than $25,000 a year, 22.6 percent do not have health coverage. Kentuckians aged 19 to 25 had the highest percentage of unisureds for a specific age group; about 400,000 Kentuckians are in that group, and 28.1 percent of them are uninsured.

The national decline in the uninsured rate was modest compared to a bigger drop in 2011 that resulted from the federal health reform law that allowed people 26 or younger to be covered on their parents' plans. The slight dip in the national uninsured rate for 2012 was due mostly to increases in government coverage, such as Medicaid and Medicare.

Nationally, the coverage by employer-provided health insurance for people under 65 remained stable. Kentucky, Michigan and Vermont were the only states to see a statistically significant increase in the rate of private health insurance coverage from 2010 to 2012.

The Census Bureau's American FactFinder report generator provides specific information about health insurance coverage.  For example, the chart below comes from a report about the types of health insurance coverage for specific age groups, and it shows estimates of the types of coverage for Kentuckians ages from 35 through 64.

When the main provisions of the health law take effect in 2014, expansion of the state Medicaid program with federal money is expected to provide free health care to as many as 308,000 Kentuckians at up to 138 percent of the federal poverty level -- currently $15,856 for an individual or $32,499 for a family of four.

The state will also offer federal tax credits for Kentuckians who lack job-based health insurance and buy private coverage through the new state health insurance exchange, Kynect, which opens for enrollment on Oct 1. Click here to read more about Kynect or to check your eligibility for coverage or subsidies.

Earlier, the Census Bureau reported there were 46.5 million people in the U.S. living in poverty median household income remained steady from the year before and was $51,017. Kentucky had a median household income of $46,362 in 2012, compared to the U.S. median of $51,371.  Click here for an interactive median income map from Stateline.

KentuckyOne Health to start around-the-clock online or phone access to health-care providers for $35 a visit on Nov. 1

Hospital group KentuckyOne Health says it will launch a program on Nov. 1 that will let Kentuckians get urgent care at any time by consulting with a medical professional over the phone or web camera. The group says KentuckyOne Anywhere Care is among the first such programs in the nation.

“KentuckyOne Health’s purpose is to expand access to quality health care, no matter where you live in the Commonwealth; is one way we are doing that,” CEO Ruth W. Brinkley said. “We can provide primary care to more Kentuckians, while saving them time, hassle and expense. We can treat conditions before they become more acute, as well as prevent unnecessary and costly emergency room visits.”

The service will cost patients $35 per visit, whether or not they are covered by insurance. "The cost is less than typical urgent care and a fraction of the cost of a normal emergency room visit," KentuckyOne said in a press release. Patients will be able to request a visit online or through a toll-free phone number. They will receive a phone call or video call from a medical provider within 30 minutes, the release promises.

"Patients will have access to board-certified doctors and nurse practitioners," the release says. "If needed, the KentuckyOne Anywhere Care provider will refer patients for a follow-up clinic visit or to an emergency department," and may prescribe medications, but won't prescribe or refill prescriptions for controlled substances.

The system will be operated by Carena Inc., which has been doing such work since 2010 and serves more than 500,000 patients in corporate programs and more than 1 million for the Franciscan Health System in Tacoma, Wash. The firm says it has a 98 percent satisfaction rating among patients.

Before going public, the new service will get a shakedown cruise by serving KentuckyOne employees who live in Kentucky. The group, Kentucky's largest, comprises Jewish Hospital & St. Mary’s HealthCare in Louisville; the Lexington-based Saint Joseph Health System, which includes hospitals in Bardstown, Berea, London, Martin, Mount Sterling and Shelbyville; and the University of Louisville Hospital and James Graham Brown Cancer Center. (Read more)

Kentuckians can act to protect against heart disease and stroke; half of preventable deaths occur in adults age 65 or younger

By Molly Burchett
Kentucky Health News

Nearly one on three deaths in the U.S. each year is caused by heart disease and stroke. At least 200,000 of these deaths are preventable, and nearly half of those preventable deaths are of people under 65, says a new report.

What can you do to stop heart disease and stroke from killing you? Change your health habits, says the federal Centers for Disease Control and Prevention's "Vital Signs" report. Changes can include quitting smoking, getting more physical activity and using less salt in your diet. Kentucky communities can also take preventive measures by creating healthier living spaces, such as smoke-free zones and safe places to exercise.

While the number of preventable deaths from heart disease and stroke has declined in people 65 to 74, it has remained virtually unchanged in those under 65, says the report. Men, particularly black men, are at a greater risk for dying early from these conditions. Overall, counties in Southern states, including Eastern and some parts of Western Kentucky, have the highest preventable death rates.

Map: Age-adjusted preventable death rates per 100,000 people from CDC "Vital Signs" 

To take action against the heart disease and stroke, risk factors should be considered. Adults in Kentucky have been found to have these risk factors for heart disease and stroke: high blood cholesterol, diabetes, overweight or obesity, not exercising regularly and not eating the suggested amount of fruit and vegetables.

If you have one of more of these risk factors, it is possible to reduce your risk of getting and dying prematurely from heart disease or a stroke. For example, you should work with your doctor on a treatment plan to control your high cholesterol and diabetes, and if you use tobacco, find resources to quit smoking.  It is also important to maintain a healthy diet and a weight, in addition to exercising for 2 hours and 30 minutes every week. (Click here to read more)

KET will show how annual county health rankings are stirring competition to improve health, community by community

The rankings are in quartiles, or fourths of the 120 counties

Kentuckians love the competition among their basketball and football teams. But what if that same spirit of competition was transferred to health? To help encourage such competition, and thus improve health county by county, the University of Wisconsin Population Health Institute produces county health rankings each year, in partnership with the Robert Wood Johnson Foundation.

The next edition of KET's "Health Three60," Tuesday at 9 p.m. ET, with Renee Shaw, looks at three communities that are taking those health statistics seriously and making positive changes. A health coalition drives change in Grant County, which moved from 89th to 60th in the rankings in three years. In Hardin County and some surrounding communities, a grassroots drive leads to a smoking ban. And new trails in Rockcastle County encourage healthy lifestyles, as well as economic development. The series is funded in part by the Foundation for a Healthy Kentucky. (Read more)

Study says obese children (Kentucky's a leader in that) may have quadruple the risk of having high blood pressure as adults

By Molly Burchett
Kentucky Health News

A new study shows that being obese in childhood may quadruple the risk of having high blood pressure risk as an adult, highlighting the need for Kentucky to curb its high rate of childhood obesity.

Eighteen percent of Kentucky high schoolers are obese, tying Mississippi for the highest percentage among the states, says a report by Kentucky's Task Force on Childhood Obesity. In the age range of 10 to 17, Kentucky trails several other states but remains a national leader.

One in three U.S. children and teens are overweight or obese, meaning their body mass index is at least the 85th percentile or at least the 95th percentile for their age and gender, respectively, says the American Heart Association. And, even more children are at-risk of becoming obese adults by the year 2030, says new report from Trust for America’s Health and the Robert Wood Johnson Foundation.

This study adds to concern about the long term impact of childhood obesity by linking it with increased risk for high blood pressure. High blood pressure, if left untreated, can damage the heart and coronary arteries that can ultimately lead to a heart attack, heart disease or congestive heart failure, says the AHA.

The findings, which were presented at the American Heart Association High Blood Pressure Research Scientific Sessions 2013, are also part of the growing body of evidence that heart disease may start in childhood, said Dr. Sara E. Watson, study author and a pediatric endocrinology fellow at Riley Hospital for Children at Indiana University in Indianapolis.

Study researchers tracked the growth and blood pressure of 1,117 healthy adolescents from Indianapolis for 27 years, starting in 1986, finding that 6 percent of normal weight children and 26 percent of obese children had high blood pressure as adults.

“It is important that pediatricians counsel patients on the risk of high blood pressure associated with overweight and obesity, and stress that a healthy diet, including reducing salt intake and exercise, may help reduce this risk,” Watson said. “Interventions to prevent and treat obesity will play an important role in decreasing the significant burden of high blood pressure in adulthood.”

Increased contact with bats leads to more rabies vaccinations in N. Ky.; health officials say all encounters should be reported

Fruit bat roosting in a home

Northern Kentucky health officials are warning residents to be more wary of bats after an unusually high number of residents have made contact with bats inside their homes and have had to receive the rabies vaccine. They are asking them to report any encounter with bats to the health department.

Bats are commonly infected with rabies and have very small teeth, and so someone who wakes up with a bat in their bedroom might not realize it has bitten them, Northern Kentucky Health Department spokeswoman Emily Gresham-Werle told Brenna Kelly of The Kentucky Inquirer.

It is crucial to vaccinate against rabies after contact with a bat, if the bat cannot be captured to receive testing for rabies. "If someone is exposed to the rabies virus and not treated, the result is neurological disease and death," Kelly notes.

Each year, tens of thousands of people are successfully protected from developing rabies through vaccination after being bitten by an animal like a bat that may have rabies, says the Center for Disease Control and Prevention. "There are usually only one or two human rabies cases each year in the United States, and the most common way for people to get rabies in the United States is through contact with a bat," says the CDC. Some of these reported cases resulted from known encounters with bats.

The problem In Northern Kentucky may be due to development in the area that has caused bats to lose their natural habitat. So far this year, 13 people who were exposed to bats have decided to get the vaccine. Usually only two to three people a year in the area have to get the vaccine because of a bat, Gresham-Wherle said. "Local and state health officials speculate that the weather and loss of bat habitat have contributed to the high number," reports Kelly.

"The rabies vaccine, which is nearly 100 percent effective against the virus, involves four rabies shots and one antibody shot over a period of two weeks. The vaccine, which is given by shots in the arm, can also be expensive, with costs ranging from $2,000 to $6,000 for the series, with additional fees for doctors or emergency room visits," Gresham-Werle told Kelly.

All exposure to bats and all bites by mammals must be reported to the local health department. In some instances the animal may be captured for rabies testing so that the bitten individual will not need to be vaccinated against the deadly disease. You can't tell if an animal carries the rabies virus just by looking at it, because rabies can only be confirmed in a laboratory, warns the CDC.

Does gum disease indicate future joint problems? Study links gum-disease bacterium to collagen-caused rheumatoid arthritis

Although researchers and clinicians have long known about an association between two prevalent chronic inflammatory diseases - periodontal disease and rheumatoid arthritis - the microbiological links have been unclear; a new study suggests this link is causative and that the bacteria responsible for gum disease leads to a faster progression of rheumatoid arthritis.

In a recent article published in PLoS Pathogens by University of Louisville School of Dentistry researchers say, "The bacterium responsible for periodontal disease, Porphyromonas gingivalis, worsens rheumatoid athritis by leading to earlier onset, faster progression and greater severity of the disease, including increased bone and cartilage destruction," according to a U of L news release.

The study says the bacterium produces an enzyme that worsens collagen-induced arthritis, a form of arthritis similar to rheumatoid arthritis produced in the laboratory.

The study was led by Oral Health and Systemic Diseases Group researcher Dr. Jan Potempa and a team that also studied another oral bacterium for the same effect, and found it did not affect collagen-induced arthritis or suggest a link to rheumatoid arthritis.

“This ground-breaking conclusion will need to be verified with further research,” said Potempa. Although the specific cause for the disease remains unknown, Potempa said he hopes these findings will shed new light on the treatment and prevention of rheumatoid arthritis.

An estimated 294,000 children under age 18 have some form of arthritis or rheumatic condition, says 2010 data from the Center for Disease Control and Prevention; this represents approximately 1 in every 250 children in the U.S. An estimated 1.5 million adults had rheumatoid arthritis in 2007. Click here for more information from the CDC.

Obamacare recruiters encounter resistance in rural Kentucky

Promoters of the new health-insurance system being created under the federal health-reform law are running into resistance in rural Kentucky, where "tend to be less connected to the Internet and less exposed to ad campaigns under way in the state," The Wall Street Journal reports. "And they are typically more conservative, sometimes with deep antipathy toward President Barack Obama and anything linked to him."

Erin Hoben

“In rural areas, they’re not getting a lot of the positive messaging” about the law, Erin Hoben, an outreach coordinator for Kentucky Voices for Health, a coalition of pro-Obamacare groups, told reporter Arian Campo-Flores, who writes: "Among the worries expressed by audience members at forums she has attended: that the law will cause taxes to rise and bankrupt federal and state governments. At one recent event, “One guy called me a ‘Yankee’ and stopped talking to me,” said Hoben, who is from Louisville.

But others in Pikeville, from which Campo-Flores reported, indicated positive interest in the state health benefits exchange, Kynect, that will go online Oct. 1 with standard policies with subsidies for most people, or a Medicaid program being expanded by Democratic Gov. Steve Beshear, at 100 percent federal expense for the first three years, 90 percent by 2020.

Nurse administrator Lee Barnard, left, and Carrie Banahan, boss of the Health Benefit Exchange,
talk with Darrell Mounts, right, and Matthew Justice, far right, in Pikeville. (WSJ photo: Ian Bates)

Rural signups are critical in states like Kentucky, where 45 percent of the estimated 640,000 uninsured people live outside metropolitan areas. Nationally, only 17 percent of the uninsured are rural, Campo-Flores notes.

"Cara Stewart, a health-law fellow at the not-for-profit Kentucky Equal Justice Center, has been driving 6,000 miles a month traversing the state to reach residents," Campo-Flores reports. "She said she has enlisted local pastors and choir leaders to help connect her with their congregations. Another avenue she is pursuing: the Cooperative Extension Service offices of Kentucky’s two land-grant universities." Stewart said, “They’re a neutral, trusted source of information.” (Read more)

University of Kentucky Extension Service Director Jimmy Henning said in an email to Kentucky Health News, "We are doing a lot of education relating to health, just as we always have done, and that would include helping people evaluate their options" under the reform law, but agents are not acting as paid navigators. That's in keeping with their roles as independent providers of information.

Hard-hitting TV ads against smoking do motivate smokers, like one mother from Elizabethtown, to quit

Hancock with CDC Director Tom Frieden

A 38-year-old Elizabethtown mother's response to a federally funded anti-smoking advertising campaign has been featured in national news this week, showing that these graphic ads can motivate smokers to quit.

Lisha Hancock's decision to stop her two-decade smoking habit was sparked by her viewing of a Centers for Disease Control and Prevention’s “Tips from Former Smokers” campaign commercial, reports Sarah Bennett of The News-Enterprise in Elizabethtown.

Hancock's husband often urged her to quit, and several of her relatives died from smoking, but she still didn't quit. She continuously had a sore throat and clogged sinuses, but she still didn't quit. Then, she saw the commercial.

The advertisement featured raw images of Terrie Hall, a North Carolina woman who was diagnosed with throat and oral cancers at age 40, getting ready in the morning by putting on a wig, artificial teeth an an artificial voice box inside a small hole in her neck, since throat cancer forced her to have her larynx removed.

TV spokeswoman Terrie Hall with grandson's picture

"The only voice my grandson’s ever heard is this one,” Hall says in a robot-like voice, displaying his picture. UPDATE: Hall died Sept. 16.

The ad made a lasting impression on Hancock, who told Bennett she decided to quit smoking after watching the ad with her son: “One time my son asked me, ‘Mom, why does her voice sound like that?’ I said, ‘Because she smoked.’ Then he asked, ‘So you’ll sound like that?’”

Hancock said she had tried to quit before, but "There's nothing that touched me like Terrie's ad. It definitely impacted my life and, in return, impacted my family's life. We all live happier and healthier now."

Hancock started to quit eight months ago. Using nicotine lozenges and a combination of exercise and healthful eating, she's been able to go without even one cigarette, reports Anahad O'Conner of The New York Times.

Others have also been struck by this hard-hitting campaign, which may have prompted more than 100,000 Americans to quit smoking permanently, says a new CDC study published in The Lancet, the leading British medical journal. The CDC says an estimated 1.6 million U.S. smokers attempted to quit this past year after viewing campaign materials funded by the Affordable Care Act.

"Hard-hitting ads work," said CDC Director Dr. Tom Frieden. The agency paid approximately $50 million to produce and place the spots, the first time the federal government funded a nationwide tobacco-education ad campaign, reports Jonathan Serrie of Fox News.

"The impact is huge because a smoker costs about $2,000 more [per year] than a non-smoker, and about $1,000 more than an ex-smoker, to care for," Frieden said. "And if you do the math, this program pays for itself in a year or two in reduced health-care and societal expenditures."

The campaign also saved an estimated 300,000 years of life that smoking-related diseases would have taken, reports Brady Dennis of The Washington Post. Smoking remains the leading cause of preventable death in the United States, killing more than 1,200 Americans each day, says the CDC.

Click here for the CDC ads and other smoking-cessation resources.

National Childhood Obesity Awareness Month: Policy changes underway in Ky. to lower its very high childhood obesity rate

September is National Childhood Obesity Awareness Month, and a number of policy changes are underway to combat the increasing trend of overweight children in America and Kentucky, where one in three kids are on their way to developing Type 2 diabetes.

Kentucky suffers from one of the highest childhood obesity rates in the country, tying Mississippi for the highest percentage of youth in grades 9 to 12 that are obese (18 percent). It has the third highest percentage of children ages 10 to 17 who are obese (21 percent), compared to 16.4 percent nationally, says a report by Kentucky's Task Force on Childhood Obesity.

The state's efforts to lower childhood obesity rates include two important studies for the Cabinet for Health and Family Services – "Shaping Kentucky’s Future: Policies to Reduce Obesity" and "Unbridled Health: A Plan for Coordinated Chronic Disease Prevention and Health Promotion." These reports contain policy recommendations for work communities, corporations, schools and the state itself to help Kentuckians eat healthy and exercise, The Foundation for a Healthy Kentucky says in a news release.

“Lowering childhood obesity rates is a positive lever for overall health change, reduced risk of chronic disease and an improved quality of life," said Susan Zepeda, president of the foundation. "Foundation polling and recent news reports signal growing awareness among Kentuckians of the importance of and the need for lowering our obesity rates."

Nationally, the recent report "F as in Fat: How Obesity Threatens America’s Future 2013" provides recommendations that could improve health in Kentucky and across the country with funding and effective implementation, including:
 · All food in schools must be healthy
 · Kids should have opportunities to be physically active on a regular basis
 · Restaurants should post calorie information on menus
 · Only healthy products should be marketed to children
 · Transportation plans should encourage walking and biking
 · Everyone should be able to purchase healthy, affordable foods close to home

“Here at home, Kentucky will host the Southern Obesity Summit in 2014 and several organizations are hard at work to advance health policies that support sound nutrition and active living at work, at school and in our communities,” said Zepeda. “These efforts create opportunities to discuss strategy and create more awareness of the compelling need to reduce childhood obesity rates in the commonwealth.”

State picks managed-care outfits for expanded Medicaid

The state awarded contracts Friday to Humana Inc., Passport Health Plan and Wellpoint subsidiary Anthem Blue Cross Blue Shield to manage the health care of Kentuckians who will become eligible for Medicaid when the state expands the program under federal health reform Jan. 1.

The newly eligible, in households with incomes up to 138 percent of the federal poverty line, can start signing up for coverage Oct. 1 through Kynect, the state health benefits exchange that will offer regular insurance policies and federal subsides for those up to 400 percent of the poverty line.

The contracts cover 104 counties. The other 16, in the Louisville region, are already covered by contracts signed last year with Humana, Passport, Coventry Cares and Wellcare of Kentucky for current Medicaid patients in all counties. They will be expanded to cover the newly eligible on Jan. 1.

An estimated 308,000 Kentuckians will become eligible for Medicaid under the federal health-care reform law. The state does not expect all of them to sign up for coverage. Under the reform law, the federal government will pay the extra cost for the first three years, then the state will start picking up part of the cost, topping out at 10 percent in 2020. Currently, federal funds cover about 72 percent of Kentucky Medicaid costs.

McConnell calls for one-year delay in reform law's key requirement, that Americans buy health insurance

U.S. Sen. Mitch McConnell

U.S. Sen. Mitch McConnell is calling for a one-year delay in the requirement for almost all Americans to buy health insurance, followed by repeal of the federal health-reform law. The Obama administration has said it will delay for a year its enforcement of the related requirement that businesses with 50 or more employees insure them.

"But what about everybody else?" McConnell asked in a speech on the Senate floor Sept. 12. "What about the recent college grad in Louisville who’s barely scraping by as it is, and won’t be able to afford a premium increase? What about the families from Covington to Paducah who are worried sick about this law? Doesn’t the administration think these folks deserve some relief too? The same kind of delay, at least, that businesses will get?"

The Senate Republican leader noted that the Republican-majority House "passed a bill on a bipartisan basis before the August recess" to delay the individual mandate, and said he tried to likewise in the Senate but was blocked by that chamber's Democratic leaders. He said he would keep trying.

McConnell also said in his speech, "Now, I know that some of you who supported this law might be thinking, 'Well, they’ll learn to like it.' But it’s precisely that kind of 'We know what’s good for you' attitude that’s so upsetting to my constituents. It’s what got us into this mess in the first place." (Read more)

Anthem gift will let Kentucky Homeplace expand diabetes self-management and education project to counties in Western Ky.

Kentucky Homeplace has been awarded a second gift of $150,000 from the Anthem Foundation to continue its diabetes self-management education project in Appalachian Kentucky counties that have high rates of diabetes but lack providers to help address it.

With this gift, Kentucky Homeplace community health workers can continue work to improve diabetes outcomes in Appalachia through a Diabetes Self-Management and Education program, which are designed to help people better manage their diabetes through improved self-testing and lifestyle changes, says a release from the University of Kentucky Center of Excellence in Rural Health.

DIABETES BELT (CDC map)

Sixty-eight of Kentucky's 120 counties are included in the “Diabetes Belt” of the rural Southeast, counties in which 11 percent or more of adults have been diagnosed with having diabetes, compared to the national average of 8.5.

In these areas, about a third of the excess risk of becoming diabetic is associated with risk factors that can be modified, such as sedentary lifestyle and obesity, says the Centers for Disease Control and Prevention.  In Kentucky, the number of certified diabetes educators in these counties is much lower than in other areas of the state, the UK release says.

The first study, in Eastern Kentucky, showed more glucose testing by patients and lower measures of hemoglobin A1c, the key indicator of diabetes. The new grant will let Kentucky Homeplace expand to include parts of Western Kentucky and enroll more than 300 additional participants.

Kentucky Homeplace was originally developed in 1994 by the UK Center for Excellence in Rural Health as a demonstration project. It now gets state funding and has worked for two decades to provide tens of thousands of rural Kentuckians with medical, social and environmental services they might not have had otherwise, says the release.

FDA changes painkiller labels to warn expectant mothers, after 2,500% growth in number of Ky. babies born addicted to drugs

The U.S. Food and Drug Administration (FDA) announced Tuesday drug-safety labeling changes and new post-market study requirements for all extended-release and long-acting opioids, and Kentucky political leaders applauded these measures to curb prescription drug abuse.

Long-acting opioids are intended to treat pain but may also lead to drug abuse, dependence or other complications if taken during pregnancy or misused. Now, as part of new FDA safety measures, the boxed warning labels on these drugs will warn expectant mothers that “the use of the products during pregnancy can result in neonatal opioid withdrawal syndrome (NOWS),” says the FDA release.

NOWS is among a group of problems called Neonatal Abstinence Syndrome (NAS) that occur in a newborn exposed to addictive drugs while in the mother’s womb. The baby's addiction can lead to birth defects, low birth weight, sudden infant death syndrome and other health conditions.

Attorney General Jack Conway and his counterparts in other states asked the FDA to act after several states reported an increase in the number of babies born addicted to prescription drugs. In Kentucky, "Instances of NAS have risen 2,500 percent over the past decade – from 29 incidents in 2001 to 730 in 2011," says a Conway release.

“I applaud the FDA for making this change that will better alert physicians and patients about the dangerous consequences of using these powerful prescription painkillers during pregnancy,” Conway said. Also as part of these safety labeling changes, certain educational materials for patients and health care professionals will be modified to reflect the new labeling.

U.S. Senate Republican Leader Mitch McConnell also praised the FDA's decision, saying it is a positive step forward in the fight against the state's prescription drug abuse problem.

Because little is known about the risks of long-term use of long-acting opioids, the FDA is also requiring the drug companies that make these products to conduct further studies and clinical trials to assess the known serious risks of misuse, abuse, increased sensitivity to pain (hyperalgesia), addiction, overdose and death, says the FDA.

"Altogether, the actions we're now announcing are part of FDA's efforts to make opioids as safe as possible for those who need them," said Dr. Douglas Throckmorton, deputy director of regulatory programs in FDA's Center for Drug Evaluation and Research. "This is not the first or last initiative, and we will continue supporting broader efforts to solve the serious public health problems associated with the misuse and abuse of opioids."

Beshear announces rates in health-insurance exchange, says Kentuckians will like them, especially the federal 'discounts'

By Al Cross
Kentucky Health News

Tossing out the first examples of what Kentuckians will pay for required health coverage through the state health insurance exchange that opens Oct. 1, Gov. Steve Beshear predicted yesterday, "The vast majority of people are going to be very excited about what they find. . . . When they check it out, they’re gonna sign up."

Beshear said there has been much speculation about premiums, but little talk about the federal subsidies (he called them "discounts") that the exchange will offer to individuals and households with incomes up to 400 percent of the federal poverty level. He said subsidies will be available to individuals earning as much as $45,960 a year, and to families of four with income as high as $94,200 a year.

Beshear notes that 15 percent of Kentuckians are uninsured (light green in pie chart); at left is
Kynect Director Carrie Banahan; at right is Health and Family Services Secretary Audrey Haynes.

Tea Party activist David Adams, who recently lost the first round of his court battle to stop the exchange and Medicaid expansion, has said some consumers will have to pay almost double for their current coverage, and he told The Courier-Journal that the subsidies won't make up for that.

About 15 percent of Kentuckians, more than 640,000, have no health coverage. About 308,000 will become eligible for the Medicaid program, which is being expanded under federal health reform to include people with incomes up to 138 percent of the poverty level. Among the other 332,000, 85 percent of those people will qualify for subsidies, Beshear said, and in some cases the subsidy will be 100 percent.

The subsidies are available only through the insurance exchange, which the state has branded Kynect. The exchange will offer five plans, with premiums based only on age, income, geography, number of people on the plan and how many of them use tobacco.

State's example of bronze plan for a smoker earning $30,000

The ceiling for the tobacco surcharge is 40 percent, which has drawn criticism, but the state Department of Insurance said that is the most common surcharge in the state's health-insurance industry. Beshear said a 50-year-old man who smokes and earns $30,000 a year would still pay only $160 a month for coverage under the "bronze" plan, the one with the lowest premiums and highest deductibles and other out-of-pocket costs. Under the plan with the lowest deductibles, he would pay $279.

The bronze plan has a very large $6,300 deductible. The other standard plans are silver, gold and platinum; their deductibles are 20 percent (called "co-insurance") plus $4,600, $2,500 and $1,000, respectively. The exchange will also offer people under 30 a plan that provides only catastrophic coverage with a "very high deductible" and no subsidy, Beshear said.

Among other examples in the bronze plan, which has a $6,300 annual deductible: A nonsmoking farmer in his mid-50s earning $34,000 a year would pay $47; a family of four with no smokers and $70,000 annual income would pay $403; a 32-year-old single mother with two children and $40,000 income would pay $133.

Beshear offered no average cost, saying “There are too many factors to create an average that would be useful. . .. The bottom line is that families must do some research,” which the Kynect website and call center can help them with starting Oct. 1. He said the plans shouldn't be compared to individual plans offered in commercial market, because “the coverages are so much different.”

One big difference is that under the federal health reform law, all plans must cover prescription drugs, hospital care, maternity and newborn services, mental health and substance abuse services, emergency care, rehabilitative services and devices, laboratory services, preventive and wellness services, chronic disease management and pediatric services. Also, they are not allowed to have any dollar limits on coverage.

The law also bans insurance companies from denying or dropping coverage because of someone's health condition, meaning that "For the first time we’re gonna be able to provide affordable health insurance of every single Kentuckian. . . . This is a historic event in the commonwealth." The federal law requires practically every American to have health insurance.

The plans' geography is based on the state's eight Medicaid regions. Beshear said at least two insurance companies will be offering plans in each region, unlike some states. He said four companies have proposed to offer dental insurance, but those plans are still under review by Kynect and the Department of Insurance, which evaluates them for actuarial soundness.

Humana Inc., Anthem Blue Cross and the new Kentucky Health Cooperative will offer policies for individuals, while Anthem, the co-op, Bluegrass Family Health and United Healthcare will provide employee coverage for businesses. Employers with fewer than 50 workers are not required to insure them, and those with fewer than 25 employees can get tax credits for doing so.

The rates are for 2014. Beshear said companies were “understandably cautious” in setting premiums without any experience on which to base them, so he expects rates to decrease in 2015.

Kentucky Health News is an independent news 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.