Courier-Journal editorial says Beshear must set Cabinet for Health and Family Services right on child-abuse records

The Courier-Journal published a remarkable editorial Sunday excoriating the Cabinet for Health and Family Services for the high level of secrecy in which it has enveloped cases of children who were killed or nearly killed while its caseworkers were supposed to see that they were protected from harm. Last week a judge ordered the cabinet to pay nearly $1 million in civil penalties and attorneys' fees to the newspapers that have been seeking the records. Rather than excerpt the editorial, we publish it in full, along with photographs of the officials it holds responsible. For larger versions, click on the images.

Hospice firms drain billions from Medicare by taking patients who aren't actually dying, Washington Post discovers

http://www.washingtonpost.com/business/economy/medicare-rules-create-a-booming-business-in-hospice-care-for-people-who-arent-dying/2013/12/26/4ff75bbe-68c9-11e3-ae56-22de072140a2_story.html

Arthroscopic knee surgery is no better than fake surgery for some people with torn meniscus cartilage, study suggests

http://www.nytimes.com/2013/12/26/health/common-knee-surgery-does-very-little-for-some-study-suggests.html

Weekly paper in Hazard calls for statewide smoking ban

A statewide smoking ban should be a priority for the Kentucky General Assembly when it begins its session Jan. 7, The Hazard Herald said in an editorial during Christmas week.

Noting that the state ranks first in both adult and youth smoking, the weekly newspaper said a ban on smoking in workplaces and enclosed public places would be "a good place to start" on public-policy changes to make Kentucky a healthier state.

"Second-hand smoke is listed as a known human carcinogen by the federal government, and has been linked to lung cancer," the editorial notes. "The American Cancer Society also notes there is evidence linking it to other diseases, such as heart disease and asthma. These are things we know, and yet our state legislature has remained unwilling to issue basic protections to non-smokers in the form of a statewide smoke-free law."

Noting the bans in nearby Prestonsburg and other Kentucky towns and counties, the newspaper said, "Local ordinances are simply not going to solve the problem, because too many local governments will never approve them. We doubt either of the current administrations in Hazard, Vicco, or Perry County would favor a local smoke-free ordinance, despite the obvious benefits one would pose. So, it will be up to our state legislature to tackle this issue and find the political courage to support the right of Kentuckians to breathe clean air." (Read more; click on image below for larger version)

Shopping for health insurance is hard; understanding it is even harder, even for some who already have it, research shows

As Kentucky and the nation settle into the second phase of the Obamacare rollout, leading up to the March 31 deadline to enroll in exchange health-insurance plans for 2014, Sarah Kliff of The Washington Post reminds us that "For those who successfully enrolled for insurance coverage, that's only one big hurdle behind them. The next is understanding how the plan works."

Many of the newly insured are likely to stumble on that hurdle, Kliff writes, citing new research showing that "Fewer than one in four uninsured Americans felt confident they understood nine basic insurance terms like 'premium,' 'co-insurance' and 'maximum out-of-pocket' charges." But many people who have had coverage also said they lacked a good handle on the nine terms.

"Confusion around these concepts would make it difficult for consumers to understand trade-offs between different health insurance plans," Sharon Long of The Urban Institute and her co-authors wrote in the journal . "Low health literacy could reduce the gains for consumers, particularly…if the consumers who do enroll face unexpected out-of-pocket expenses."

Kliff writes, "Those with the most difficulty tended to be those who were bilingual or Spanish-speakers, younger people and those with less than a high school education. While these groups had the lowest rates of understanding, that's not to say that other demographics did great: Among those who were college graduates, just over half felt confident in understanding all nine terms. . . . The Blue Cross Blue Shield Association, for example, has launched an AskBlue Web site that's pretty much aimed at educating consumers about these terms."

Ky. Obamacare enrollments surpass 100,000; Medicaid down to 74%; state publishing updated county-by-county enrollment data

As the 100,000th Kentuckian enrolled in health insurance under the federal health reform law, the state started releasing county-by county tabulations of people the state's health benefit exchange had enrolled in private health insurance (with and without tax-credit subsidies) and Medicaid. For the chart, click here. Here's a screen grab of the top of it:

Monday, Dec. 23 was the latest deadline for signing up through the Kynect exchange for coverage that will begin Jan. 1. Those in the process on Dec. 23 could complete the application on Dec. 24. The deadline to enroll, and avoid a federal penalty unless exempted, is March 31.

In the last week or so, enrollment in private insurance plans rose again. Since Thanksgiving week, enrollments in private plans have increased 121 percent. Forty percent of the enrollees in Medicaid or qualified health plans are under 35 years old. The new health-insurance system needs strong enrollment by the young to work effectively, as The Washington Post reminded us in a story about efforts to sign up the "young invincibles."

The Kentucky exchange said in a news release Dec. 23 that through 5 p.m. Saturday, Dec. 21, about 518,000 people had conducted preliminary screenings to determine qualifications for subsidies, discounts or programs like Medicaid, and 100,096 Kentuckians are now enrolled in new health coverage, including Medicaid and private insurance – an 18.5 percent increase over the previous week. Medicaid has enrolled 74,054 and private health plans have enrolled 26,042. Another 10,000 or so had been found eligible for a subsidy to purchase a private plan, but had not chosen a plan.

The exchange said 8,437 people had enrolled in dental plans and 1,232 small businesses had started applications for employee coverage; 500 of those businesses had completed applications and become eligible to offer coverage to employees. More information and updated statistics are available at http://governor.ky.gov/healthierky.

HIV and AIDS cases are on the rise in Kentucky; officials blame lack of education and increase of heroin use

Despite readily available information and awareness about practicing safe sex, and avoiding sharing needles, HIV and AIDS cases are on the rise in Kentucky. And the reason, say officials, is ignorance and an increase in heroin use, Mary Meehan reports for the Lexington Herald-Leader. Mark Royse, executive director of AVOL, which serves clients with HIV and AIDS in 72 Kentucky counties, said "his nonprofit routinely offers support services, including housing assistance, to about 400 families affected by HIV and AIDS."

Lauren Kirk, HIV and AIDS outreach specialist for the Lexington-Fayette County Health Department, "said a lot of the people they see are young and were born after the AIDS epidemic was at its lethal peak," Meehan writes. Another specialist, John Moses, told hr that the health department is seeing more young people with HIV. Part of that surge, he said, is from the use of shared needles as heroin use in Kentucky is on the rise." Heroin drug deaths in Kentucky increased by 550 percent in 2012, John Cheves reports for the Herald-Leader.

Another problem is that many people refuse to get tested, because discussion of HIV and AIDS includes talk of sexuality, homosexuality and drug abuse, Meehan writes. Royse told her, "It is a perfect storm of things we don't like to talk about." Royse said "a 'silence-is-better' policy is especially prevalent among Latinos and blacks, who account for the majority of new infections in Kentucky. He's concerned that if people stop talking about HIV and AIDS and become complacent, the infection will continue to spread." (Read more)

The state Cabinet for Health and Family Services, in its annual report from June, 2012, said 8,513 Kentuckians are diagnosed with HIV, with 7031 men and 1,482 women. Most of the cases are in urban areas, with 3,849 in Jefferson County and 1,099 in Fayette County. Of those cases, 4544 are classified as from men having sex with men (MSM), 917 as injection drug users (IDU) and 425 as people who reported to having engaged in both MSM and IDU.

The overall total of HIV and AIDS cases includes 21 boys under 13 years old, 107 between ages 13-19, and 1,269 between ages 20-29. For women, it includes 13 girls under 13 years old, 39 between ages 13-19, and 203 between ages 20-29. (Cabinet graphic: Newly diagnosed HIV cases in 2010 for Kentuckians ages 20-29 years old accounted for 32 percent of all new cases, even though that age group only makes up 13 percent of the total population)

Kentucky ranks 25th in HIV infections. In 2010, the state had 85 new HIV cases for people ages 13-24, accounting for 25 percent of all new cases in the state, which is higher than the national average for that age group of 21 percent. The average age of Kentuckians diagnosed with HIV went down from 37.1 years of age in 2006 to 35 years of age in 2010. To read the full report click here.

Feds allow people whose health plans were canceled, and haven't gotten a new one, to keep old one or get catastrophic plan

If you were among the 280,000 or so Kentuckians whose health plan didn't meet the requirements of the federal health-reform law, and you haven't enrolled in a qualified plan, you will be able to keep your old plan for a while, or buy a cheap, catastrophic-coverage plan that has been available only to people under 30, the U.S. Department for Health and Human Services announced Friday.

The Obama administration acted under the law's "hardship" exemption  for people who "experienced financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan."

"For these people, in other words, Obamacare itself is the hardship," writes Ezra Klein of The Washington Post. "The administration agreed with a group of senators, led by Mark Warner of Virginia, who argued that having your insurance plan canceled counted" as an unexpected human-caused event.

The White House estimates that only 500,000 people who had their plans canceled because of Obamacare have not yet obtained insurance. However, insurance companies "worry the White House is underestimating," Klein reports.

In Kentucky, 48,302 of the approximately 280,000 whose plans didn't qualify are in "grandfathered" plans that were extended in advance by insurance companies, according to the state Department of Insurance. Another 63,832 were offered transitional relief by their insurance company under President Obama’s request to states, which Kentucky approved. "The remaining had the option to take early renewal to continue current health insurance policies through at least 12-1-14," department spokeswoman Ronda Sloan told Kentucky Health News in an email.

The move "puts the administration on some very difficult-to-defend ground," Klein writes. "Normally, the individual mandate applies to anyone who can purchase qualifying insurance for less than 8 percent of their income. Either that threshold is right or it's wrong. But it's hard to argue that it's right for the currently uninsured but wrong for people whose plans were canceled. Put more simply, Republicans will immediately begin calling for the uninsured to get this same exemption. What will the Obama administration say in response? Why are people who plans were canceled more deserving of help than people who couldn't afford a plan in the first place?" (Read more)

"Catastrophic plans generally have lower premiums than other plans but offer more limited benefits," writes Louise Radnofsky of The Wall Street Journal. "They typically cover three primary-care visits a year and some preventive benefits, but beyond that they only cover large medical costs after a high deductible. Carriers offering them for the coming year already have cleared the plans with state regulators and set prices in the expectation that few people over the age of 30 would be purchasing them."

Survey finds that 93 percent of hospital executives think Obamacare will improve systems and save costs

While there has been much grumbling about federal health reform, at least one very affected group of people think it's a great idea. A survey by Health Affairs found that 93 percent of hospital executives believe the Patient Protection and Affordable Care Act will make health care better, and cheaper, Ezra Klein reports for The Washington Post.

The magazine surveyed 74 senior executives at hospitals that had an average of 8,520 employees, and annual revenues of $1.5 billion, Klein reports. The survey found that 65 percent felt that by 2020 "the healthcare system as a whole will be somewhat or significantly better than it is today," and "93 percent predicted that the quality of care provided by their own health system would improve. This is probably related to efforts to diminish hospital acquired conditions, medication errors, and unnecessary re-admissions, as encouraged by financial penalties in the ACA." (Health Affairs graphic)

Executives also responded to favorably to other questions about reform, with 91 percent forecasting "improvements on metrics of cost within their own health system" and "85 percent expected their organization to have reduced its per patient operating costs" by 2020, Klein writes. "Overall, the average operating cost reduction expected was 11.7 percent, with a range from 0 percent to 30 percent. Most executives believed they could save an even higher percentage if Congress enacted legislation to accelerate the shift away from fee-for-service payment toward models like bundled payments. In such a case, the executives projected average annual savings of 16.0 percent, which, if applied across the healthcare system, would amount to savings of nearly $100 billion per year."

Respondents said savings can be achieved "through a combination of greater administrative efficiency, price reductions, and reduced reliance on hospital services," Klein reports. About 54 percent said this can be done by reducing the number of hospitalizations, 49 percent by reducing, re-admissions, 39 percent by reducing emergency room visits, 36 percent by reducing costs for medical devices, 27 percent by reducing costs for drugs, and 23 percent by improving office efficiency.

About 31 percent of respondents said another goal is to set "a specified timeline for transitioning Medicare reimbursement off of the fee-for-service payment system as a policy change that would facilitate cost control," Klein writes. "Another 30 percent supported aligning payment policies between Medicare and private insurers, and 28 percent supported separating funds for training and research from Medicare payment and maintaining current funding levels." (Read more)

Christian County Public Schools ban brought-in fast food as part of an effort to battle childhood obesity, a big problem in Ky.

Fast food is no longer a lunch option for students in Christian County Public Schools, Margarita Cambest reports for Kentucky New Era after the Board of Education voted to ban "commercially prepared, restaurant meals" Tuesday. Parents have been bringing fast-food meals to schools, even though 14 schools offer free meals under a federal program.

"Prepared foods must now be put in a non-identifiable container to pass the cafeteria doors—essentially meaning no logos," Cambest reports. "Takeout containers and bags must be discarded, and the food placed in a lunch box or brown bag if brought from home. Soda is out as well. The consumption of bottled or canned carbonated beverages during meal times is also forbidden."

Sandra McIntosh, the system's food-service director, "said the decision allows her to enforce a federal mandate that has been questioned by some local principals," Cambest reports. But then she notes that the federal school-lunch program "leaves the authority to control the sale of foods in direct competition with the national program with state and local agencies, according to the United States Department of Agriculture," which runs the program.

Changes in the program, which McIntosh said have made meals "more nutritional" by having "lower fat, more whole-grain and more dark green and red vegetables, have been unpopular with many students and parents.

A study by USDA's Economic Research Service in 2005 showed that "Students in schools that offered greater quantities of fruits and vegetables consumed more of these foods by most measures." And fast food has more calories. Research at the Yale Rudd Center for Food Policy and Obesity says on days that children eat fast food, they consume 126 additional calories and teens consume 310 more calories. The center says 33 percent of children and 41 percent of teens consume fast food daily.

Kentucky children rank third worst among the states for in obesity, with 37.1 percent of them considered either overweight or obese, according to the Child Policy Research Center.

Health reform should make Medicaid and Medicare more interested in preventing chronic diseases in young, expert says

Dr. Wayne Myers

While some rural areas may not have enough doctors (or those who accept Medicaid patients) to treat new patients generated by federal health reform, the key to healthy living is more education, not more physicians, rural medical expert Dr. Wayne Myers opines in The Rural Monitor. As an example, Myers points to Hazard and Perry County, where he once worked. The Appalachian county leads the nation in shortest average life span for women (72.65 years) and is third shortest for men (66.52 years) despite having an abundance of doctors and health facilities. The reason, Myers says, is bad habits that lead to unhealthy lives, something no amount of medical attention can cure.

"In Perry County, as in much of America, medical care is losing to unhealthy behavior," Myers writes. "Clinicians aren’t trained, nor is our clinical system structured, to accomplish changes in long-term cultural behavior, or to respond to the needs of groups of people. Certainly the 15-to-20-minute acute-care visit is a poor situation to try to work with a person on diet, level of activity, his/her addictions. We can’t modify family and social patterns with tools developed to treat strep throat, sprained ankles or breast cancer."

Myers, who headed the federal and Kentucky rural-health offices, said the solution is education at the local level, with "a lot more health educators, community health nurses and nutrition educators" that are trained within the community. Areas with community colleges can build partnerships with schools to receive training, he suggests. His hope is that the Patient Protection and Affordable Care Act will provide the resources and motivation necessary to bring about changes.

As the law generates enrollees, the Center for Medicare and Medicaid Services’ "book of business will shift from old people on Medicare toward younger people on Medicaid," he writes. "When the main business of CMS was Medicare, the rational business strategy was to seek the most economical quality care for those with only a few years to live. As the business shifts toward Medicaid and subsidized private insurance customers, the rational business strategy for CMS shifts toward preventing chronic disease. From an insurer’s point of view, a 70-year-old obese hypertensive diabetic is a self-limited problem. She’ll die soon. A 30-year-old with the same diagnoses will be a very long-term financial drain.  It will be good business for CMS to keep their 'covered lives' healthy."

This, he said, is kind of forward thinking we need to ensure young Americans get healthy. "We need new approaches to keeping people healthy, instead of trying to heal them after they get sick," Myers writes. "Clinicians can’t change the way people live and raise their kids, even if some of the choices the parents make turn out to be pretty dangerous for the kids. These are sensitive life and death issues. We need to tackle them." (Read more)

As Obamacare spreads in Kentucky, the state remains conflicted about it and other forms of government help

By Al Cross
Kentucky Health News

Even as Obamacare coverage spreads in Kentucky, more widely than in almost any other state, the commonwealth remains conflicted about it and other forms of government aid -- creating a political battle that is likely to continue at least until the November 2014 elections, and perhaps into the governor's race in 2015.

The federal health-reform law and its presidential namesake have been the centerpiece of the U.S. Senate race, with Republican Sen. Mitch McConnell railing against it, primary challenger Matt Bevin saying McConnell hasn't done enough to dismantle it, and likely Democratic nominee Alison Lundergan Grimes keeping mostly mum as she waits for the political landscape to settle.

McConnell's Kentucky strategy is part of a national game plan, in which "Republicans are launching a class war with racial undertones—and hurting the poor whites they'll need to win in 2014," the respected, non-partisan National Journal said in a cover story in its weekly magazine over the weekend, reported from Louisville by political writer Beth Reinhard. It is titled "Return of the Welfare Queen," a trope popularized by Ronald Reagan.

Reinhard first looks beyond Kentucky, noting that "25 Republican-led states have — astoundingly" rejected expansion of Medicaid under the law. "To justify this unprecedented rejection of federal relief, these governors and state lawmakers say they just do not believe Washington will keep its promise to pick up the tab. Republicans in Congress are egging them on, denouncing Obamacare's disastrous launch as proof of the arrogance and folly of big government."

"The chances of the federal government picking up the tab for the newly eligible Medicaid people long term is zero, which means that the next governor, whoever that may be, is going to be stuck with a huge, huge problem," McConnell said at a Nov. 12 press conference which he limited to the subject of Obamacare. "The Medicaid expansion that we have already experienced, the Medicaid increases that we've already experienced, is the principal reason your kids' college tuition is going up. . . . So we're paying for it already."

National Journal's coverage has a video, the middle frame of which
shows Gov. Steve Beshear and House Minority Leader Nancy Pelosi.

Thus did McConnell conflate recent increases in Medicaid spending with Democratic Gov. Steve Beshear's expansion of the program to households earning up to 138 percent of the poverty line, from the current 69 percent. That will cost the state nothing for three years, because the federal government will pay the entire cost of care for the newly eligible. In 2017, the state will begin to hep out, hitting the law's 10 percent cap in 2020.

Reinhard notes that Republican "tirades" also target food-stamp recipients, and "Pitting makers against takers is simply smart, hardball politics for some Republicans whose "primaries that will be largely decided by a mostly white conservative base that hates the welfare state. . . . Class warfare can work in a primary. But, ultimately, Republicans' scorn for antipoverty programs hinders the party's efforts to expand beyond its conservative base."

Reinhard writes, "This opposition carries an unmistakable undertone of class warfare, a theme easy to exploit in states such as Kentucky, packed with low-income white voters who have a strong distaste for the federal government. To hear the rhetoric coming from Capitol Hill and the campaign trail, Medicaid and food-stamp recipients are a bunch of shiftless freeloaders living high on king crab legs and free health care, all on the backs of hardworking Americans."

But sometimes people who hold those opinions are relying on the government, too. Reinhard writes about Terry Rupe of Louisville, whose "household's $13,000 yearly income comes exclusively from Washington," and whom she met at a clinic where he was signing up for Medicaid: "The 63-year-old widower can't remember the last time he voted for a Democrat, and he's got nothing nice to say about President Obama. He's also never had health insurance, although he started working at age 9. Since his wife's death four years ago, he's been taking care of their 40-year-old, severely disabled daughter full time. She gets Medicaid and Medicare assistance."

Nevertheless, Rupe told Reinhard, "I don't have any use for the federal government. It's a bunch of liars, crooks, and thieves, and they've never done anything for me. I'm not ungrateful, but I don't have much faith in this health care law. Do I think it's going to work? No. Do I think it's going to bankrupt the country? Yes." Reinhard cites a poll which found that "A majority of whites believe the health-care law will make things worse for them and their families."

Next Reinhard introduces us to Adele Anderson, a white, middle-aged woman who gets $10 an hour for child care and $86 a month in food stamps, and was also signing up for Medicaid. She told Reinhard, "Democrats are too liberal. They just want to give handouts."

Reinhard observes, "The disdain she and Rupe show toward living on the government dole at the very moment they are doing just that is typical in a state that distrusts Washington as much as it needs federal help. . . . Still, Obamacare is so politically toxic that McConnell continues to flog the law that appears to be working in his own state. What's more, he's disqualifying its fledgling success by inciting class warfare."

At his Nov. 12 press conference, McConnell noted that more than 80 percent of Obamacare signups in Kentucky had been for Medicaid, and said, "You know, if I went out here on the street and said, ‘Hey, you guys want free health care?’ I expect I’d get a lot of sign-ups. The most successful part of it has been if you’re talking about getting people signed up is people who are signing up for something that’s free."

In response, the Grimes campaign issued a written statement: "It's unfortunate that Sen. McConnell chooses to look down on Kentuckians who need health care, instead of working to fix the problems. He ought to help those Kentuckians, not attack them."

Reinhard notes that Grimes has yet to say whether she supports the Medicaid expansion, but concludes: "Because Kentucky did take the cash, 308,000 poor people are now eligible for health insurance in the Bluegrass State. Over the 11 months leading up to the election, McConnell and other Republicans opposing Medicaid expansion will be hard-pressed to explain why they want to take health insurance away from needy constituents who belong to their own party." (Read more)

UK gets biggest-ever grant from National Institutes of Health to probe links between obesity and cardiovascular disease

The University of Kentucky has received its largest-ever National Institutes of Health grant to explore connections between two of the state's biggest health problems, obesity and cardiovascular disease.

Dr. Lisa Cassis
directs the program.

The university's Center of Biomedical Research Excellence "supports research of promising junior faculty focused on identifying mechanisms linking the epidemic of obesity to a high prevalence of cardiovascular diseases," a UK press release said. The faculty support helps the researchers compete for new NIH grants. In the first phase of the program, 90 percent competed successfully, and they published 500 study reports.

"Research to be executed under the present grant runs the gamut from laboratory research conducted at the cellular level, to bedside translational research conducted in pediatric and adult patients," the release said. "Projects focus on mechanisms for the development of obesity, the influence of obesity on recovery of the heart following a heart attack, obesity-induced inflammation, and how this influences the cardiovascular system, and imaging of heart dynamics and function in obese children."

Statewide farm editor identifies self-employed workers' problems with Obamacare, and hers with Congress

Farmers and other self-employed people may have special trouble maneuvering through the process of obtaining health insurance on the state exchange, writes Sharon Burton, editor and publisher of The Farmer's Pride, Kentucky's statewide agricultural newspaper.

Sharon Burton

"The first thing I realized is the system doesn’t know how to deal with people who are self-employed," Burton writes. "I figure that’s just about every farmer in the commonwealth" of Kentucky, which is operating its own exchange, Kynect.

"My husband is a owner/operator commercial truck driver, so his income can fluctuate from year to year. When I adjusted our income based on that fluctuation, the system was not happy with me because I estimated our 2014 income to be different than our 2012," Burton writes, adding that her kynector, a state-paid adviser who helps people use the exchange about it, "She said she too had problems signing up anyone who was self-employed. She also warned me that we should notify Kynect if our income varied even within $1,000 or could face serious ramifications at the end of the year."

Kynect spokeswoman Gwenda Bond told Kentucky Health News, "If self-employed individuals have variable incomes there might be an extra step for them to accurately verify income. They would have to submit additional information, in some cases, because the income verification system accepts the amount reported only if it is within 10 percent of what the IRS has on file for the most recent year."

Burton adds, "There are a lot of bugs in the system. For one, if your spouse’s employer offers family coverage – even if they don’t pay any portion of it – you are not eligible for any subsidies. We all know insurance offered through companies often provides family coverage but it isn’t affordable.
Now you will be disqualified from Obamacare because that unaffordable plan is out there."

Burton has also lost patience with Congress. "The ones who voted for it spend all their time defending it, and the ones who voted against it spend their time trying to make sure it fails," she writes. "Just fix it people. Get on with it. It’s like starting a business. You have a plan, but where you end up often looks a lot different than where you start because you make changes as needed. This is a starting point; let’s move on to the next stage and stop bellyaching." (Read more)

Low-dose CT scans find lung cancer before X-rays, save lives

Low-dose computed tomography, commonly known as CT scans, are reducing lung-cancer deaths by finding the cancer early before it spreads to other parts of the body, UK HealthCare reports. Used as a screening tool, the American College of Radiology says CT is "the only test ever shown to reduce mortality in high-risk smokers."

This is good news for Kentucky, which leads the nation in both lung cancer and deaths from it.  It also leads, by some estimates, in smoking, the leading cause of cancer.  An estimated 25 to 28 percent of Kentuckians are smokers, compared to 18 to 19 percent nationally.

Low-dose CT screening for lung cancer is recommended for high-risk patients, defined in a Mayo Clinic article as someone 55 to 79 who's smoked the equivalent of a pack of cigarettes every day for 30 years, or those 50 and older who have smoked a pack a day or more of cigarettes for 20 years or longer and have one additional risk factor for lung cancer.

Chest X-rays, the other screening technique, typically are not done until a person has symptoms because studies have shown that they are not effective in detecting lung cancer early. However, researchers have found that heavy smokers screened with low-dose CT scans can pick up much smaller tumors than chest X-rays and have a "20 percent lower risk of dying from lung cancer than those screened with chest X-rays," UK HealthCare reports.

A recent study found that nearly one in five lung tumors detected on CT scans are probably so slow-growing that they would never cause problems, reports Lindsey Tanner of The Associated Press. These tumors are not false positives, but cancerous tumors without symptoms, which are unlikely to become deadly, according to the research. However, National Lung Cancer Screening Trial results conclude that the benefits from low-dose CT scans significantly outweigh the "comparatively modest rate of over-diagnosis," according to the American College of Radiology. "Overdiagnosis is an expected part of any screening program and does not alter the benefits you get from the screening,"

Dr. Paul Ellenbogen, chair of the American College of Radiology Board of Chancellors, said in the release, "Physicians should certainly discuss the risk and benefits of CT lung-cancer screening with patients – including that of overdiagnosis. However, for high-risk patients, the group in which CT lung cancer screening is proposed, the lifesaving benefit outweighs the risks."

McConnell shares excerpts from letters he received from Kentuckians who are frustrated by health-reform law

By Melissa Patrick
Kentucky Health News

Continuing his attack on Obamacare, Senate Republican Leader Mitch McConnell took to the floor last week to read excerpts from letters he received from Kentuckians who are angry about the Patient Protection and Affordable Health Care Act. UPDATE, Dec. 17: He did so again today; video is here.

Generally, the main issues cited by McConnell are frustration with President Obama's promise that people happy with their health insurance could keep it; anger that their premiums and deductibles had increased under new policies that meet the law's requirements; and dissatisfaction with their inability to choose and pay for only the services they wanted. For example, several constituents said they did not have children, but were required to pay for pediatric dental care and maternity care.

A 35-year-old college graduate and married father of two from Bowling Green told McConnell that his plan, which he said best met his family's needs, had been canceled. As he sought a new plan that met the requirements, he was told it would cost 124 percent more. He noted that Vice President Joe Biden said Sept. 27 that a family of four with $50,000 income could get health insurance for "as little as $106 per month." McConnell said the Bowling Green man was quoted a price eight times that amount and asked him, "Why should the price of a product be based on my ability to pay?" The law provides subsidies for insurance coverage based on income and the type of plan purchased through the state insurance exchange, Kynect, up to $94,000 for a family of four.

Sherry Harris of Nicholasville told McConnell she was concerned that Lake Cumberland Hospital in Somerset was not on the Anthem network, "which means anybody in Pulaski and surrounding counties that qualify for a subsidy and want to use it will have to drive to London, Corbin or Lexington to get care" if they have an Anthem policy. Insurance companies are being more selective about their care networks in an effort to reduce costs; for details, click here.

A "Mr. and Mrs. Spears" of Louisville told McConnell that when they signed her up for the Kentucky Health Cooperative plan on Kynect, they did not sign up for a subsidy and thus were told no income verification was necessary.  Since then, they have received mailings from the insurance exchange declining coverage unless they sent income verification.

Exchange spokeswoman Gwenda Bond told Kentucky Health News in an email, "A request for additional documentation related to income verification might be generated, if they are likely to qualify for a subsidy based on the information provided on the application. Everyone is eligible to purchase a qualified health plan at sticker price at any time." The sticker price is the amount before the subsidy is subtracted.

Mrs. Spears also questioned the exchange's request for her voter-registration information. Bond said the federal "motor voter" law requires public-assistance agencies to ask applicants if they would like to register to vote. "Because Kentucky’s exchange is a single streamlined system for both Medicaid and subsidies, applicants are asked if they would like to register to vote," she said. "A voter registration form is mailed to them if they request one. There is no follow-up related to whether an individual registers or not, and it does not have an impact on coverage."

Mike Conn of Prestonsburg was upset that a policy with similar coverage to his previous policy would cost double.  He told McConnell that he was informed by the individual who helped him find coverage that it was because he lived in Eastern Kentucky and his old insurance company was "apparently not available there." Humana Inc. chose not to offer plans in all parts of the state.

Newspaper in Alabama, a similar state in many ways, gives its readers a look at Kentucky's embrace of Obamacare

The latest newspaper to look at Kentucky's embrace of Obamacare is in Alabama, a state that offers almost a mirror image of Kentucky: another Southern state with a very high poverty rate and very low health outcomes.

"Politically, both are deeply conservative, and both are home to wide expanses of rural poverty," writes Tim Lockette of The Anniston Star. But Alabama's approach to Obamacare "couldn't be more different," because it has rejected Medicaid expansion and a state-run insurance exchange.

The difference in Obamacare outcomes really is as stark as it looks, Douglas Scutchfield, a professor of health services research at the University of Kentucky, told Lockette. Scutchfield, who taught in Alabama for years, said that in demographic terms, "The only real difference is that most of your uninsured folks are black, and most of our uninsured folks are white. We have the Appalachians, you have the Black Belt." In politics, the states' governors have made a big difference.

While Democratic Gov. Steve Beshear expanded Medicaid and set up an exchange, Republican Gov. Robert Bentley and other state officials rejected both the Medicaid expansion and an exchange, citing costs.

Bentley cited the state's struggle to even cover the new enrollees that had been added since the Great Recession. Some Kentuckians are concerned about how the state will pay for its expansion. The federal government will pay all the cost of care for the newly eligible from 2014 through 2016, when the state will increasingly pick up part of the tab, rising to 10 percent by 2020. Beshear, citing a study, has said the expansion will expand the state's health-care industry enough to pay for it, and make the state more attractive to employers in the long run.

Bentley told Lockette that Alabama could not have had success with its own exchange because there is basically one major insurance company in Alabama, Blue Cross Blue Shield. But Alabama could have had more competition if the state had set up a nonprofit, cooperative insurance company, which Kentucky did.

"In Kentucky, everybody has an option," Cara Stewart, a fellow at the Kentucky Equal Justice Center, told Lockette. "Unless you're undocumented or in jail, there's something for you," she said.

Still, Stewart "said she’s run into difficulty working with people who already have employer-provided insurance, but want to switch to the exchanges to cover family members," Lockette report. Also, "The Kentucky system has refused to recognize some enrollees because they don’t have a credit history, health care advocates say." (Read more)

Kentucky spends less than a penny of its tobacco-settlement money on prevention programs; few states do very much

By Molly Burchett
Kentucky Health News

A new report says that 15 years after the 1998 state tobacco settlement, Kentucky ranks 38th in the nation in funding tobacco prevention and cessation programs, only 3.7 percent of the amount recommended by the federal Centers for Disease Control and Prevention.

The CDC recommends that the state spend $57.2 million a year on programs to help people quit smoking, but Kentucky is only planning to spend $2.1 million in 2014 on them, says the new annual report from the Campaign for Tobacco-Free Kids. Last year's report ranked Kentucky 37th as it planned to spend the same amount.

The goal of these programs is to help kids and adults quit smoking. Of the $320.3 million in revenue the state will get from the settlement in the current fiscal year, Kentucky will spend just 0.7 percent of it on tobacco-prevention programs, or less than a penny of every dollar it collects in revenue, the campaign says in a news release and a chart.

Kentucky has the highest smoking rates in the country, a an estimated 28.3 percent of adults and 24.1 percent of high-school students smoke. Each year, tobacco claims 7,800 lives and costs the state $1.5 billion in health care bills, about $487 million of which are covered by the federal-state Medicaid program, and each Kentucky household pays an estimated $582 per year in taxes to cover smoking-caused government expenditures, the release says.

To reduce smoking and its negative consequences, health advocates are calling on Kentucky leaders to pass a comprehensive, statewide ban on smoking in workplaces and enclosed public spaces. Some advocates also call for an increase in the state's tobacco tax. The report says Kentucky has the 40th lowest cigarette tax in the country at 60 cents per pack, 93 cents below the state average. It was doubled a few years ago.

"Tobacco takes a terrible health and economic toll on Kentucky, but state leaders can do something about it by increasing funding for tobacco prevention and passing a comprehensive, statewide smoke-free law," said Matthew L. Myers, president of the campaign. "The evidence is clear that reducing tobacco use not only saves lives, it also saves money by reducing tobacco-related health care costs. It's one of the smartest investments Kentucky can make."

Nationally, the report finds that most states are failing to adequately fund tobacco prevention and cessation programs. States will collect $25 billion from the tobacco settlement and tobacco taxes in 2014, but will spend just 1.9 percent of it on prevention programs.

States are spending only 13 percent of the CDC's recommended $3.7 billion in funding for these prevention programs, and only two states – Alaska and North Dakota – spend the recommended amount.

Green = State spends 50 percent or more than recommended amount; Orange= 25-45 percent of recommended amount; Yellow = 10-24 percent of recommended amount; Gray = less than 10 percent of recommended amount 

"Tobacco use is the number one cause of preventable death in the U.S., killing more than 400,000 people and costing $96 billion in health care bills each year. Nationally, about 18 percent of adults and 18.1 percent of high school students smoke." says the report.

Since the states settled their lawsuits against the tobacco companies in November 1998, the Campaign for Tobacco-Free Kids has issued annual reports to hold states accountable for settlement spending, an amount estimated to be $246 billion over the first 25 years.

The annual report on states' funding of tobacco prevention programs, titled "A Broken Promise to Our Children: The 1998 State Tobacco Settlement 15 Years Later," was released by the campaign, the American Heart Association, the American Cancer Society Cancer Action Network, the American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers' Rights.

Federal budget deal targets Medicare payments, and that means Kentucky hospitals won't be happy

Looking for a way to localize the budget deal announced by congressional negotiators last night? Call up your local hospital.

David Rogers of Politico reports that hospitals are "furious with the fact that the deal offers no relief from future cuts on Medicare providers – and even extends these annual 2 percent reductions into 2022 and 2023." The cuts would be a continuation of those imposed by the "sequester" legislation that took effect when Congress failed to reach an anticipated deal on the federal deficit and taxes.

The $28 billion extension of the cuts, almost a third of the $85 billion total, "helps to dress up the package with tens of billions in savings, but at a time when hospital networks are already feeling the impact of health-care reform, there is a fear that Congress is not seeing the long term impact of these budget assumptions," Rogers writes.

Most rural hospitals are already facing Medicare cuts because reform law reduces the extra payments made to hospitals that have large percentages of Medicare patients. Those hospitals are disproportionately rural.

The deal also includes "a provision that aims to prevent fraud and abuse in the Medicaid program for the poor and disabled," Modern Healthcare reports. "According to a summary, the provision allows states to delay paying for suspect claims as long as the delay does not harm a beneficiary's access to care. It also would allow states to collect medical child support in cases where health insurance is available from a non-custodial parent and allows Medicaid to recoup costs from beneficiary-liability settlements."

Why cut Medicare payments? "Congressional staffers were not prepared to talk about the cuts on the record, but said it boiled down to Medicare providers being the least painful target. Democrats, they noted, have not traditionally been strong supporters of preserving the payments to providers, being much more concerned with maintaining funds for beneficiaries. Republicans saw extending for two years cuts that are already in the law for mandatory programs as a simple way to add deficit reduction to the replacement of sequestration for discretionary programs," Michael McAuliff reports on The Huffington Post.

Kentucky's health-insurance exchange has covered a greater share of population than any other state-based exchange

Kentucky has registered more people for Medicaid and private health insurance than any other state with its own exchange created under the federal health-reform law, Christine Vestal reports for Stateline, in a story explaining why Kynect and some other state exchanges are working well.

“Our system doesn’t have a lot of bells and whistles,” Carrie Banahan, executive director of the Kentucky Health Benefits Exchange (the formal name of Kynect), told Vestal. “There aren’t a lot of graphics that would take a lot of bandwidth.”

"Kentucky and other top-performing states enable consumers to browse the various plans available on the exchange without first having to set up a password-protected account," Vestal notes. "That step alone spared those exchanges a lot of error messages and screen freezes experienced by people using the federal site," Healthcare.gov.

"Successful states also devoted months, not weeks, to exhaustive, round-the-clock testing," Vestal writes. "Kentucky tested for three months, while the U.S. Department of Health and Human Services reportedly devoted only the last two weeks of September to testing Healthcare.gov before its Oct. 1 launch."

The four most successful states – Connecticut, Kentucky, Rhode Island and Washington – all contracted with the consulting firm Deloitte "to manage and develop their sites," using federal funds, Vestal reports. Kentucky's expenses for its exchange were higher than average. (Stateline chart)

UPDATE: As of 7 p.m. Thursday, Dec. 5, after 10 days of increased traffic and enrollments, the exchange said it had enrolled 71,955 people, 56,437 of them in Medicaid and 15,518 in private plans. Most of the 28,307 who had been found eligible for a subsidy to buy a private plan had not chosen a plan yet. Dental plans had 5,074 enrollees.

Kids Count shows Ky. tops in smoking by pregnant mothers, has a wide range of local data about children's well-being

By Molly Burchett
Kentucky Health News

The annual Kids Count report on children's well-being, released Tuesday by the Annie E. Casey Foundation and Kentucky Youth Advocates, says the state leads the nation in smoking by pregnant mothers and more than one in four children in Kentucky lived in poverty in 2012. It argues for improvements in preventive care and newborn health throughout the state.

The report is part of the 23rd annual release of the County Data Book, which contains a wide range of county-by-county data that are indicators of children's well-being. Unlike previous annual reports, this one ranks Kentucky counties on overall child well-being and on four domains: economic security, education, health, and family and community strength.

The county-by-county assessment found seven counties that scored substantially higher on overall child well-being rankings: Boone, Calloway, Meade, Oldham, Spencer, Washington, and Woodford. The six counties clearly at the bottom, in descending order, were Owsley, Knox, Elliot, Martin, Fulton, and Clay.

Health affects almost every aspect of child well-being. On the four scores in the Health domain (smoking during pregnancy, low-birthweight babies, asthma hospitalizations and teen births) Oldham and Boone counties scored much higher than other counties, and Bell and Fulton counties, in the southeastern and southwestern corners of the state, scored the lowest.

The chart to the right indicates how much worse Bell and Fulton ranked than similar counties. 

The data from this year’s Kids Count book, as well as new and historical data for the many other indicators Kentucky Youth Advocates tracks, can be found at the Kids Count Data Center by clicking here. The data cover counties, school districts, cities and Metro Louisville council districts.

Based on the latest available data from 34 comparable states, in 2011 Kentucky had the highest rate of women who smoked during pregnancy. Nationally, 9 percent smoked during pregnancy while 23 percent did in Kentucky.


Babies born to mothers who smoked during pregnancy are more likely to suffer low birth weight, premature birth and infant death, and almost one in every 10 babies in Kentucky were born at low birth weight, says the report. While the national average for low-birthweight babies is 8.1 percent of all live births, low-birth-weight babies made up more than 14 percent of births to mothers in Lawrence, Lewis, Martin, and Wolfe counties.

“We know smoke-free policies will reduce smoking during pregnancy and reduce the number of babies born at a low birth weight,” said Terry Brooks, executive director of Kentucky Youth Advocates. “It’s time to do what works and enact a comprehensive, statewide smoke-free law. We need to protect all children, not just those lucky enough to be born in a smoke-free community.”


In addition to babies born to mothers who smoke during pregnancy, those born to teenage mothers are at increased risk of low birth weight and other health problems, says the report.

While the state's rate of births to teenage mothers has declined each year since 2007, it remains higher than the national average, which has shown a similar decline. There were 43 teen births for every 1,000 females aged 15-19 in 2011, compared to the national rate of 31. The report says Oldham County had the lowest rate of teen births (1.3 percent) while McCreary County had the highest (8.6 percent). It also says the most effective way to keep reducing teen births rate is to educate young people about sex and risky sexual behaviors, and to provide access to contraceptive methods.

While Kentucky has made progress in providing health-care coverage for children and newborns, the state is among the leaders in childhood obesity, diabetes and asthma, and has a greater-than-average number of children with disabilities or other chronic health problems like cystic fibrosis or heart disease, the report says. "Yet families face many hurdles when they seek treatment for their children. They may lack health insurance or lack transportation," it says. "Some areas do not have enough health-care providers."

Report calls for investments in Kentucky children

Higher teen-birth rates are found among communities of color, which are also disproportionately affected by poverty, says the report. One in four of Kentucky's children live in poverty.

This rate and the number of unemployed parents, which went up by 24,000 between 2007 and 2012, have increased since the 2008-09 recession. Poverty rates in 2012 were highest among African American children (52 percent) and Hispanic or Latino children (41 percent). Living in a high-poverty area puts a child at greater risk for poor health and educational outcomes.

A widespread lack of economic security is perhaps the greatest concern for many kids in the state, says the report. The Kentucky Cabinet for Health and Family Services recently cut spending for the Child Care Assistance Program and the Kinship Care Program. As a result, 8,700 families lost assistance for child care, and financial support was also eliminated for main relatives who raise children unable to live with their parents. The report calls for restoration of these programs and more investments in Kentucky’s children.

"Taken together, the data tell a clear story: Kentucky kids need the attention of Kentucky leaders," says the report. “It’s time to make children and families a priority in our state by investing in programs that keep parents working and promote economic security,” said Brooks.

Click here to get more information about the Annie E. Casey Foundation or view its policy reports.

Free clinics are wary of how health reform will affect them

By Melissa Patrick
Kentucky Health News

Free health clinics for the uninsured face an uncertain future as the Patient Protection and Affordable Health Care Act is implemented. Kentucky has more than 50 such clinics.

The Anderson County Community Medical Clinic, which just celebrated its one-year anniversary this month, serves uninsured people in its community and faces a "threat with the power to close its doors for good: Obamacare,"  Meaghan Downs of The Anderson News reports. Still, several board members told Downs that they do not expect to have to "shut down anytime soon" because some people will remain uninsured even though the health-reform law requires all Americans to sign up for health insurance or face a penalty.

“As long as the people qualify as living in Anderson County and having no insurance, we’re going to serve them,” Opal Phillips, the non-profit clinic's board chairman, told Downs. “If we are at the end of our usefulness, we will be there until we are no longer needed.”

Since it opened, the clinic has seen about 175 uninsured patients with chronic illness, Phillips told Downs. Lately, he said, the clinic has encouraged patients to sign up for coverage through the state's health-insurance exchange, Kynect.

The state says Kentucky has more that 640,000 uninsured citizens, or 15 percent of its population, and 308,000 will qualify for the expanded Medicaid program, but only about two-thirds of those people are expected to sign up.

Funding is another concern for free clinics under the reform law. Jane Bennett, the Anderson County clinic board's secretary for the last three years, told Downs that she is "extremely concerned about the health-care law and how that will affect fundraising for the clinic in the new year."  After the initial start-up funding from donations, the clinic must continue to find ways to pay for all of its services.

Bennett also told Downs that board members at the clinic may need to change the way it does business by changing the requirements on the types of patients they see. She went on to tell Downs that the uncertainty of how many will be uninsured after the exchange closes and taking into consideration the "blips" that occurred in the roll-out, the implementation of the law will take time.

Laura Ebert, president of the Kentucky Free Health Clinic Association, told Downs that she estimates it will be "at least two years before clinics like Anderson's will see any impact from Obamacare."  Many lower-income people, she said, "may not even take the first step to sign up for exchanges because of a lack of access to technology or education about the new health care law. There will still be a great need for clinics like hers and Anderson County’s."  She said "22 million Americans will still be uninsured even after every element of the federal and state exchanges are put into place," Downs reports.

Ebert is also the executive director of Surgery on Sunday, a clinic in Lexington that performs free outpatient surgeries for free to income-eligible individuals and their families. She told Downs that future considerations for this clinic and the other 54 free clinics across the state will be whether they will have to start accepting Medicaid patients or any patients eligible for state or federal assistance or allow the local health department to take over their services. The Owensboro health department and Danville's Ephraim McDowell Regional Medical Center "are two medical facilities that have absorbed formerly non-profit clinics," Downs reports.

Family Health Centers, which has seven community health clinics in Louisville, is free for those who are unable to pay, but it also accepts insurance. Its primary concern is how their business will need to change in order to not lose patients to local private practices that only accept insurance, Abby Goodnough reports in The New York Times.

"They expect their patient load to double, even as they struggle to recruit doctors and other staff members," Goodnough reports.  The clinics have focused on improved customer service and efficiency as they prepare for the expected changes the health care reform will bring. These efforts include: installing an appointment system instead of the current first-come, first-serve system, improving their facilities through the money allotted in the health care reform and converting to electronic medical records.

UPDATE, Dec. 21: The New Hope Clinic in Bath County "expects to continue serving patients who fall through the cracks," reports cn|2, a service of Time Warner Cable. Clinic Director Bill Grimes told senior reporter Don Weber that the expansion of Medicaid to households with incomes up to 138 percent of the federal poverty level will cover about 2,000 of the clinic's 2,700 patients. "Julia Maness, a nurse practitioner who is one of the New Hope Clinic’s co-founders, says she expects the first year under the Affordable Care Act to expose many issues that cause individuals to fall through the cracks," Weber reports.

'Faces of Lung Cancer' photo exhibit at Markey Cancer Center is meant to spread awareness about disease and its prevention

Lung cancer survivor Juanita Meade

"Faces of Lung Cancer," a photo exhibit with portraits and inspirational messages from nine lung cancer survivors in Kentucky, is on display at the University of Kentucky Markey Cancer Center on the 1st floor atrium of the Combs Research Building, 800 Rose St., until Monday, Dec. 16.

This exhibit was coordinated by the Kentucky Cancer Program to spread awareness about lung cancer and prevention, according to a UK press release.

Lung cancer kills more Kentuckians every year than the next eight most common cancers combined, and Kentucky leads the nation in both lung cancer and deaths from it, and by some estimates also leads in smoking, the leading cause of lung cancer.

An estimated 25 to 28 percent of Kentuckians are smokers, compared to 18 or 19 percent nationally.

Kathy Sinclair, lung cancer survivor

And while tobacco use increases your risk, the UK release notes that anyone can develop the disease: "Lung cancer kills nearly twice as many women as breast cancer, and is the leading cause of cancer deaths for both men and women in the U.S."

Symptoms are generally not noticeable in the early stages of lung cancer, according to UK's Health Education through Extension Leadership newsletter.

Signs and symptoms of lung cancer include:
• Chronic cough
• Hoarseness
• Coughing up blood
• Weight loss
• Loss of appetite
• Shortness of breath
• Unexplained fever
• Wheezing
• Repeated bouts of bronchitis and/or pneumonia
• Chest pain

Advocates hope push in rural areas will help pass statewide smoking ban, at least in the state House

By Justin Richter

University of Kentucky College of Communication and Information

Kentucky has had a love affair with both growing and smoking tobacco, but supporters of a statewide smoking ban believe that smoke should not be shared with people who don’t smoke.

Rep. Susan Westrom

For the fourth straight year, Democratic State Rep. Susan Westrom of Lexington is filing a bill for a smoking ban in workplaces and enclosed public places. She and her allies are focusing increased attention in the state’s rural areas, where smoking is more prevalent.

This summer Westrom visited several towns, from Owensboro to tiny Sandy Hook, to talk with fellow legislators and their constituents about the bill. “We want to be able to access legislators in the rural areas, meet them on their own turf,” showing them their constituents care about secondhand smoke, Westrom said.

A third of the adults in Eastern Kentucky smoke, and almost a third of those in Western Kentucky do, according to the Behavioral Risk Factor Surveillance System, an ongoing telephone survey by the federal Centers for Disease Control and Prevention.

"We're going to need a lot more legislative support, and we're pretty much doing that one legislator at a time," Smoke-Free Kentucky Coordinator Betsy James said at last month's meeting of Kentucky Voices for Health, an association of health lobbying groups. "This is sort of a rural-urban issue, so we do need help out in the counties."

Advocates are hoping to build on the passage of smoking bans in 28 Kentucky cities and 10 counties.  “We’ve got 38 different locations that have smoke-free ordinances and we want to meet the standard we have in Louisville and Lexington,” Westrom said in an interview. 

Louisville and Lexington were two of the first cities to ban smoking in enclosed public places.  Each had exemptions, including bars and clubs, but by 2008 both went to comprehensive bans, unlike some other jurisdictions in the state that have large exceptions.

The Hopkins County Board of Health, for example, passed a regulation in 2009 that permits individuals from smoking in workplaces but has large exceptions that allow individuals to smoke in private clubs, privately rented restaurants, as well as hotel and motel rooms that are rented.

Westrom is working with Dr. Ellen Hahn, director of the Tobacco Policy Research Program at the University of Kentucky College of Nursing, who has led the efforts to pass local smoke-free measures.  After working for years on local bans, she is now working on both local and state fronts. 

Work towards smoke-free public enclosed places has gained ground steadily since Hahn started 10 years ago, but most of the state remains unaffected by any smoking ordinances or regulations.

According to a booklet prepared by the College of Nursing and the state Cabinet for Health and Family Services, “70 percent of Kentuckians are regularly exposed to secondhand smoke in the workplaces and public places.”

Smoking is more common in Kentucky than any other state, with 28.3 percent of adults smoking, compared to 19 percent nationwide according to the CDC. Kentucky Youth Advocates recently released a study done that revealed Kentucky has one of the highest rates of smoking during pregnancy in the nation. 

Westrom and Hahn have been working together since 2011, when Westrom first filed a state-wide smoking ban bill. The first bill did not get out of the House Health and Welfare Committee, but the next two bills did. 

Last year, her bill was then sent to the Judiciary Committee, a sign that it was being taken a bit more seriously, because that panel was more skeptical of it and raised issues that if resolved could help the bill pass.

In 2013 the bill was not given a vote on the House floor, presumably because it did not have enough votes to pass.  Westrom is anticipating getting past the House floor and into the Senate this year. “I think we’re really close in the Senate,” she said, noting that almost every Senate district has at least one smoke-free community.

The Kentucky Chamber of Commerce has supported Westrom’s bill since it was introduced three years ago.  “Over 90 percent of respondents expressed support for a smoke-free law in Kentucky in a recent Chamber survey,” said Ashli Watts, the business lobby’s public-affairs manager.

The chamber is advocating a smoke-free workplace largely because of lost worker productivity due to illnesses causes or worsened by smoking. Research by The Ohio State University's College of Public Health found that every U.S. smoker is costing his /her company an extra $6,000 per year.

Democratic Gov. Steve Beshear said he will continue to support a statewide smoking ban, and that it would be a help to business.  House Speaker Greg Stumbo, D-Prestonsburg, said he hopes the House will pass the bill.

Stumbo spoke at a panel discussion held by the Kentucky Hospital Association with Senate President Robert Stivers, R-Manchester.  Stivers said individual businesses should be able to allow smoking, but said that he would not impose his view on the rest of the Senate.

Beshear says other governors will follow his lead on Medicaid

Associated Press file photo

Gov. Steve Beshear says states that have not expanded the Medicaid program under the federal health-reform law, as he did, will do so in the next few years because their voters will demand it.

“I believe the pressure will be so great over the next three or four or five years, on the states that haven’t gone in this direction, that they will end up just where Kentucky is,” Beshear told Alexander Burns of Politico, in the governor's latest appearance in a national publication.

Burns writes, "It’s precisely the message national Democrats are aching to hear, even – or perhaps especially – from a source as unexpected as a pro-gun, pro-coal, red-state governor who once endorsed using state tax incentives to build a creationist theme park."

The story, headlined "Kentucky's unlikely health care heartthrob," focuses on Beshear's high national profile stemming from his expansion of Medicaid to people earning up to 138 percent of the federal poverty line and the state's successful rollout of a website that is enrolling about 1,000 people a day in Medicaid or private insurance -- unlike the federal government's site, which seems to be getting in order after a disastrous rollout that made many Democrats nervous. He is the only Southern governor to take both steps.

"For anxious national Democrats who have pined for a white knight in the health-care reform debate, Steve Beshear is starting to look like the one they’ve been waiting for – implausible as that development may be," Burns writes. "Amid a torrent of negative national headlines about the Affordable Care Act, the 69-year-old Kentucky governor – a canny Southern operator who’s spent his career at arm’s length from the [national] Democratic base – has charged out of Frankfort as a kind of ambassador-by-default for the controversial law."

Burns says the verdicts on the state and national programs are "far from decided, but Beshear says his mind is entirely made up on both the merits and the politics of health care. From his perspective, voters’ opposition to the ACA is driven largely by a sense of anxiety about how the program may change their lives. If they find a year from now that the law has left their personal care unchanged, or even improved it, public opinion could shift quickly."

State Senate Republican Floor Leader Damon Thayer, "a leading Obamacare critic in the state, said Democrats would pay a price for Beshear’s decision to 'channel his inner liberal Democrat with no election ever facing him again in the future'," Burns writes, quoting Thayer: “While it appears that Kentucky has done a competent job implementing a website, it’s still a bad policy. . . . The people of Kentucky don’t like the fact that he has unilaterally implemented Obamacare without legislative approval, and they don’t like Obamcare.” (Read more)

Psychologists honor KHN publisher Cross for health work

The Kentucky Psychological Association recently recognized Kentucky Health News Publisher Al Cross, director of the Institute for Rural Journalism and Community Issues at the University of Kentucky, for "his outstanding career in journalism, his work in bringing coverage to every corner of the Commonwealth and his passion for improving the health of Kentucky," KPA and the university said in press releases.

Cross's work to advance the health of Kentucky is reflected in Kentucky Health News, which is published with support from the Foundation for a Healthy Kentucky, and the institute's national publication, The Rural Blog. Cross is a member of the Friedell Committee for Health System Transformation, a statewide group working on ways to improve the health in Kentucky.

Anthem says Kynect has delivered inaccurate enrollment forms, but is nevertheless a model for insurance exchanges

Some health-insurance companies say Kentucky's Kynect exchange for acquiring coverage is giving them inaccurate or incomplete enrollment forms, and that is also a problem in other state-operated exchanges, Kyle Cheney and Jason Millman reported for Politico Dec. 4.

"It’s a new twist in the unfolding saga of so-called 834 forms — industry jargon for the application files that insurers receive when someone signs up for coverage through an exchange," the reporters write. "Insurers in Kentucky and New York, for example, say they’ve received flawed 834 enrollment forms from their local exchanges, though the extent of the errors is unclear. Washington state has already had to correct thousands of 834s with faulty information about federal tax credits. . . . It’s uncertain how deep the problems go, in part, because the states themselves aren’t sure — and are reluctant to divulge much about their technical challenges."

As for Kentucky specifically, "Although a Kynect spokeswoman said the exchange has dealt with only 'minor issues' since it started sending enrollment files to insurers a month ago, she didn’t indicate whether those issues had resulted in flawed forms or if they’d been resolved."

Tony Felts, a Kentucky spokesman for Anthem Blue Cross and Blue Shield, told Politico that it's too early to say if the problems have been solved: “In general, the situation is the same for the state-run exchanges as it is for the federally facilitated exchanges. As far as the quality of the data that’s coming in, I can’t say that everything has been completely accurate.” Still, he told Kentucky Health News Dec. 9, "There is no question that Kentucky's exchange is performing substantially better and is a model for how the exchanges could be running."

Robert Zirkelbach, spokesman for America’s Health Insurance Plans, a lobbying group, told Politico, “While there is significant variation from state to state, health plans in many state-based exchanges are seeing similar problems with enrollment files.” (Read more)