Beshear promises plan to make Kentucky healthier, including smoking ban and goal to reduce state smoking rate to 10%

Beshear speaks, Stivers listens

By Al Cross
Kentucky Health News

A healthier Kentucky was a big part of Gov. Steve Beshear's agenda as he delivered his State of the Commonwealth address to a joint session of the General Assembly and statewide TV and radio audience Tuesday night, on the first day of the legislative session.

After touting the favorable national attention Kentucky has received for Beshear's successful embrace of federal health reform, saying "we are shrugging off an historic reputation for backwardness," the governor listed other progress in health care and said he wanted to do more to make the state healthier.

"We are not finished," he declared, saying that in the next few weeks, he would unveil a health initiative that would include several goals, many with specific targets:

• Reducing the state's smoking rate, now at least 28 percent, to only 10 percent by 2018. Saying "Tobacco use is the single-biggest factor negatively impacting our health," he again endorsed a statewide ban on smoking in most public places.
• Ban the sale of electronic cigarettes to minors. Philip Morris, which typically spends more lobbying Frankfort than any other interest, recently said it would enter the e-cigarette market.
• Reducing the number of Kentuckians without health insurance, presumably by recruiting those who have not yet enrolled in Medicaid or insurance-exchange plans.
• Reducing heart disease and obesity, improving dental care, and "addressing mental health challenges" with unspecified measures. Details are expected in a state health plan that the Department for Public Health has been drafting.
• Reducing cancer deaths by increasing screening rates and requiring young girls and boys to be vaccinated for the human papilloma virus, which causes cervical cancer.

The last item will prompt objections from some social conservatives, but Beshear may be able to accomplish it by regulation, without legislative action, much as he did in creating the insurance exchange and expanding Medicaid to people with incomes up to 138 percent of the federal poverty level, with the first three years of extra cost paid by the federal government. State law allows the health department to require any vaccinations recommended by the American Academy of Pediatrics, which has recommended HPV vaccinations for boys and girls.

The only items in Beshear's list that drew applause, and it was limited in both cases, were the smoking ban and e-cigarettes. The legislators also applauded politely when he concluded, "Kentucky's leaders must recognize the direct relationship between a healthier, more productive workforce and our ability to attract and retain good-paying jobs for our people."

Besides his embrace of the Affordable Care Act, generally known as Obamacare (he used neither term in his speech), Beshear said his work for better health has included converting Medicaid to managed care, which "more directly links public spending to better health outcomes;" improving dental care for the poor, especially for children; and funding more screening to catch cancer and other diseases in their early stages.

In defining the state's major challenges, Beshear listed first "a population whose collective health stubbornly remains among the worst in the nation." He also decried "An education system that still isn't as effective as it needs to be, a workforce that isn't as trained and skilled as the marketplace demands, and an archaic tax system that works against us, not for us."

Beshear, a Democrat, said he would propose a specific tax-reform plan and again support expanded gambling because "We need more resources," primarily for education.

The legislature's top Republican, Senate President Robert Stivers, was asked after the speech if he agreed or disagreed. He didn't answer directly, but was clearly skeptical, and said any tax-reform bill should not increase any individual's tax liability.

Stivers said he opposes the smoking-ban bill because businesses should have the right to set their own smoking policies. Asked about the evidence that secondhand smoke causes cancer and the federal Centers for Disease Control says there is no safe level of it, he said "The CDC says a lot of things cause cancer and we don't legislatively stop that."

The governor made no significant departures from his prepared text, which is available at http://governor.ky.gov/Speeches/20140107_SOTC.pdf.