Uninsured young adults may qualify for high-deductible health coverage for $50 or less per month on state exchanges

Almost half of single young adults who are uninsured may qualify for coverage for $50 or less per month under federal health reform, according to a report from the U.S. Department of Health and Human Services.

HHS says young adults often qualify for lower costs on monthly premiums through tax credits based on family size and income. A single person's income must not be more than $45,960 to qualify for a tax credit, according to the Kynect website, and lower-income families receive the most assistance.

The federal report examined the 34 federally facilitated and state-partnership marketplaces and found that 46 percent of single young adults (ages 18-34) who may be eligible for coverage could purchase a "bronze" plan with high a deductible for $50 per month or less after tax credits, and 66 percent may be able to pay $100 or less for coverage. The report also found that "an additional 1 million eligible uninsured young adults may qualify for Medicaid in the states that have opted to expand the program in 2014."  (Read more)

Find out about your eligibility at Kynect, Kentucky's online insurance marketplace.

University of Louisville announces global licensing agreement with Novartis for collaboration to help transplant patients

The University of Louisville's Suzanne Ildstad 

is shown with research coordinator Thomas Mille

The University of Louisville announced Wednesday a research collaboration agreement between one of its researchers, Suzanne Ildstad, representing Regenerex LLC, with Novartis. The agreement will provide access to stem cell technology that could help transplant patients avoid taking anti-rejection medicine for life and may also serve as a platform for treatment of other diseases.

This global licensing agreement between Regenerex and Novartis will significantly enhance the university’s ability to carry out cutting edge research related to the Facilitating Cell, a novel cell discovered by Ildstad, CEO of Regenerex and director of U of L's Institute for Cellular Therapeutics, says a U of L news release.

"Being a transplant recipient is not easy. In order to prevent rejection, current transplant recipients must take multiple pills a day for the rest of their lives. These immunosuppressive medications come with serious side effects with prolonged use including high blood pressure, diabetes, infection, heart disease and cancer, as well as direct damaging effects to the organ transplant," Ildstad said in the release. "This new approach would potentially offer a better quality of life and fewer health risks for transplant recipients."

Ildstad published results of "Facilitating Cell Therapy," which is undergoing Phase II trials, in March 2012 in Science Translational Medicine. The results say the therapy enables five of eight kidney transplant patients to stop taking about a dozen pills a day to suppress their immune systems; this is the first study in which the donor and recipient did not have to be biologically related or immunologically matched.

Ildstad was originally recruited to U of L under the state's "Bucks for Brains" initiative for endowed professorships, advanced in by then-Gov. Paul Patton in 1998. Along with her research team, she began examining the facilitating cell platform technology for the treatment of kidney transplant recipients.

"Dr. Ildstad was among the first faculty members hired utilizing seed funds from the state to help us attract highly talented researchers through the Bucks for Brains program," U of L President Dr. James Ramsey said. "Regenerex demonstrates the potential for that vision to be realized bringing new jobs to the city, adding to the revenue from the Tax Increment Financing district and providing funding to U of L in support of our academic mission," he said.

The collaboration with Novartis provides for investments in research and applications of new technology as well as milestones and royalty payments from Regenerex to the university.

"The 'holy grail' of transplantation is immune tolerance, that is making the body recognize a transplanted organ as 'self' and not reject it as foreign tissue, but without the need for immunosuppressive drugs with their numerous serious side effects," said Dr. David L. Dunn, executive vice president for health affairs at U of L. "Dr. Ildstad and her team may well have solved this puzzle."

Scammers taking advantage of new health-insurance system

Scammers are using the new health-insurance system "as an opportunity to try to collect consumers’ personal information or to make false claims," Gov. Steve Beshear and Attorney General Jack Conway warned Tuesday.

Conway's office sent civil investigative subpoenas and cease-and-desist orders Monday to the operators of two websites that had brought complaints from consumers to the Cabinet for Health and Family Services, which oversees Kynect, the state's health-insurance marketplace.

Scam sites try to mimic legitimate government sites, the officials said. People who register on the sites have reported getting telephone calls as a result. That is not the way the secure, state-operated website works. Its web address is Kynect.ky.gov; beware of sites ending in .com or .net, Conway advised.

“If something seems suspicious, do not share your personal information, and if you suspect fraud, report it immediately,” Conway said. He also warned Kentuckians to be on guard for attempts by identity thieves to collect personal or financial information by email, phone or mail.

Scammers may also try to sell bogus “discount medical plans” or mislead older consumers on Medicare by making false claims that Medicare coverage is affected by the new law, Conway said. It is not, but the annual Medicare re-enrollment period runs through Dec. 7, perhaps creating confusion.

“It’s appalling to think there are individuals out there who would prey on Kentuckians during this process,” Beshear said. “Everyone should be on guard and report any questionable websites or businesses. There is a lot of misinformation on the Affordable Care Act, which is why we have qualified staff who can answer questions and point consumers in the right direction.”

The attorney general's Office of Consumer Protection offered these tips:

• Make sure you’re working with a registered insurance agent or certified Kynector. Only legitimate insurance agents and government-contracted assisters, called “kynectors,” are authorized to assist Kentuckians with signing up for health care. A list of approved agents and kynectors maintained by the Cabinet for Health and Family Services can be found online or by calling 1-855-459-6328.
• Protect your personal information. Only a registered insurance agent, a certified Kynector, or customer-service representative at a contact center should ask for your personal information to help you apply. Keep personal and account numbers private to any others who offer assistance. Don’t give your Social Security number, credit card or banking information to companies or individuals you didn’t contact. Never give your information to someone whose identity you question.
  
• Do not pay for help. Insurance agents and Kynectors will not solicit money. There is no charge to use Kynect services with the help of an insurance agent or certified Kynector. If consumers get an offer to register for a fee, they should hang up the phone or walk away.
• Remember that you can only get tax credits through Kynect. Most Kentuckians who buy insurance through Kynect will qualify for tax credits to subsidize their premiums. No one but Kynect can offer these credits, and there is no charge to apply for them.
  
• Beware of phishing scams online. Consumers should be cautious of any email claiming to be connected to the Affordable Care Act, including any emails claiming to be affiliated with kynect and asking for personal information.
  
• Ask questions. Don’t sign anything you don’t fully understand, and verify the answers you get with trained kynect representatives.

If people think their personal information may have been compromised, they can visit www.ag.ky.gov, the attorney general’s website, which has an identity-theft toolkit.

A Ky. guide to the Patient Protection and Affordable Care Act

By Molly Burchett
Kentucky Health News

Few laws have generated as much confusion, opposition or news coverage as the Patient Protection and Affordable Care Act. Despite the flood of news stories about the law widely known as Obamacare, there is still much confusion about it.

That's not surprising. The 906-page law is complex and is accompanied by 10,535 pages of regulations. This guide to the law is designed to clear up confusion and offer various perspectives about how the law may affect you, your family or your business.

What does the Affordable Care Act do?

The law is a set of reforms that impose many requirements on insurance companies and requires all Americans, with very few exceptions, to have health coverage or pay a penalty starting Jan. 1.

Kynect home page

In addition to those mandates, the law created online health-insurance marketplaces and encouraged states to expand the federally subsidized Medicaid program for the poor and disabled. Gov. Steve Beshear expanded Medicaid and decided the state would run its own marketplace or exchange, Kynect, which launched Oct. 1.

Why did Congress pass the law?

The law is designed to extend health coverage, either through private insurance or Medicaid, to Americans without health insurance. More than 47 million Americans were uninsured in 2012, says the Kaiser Family Foundation, and about 640,000 of them were Kentuckians.

The law's rules for insurance will increase costs for many, so it provides Medicaid or subsidized coverage to help qualifying individuals pay for coverage. Those with incomes under 138 percent of the federal poverty threshold qualify for Medicaid, and those with incomes up to 400 percent of the poverty line get premium subsidies. The line for a family of four is $23,550, so such a family would qualify for subsidies if it makes less than $94,200 a year.

Who will be affected by the law?

Obamacare will affect almost everyone, but it will have less impact on people 65 and up because they're eligible for Medicare. Virtually everyone must have health insurance coverage by 2014 or pay a penalty. Beginning in 2015, employers of 50 or more full-time workers (defined as working at least 30 hours a week) must provide coverage for their employees.

Insurance companies can no longer deny coverage because of pre-existing conditions such as a disability, pregnancy, or chronic disease. Under one part of the law that took effect early, parents are able to keep their children on their insurance until the children turn 26.

The law aims to help people who can't get affordable insurance through an employer or who aren't ineligible for public coverage through Medicare or Medicaid. It also affects the self-employed, small businesses and employees of businesses that don't provide coverage.

Because the law is making fundamental changes in the health-insurance system, "In the long run, pretty much every American will be affected by Obamacare," reports Abby Hayes of The Dough Roller, a financial-advice site. "Next year, employer-sponsored insurance premiums are likely to fluctuate as insurance companies adjust their offerings."

Will the law lower health costs?

It's too soon to tell what impact the law will have on costs. Remember, there are two types of health costs: the country's overall cost and the cost that you feel in your pocketbook from the money your household spends on health services.

If you buy an insurance policy through the state exchange, www.kynect.ky.gov, your cost will depend on your individual situation, such as the size of your household and the number of smokers in it, and your income, which will determine your eligibility for subsidies or Medicaid.

Most people who buy coverage in the individual market will pay higher premiums in 2014, mainly because companies are required to cover people with pre-existing conditions and a broader range of services, such as prescriptions, than many people have been paying for.

Rates in the individual market will change yearly, as explained in a report from the Kaiser Family Foundation. It says the broader coverage, and limiting surcharges due to age, will spread the overall cost of care across the insurance marketplace, tending to lower premiums for people who are older and sicker and raise them for people who are younger and healthier. Thus, the trade-off for pre-existing coverage is the individual mandate, which requires everyone to purchase coverage to spread the cost.

Think of it this way: When you go out to eat with two grade-school children, they can order off the kids' menu, so you pay less for their smaller portions. The total bill is $30. Your kids' chicken finger platters are $5 each, and you and your spouse both have $10 items. However, if the restaurant must charge all patrons equally for the same meal, the $30 cost would be assessed differently. The cost for each individuals would be $7.50; the cost of your kids' meals would be higher and you and your spouse's meal would cost less.

Many Kentucky businesses have expressed concern about rising premiums for employee coverage. Some are moving to high-deductible plans that require employees to pay a larger share of their costs, and some may drop coverage, letting employees obtain insurance and subsidies through the government exchanges.

How do I get coverage from the exchange?

The Kynect website will determine your eligibility for Medicaid or subsidies, allow you compare plans and process the insurance application. If you don't have a computer, you can call toll-free to 1-855-459-6328 to apply or locate a local "Kynector."

Unless you qualify for a special enrollment period, you must enroll in a health plan by March 31, 2014. A "life-changing event," such as moving to a new state, major changes in income and changes in family size, can make you eligible for a special enrollment period, says Healthcare.gov, the federal website. (Kentuckians do not use the federal site because the state has its own site, Kynect.)

The date coverage starts depends on when you buy it. If you enroll before Dec. 15 and pay your first premium, your coverage starts Jan. 1. Likewise, in succeeding months, if you enroll between the 1st and 15th, your coverage starts on the 1st of the next month. If you enroll after the 15th, coverage starts the month after the next one.

What do the health plans cover?

Regardless of which plan you chose, the law requires all plans offered by any insurance company to cover these essential health benefits:

1. Ambulatory patient services (outpatient care)
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance abuse services (including behavioral health treatment)
6. Prescription drugs
7. Rehabilitative and habilitative services/devices
8. Laboratory services
9. Preventative, wellness, and chronic disease management services
10. Pediatric services (including oral and vision care) 

What will I pay for a plan?

Premiums depend on individual circumstances, such as income and the level of coverage, such as the amounts of deductibles and co-payments. Kynect is connected to federal databases — including Internal Revenue Service databases — to determine whether you qualify for assistance in paying a premium. People on Medicaid do not pay premiums.

Plans on Kynect vary widely. In addition to comparing premiums, it is important to consider deductibles, co-payments and other plan details. Kynect offers four basic types, labeled bronze, silver, gold and platinum. Bronze plans have the lowest premiums but have a $6,300 deductible. As you move up the plan spectrum to platinum, your premiums increase and your deductibles decrease. The exchange also offers people under 30 a plan that provides only catastrophic coverage with a "very high deductible" and no subsidy.

Let's consider a basic example. A 45-year-old Floyd Countian named John Smith earns $36,000 a year, which means he is eligible to buy subsidized insurance through Kynect.

The individual market in Floyd County is limited to two companies, Anthem Blue Cross and the non-profit Kentucky Health Cooperative; Humana Inc. isn't offering individual coverage there. Depending on the type of plan John chooses, his premiums will range from $182 (bronze) to $421 (platinum), with deductibles ranging from $6,300 (bronze) to $500 (platinum).

Kynect shows selected plans' ranges of premiums, 
deductibles and out-of-pocket limts.

John has several options. Let's say he decides that he needs to keep his premium payments below $250 per month because he just bought a house and is on a tight budget. He doesn't expect to have many doctor visits because he's pretty healthy, but he doesn't have enough money saved to afford a $6,300 deductible if things went south.

Considering his obligations, John decides to set aside 15 percent of his monthly income for health care. Based on this budget, he narrows his options down to three plans. The Kynect website displays them.

After eliminating the gold plan, John decides he would prefer to pay an additional $40 per month to reduce his deductible to $2,000, so he purchases the cooperative's PPO Silver plan. About 7 percent of his income each month will go toward the premium. He will save the other 8 percent ($240) to apply to his deductible, prescription drug costs and co-pays for office visits.

A $2,000 deductible means that John must pay all of his medical costs, excluding certain preventive services like immunizations and screening, until he reaches this threshold. Co-payments and premiums cannot count toward the deductible.

John really likes his family doctor, whom he's been seeing for 20 years, and the doctor is in the cooperative's network. This plan has a $30 co-pay for primary care and mental health services, and he feels comfortable paying this amount for an office visit. If he were to see an out-of-network doctor, he would pay co-insurance: 60 percent of the doctor's full charge for the visit. For prescription drugs, there is a $500 deductible, and John will pay $20 per prescription for generic drugs after reaching this amount.

John has peace of mind knowing that he's covered if he were to have an accident. The total amount he may have to pay each year is his out-of-pocket limit of $6,350, and since he has purchased this plan during the enrollment period, he will not face a penalty for not having coverage.

As he navigates the site, John sees that he qualifies for a payment assistance in the form of a tax credit that will either reduce the amount John will pay in taxes or increase his refund, depending on his personal situation; or it will reduce his monthly premiums, if he so chooses.

What happens if I don't get covered?

The penalty for 2014 will be the larger of either $95 per adult and $47.50 per child under 18, up to a total of $285 per family or 1 percent of household income in excess of $10,000 for an individual or $20,000 for a family.

For example, let's say an individual making $40,000 per year doesn't buy health insurance in 2013. This person would would pay 1 percent of $30,000, or $300, in 2014. What about a family with a $50,000 household income? It would pay a penalty of 1 percent of $50,000, or $500.

The initial penalties are much less than the cost of health insurance, but will go up each year. The minimum penalty may increase to as much as $695 per person by 2016.

What if I'm on Medicare or Medicaid?

Almost nothing will change if you have coverage through Medicaid, but there are some changes for Medicare beneficiaries. The law doesn't require Medicare beneficiaries to buy more insurance and won't force beneficiaries to see different doctors, reports Andrea Adleman of U.S. News.

Obamacare does, however, increase premiums or prescription-drug costs for some Medicare beneficiaries, and it mandates $716 billion in Medicare payment reductions over the next 10 years. These cuts are made by changing payment formulas for hospitals, nursing homes, home-health agencies, hospice agencies and Medicare Advantage plans, says the Congressional Budget Office.

The law already affects higher-income Medicare beneficiaries. Those who earn more than $85,000 ($170,000 for a couple) are paying higher Part B premiums, which cover physician and outpatient services, and for Part D, which covers prescription drugs, says Kaiser Health News. As a result of this sliding scale, about 5 percent of Medicare beneficiaries are paying more for premiums and prescription drugs.

It is projected that by 2019, 7.8 million beneficiaries will be paying the higher Part B premiums and of that group, 4.2 million will pay the higher Part D premiums. Kaiser estimated the combined premium in 2019 would be $299 to $683 a month, depending on income.

However, typical Medicare beneficiaries, those below the $85,000/$170,000 income threshold, will pay less for their premiums since the the law closes the "doughnut hole," the coverage gap in prescription benefits, by 2020. The National Council on Aging estimates the savings could reach $1,800 for some beneficiaries.

Also, both Medicaid and Medicare beneficiaries will qualify for more free preventive care, such as a yearly wellness visit, vaccinations and colorectal screenings, starting Jan. 1.

What if my employer covers me?

About 57 percent of Americans have health insurance through an employer with fewer than 200 employees, and those who are covered do not have to purchase a new plan on Kynect. If your employer’s plan covers less than 60 percent of allowed medical expenses, or costs you more than 9.5 percent of your household income, you can shop on the exchange.

Over the past 10 years, employers have been shifting more health costs to employees. Worker contributions increased 89 percent during the decade, and are 14 percent higher than in 2009, Kaiser Health News reports. So, while the nature of your work plan may be changing, this is not a direct result of the health law.

If you aren't covered by your employer or if your employer decides to drop your coverage, you must obtain coverage or face a penalty. Religious conscience and hardship exemptions to this mandated coverage exist, and you will need to complete an application to request such an exemption.

What if I'm an employer?

Steve Wilson, senior vice president of Benefit Insurance Marketing in Lexington, said in an email that employers with fewer than 50 employees are facing 2014 premium increases that may lead them to drop coverage for their employees.

Wilson said unless companies act quickly to renew early based on 2013 underwriting rules, the average 2014 renewal for his company's small business clients will increase 63 percent. He said his clients represent a broad range of industries that will, on average, pay $3,508 more per employee for coverage next year.

On the other hand, a study by the RAND Corp. says Obamacare could alleviate some of the difficulties for small employers by putting their employees into a single risk pool. The study predicts that the number of workers offered coverage will increase after the reform, mainly because more small businesses will offer coverage.

If you have a small business with 25 or fewer employees, there may be significant tax credits available through Kynect to help cover the cost of insurance.

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.

Kentucky's Obamacare website's success resulted from careful and early testing, unlike the federal website, writers say

While Kynect, Kentucky's online health insurance marketplace, is being hailed as the country's best Obamacare website, the federal government's $634 million Healthcare.gov website continues to marred by technological glitches and bad press.

"The Kentucky Kynect likely takes the award for most written-about Obamacare marketplace -- and for good reason," reports Sarah Kliff of The Washington Post. "It had one of the most flawless launches of any state marketplace, posting robust application numbers on Oct. 1. So far, the state reports that 26,174 people have enrolled in private insurance or Medicaid." That figure was through Oct. 24.

Kentucky's success resulted from the creation and careful testing of a pared-down website before the Oct. 1 deadline, writes Dylan Scott on Talking Points Memo. Beshear officially created the marketplace, Kynect, without approval from the General Assembly on July 17, 2012, a few weeks after the U.S. Supreme Court upheld the law. In October 2012, the state hired software developers to build the technological infrastructure behind the marketplace.

Testing was undertaken throughout every step of the process, Carrie Banahan, Kynect's executive director, told Scott. The system was developed from January to March of these year, was developed by June, and began testing in July, he reports.

On the other hand, testing for the federal website began just two weeks before the launch. Private contractors in charge of building the federal online health insurance marketplace said that the administration went ahead with the Oct. 1 launch of HealthCare.gov despite warnings of insufficient testing, reports The Washington Post.

“This system just wasn’t tested enough,” said Julie Bataille, communications director for the federal Centers for Medicare and Medicaid Services. 

Frustration with the federal rollout continues to grow, but Sunday on NBC's "Meet the Press" Gov. Beshear defended Health and Human Services Secretary Kathleen Sebelius and President Obama and told Obamacare critics to take it easy.

“Look, this is going to take some time to get done, but everybody needs to chill out because it is going to work,” said Beshear.

Kentucky received $252 million from the federal government to set up Kynect, and about $23.8 million of that was applied to contracts and outside vendor payments. Although startup costs for the exchange are being covered by federal grants, the state will be responsible for all funding beginning in 2015. It plans to get the money with assessments on insurance companies using the exchange, but that may prompt a battle in the 2014 General Assembly.

Information session on state health insurance exchange to be offered at Paducah Thursday, Nov, 7

The Kentucky Health Benefit Exchange will present an information session and allow time for questions about Kentucky's online health insurance exchange, KYnect, Nov. 7 at the West Kentucky Community and Technical College in Paducah from 11 a.m. to 1 p.m.

This event is geared toward health-care providers, administrators, directors, community agencies, coalitions, Kynect navigators, mid-level managers, front-line staff and other health-care workers.

Bill Nold, deputy director of the exchange, will present this program, sponsored by the University of Kentucky Center of Excellence in Rural Health, the Kentucky Office of Rural Health, the Purchase Area Health Education Center and the Western Kentucky Rural Health Network.

The event is free, but pre-registration is required because seating is limited. Contact Alice Combs, Kentucky Office of Rural Health, alice.combs@uky.edu, or call 606-439-3557, ext. 83703.

Herald-Leader blasts UK for secrecy surrounding children's heart program and its efforts to rebuild it despite nearby competition

The Lexington Herald-Leader blasted the University of Kentucky in an editorial Sunday for "stonewalling questions about the decision to halt pediatric cardiothoracic surgeries and the mysterious sidelining of Dr. Mark Plunkett, the high-profile surgeon UK hired in 2007 to rebuild that program."

Mark Plunkett

The editorial says UK officials implied that "all would be clear" after their examination of the children's heart program, but "nothing is clear" after they issued a 100-page report that "offers no explanation about what went wrong. In fact, Plunkett's name never appears in the report."

But the report does acknowledge two challenges in rebuilding the program: "There are several excellent congenital heart centers in close proximity" to Lexington, and "In some cases we must regain the trust of our referring providers." Dr. Michael Karpf, UK's vice president for health, has been publicly appealing for referrals of all types from hospitals and physicians in Western Kentucky, where UK competes with Vanderbilt University.

Michael Karpf

"After two unsuccessful, no doubt very expensive, efforts to build this program, UK wants to try again," the editorial says. "And it wants to regain trust of referring physicians and families with very sick, very young children despite the fact that it has consistently undermined trust by refusing to answer legitimate questions. UK has in fact agreed to pay a lot of money to avoid a public discussion of what went wrong," keeping Plunkett on the payroll, then paying him $1.5 million for "a vow of silence on both sides."

The editorial concludes, "It is aggravating that UK, a public land-grant institution in a very sick state, is intent on carving out a specialized, expensive health-care niche that's already filled when there are so many needs that are not being met. It is also deeply disturbing that UK's energy and treasure are aimed at maintaining a shroud of secrecy over this program. We still don't know much about what happened in Plunkett's operating rooms but it is clear that UK botched this opportunity to regain the public's trust." (Read more)

Asked to reply, UK spokesman Jay Blanton said, "First, our job is to make sure that Kentuckians have access to the most complex health care. Kentuckians should not have to go outside Kentucky to have access to such high-quality, complex care. . . . If we didn’t have such a program, Kentuckians – particularly those in Eastern Kentucky – will have to leave the state for critically important pediatric care. Moreover, part of the requirements of having a Level 1 trauma center and service for this region is to have an appropriate presence in this critical area of children’s care.

"Second, we’ve been totally forthright. Our standards and expectations – for both transparency and quality – are evidenced by, among other things, our ranking just this month of 12th out of 118 academic medical centers for quality, by University Health Consortium. UHC provides an objective, impartial analysis across a range of quality measures. You don’t rank 12th in the country if you are not putting forward, in a transparent fashion, your numbers and outcomes across an array of metrics and quality measurements."

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.

Obamacare will work, Beshear promises on 'Meet the Press'

By Al Cross
Kentucky Health News

Citing Kentucky examples, Gov. Steve Beshear promised a national audience on "Meet the Press" Sunday morning that the federal health-reform law will work, despite problems with the federal insurance exchange and doubts that the overall law will work.

"I'll guarantee you we're gonna make it work, because it's good for the American people," said Beshear, who is Democrats' national poster boy for Obamacare because Kentucky is the only Southern state to expand Medicaid under the law and create its own health-insurance exchange, which appears to be working well.

Beshear (AP photo)

The governor said more than 26,000 Kentuckians have obtained coverage through the exchange, which has had more than 300,000 visitors. He conceded to interviewer David Gregory that 21,000 of the enrollees are in Medicaid, but said another 10,000 people "are in the process of choosing" private insurance plans. He said Medicaid enrollment is done much more quickly.

To another question, Beshear said "about a third" of Kentucky's enrollees are under 35, "and that's what's going to happen all over this country." Obama administration officials have said the key to making the program work is enrollment by young, healthy people who are not now insured, to make up for increased costs, such as covering people with pre-existing conditions.

In reply to another question, Beshear said the cost of coverage would stay low enough to justify the law.

The governor repeated his rationale for embracing Obamacare: Kentucky's horrible health status. "The only way we're gonna get ourselves out of the ditch is some sort of transformational tool," he said. "That's what the Affordable Care Act is gonna do for us."

Also on the NBC show, Gov. John Kasich of Ohio cited similar reasons (covering the working poor, drug addicts and the mentally ill, including some veterans) for becoming the eighth Republican governor to expand Medicaid to people with incomes up to 138 percent of the federal poverty level. But that doesn't mean he supports the rest of Obamacare.

"The rollout is the least of the problem here," Kasich said, referring to the federal exchange's website problems. "The problem with Obamacare is, it doesn't get to higher health care costs, which are the nub of the problem." He said it will "drive up costs for the vast majority of Ohioans" discourage employers from having payrolls of 50 or more, the threshold for the mandate to cover employees.

Kasich, a former congressman, said President Obama "needs to figure out how to get some bipartisan support to move forward," but acknowledged that Washington politicians talk past each other in a polarized environment, while governors like him and Beshear could get in a room and "figure out what's good, what's bad, how do we fix it."

In NBC's Washington studio, Gregory pressed Beshear for his views on the federal exchange's problems. The governor said it would be fixed, adding, "The advice I would give the news media and the critics up here is take a deep breath. . . . This is gonna take some time to get done, and everybody needs to chill out." Here's an NBC video of the segment with Beshear and Kasich:


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.

1/4 of those in Pike drug roundup are charged with trafficking in heroin, a substitute for illicitly obtained prescription painkillers

The spread of heroin, at least partly as a substitute for prescription painkillers that have become more difficult to obtain because of stricter state laws, was apparent in a drug roundup by law-enforcement agencies in Pike County on Friday.

"A quarter of those sought were charged with trafficking in heroin," Russ Cassady reports for the Appalachian News-Express in Pikeville. "According to a statement from Operation UNITE, which led Friday’s operation, heroin is becoming a 'trendy drug' among Pike County dealers." (Read more, subscription required)

Halloween candy hikes risk of cavities, not just from more sugar, but from more frequent eating of it; here are tooth-friendly tips

Photo from EnviroDad.com

Halloween candy can rot your teeth.

At Halloween, the issue is not just sugar, it's how often you eat it. Often, kids bring enough candy home from trick-or-treating to last a lifetime, but then eat the candy in a few days.

Every time we eat or drink something that contains sugar or starches, bacteria in our mouth use the sugar and starch to produce acids. These acids eat away at tooth enamel and cause cavities.

With Halloween candy, the problem is twofold, according to the National Institute of Dental and Craniofacial Research. Not only do kids increase the amount of sugar consumed, they also increase the frequency at which they eat it. hat increases the exposure of their teeth to sugar, which increases acid exposure, which can cause cavities.

The University of Louisville School of Dentistry has worked for the past decade to inform the students in the Jefferson County Public Schools of the increased risk of cavities during the Halloween season. Over the years, the school's program has provided more than 25,000 students with free education about oral health and general health. This year, the dentistry freshmen continued the tradition and went to more than 70 classrooms and spoke to 3,300 students about the importance of oral health, especially during the Halloween season. The focus of their discussion was to teach the students about candy and the decay process.

The Dental and Craniofacial Research Institute offers these tooth-friendly tips to decrease the chance of tooth decay, especially important during the months after Halloween, when children (and even some adults!) see increases in both volume and frequency of sugar:

Limit between-meal snacks.

Save candy, cookies, soda and other sugary drinks for special occasions.

Limit fruit juice.

Don't eat or drink anything with sugar in after bedtime tooth brushing.

Brush your teeth.

Use fluoride toothpaste, especially if you have well water or only drink bottled water.

Safety tips for trick or treating, Halloween parties

The state Department for Public Health offers these food safety tips to help you have a safe Halloween:

• Avoid having children snack while they’re out trick-or-treating so you can inspect the contents of their treat bag. Give children a light meal or snack before they go out trick-or-treating to help prevent them from snacking.
• Inspect commercially wrapped treats for signs of tampering, such as unusual appearance, discoloration, tiny pinholes or tears in wrappers. Throw away anything that looks suspicious.
• Discard fruit and homemade treats unless you personally know their source and make sure that all fresh fruit is washed prior to eating. When in doubt, throw it out. Parents of very young children should also remove any choking hazards such as gum, peanuts, hard candies or small toys.

Follow these tips for Halloween parties at home:

• If juice or cider is served to children at parties, make sure the juice is pasteurized or otherwise treated to destroy harmful bacteria. Juice or cider that has not been treated will state this on the label.
• Don’t taste raw cookie dough or cake batter.
• Before going bobbing for apples, reduce the number of bacteria that might be present on apples and other raw fruits and vegetables by thoroughly rinsing them under cool running water. As an added precaution, use a produce brush to remove surface dirt.
• Keep all perishable foods chilled until serving time, including cut melons, finger sandwiches, cheese platters, tossed salads, cold pasta dishes with meat, poultry or seafood and cream pies or cakes with whipped cream and cream cheese frostings. Don’t leave these foods out at room temperature for more than two hours.
• Remind children to wash their hands before eating to prevent foodborne illness.
• Remember some children have food allergies, so make sure that treats with peanuts or other nuts are clearly identified. 

The Cabinet for Health and Family Services Food Safety Branch can answer questions about food safety; it's at (502) 564-7181.

Get a prescription before buying decorative contact lenses for Halloween, optometrists recommend

Many people incorporate decorative contact lenses into their Halloween costumes, and not all of them are purchased legally. They can be found on the Internet, beauty salons, convenience stores and some national retailers.  The Kentucky Optometric Association recommends that you never buy lenses from these sources.

Wearing decorative contact lenses purchased illegally and without a prescription can lead to serious health issues and potentially damage your eyesight, the association said in a news release.

The Food and Drug Administration classifies all contact lenses as medical devices, whether they correct vision or not. When considering decorative contact lenses as part of your costume, the optometrists say you should obtain a prescription from a doctor, who can also teach you how to properly care for your eyes while wearing contacts.

“Even though these are non-corrective lenses, they still pose the same potential health and safety risks as other contact lenses,” said Dr. Bill Reynolds, an optometrist in Richmond and a trustee of the American Optometric Association. “When purchased over the counter, decorative contact lenses can put people at risk for bacterial infections, allergic reactions or even significant damage to the eye’s ability to function with the potential for irreversible sight loss.”

School nurses are an unfunded mandate for schools, which are picking up more of their cost as health department budgets shrink

Marion County nurse Renee Schooling helps
Levi Hardin, a Marion County first grader with
diabetes, check his blood sugar. (Lebanon
Enterprise Photo by Stevie Lowery)

Kentucky school nurses are stretched thin across the districts they serve and the budgets to pay for  them are stretched even thinner, because of budget cuts in the state Department of Public Health.

School districts are picking up the load, but often not all of it, because of their own financial challenges. "Basically it's one of the many unfunded mandates," Editor Stevie Lowery writes for The Lebanon Enterprise.

Lowery reports that the Marion County Schools currently share the cost of nurses with the Lincoln Trail District Health Department, with the schools paying 58 percent, or $161,000 a yera, and the department paying 42 percent, $116,000.

In some counties, schools are bearing the entire cost, which in some cases has reduced the availability of nurses, but Thursday night, the Christian County school board voted to hire another nurse, giving it one at every school, Editor Eli Pace reports for the Kentucky New Era in Hopkinsville.

Marion County Supt. Taylora Schlosser told Lowery that while her district values the services nurses provide, she and the school board will need to keep evaluating who pays for that service. The district plans to compare the cost of its contract with the health department and the cost of hiring its own nurses, with a commitment to not allow the level of service to change, Lowery reports.

“We will always have school nurses because we are going to take care of our kids,” Schlosser told Lowery. “How we pay for school nurses might change.”

In Kentucky, if a student requires medical care in order to attend school, state law requires school districts to provide the care.  Districts may hire nurses, contract with the health department, or use the medical supervision and delegation of medical tasks to district staff by local medical professionals, Lowery reports.

School nurses take care of students and staff who are injured or not feeling well, care for students with special medical or dietary needs, administer medications, conduct screenings, give flu shots, provide nutrition and wellness education, certify and give immunizations, and train staff in CPR, first aid and emergency administration of medication, Lowery reports.

“We’re not just boo-boos and Band-Aids,” Keown told Lowery. "Our main goal is to keep kids in school and keep them healthy so they can get a better education. Healthy kids make healthy students.” (Read more)

In Christian County, nurses have been called on almost 13,000 times this year, nurse coordinator Megan Kidd reported to the school board Thursday night. She said many students in the district don't have primary-care physicians and are told by their parents to see the school nurse, Pace reports.

"Kidd said 11 out of the district’s 15 schools have at least one diabetic student who depends on insulin," Pace writes. "In addition to insulin injections, other common reasons for trips to the nurse include allergic reactions requiring EpiPens and asthma attacks. Seizures also seem to be on the rise, Kidd said.

"But even though most of the visits were related to fairly common issues, Kidd told a story of a school nurse who once saw a student starting to show signs of leukemia. The nurse didn’t diagnose the child with cancer — that’s something a school nurse would be not allowed to do anyway, Kidd said — but the nurse pushed the child’s parents to go to the doctor, and the child did in fact turn out to have cancer." (Read more; subscription required)

GOP claim that Obamacare will hike Kentuckians' premiums 34 percent is 'mostly false,' Herald-Leader says in an analysis

A Republican Party claim that Obamacare will raise Kentuckians' health-insurance premiums 34 percent is mostly false, the Lexington Herald-Leader said in a news analysis Saturday.

The National Republican Senatorial Committee made the claim in a news release attacking Democratic U.S. Senate candidate Alison Lundergan Grimes. It said, "In Kentucky, individuals will see a 34 percent increase in their health-care premiums," citing a March report by the Society of Actuaries.

But the report itself cautioned, "We suggest readers carefully consider possible variations in outcomes and the actions of competitors and regulators when using this report. We suggest that actual per-member, per-month figures generally should not be used."

And one author of the report told Herald-Leader reporter John Cheves, "We didn't even try to predict the future of premiums in that study." Randy Haught, senior scientist at Dobson | DaVanzo, a health-care consulting firm, said the study "is a heck of a lot more nuanced than that."

Read more here: http://www.kentucky.com/2013/10/25/2894759/campaign-watchdog-gop-claim-that.html#storylink=cpy

Cheves cited other health-care experts in writing, "Because there are so many variables involved and changes coming to the marketplace, it's impossible to accurately predict the law's impact on premiums."

The study did make some projections. "The NRSC picked one number from one of many charts in the 83-page report," Cheves reports. "That chart dealt with the small subset of Kentucky's population that would not be covered by employers' insurance plans or Medicaid," about 7 percent of Kentuckians. Using several variables, it estimated premiums for individual policies would average $398 a month, up from $297.

"Though premiums may rise for some Americans, particularly young adults who typically avoid big medical bills and therefore have enjoyed lower rates, different factors will push costs up and down," Cheves writes. "For example, Americans with existing medical problems now will be allowed to buy insurance, which will increase prices overall. At the same time, young people who have avoided insurance are expected to enroll, helping offset that impact. In addition, the law provides for subsidies and tax breaks to lower the final costs for many consumers."

The newspaper's "mostly false" label in its "Campaign Watchdog" series is the next-to-worst on its rating scale, between "false" and "half true."

FDA wants to limit number of hydrocodone refills available without another doctor visit; approves pure version of drug

"The Food and Drug Administration on Thursday recommended tighter controls on how doctors prescribe the most commonly used narcotic painkillers, changes that are expected to take place as early as next year," Barry Meier reports for The New York Times. "Drugs at issue contain a combination of hydrocodone and an over-the-counter painkiller like acetaminophen or aspirin and are sold either as generics or under brand names like Vicodin or Lortab." (Associated Press photo by Toby Talbot)

"Doctors use the medications to treat pain from injuries, arthritis, dental extractions and other problems," Meier writes. "The change would reduce the number of refills patients could get before going back to see their doctor. Patients would also be required to take a prescription to a pharmacy, rather than have a doctor call it in. The new regulations would reduce by half, to 90 days, the supply of the drug a patient could obtain without a new prescription."

On Friday, the FDA announced it had approved a stronger version of hydrocodone, Zohydro ER, for patients who require 24-hour, long-term pain medication. "The new version is the first pure hydrocodone drug approved in the U.S.," ABC News reports. "Hydrocodone is currently sold in combination pills like Vicodin to treat pain from injuries, surgery, arthritis and migraines." Activists against prescription-drug abuse criticized the decision.

U.S. Rep. Hal Rogers of Kentucky's 5th District "said on Friday that top FDA officials had recently assured him they would only approve new opioids like Zohydro if they were marketed in formulations intended to deter abuse," Meier and Eric Lipton report. "OxyContin is now formulated that way, but Zohydro, which is contains hydrocodone without acetaminophen, is not. Its producer, Zogenix, says it will closely monitor use of the drug." Rogers told the Times, “It is like the original OxyContin, so that is real problematical.”        

More than 6.1 million Americans abuse prescription pills, and last year there were 22,133 prescription drug deaths. The problem is most rampant in Central Appalachia, including Eastern Kentucky.

In 2011, about 131 million prescriptions for 47 million patients, or about five billion pills, were written for medications containing hydrocodone, Meier notes. "Prescription drugs account for about three-quarters of all drug overdose deaths in the United States, with the number of deaths from narcotic painkillers, or opioids, quadrupling since 1999, according to federal data." (Read more)

Beshear says his managed-care plan is saving money and improving health outcomes; state points finger at hospitals

Six months ago, Gov. Steve Beshear applied an intensive plan to solve Medicaid managed-care implementation issues. On Thursday, he said the system is working more effectively for both providers and managed care organizations. He also said hospitals' complaints were overstated and some of them need to adapt to the new system, which will be two years old Nov. 1.

Gov. Steve Beshear

"There will still be a few—be they hospital or individual medical providers—who will say the program doesn't work, but it's tough to refute the facts," Beshear said at a news conference and in a press release. All but three states use managed care to save money and improve health.

Beshear asked each managed-care organization (MCO) to meet with every hospital in their networks to look over their accounts receivable to resolve billing disputes. "The final analysis—the MCOs and hospitals agreed that what was actually disputed and owed was a tiny fraction—just 2 percent of the original $346.6 million claim," the release says in boldface type.

The Kentucky Hospital Association said in a news release Friday, "The overwhelming majority of hospitals still report significant dollar amounts owed to them by the MCOs in unpaid claims. . . . While hospitals have seen a slight improvement in current claims processing and a slight decline in overall accounts receivables since the Governor issued his directive to the MCOs to clean up these claims, the amount of unpaid claims actually owed to hospitals (not billed amounts) is 60 to 70 percent higher compared to unpaid bills in October 2011 before managed care was implemented."

Beshear ordered that complaints about MCOs' payments be handled by the Department of Insurance instead of the Department for Medicaid Services. He said it has closed or nearly closed two-thirds of the 1,935 complaints it received. "Most complaints were related not to prompt pa y— which is what hospitals alleged — but instead related to claim denials, prior authorization disputes or unsatisfactory settlement offers," the release says.

The Insurance Department said MCOs often failed to offer a good explanation for denying claims. The Medicaid agency "sent corrective action plans to Coventry and Wellcare," the two MCOs operating outside the Louisville region. They will report progress each quarterly.

In general, the reviews didn't find that MCOs were holding payments on a regular basis, but concluded that Coventry Cares did not follow the state law requiring prompt payment if insurance claims. The Insurance Department has proposed that the company pay a civil penalty of $9,000.

Managed care has reduced "unnecessary ER use and inpatient hospital days in favor of more consistent disease management and prevention," Audrey Tayse Haynes, secretary of the Cabinet for Health and Family Services, said in the release. Kentucky has many people who go to the ER 10 times or more in a year, contributing to total ER expenses of $340 million for Medicaid. Unfortunately, Haynes said, some hospitals have used ERs to create revenue to support operations, "even advertising the average wait time in their ERs on their websites. For some communities, the ER has been the de facto primary care center." Haynes said hospitals have to put together a new business model that "dovetails with the goal of preventive care and wellness instead of high-cost emergency treatment."

The hospital association said it supports the state's efforts to reduce ER abuse, but "That project does not and will not solve the ongoing problem of WellCare and Coventry continuing to pay hospitals only $50 for emergency room care by reclassifying, on average, 50 percent of all ER patients, as non-emergency — under criteria they refuse to share with hospitals."

The implementation of the managed health care plan has saved money and improved health care, Beshear said. Per-patient costs are below predicted amounts and new enrollment is the same or declining. In November 2011, budget analysts predicted that the state would save $1.3 billion in the next two years, and "to date, Kentucky is still on target to meet that savings amount," the release said.

Statistics about health show the improvements to the system. For example, there has been a 93 percent increase in consultations to stop smoking, a 33 percent increase in flu vaccines for children, huge increases in mammograms and screenings for heart problems, and a 17 percent decrease in amputations (often because of untreated diabetes), and nearly an 11 percent decrease in CT scans.

Shortages of insurance providers and hospitals lead to higher insurance premiums under Obamacare in rural areas

The Patient Protection and Affordable Care Act was designed to make it easier for uninsured Americans to buy insurance at an affordable rate. But the exact opposite is happening in rural areas in many states, where a lack of insurance providers has eliminated competition between insurance companies, leading to higher prices, Reed Abelson, The New York Times reports. In the roughly 2,500 rural counties served by the federal exchange, 58 percent have plans offered by only one or two providers, and people in 530 counties only have one choice for a provider. A state-by-state interactive map is available by clicking here. (NYT photo by Rich Addicks: Shopping for insurance)

In Kentucky, all counties have at least two providers, but the Times found that in other states, competition among three or more providers is needed to make a substantial difference in premium rates.

"In rural regions, several factors combine to create a landscape that is inhospitable to newcomers," the Times reports. "Developing relationships with doctors and hospitals can be costly where cities and towns are widely scattered and the pool of potential customers is small." States such as Wyoming, with a population of 600,000, are in a difficult situation. Tom Hirsig, Wyoming’s insurance commissioner, told the Times, “I think the problem was that the Affordable Care Act was designed for where the majority of the people live, in the big cities where there’s a lot of competition among health care providers. You’ve got to have some bargaining chips, and we don’t have that much."

Many rural areas only have one hospital, "giving insurers little leverage when negotiating reimbursement rates," the Times reports. "Only one Wyoming county is served by more than one hospital, said Stephen K. Goldstone, the chief executive of WINHealth. In southwest Georgia, another rural region, Blue Cross and Blue Shield of Georgia is the dominant carrier, and it is the only insurer operating in 54 of the state’s 159 counties. Only one carrier, Highmark Blue Cross, is offering coverage in West Virginia, which has high rates of obesity and chronic diseases like diabetes." (Read more)

Ovarian cancer screening is critical in detecting tumors that don't show up on clinical exams, and increases chance of survival

Kentucky First Lady Jane Beshear joined some of the state's female legislators to highlight the importance of screening for ovarian cancer, which can be done for free through the University of Kentucky Markey Cancer Center's ovarian cancer screening program.

Ovarian cancer is fifth among cancer killers of American women and accounts for more cancer-related deaths, causing more deaths than any other cancer of the female reproductive system, says the federal Centers for Disease Control and Prevention.

SYMPTOMS OF OVARIAN CANCER (CDC)

When ovarian cancer is found in its early stages, treatment is most effective, but most women with ovarian cancer don't have symptoms of it until the disease progresses into a more advanced stage. As it progresses, survival rates drop sharply, making screening and early detection critical. Data from the screening program at UK shows that regular screening increases survival rates, says a UK news release.

"This preventative ovarian cancer screening is free, quick and confidential – an easy way for women to protect themselves from this life-threatening illness," Jane Beshear said. "This simple procedure is available to women in all parts of Kentucky, not just the Lexington area, and I encourage all who are at-risk for the disease to participate in the program."

Dr. John van Nagell, professor of obstetrics and gynecology at the Markey Cancer Center, said "While regular pelvic examinations are important and can detect many other abnormalities, including cervical cancer, they are not effective in detecting ovarian cancer in its earliest and most treatable stages."

Van Nagell started the screening program in 1987 to test the use of transvaginal sonography to detect ovarian tumors that are too small to be detected during an annual exam, says the release. Over the program's 26 year period, more than 241,000 free screening examinations have been provided to more than 41,000 Kentucky women, and 558 ovarian tumors and 86 malignancies have been detected.

Women from every county in the state have participated in this program, says the release. Screenings through the program are now being performed in Lexington, Elizabethtown, Somerset, Prestonsburg, Maysville, Paducah and Greenup County.

All women are at risk for ovarian cancer, but older women are more likely to get the disease. About 90 percent of women who get it are older than 40, says the CDC.

The UK screening program is free and open to women age 50 or older, or women over the age of 25 who have a family history of ovarian cancer. For more information, call (859) 323-4687 or (800) 766-8279. Click here for more CDC information.