States and their congressmen battling new painkiller that is easier to crush and inject

Some states are restricting the use of the new painkiller Zohydro, "setting up a showdown with the federal government over who gets to decide the best way to protect public health," Michael Ollove reports for Stateline.

Rogers (Herald-Leader photo)

Though millions of chronic pain sufferers could benefit from the drug, some officials worry that abusers will crush and inject it for a big high, will significantly worsen the painkiller abuse crisis they have been battling. Combating prescription drug abuse has been a focus in Kentucky for the past few years. U.S. Reps. Hal Rogers of Somerset and Stephen Lynch of Massachusetts have introduced a bill to withdraw the Food and Drug Administration's approval, done though an advisory board voted 11-2 against it.

A federal judge told Massachusetts officials that they cannot ban a drug that the FDA has declared safe and effective, but Gov. Deval Patrick is restricting its use. Vermont Gov. Peter Shumlin has taken similar measures, and the Ohio legislature is debating similar action. Twenty-nine state attorneys general, including Kentucky's Jack Conway, have requested that the FDA rethink its approval of Zohydro.

"We're in the context of a very serious epidemic of opioid drug addictions and opioid deaths, and that's a public health crisis that has been growing over the last decade and half," said Michael Carome, director of the Health Research Group at the consumer organization Public Citizen. "The last thing we needed was another extended release opioid for treating chronic pain."

According to Trust for America's Health's 2013 report, "6.1 million Americans abuse or misuse prescription drugs," and "Overdose deaths involving prescription painkillers have quadrupled since 1999, and now outnumber those from heroin and cocaine combined, Ollove reports. Zohydro is an opioid, and opioids are not only easily abused but are also unfortunately gateway drugs, influencing people to use heroin, which isn't as expensive. One advantage to Zohydro is that it is a single-ingredient, long-acting product, unlike other painkillers that were combined with acetaminophen, which can be injurious to the liver.

Opponents are frustrated that the FDA not only approved the drug but also did not force the manufacturer, Zogenix, to create a version that isn't so easy to abuse. The company has said it is making such a version. "In the meantime, it said it has implemented other safeguards, such as compensating sales representatives for educating doctors, pharmacists and patients on the risks and benefits of extended-release opioids," Ollove writes.

Sherry Green, chief operating officer of The National Alliance for Model State Drug Laws, agreed withZohydro maker Zogenix "that taking action against selective prescription drugs is the wrong approach," Ollove reports. Green said, "When we focus almost solely on an individual drug, we tend not to put as much attention on the underlying problem, which is the abuse and addiction. Obstructing illicit routes to one medication only creates pathways to another one." (Read more)

Health reform law isn't as sweeping when it comes to dental coverage, but Appalachian dentists say it should help

Dr. Heather Whitt explains costs to Anita Slone at the Eula Hall
Health Center in Floyd County. (C-J photo by Jessica Ebelhar)

In Floyd County, almost 40 percent of adults have lost six or more teeth to decay or gum disease, more than 50 percent of adults have had at least one tooth pulled, and 25 percent of people older than 65 have lost all of their teeth. But "When it comes to dental care, the Affordable Care Act's reach is limited," Laura Ungar reports for The Courier-Journal.

The Patient Protection and Affordable Care Act requires health plans to cover children's oral health, but adult coverage is optional. Kentucky's Medicaid benefits only cover certain services, such as oral exams, emergency visits, X-rays, fillings and extractions, and rural areas are dealing with a shortage of dentists who increasingly do not accept Medicaid.

Despite these obstacles, Dr. Heather Whitt, director of dental services for a network of health centers called Big Sandy Health Care, said she thinks the reform law will help people who live in Central Appalachia, a hotbed of bad oral health. She said the number of uninsured—which for a long time was almost 75 percent of her patients—is finally beginning to decrease. "Now, there are more adults having Medicaid. It's definitely improved the patients we see here. . . . We stay very busy," she said. "I'm excited more people have benefits."

"She and other dentists said Medicaid, which is covering most of the area residents newly insured through the ACA, does not cover every service they might need," Ungar writes. Whitt noted that Medicaid doesn't cover costs for dentures or root canals for patients older than 21, and some dentists said Medicaid managed-care organizations do not send reimbursements quickly enough.

Whitt said that she and her staff try to teach patients about brushing, flossing and regular checkups. They also teach those things in schools, encouraging children to visit dentists. Dentists say that if the law and Medicaid can get more people to visit the dentist, they'll learn to take better care of their teeth. "A lot of our patients just kind of fall through the cracks," said Dr. James Stambaugh, another dentist at the clinic. "Small problems just grow exponentially." (Read more)

In Floyd County, opinions about health care reform depend on whom you ask, and in some cases they are surprising

At the Eula Hall Health Center in Grethel,
nurse Stephanie Clark takes vitals of Mary
Murphy, 54, whose leg blood clot wasn't
treated for 15 years because she couldn't
afford it. (C-J photo by Jessica Ebelhar)

"A team of journalists from USA Today and The Courier-Journal has found that in Floyd County, Obamacare is a neither a train wreck nor a cure-all. It's a work in progress; widely misrepresented and misunderstood, it's helped some people and hurt others, while a handful seem unaffected." So write Chris Kenning and Laura Ungar of The C-J, with Jayne O'Donnell and Rick Hampson of the national newspaper of C-J owner Gannett Co. Inc.

Newly insured people are being treated for ailments that they long ignored or tried to treat with inadequate resources, and people who couldn't get or afford insurance because of pre-existing conditions have been able to get it. "Yet, also because of Obamacare, insurance customers in this Appalachian community complain about higher deductibles and insuring those who don't work. Many say they can't afford even subsidized plans on the state's insurance exchange," the writers report. "Some small business owners say they may cut workers' hours. And hospital leaders say the law has exacerbated health-care trends, leading them to lay off workers and shut down an entire floor of Floyd County's largest hospital."

Advocates say the health-reform law will improve Kentucky's health by bringing care to those who haven't had it, but "Obamacare so far shows scant promise of being able to heal Floyd County, where generations of poor health habits and attitudes testify to poverty's victory" despite the "war" on it that President Lyndon Johnson declared in the region 50 years ago. "Real change, many say, will take decades, given the county's poor health: 35 percent of adults smoke, and the overall death rate is 42 percent above the national average. Many lack reliable transportation, have trouble taking time off from low-wage jobs for medical appointments or just don't believe in going to the doctor."

Some say the law didn't go far enough, and worry about its effect on hospitals. "It's insurance reform," said Bud Warman, president of Highlands Regional Medical Center in Prestonsburg, the Floyd County seat. "It's not health care reform.''

Ky. leads U.S. in emphysema (COPD), but study shows fewer COPD hospitalizations in Ky. places with smoke-free laws

Click on image for larger version

People who live in smoke-free communities are less likely to be hospitalized for emphysema, according to a study by the University of Kentucky's College of Nursing and College of Public Health and recently published in the American Journal of Public Health.

The study found that people who live in communities with comprehensive smoke-free workplace laws are 22 percent less likely to be hospitalized for chronic obstructive pulmonary disease (COPD), or emphysema. Living in a community with an established law also resulted in a 21 percent lower likelihood of experiencing hospitalization due to emphysema.

Kentucky has the nation's highest rate of chronic obstructive pulmonary disease, 9.3 percent of the population, according to the federal Centers for Disease Control and Prevention. Tobacco use is the primary cause of emphysema, but air pollution and genetics can also play a role.

The study matched 2003 and 2001 data on hospital discharges with communities that were part of the Smoke-free Ordinance database from the Kentucky Center for Smoke-free Policy, Ann Blackford reports for UKnow.

Dr. Ellen Hahn (Herald-Leader photo by Matt Goins)

“Smoke-free public policies, particularly when they cover all workplaces with no exceptions and have been in place for at least one year, may provide protection against exacerbation of COPD that lead to hospitalizations, with potential to save lives and decrease health care costs,” said Nursing Professor Ellen J. Hahn, director of the center and lead author of the study. “Given that such a high percentage of Kentuckians live in at-risk rural areas and lack the protective factor of income or smoke-free laws, the state faces a higher risk of COPD."

Lexington was the first Kentucky city to pass a smoking ban. "Lexington's smoking ordinance, which bans smoking in most indoor public spaces, doesn't specify that smokers be caught in the act. But that has become the default standard since the ban went into effect 10 years ago," Mary Meehan reports for the Lexington Herald-Leader. "As the smoking ban in Lexington has aged, the challenges have lessened. In many cases, Hahn said, the ban has been self-enforcing. Patrons at restaurants complain to management about smokers, or bar employees take it upon themselves to keep people from lighting up. Gradually, she said, smoking just isn't accepted or expected anymore. Non-smoking in most places has become the 'new normal.' There are now only a handful of businesses that receive citations. Most are small bars and strip clubs."

Read more here: http://www.kentucky.com/2014/04/26/3214347/10-years-after-it-became-law-fayette.html#storylink=cpy

Read more here: http://www.kentucky.com/2014/04/26/3214347/10-years-after-it-became-law-fayette.html#storylink=cpy

Insurance companies will be allowed to add one more year to policies that don't comply with reforms; decisions due May 5

Kentucky’s health insurance companies may extend through Oct. 1, 2016, individual and small-group policies that don't comply with federal health reform, the state Department of Insurance announced Friday. This means some consumers can continue these policies until Oct. 1, 2017.

Insurance companies are supposed to notify the Insurance Department of their decisions by May 5.

This is the second “transitional relief” option offered to states by the federal government. The earlier one came in November 2013 and offered a one-year extension of existing policies; the most recent adds two more years. The latest relief does not affect “grandfathered” plans (those in existence prior to March 23, 2010, the date the law took effect) or newly issued policies.

The Patient Protection and Affordable Care Act requires 10 essential health benefits and includes other provisions that were not part of many old policies.

“We know that health insurance needs are personal,” Insurance Commissioner Sharon P. Clark said in a press release. “This choice would give individuals and small employers the flexibility to make the decision that best fits their needs at this time while planning for full implementation of the Affordable Care Act.”

Poll: Kentuckians still oppose Obamacare, but favor fixes, not repeal, and think state insurance exchange works well

Most Kentuckians still oppose the federal health-reform law, but think it should be changed rather than repealed, and most think the state health-insurance exchange created under the law is working well. So says a poll taken for The New York Times and the Kaiser Family Foundation in four Southern states with key U.S. Senate races this year: Arkansas, Kentucky, Louisiana and North Carolina.

"Debate over the law is expected to dominate the midterm elections. Attacks on the law are featuring prominently in campaigns across the country, and Republican lawmakers have continued to push for the law’s replacement," Sabrina Tavernise and Allison Kopicki write. "Questions about it may evoke associations with an unpopular president, the remoteness of Washington from ordinary Americans and extra costs in family budgets. But majorities say they do not want it taken away, even in states that lean Republican in presidential elections."

Among the four states, Kentucky is the only one that is running its own exchange, and the only one in which a majority said it is working well. In Arkansas, which has a combined state-federal exchange, a plurality said it was working well. The other two states use the federal exchange, which had a troubled rollout.

Kentucky is the only Southern state that created its own exchange and expanded Medicaid to include people in households with incomes up to 138 percent of the federal poverty level. The poll found support for Medicaid expansion in all four states, and 55 percent in Kentucky gave Gov. Steve Beshear, who made both decisions, a positive job rating.

The poll, done with landline and cellphone interviews April 8-15, has a margin of sampling error of plus or minus 4 percentage points in each state. (Read more)

At National Prescription Drug Abuse Summit, Beshear cites Kentucky's successes

Gov. Steve Beshear told attendees at the 2014 National Prescription Drug Abuse Summit in Atlanta on Wednesday about the progress Kentucky has made in the last two years in its battle to combat abuse of prescription drugs.

"Prescription drug abuse was wasting away the future of Kentucky... and collectively, as a state, we decided it was past time to take aggressive action," Beshear said.

Two years ago, Beshear attended the summit  and described a plan; what Kentucky was going to do about prescription drug abuse. Since then, not only has Kentucky implemented an aggressive, strategic plan, it has data showing significant progress.

The plan included increased monitoring of prescriptions, tighter regulations for painkillers, closing pain clinics that did not meet tougher requirements, collecting and disposing of leftover drugs and educating prescribers and the public about the dangerous, addictive nature of these drugs.

The state also set up an electronic prescription drug monitoring system, called KASPER and increased coordination among health regulators and law enforcement both inside Kentucky and with other states.

As for the progress, the evidence is in the numbers. From August 2012 to July 2013, Kentucky saw an 8.5 percent drop in the prescription of controlled substances, Beshear reported, adding that there must have been " a lot of unnecessary prescribing going on."

He also noted the closure of 36 pain clinics that did not meet the new requirements: "They packed up and left, essentially in the dark of the night."

Beshear reported the third area of improvement as less reported abuse of prescription drugs by teen-agers, based on every-other-year surveys of Kentucky 10th graders by Kentucky Incentives for Prevention.

In 2008, 19.3 percent of 10th graders said they had used prescription drugs for non-medical purposes at some point in their lives. In 2012, that number had dropped to 10.4 percent. In 2008, 14.1 percent said they had illegally used prescription drugs in the last month; in 2012, that number dropped to 7.6 percent.

Getting rid of old, unused drugs, whose presence in medicine cabinets can lead to abuse and theft, has also been a strategy of success in Kentucky, Beshear said. He said 172 permanent drop-off sites have been established, with at least one site in 110 of Kentucky's 120 counties.

Beshear also stressed the importance of educating both prescribers and the public. Kentucky's medical community has access to a free, on-line education program and students in Kentucky participate in Keep Kentucky Kids Safe program which has reached 40,000 students so far.

The governor said increased availability of substance abuse treatment is important, and mentioned his expansion of Medicaid under federal health reform. "Access to treatment is at an all-time high in Kentucky, thanks to expanded Medicaid programs and the Affordable Care Act," he said. "There are many addicts who want to get clean, and we’re helping them." For a copy of the speech, click here.

Beshear says Kynect signups show importance of health-care reform to Kentucky's health; Republican foes keep attacking it

By Al Cross
Kentucky Health News

Opponents of federal health reform kept up their drumbeat Tuesday as Gov. Steve Beshear announced the latest, but still not quite final, signup figures from Kynect, the state health-insurance exchange.

Kynect Executive Director Carrie Banahan listened to Beshear.
(Lexington Herald-Leader photo by Pablo Alcala)

Beshear held a news conference to announce that 413,410 Kentuckians enrolled for coverage via the exchange through April 11, when most enrollment in private insurance plans closed until Nov. 15. he said "A significant number" of paper enrollments are still being processed. Enrollment is open year-round for the Medicaid program and for people who experience a major event such as change of jobs or birth of a child.

So far, 68 percent of those who signed up for a private insurance policy through the exchange have paid their premiums, according to a state press release. About three-fourths of the policies are from the Kentucky Health Cooperative, a non-profit insurance company created under the Patient Protection and Affordable Care Act, known as Obamacare. The rest of the market was about equally divided between Humana Inc. and Anthem, the only for-profit company offering exchange policies statewide.

Beshear said state officials estimate that three-fourths of exchange enrollees did not have health insurance when they signed up, and Health and Family Services Secretary Audrey T. Haynes estimated that the number of uninsured Kentuckians has dropped to around 200,000, from an estimated 640,000. She said an unknown number of the uninsured obtained insurance outside the exchange.

About three-fourths of the exchange enrollees are in Medicaid, which Beshear expanded to cover people with household incomes up to 138 percent of the federal poverty threshold. The previous income limit was only 69 percent of poverty. The federal government will pay the entire cost of covering the newly eligible people through 2016, when the state will have to start picking up a small share, reaching a cap of 10 percent in 2020.

The federal government pays about 71 percent of benefits for previously eligible Medicaid recipients in Kentucky. Some who had been eligible but never enrolled signed up through the exchange; Haynes said she didn't know the number, but said she still feels good about the estimate of 17,000, made before the exchange opened Oct. 1.

Beshear reiterated his belief, based on a study by the international accounting firm PriceWaterhouseCoopers, that expansion of Medicaid will pay for itself by expanding the health-care industry and creating 17,000 jobs. Republicans in the General Assembly have expressed skepticism about that but have offered no countervailing information.

The leading Republican attacker has been U.S. Sen. Mitch McConnell, who sent Kentucky newspapers his latest column on the subject Monday, saying claims that the law has been successful are refuted by the experiences of those who had their policies canceled despite President Obama's promise that they could keep them, and have had to pay higher premiums and deductibles, "often for a plan that offers less access to hospitals and their favorite doctor."

McConnell called "shocking" the signup of inmates by jails and prisons, which he said could limit access to care because the demand for it may outstrip the supply of doctors, nurse practitioners and other health-care providers. Officials have said the signups save the state money by transferring costs to the federal government.

Asked about McConnell's criticism, Beshear said, "These critics continue, apparently, to sit in their own echo chambers and talk to each other, because when you get out and talk to these 413,000 people, they are very thankful that we have moved forward both in expanding the Medicaid program and in setting up our own health-benefits exchange." Haynes said the program has been "overwhelmingly successful by all measures."

Read more here: http://www.kentucky.com/2014/04/22/3207241/beshear-says-more-than-413000.html?sp=/99/322/&ihp=1#storylink=cpy

Tea party activist David Adams, who is appealing initial adverse rulings in two lawsuits he filed to challenge Beshear's actions, disputed the estimate that three-fourths of the exchange enrollees had been uninsured, "arguing that enrollment questions on the Kynect website prompted people to falsely claim that they lacked insurance when submitting applications," Mike Wynn reports for The Courier-Journal.

Beshear said the reform law is "a tool to improve people's health, to help those who are vulnerable to to remove lack of health coverage as the determining actor in a family's financial security." He said the nearly-final enrollment figure is "a milestone that shows just how important health-care reform is to our families and our future. . . . We're going to keep enrolling people until everybody in Kentucky who needs health coverage has health coverage."

Skeptics of the law say research has shown that enrollment in Medicaid doesn't improve enrollees' health, but defenders say that study didn't last long enough. Beshear said, "It'll probably take several years to see a change in our rankings, but you will see a change in our rankings over the next generation." He said the reform law's emphasis on prevention and wellness will give the state a healthier workforce that will attract more jobs.

Republicans are making Obamacare the centerpiece of their campaigns for the Nov. 6 elections, but Beshear told The Washington Post in January that by Election Day the law will be a net plus for Democrats. Asked yesterday if he would recommend to Democrats in the legislature that they use the reform law in their campaigns, he said candidates will have to make their own decisions, but "The Affordable Care Act, some next November, is going to be looked at a lot differently than it was looked at last November," when the national rollout was very troubled.

"The 80 percent of Americans and Kentuckians whom the Affordable Care Act will not affect at all are gonna know that it's not gonna affect them, so it's not gonna be a big issue for them one way or the other," Beshear said, and the 20 percent who are affected "like what they're getting. . . . I would say to those who think they're gonna make this the crowning issue and defeat somebody on it, have at it, because I don't think they're gonna get to first base by next November."

Reminded that Republicans use the law's nickname to run against a president who is unpopular in Kentucky, and asked when the tipping point in public opinion might come, Beshear suggested that he will find a way to gain political advantage.

"Whether you see a big change in the polling numbers when you use the phrase Obamacare or not, I don't think is gonna be all that relevant come next November, because people out here in Kentucky are gonna hear a lot about Kynect and the Affordable Care Act and the successes that we've had," he said. "I think you are seeing the polling now, when you talk about Kynect and what is going on in Kentucky, that people are very favorably disposed to it."

Democrat Elisabeth Jensen, running for Congress in the 6th District, has run a radio ad embracing "Kentucky Kynect" and said, "It polled well." (Read more)

Berea students' second health fair tackles touchy topics

Della Walters tries to walk straight while wearing "drunk goggles" at
the Berea health fair. (Richmond Register photo by Crystal Wylie)

Student-run health fairs are becoming more popular across Kentucky, and some of them are touching on touchy topics. At their second health fair recently, for middle- and high-school students, Berea Community High School health students "handled more mature issues" than at their first, for elementary-school students. reports Crystal Wylie of The Richmond Register.

"Although students had their pick of topics ranging from sexually transmitted diseases, drunk driving, smoking, mental health, sugary drinks, learning disabilities and fitness," health teacher Cathy Jones said some students wanted to include 'sexting,' sexually oriented text messages. She allowed their presentation to pair the topic with cyber-bullying; students asked their classmates to sign a pledge against doing both.

“It’s a hot topic and something teenagers encounter,” Jones told Wylie. “They thought it was important to cover.” Jones said she plans to hold a fair twice a year. Meanwhile, Eastern Kentucky University professor Laurie Larkin and her public-health students conducted a health fair at Clark-Moores Middle School, Wylie reports. (Read more)

General Assembly's failure to pass heroin bill incites wrath, calls for local action and a special session

In the final hours of the 2014 legislative session, the House failed to pass Senate Bill 5, which would have helped combat heroin abuse. Some heroin-recovery advocates and community leaders are outraged, and now people are searching for local solutions to the problem while waiting for the General Assembly to act.

Senate Bill 5 would have allowed prosecutors to charge drug traffickers with homicide if someone died from an overdose of drugs sold by a trafficker, and allocated savings from a 2011 prison reform to fund drug-treatment programs. It would have permitted first responders and addicts' family members to give naloxone, a life-saving drug, to someone who overdosed. Amendments to the bill would have begun an program for addicts to exchange used needles for new ones, decreasing the prevalence of hepatitis C and HIV, and making Zohydro, a powerful painkiller, illegal—until it is changed into a tamper-resistant variety, Scott Wartman and Terry DeMio write for The Kentucky Enquirer.

"During a meeting in Campbell County Thursday night, many who are involved in heroin treatments predicted that a delay in passing the bill will result in more deaths and heartache throughout the commonwealth—and specifically in Northern Kentucky, which has been the most affected area by the deadly drug," Don Weber reports for cn|2's "Pure Politics." 

Charlotte Wethington, who works as a recovery advocate at the residential treatment center the Grateful Life Center, lost her son Chad 12 years ago because of an overdose. "I've been fighting this battle for well over a decade, and it is long overdue, past overdue, that we address the heroin epidemic," Wethington said, Weber writes. Dr. Mike Kalfas, a Northern Kentucky physician who treats heroin addicts, says Senate Bill 5 could have stopped what he says might be HIV or Hepatitis C epidemics in the near future. "Everywhere else there's been an IV drug problem, over time, the drug problem builds, then the Hepatitis C problem builds, and not far behind them is HIV," he said.

Because the bill didn't pass, communities are looking for local solutions, even if resources are limited. Dr. Bonnie Hedrick of the Northern Kentucky Agency for Drug Abuse reported that her organization is not only working on needle cleanup projects but also encouraging local doctors to prescribe the antidote to those who are addicted, Rae Hodge of The Associated Press reports. "Northern Kentucky Drug Strike Force director Bill Mark said that unless Gov. Steve Beshear calls the legislature into a special session to consider the bill, his organization has few tools to fight the state's growing heroin problem."

Beshear hasn't decided whether to call a session. "He argued that every session produces worthy bills that die, and 'it's too early to determine if a special session on any topic is prudent or needed,'" Beshear said, Mike Wynn writes for The Courier-Journal. Republican Senate President Robert Stivers has urged Beshear to call a session. He said, "This isn't political. This is about real people; this is about real problems; this is about real people losing their lives."

CEO of Somerset hospital, rated by Consumer Reports as clearly the least safe in Kentucky, is resigning

Mark Brenzel (Photo via Somerset Commonwealth Journal)

The CEO of the Kentucky hospital with by far the lowest safety rating from Consumer Reports magazine is resigning. Lake Cumberland Regional Hospital is one of 61 owned in 20 states by LifePoint Hospitals of Brentwood, Tenn.

In an April 14 message to the hospital staff, Mark Brenzel wrote, “A few weeks ago, I informed Scott Raplee, President of LifePoint’s Central Group, about my decision to step down  . . . I have struggled managing some health problems since last year that have required me to limit some activities including work hours. While these lifestyle changes have been helpful, they have made it difficult for me to keep up with the demands of this job.”

Brenzel concluded, “I have greatly enjoyed the last four years and am glad to be ending my hospital management career where it began in 1976 when I first visited LCRH [soon after it opened]. We have made great progress in improving patient care and implementing new strategies that will help LCRH be successful in the new healthcare reform environment. My wife and I are planning to stay in the community for the long term and look forward to supporting LCRH in any way that we can.”

Raplee told the Somerset Commonwealth Journal that LifePoint is doing national search to find a replacement for Brenzel, who will remain as CEO during the search. “We are discussing the possibility of Mark taking a new role with LCRH once the new CEO is hired,” Raplee said in a press release.

High school students in Bourbon County campaign for indoor smoking ban, also against teenagers' use of e-cigarettes

From left: LaShana Harney, Tyler Boyle
and Jessica Jones (Coriá Bowen photo)

By Coriá Bowen
Kentucky Health News

A group of young people in a Bluegrass county with a strong tobacco tradition is trying to make the county's indoors smoke-free.

Students Making a Change in our Community started at Bourbon County High School in the late 1990s and was revamped in 2013 by several students and Cyndi Steele of the Bourbon County Health Department. SMACC members said they felt it was time for the voices of youth to be heard again on smoking issues.

“Our main idea is to try to establish a smoke-free ordinance in Bourbon County,” senior Lashana Harney said.

The group has been busy this year collaborating with other youth in Paris at events such as the 2013 National Kick Butts Day – a youth rally against tobacco use and secondhand smoke – as well as attending a recent Kentucky Supreme Court hearing on an anti-smoking ordinance enacted by the Bullitt County Board of Health.

“It was interesting to be at an actual case,” Harney said. “It could go either way with this case.”

Jessica Jones, a junior, said that while SMACC targets adults, it also educates and trains elementary students on how to say no to tobacco, and about the harms of smoking. “We’ve been traveling and training fifth-graders,” she said.

SMACC members are working towards a school regulation against electronic cigarettes, which they think are deceptive. They don’t believe their peers realize the harmful effects associated with them.

“E-cigarettes are becoming more popular than traditional cigarettes,” junior Tyler Boyle said. ““The best way to get to youth is other youth.”

The Kentucky Tobacco Policy Research Program lists chemicals in e-cigarettes that can have negative effects on health including acetone (nail polish remover) and formaldehyde. The legislature recently banned sales of e-cigarettes to people under 18.

Harney, Jones and Boyle say they have seen a decrease in their parents’ smoking since each student has become an anti-smoking advocate.

With Steele’s guidance, SMACC plans to keep educating and making its presence known in the community. Members will launch a group-written and directed YouTube video at the end of April that addresses secondhand smoke, titled, “It Could Be You.”

Steele said the road to banning smoking in public places for Bourbon County has been a work in progress for a long time: “I knew 20 years ago that when I chose to do this … it would be my career.” Now she has more help.

Poll: most Kentuckians support tobacco-free campuses, school nutrition standards and student physical activity requirements

Kentuckians overwhelmingly support several school policies than can influence student health but are not all embraced by Kentucky schools, according to the latest Kentucky Health Issues Poll, taken in October and November.

The poll showed that 84 percent of Kentuckians—and 72 percent of smokers—support tobacco-free campus policies, which have been adopted by only about a third of Kentucky school districts. The survey also found that 72 percent strongly favor the tobacco-free policies, while 12 percent said they favored it somewhat.

The survey found that 57 percent of Kentucky adults strongly supported, and 21 percent somewhat supported, the U.S. Department of Agriculture's new standards for school nutrition, which reduced salt and saturated fat, increased offerings of whole-grain foods, fruit and vegetables, and put stricter controls on calories and portion size.

Because the U.S. Department of Health and Human Services recommends that young people exercise for 60 minutes per day, KHIP's survey asked Kentucky adults if they think Kentucky schools should offer 30 minutes of physical activity per day for students. It found that 88 percent strongly agreed and 9 percent somewhat agreed with the policy. Physical activity is an important topic for Kentucky because 18 percent of Kentucky children are obese, according to the Kaiser Family Foundation.

Democrats were more likely to be supportive of tobacco-free campuses and the new school menus, but there was no partisan difference on physical activity. "Poll findings show that support for the health of our children cuts across party lines," said Susan Zepeda, President/CEO of the Foundation for a Healthy Kentucky, which sponsors the poll with Interact for Health of Cincinnati. It is conducted by researchers at the University of Cincinnati.

UK's advanced ventricular-assist device program for heart patients saves and improves lives

Two years ago, John Doty was diagnosed with walking pneumonia, and though antibiotics originally helped, the pneumonia came back with a vengeance, and he went to see a cardiologist. He found out his heart was severely weakened with an ejection fraction of less than 10 percent. "The ejection fraction is a measure of how effectively the heart can pump blood volume into the body, and in a healthy heart, that number falls between 50-65 percent," Allison Perry writes for the University of Kentucky, where Doty received a left ventricular assist device (LVAD) because his heart was so weak.

UK Chandler Hospital is Lexington's only hospital, and one of two in the state, that can perform emergency VAD procedures. "When Mr. Doty was transferred to UK, he was very sick, on a ventilator and requiring two medications to support his blood pressure," said Dr. Navin Rajagopala, a heart failure cardiologist at the UK Gill Heart Institute. "He was going into kidney and liver failure. It was clear that he needed an assist device as soon as possible before the damage to his body was irreversible."

VADs partially take the place of the function of a failing heart. They're more often used for the left ventricle, but some patients need the device for the right ventricle or even two devices to help both ventricles (BiVAD). Because VADs can help the heart rest and heal, some patients receive them after a heart attack or a surgery. People suffering from congestive heart failure might need a VAD for the rest of their lives.

A viral infection damaged Andy Baker's heart, and though he originally resisted the idea of a VAD, now he says he's "happy to keep the device and has no interest in getting a heart transplant," Perry writes. "I had mixed feelings about it," Baker said about getting the VAD, "but it's given me life again."

VAD treatment can save money for the both the patient and the hospital and allow at-home recovery. VADs can allow people to return to their normal lives, participating in many of the same activities they did previously. in about 5 to 10 percent of cases, the VAD even helps the heart to heal to the point that the device can be removed. That was the situation for Doty, whose device was removed 16 weeks after he got it. "I almost feel like I never had it," Doty said. "It wasn't that great of an imposition, considering that it was keeping you alive."

UK performs about 20 to 30 VAD procedures per year, and recently received its third straight biannual Certificate of Distinction from The Joint Commission, the leading accreditor of U.S. health-care organizations. That "shows just what an outstanding job our physicians, nurses and support staff are doing when it comes to treating patients who require these assist devices," said Dr. Maya Guglin, director of UK's Mechanical Assisted Circulation Program. (Read more)

Ear, nose and throat doctor at UK aims to reduce state's high rate of hearing loss among children

Dr. Matthew Bush, an otolaryngologist at the University of Kentucky, is working to reduce the state's high rate of hearing loss, especially in Appalachia and among children. He was born in Charleston, W.Va., and attended medical school at Marshall University in Huntington. "In the course of his extensive training, Bush 'fell in love' with hearing health care, ear surgery and technologies like cochlear implants that offer revolutionary opportunities for people who are deaf or hard of hearing to rejoin or enter the hearing world," Mallory Powell writes for UK. 

"It was the clinic setting that informed and fueled my efforts and interests because the patients that we see have some tear-jerking stories," Bush said. "They didn't have access to services, or they were totally unaware that there were options to help their hearing impaired child. So they show up at the clinic very delayed, well past the optimal age for intervention, and the child has already lost a lot of language development potential."

About 1 in 1,000 children experience pediatric hearing loss, and Bush said the rate is much higher in Kentucky, 1.7 out of 1,000 in Kentucky. Though hearing loss isn't life-threatening, it can greatly impact the quality of life, influencing speech, language and cognitive development in children. Early detection is important for successful treatment. "The consequences of delaying care in the first few years of life are amplified dramatically," Bush said.

Rural residents deal with many health disparities, and "delays in pediatric hearing health care are unfortunately common," Powell writes. "Children with hearing loss in rural areas are diagnosed later than children in urban areas and subsequently receive interventions like hearing aids and cochlear implants at a later age."

This rural hearing-health disparity results from factors such as distance from health-care facilities and inadequate knowledge of the importance of timely care for pediatric hearing loss. Bush says he hopes to employ telemedicine to reduce the effects of distance from facilities, with "diagnostic testing, patient counseling and hearing loss rehabilitation with hearing aids and implants. These services have not been offered before in Appalachia."

Bush is also working to increase parental knowledge about pediatric hearing loss and educate rural primary-care physicians in diagnosing and treating pediatric hearing loss. "This is not something that they're seeing on a daily basis, so provider knowledge about next steps and resources is limited," Bush said. He and his colleagues have created online educational modules that will be circulated to providers.

"In an ideal world . . . there would be a seamless transition from the birthing hospital to resources for hearing testing and treatment, whether face-to-face or via telemedicine. We'd like the quality of care and access to care to be the same for all children. That's really what our passion is," Bush said. (Read more)

FactCheck.org takes apart attacks on Obamacare

FactCheck.org is a non-profit, non-partisan center in the Annenberg Center at the University of Pennsylvania. It blows the whistle on misleading advertising and other statements of political figures. The center tries to balance its analyses between the parties, but the Republican attacks on federal health-care reform have been so strong and subjective, and Democrats have mounted so little defense or so few counterpunches, that the center's latest "Party Lines" report is all about Republican advertising against Obamacare. Here are capsules provided by FactCheck, with the label linking to each report:

Government-Run Health Care: Republican congressional candidates claim the health care law puts the government between you and your doctor. But the law boosts private insurance, and it doesn’t create a government-run system.

ACA ‘Hurting’ Families: Ads criticizing the Affordable Care Act make the general claim that it’s “hurting” families. Some families could pay more for insurance, but millions of the uninsured will gain coverage. And millions will get subsidies to help pay for coverage.

‘Skyrocketing’ Premiums: Several ads make the misleading claim that premiums and health care costs are “skyrocketing” under the Affordable Care Act. Overall, both are growing at historically low rates. Some who buy their own insurance will pay more, but others will pay less.

‘Millions’ Lost Insurance: Anti-Obamacare ads have claimed that “millions” lost their health insurance and their doctors because of the law. But policyholders weren’t denied coverage, and there’s evidence that far more gained insurance than had their plans canceled.

Season has arrived for poison ivy, oak and sumac; here's plenty of advice on how to deal with them and their rashes

Leaves of three, let them be.

This old childhood rhyme still holds true today,well at least for poison oak and poison ivy. Poison sumac has seven to 13 leaflets on each leaf. But the result is the same: If you come into contact with the oil from their leaves, you are likely to end up with a an itchy rash that can last from one to three weeks.

About 85 percent of people will develop an itchy, blistering rash when they come in contact with the oil from these plants, says the American Academy of Dermatology in a news release.

The rash itself isn't contagious, but the oil is, and it can linger on just about any surface: skin, clothes, under fingernails, tools, pets -- you get the picture. It can even come through the air if someone is burning brush. So, you can get poison ivy, poison sumac or poison oak without stepping one foot into nature.
Avoiding the plants and wearing protective clothing are the two proven ways to avoid getting a rash from these plants.

“If you are absolutely certain that your rash is due to poison ivy, poison oak, or poison sumac, and if the rash appears on a small section of your skin, you may be able to treat the rash at home,” Seemal R. Desai, dermatologist from Texas, said in the news release. “However, if you have difficulty breathing or swallowing, you experience swelling, or you have many rashes or blisters, go to the emergency room right away.”

The association also recommends going to the emergency room if the rash covers most of your body, if your eyelid swells shut, if the rash develops anywhere on your face or genitals, if much of your skin itches, or nothing seems to ease the itch.

Fortunately, there are simple steps people can take to safely treat a mild rash at home. Here are the association's recommendations for treating mild cases of poison ivy, poison oak or poison sumac:

1. Immediately rinse your skin with lukewarm, soapy water. Initially take a shower, not a bath, to get the oil off of your body.
2. Wash your clothing.
3. Wash everything that may have come in contact with the oil from the leaves.
4. Do not scratch. Scratching can cause infection.
5. Leave blisters alone. If blisters open, do not remove the overlying skin, as the skin can protect the raw wound underneath and prevent infection.
6. Take short, lukewarm baths to relieve the itch. Add colloidal oatmeal from the drugstore or one cup of baking soda to the running water for additional relief.
7. Consider using calamine lotion or hydro-cortisone cream.
8. Apply cool compresses to the itchy skin.
9. Consider taking antihistamine pills. These pills can help reduce itching, however use with caution. Call your doctor if you are uncertain if you should take an antihistamine.
10. Do not apply a topical antihistamine to your skin; doing so can worsen the rash and the itch.
11. See a dermatologist if the rash has not improved within 10 days.

Here are spring-cleaning tips to help allergy sufferers

Spring cleaning often stirs up dust and pet dander, and can leave a strong scent of cleaning supplies in the air. All can cause those with allergies to reach for a tissue and dread the task. But stirring up a little dust and dander is worth a few extra sneezes, the American College of Allergy, Asthma and Immunology says in a news release, because a thorough spring cleaning will ultimately help you avoid allergy symptoms.

“Thoroughly cleaning your home can help eliminate allergens and keep new ones from easily entering,” James Sublett, president-elect of the ACAAI, said in Newswise, a research-reporting service.  “Allergy season can last all year for those sensitive to indoor allergens, but it can worsen in the spring months when pollen becomes an issue. It’s important to remove allergens from the home so you can lead a healthy and active lifestyle.”

The ACAAI  offers tips to remove allergens from your home as well as ways to prevent more from entering.

The best way to prevent allergens from building up in your home is to stay on top of certain chores, such as vacuuming regularly to get rid of dust mites using a cyclonic vacuum or HEPA filter, changing air filters every three months using filters with a MERV rating of 11 or 12, and washing bedding and stuffed animals weekly.

It is also important to resist the urge to open the windows as the weather gets warmer, because this lets unwanted pollen into the house.Those with allergies also have to be careful to avoid air fresheners and candles because chemicals in these items can spur asthma attacks.

A top allergen target in spring cleaning is mold, paying special attention to mold-prone areas like bathrooms, basements and tiled areas, says the release. Make sure bathroom fans are functioning and usable, and always make sure not to leave any standing water in these areas. Use detergent and water to remove any visible mold, and to prevent further mold from growing, keep the humidity in your house below 60 percent.

Because pets spend so much more time indoors over the winter, chances are there is an increased amount of fur, saliva and dander in your house. Remove these allergens by vacuuming frequently and washing upholstery, including your pet's bed, the release says. Also, don't allow your pet in your bedroom.

Those with allergies should avoid being outdoors in noonday and afternoon, because pollen counts are highest then. Wear gloves and a N95 pollen mask when mowing or gardening, and make sure to wash your hands, hair and clothing when finished. Also, make sure to take your medication before going outside.

McConnell continues attack on Obamacare as Washington Post gives him 'four Pinocchios' for misleading article in C-J

U.S. Sen. Mitch McConnell took the resignation of Health and Human Services Secretary Kathleen Sebelius as an opportunity to repeat his criticism of the Patient Protection and Affordable Care Act.

"Regardless of the administration’s public explanation for the secretary’s exit, Obamacare has been a rolling disaster and her resignation is cold comfort to the millions of Americans who were deceived about what it would mean for them and their families," McConnell said in a press release. "Countless Americans have unexpectedly been forced out of the plans they had and liked, are now shouldering dramatically higher premiums, and can no longer use the doctors and hospitals they choose. Beyond that, virtually everyone who has come into contact with this law has had new reason to worry about what it means for the government to control their health care."

McConnell has been perhaps the leading critic of the law, which led New Yorker magazine cartoonist Barry Blitt to make him the focal point of his artwork on this week's cover, which shows President Obama administering medicine to McConnell as House Speaker John Boehner moves on and Rep. Michelle Bachman and Sen. Ted Cruz await their spoonful. For Blitt's brief explanation of his work, click here.

The point of the cartoon is that despite criticism and a troubled national rollout, the administration exceeded its goal of 7 million people signing up for Obamacare by the original March 31 deadline. In Kentucky, enrollment on the Kynect exchange is now more than 402,000, with several thousand more having been determined eligible for a subsidy to buy private insurance. In an April 10 press release, the state said 79,580 people have bought private policies and 322,827 have qualified for coverage under the federal-state Medicaid program.

McConnell bases part of his criticism on the state's initial report that 285,000 people "might be affected if they had substandard plans," The Courier-Journal said in an editorial. "A month later—in December 2013—Kentucky revised the figure to 168,000 and the [Washington] Post said the number could be as low as 100,000." The Post's Glenn Kessler, in his Fact Checker column, recently gave McConnell the maximum "four Pinocchios" for a misleading op-ed piece in the Louisville newspaper attacking the reform law.

The senator wrote, “Only approximately 64,000 Kentuckians enrolling in Obamacare have enrolled in a private plan in Kentucky’s own Obamacare exchange, far fewer than the 280,000 who received cancellation notices of plans they had and liked.” Kessler says that number is nowhere near correct.

Kessler writes that the 64,000 number (now up to almost 80,000; see above) "can be related only to the 130,000 individual plan policies. Adding in small-group policies inflates the total. . . . When the state made the announcement, it did not know how many plans might actually comply with the law; it just described the size of the individual and small-group markets." Also, he notes, not all the cancellation notices are going out at once: "We have no idea what the flow would be, but just taking a simple average over 12 months yields 11,000 individual policies a month. That adds up to only 55,000 individual policies since November, yet McConnell assumed that all of the notices had been mailed and received."

Finally, Kessler writes, "The 280,000 figure is out of date. In December, the state said it had determined that more than 48,000 plans were grandfathered in under ACA and that nearly 64,000 qualified for transitional relief under an administrative fix announced by the Obama administration. (The state did not distinguish between individual and small-group plans in its announcement, but overall that’s a 40 percent reduction.) That brought the total down to 168,000, a figure that was reported." McConnell spokesman Don Stewart said the fundamental point of the letter, that Democrats were touting Obamacare's successes and ignoring its pitfalls, was still correct.

Louisville jails sign up inmates for health coverage to save the state money; other jails around state may follow suit

Louisville jails are holding daily health insurance sign-ups for released inmates, Chris Kenning reports for The Courier-Journal.

Most inmates qualify for expanded Medicaid under the Patient Protection and Affordable Care Act, and Medicaid applications can be made at any time, not just during the annual sign-up period. Officials told Kenning that after the first four days, they had processed 18 applications, mostly for Medicaid.

The benefit to prisons and jails is twofold: Inmate hospitalizations lasting more than 24 hours can be billed to Medicaid, and getting coverage for released inmates provides insurance to a population that has a high rate of chronic disease, substance abuse and mental illness -- conditions that often bring them back to prison, Kenning writes.

This treatment is often only a temporary fix, because repeat offenders fail to continue their treatment when released because of a lack of health insurance, officials acknowledged.

"I know some people will think, 'I can't afford health insurance myself. Now a person in jail gets access to health care?'" Mark Bolton, director of Metro Corrections, told Kenning. "But taxpayers are paying for these people anyway."

Kenning reports that in Louisville, "Metro Corrections' health care costs make up $9 million of its $52 million budget — a result of treating medical conditions including diabetes, heart disease, infections and drug problems." The jails house an average of about 2,000 people.

U.S. Sen. Mitch McConnell does not support the signups, telling The Courier-Journal that it adds burdens to an already strained Medicaid program that is hard-pressed to find enough doctors willing to accept Medicaid patients. "This is yet another disturbing aspect of a profoundly troubling piece of legislation," he told Kenning.

Plans to expand to other jails and other parts of the state are in the works, said Barbara Gordon of the Kentuckiana Regional Planning and Development Agency, a Louisville-area government clearinghouse that provides "Kynectors" to help people sign up on Kynect, the state health-insurance exchange. They now spend two hours a day at the jail and hope to eventually have someone there full time, Bolton told Kenning.

About a third of people going in or out of prisons and jails would qualify for expanded Medicaid, and 24 percent would qualify for subsidized private insurance, estimates Dr. Fred Osher, director of health systems and services policy for the nonpartisan Council of State Governments Justice Center.

The state Department of Corrections projects that by shifting the costs of those 24-hour hospital stays to Medicaid, the state prison system would save more than $5 million a year, Kenning reports. The system has seen health costs rise to more than $54 million this year, from $34 million in 2004.

New law bans sales of electronic cigarettes to minors

Sales of electronic cigarettes to people under 18 are now illegal in Kentucky, following Gov. Steve Beshear's signing into law Thursday of a bill that had support from cigarette manufacturers, many of whom are also getting into the e-cigarette business.

Senate Bill 109, sponsored by Republican Paul Hornback of Shelbyville and Dennis Parrett of Vine Grove, took effect immediately because it contained an emergency clause. A House committee had approved a similar bill, but it did not contain an emergency clause and never came to a vote in the full House.

The law bans the sale to minors of "alternative nicotine products," defined as "a noncombustible product containing nicotine that is intended for human consumption, whether chewed, absorbed, dissolved, or ingested by any other means," but "does not include any tobacco product, vapor product, or any other product regulated as a drug or device by the United States Food and Drug Administration." It also adds to state law more detailed definitions of "tobacco product" and "vapor product," and also bans the sale of the latter to minors.

KET's 'Safe and Sound: Raising Emotionally Healthy Children in a Stressful World' premieres April 17, first airs April 21

Though new parents often have access to many resources of information on how to care for their children physically, they are usually not as well-informed about raising them to be strong and healthy emotionally, and esearch shows that children who grow up stressed can face brain development  and long-term health issues, KET "Be Well Kentucky" reports.

The state network will present a special report, "Safe and Sound: Raising Emotionally Health Children in a Stressful World," designed to teach parents to be the best they can be, in various locations across the state.

The program will be aired Monday, April 21 at 9/8 p.m. It was produced partly with funding from the Foundation for a Healthy Kentucky.

A public screening and panel discussion of the program will be held Thursday, April 17 at 5:30 p.m. at the Kentucky Science Center in Louisville.

Guests are invited to a 4:30 p.m. reception at the Leadership Louisville Center at 732 W. Main St. The event is free, but registration is required, and seats are limited. Click here to register.

Beshear signs bill allowing limited use of oil extracted from marijuana to treat children's seizures

Gov. Steve Beshear has signed into law a bill allowing doctors at the University of Kentucky and the University of Louisville, or those conducting a clinical trial approved by the U.S. Food and Drug Administration, to prescribe a marijuana extract to treat seizures in young people.

Denton (Herald-Leader photo)

Senate Bill 124 was sponsored by retiring Sen. Julie Denton, R-Louisville, who said its passage was unimaginable a decade ago, according to the Lexington Herald-Leader. The General Assembly rejected legislation to authorize medical use of marijuana, but legislators and the Beshear administration agreed to SB 124 because tearful parents testified for the bill and cannabidiol contains none of marijuana's psychoactive ingredient.

"Both our law enforcement leaders and our drug policy director worked with the legislators on this bill, and they gave the bill their support," Beshear said in a press release. "Because the bill has been carefully constructed to require that any prescriptive recommendation for the oil can come only from physicians at the state’s research universities or through an FDA clinical trial, I am confident that this law will provide the relief that these families seek, without creating complications for our law enforcement community.”

Roy Butler, 'father of Medicaid' in Kentucky, passes

Roy Butler, called "Father of Medicaid" in Kentucky, died Monday morning of complications from Parkinson's disease. He grew up during the Great Depression on a farm in Franklin County, where he learned to work hard, reports Kristie Hamon of The State Journal. He served in the Army with occupation forces in Japan, then Georgetown College and the University of Kentucky. In 1951 he began working with the commonwealth of Kentucky; he spent more than 41 years with the state, and he prioritized "health and social programs within the Cabinet for Human Resources," Hamon writes.

Roy Butler and his family (State Journal photo)

Butler had a very positive influence on Kentucky Medicaid. "The most satisfying aspect was being able to expand the program in terms of the number of health services being offered as well as increased benefits to the providers of care," Butler said recently. He acknowledged co-workers' contributions: "The second-most satisfying aspect of the job was the number of terrific, talented people that I met, especially the staff of people that I worked with such as Janie Miller and Mark Birdwhistell, and having a major impact on the direction of the program."

Miller, a former secretary of health and family services, now runs the Kentucky Health Cooperative, a non-profit insurer created under federal health reform. Birdwhistell, a UK HealthCare executive, told Hamon, "Roy Butler is an extremely phenomenal administrator, extremely knowledgeable and hardworking. . . . I owe him a great deal of gratitude for teaching me everything I learned."

Butler was named to UK's College of Public Health Hall of Fame last fall. He remained married to Elise Lois Watkins Butler for 53 years until she died in 2004, and they had three children. One, Lane Butler Jacobs, recalled an occasion when he father was very upset that someone required a medical procedure and no apparent way to get it covered by Medicaid. Jacobs said she asked her father if he knew the person, and he said, "No, but then what difference would that make? What if this was your mother or your aunt or your daughter? Wouldn't you want to do everything you could do to save their life?"

Jacobs told Hamon, "He also benefited the lives of many other people. Probably more than he can possibly imagine." The story requires a log-in and password to view.

Poll gauges Kentuckians' consumption, sources and opinions of drinking water; E. Ky. likes bottled water more than other areas

Drinking water is necessary for the human body to work properly. Because one can consume water through drinking other beverages or eating foods like lettuce, tomatoes, oranges and melons, the federal Centers for Disease Control and Prevention does not recommend drinking a particular number of cups per day. However, it does recommend drinking water instead of other high-calorie beverages, especially if a person is trying to remain at a healthy weight, according to the Foundation for a Healthy Kentucky's latest release of information from its 2013 Kentucky Health Issues Poll.

The poll, in October and November, gauged Kentuckians' consumption, sources and opinions of their drinking water. While 24 percent reported drinking eight or more cups of water each day, 8 percent said they don't drink water daily. Thirty-two percent said they drink one to three cups per day, and the remaining 35 percent say they drink between four and seven cups.

About half of those surveyed (52 percent) reported drinking tap water most often, and 39 percent said they drink mostly bottled water. Only 4 percent said they primarily drink well water, showing how extensive water lines have become in rural areas. Louisville-area citizens are more inclined (61 percent) to report drinking tap water than people from other areas, and Eastern Kentucky residents were most likely to report drinking bottled water (50 percent) or well water (10 percent).

Why don't some Kentuckians drink tap water? More than four in ten (43 percent) cite the taste of the water as an explanation. Some also say it seems unsafe (13 percent), that they have access to bottled water (13 percent) or that they believe chemicals are in the water (11 percent).

The poll, co-sponsored by Interact for Health of Cincinnati, has an error margin of plus or minus 2.5 percentage points.

Kentucky ranks 49th in well-being survey, and Eastern Kentucky's congressional district ranks last in the nation

Kentucky ranked 49th in the nation in a survey that measures perception of well-being, ranking higher than West Virginia and lower than Mississippi, and its 5th Congressional District ranked dead last in the nation.

"The survey assessed people's emotional and physical health; behavior that affects health, such as smoking or exercising; job satisfaction and access to basic needs, including food and housing; and their outlook on life," Bill Estep reports for the Lexington Herald-Leader. The Gallup Organization and Healthways, a Tennessee-based company that provides services to improve well-being, administered the survey.

Kentucky has ranked 49th each year except for 2008, the year the index began, when it ranked 48th. Factors contributing to this result include high poverty, top smoking rates, many uninsured people, high depression rates, drug abuse, obesity and other health issues. "Our health status is dismal in Kentucky," state Health Commissioner Stephanie Mayfield told Estep.

Louise Howell, a consultant for Kentucky River Community Care, said Eastern Kentucky has "profound health disparities." Harlan County lost 13,054 years of individual lives due to premature death, according to the survey. In Breathitt County, only 25.1 percent of people have access to satisfactory exercise opportunities. In Martin County, 37.4 people smoked.

Shaping Our Appalachian Region, a program Gov. Steve Beshear and 5th District Rep. Hal Rogers began last year, is forming strategic plans to improve the region's economy through expansion and diversification. This summer the public meeting will take place to brainstorm ideas and promote involvement. "I think this is the toughest most difficult region we've worked in, ever," said Charles W. Fluharty, who heads the Rural Policy Research Institute and is interim executive director of SOAR. However, he said the region will benefit from people's awareness that the coal-depend region has to try to a new strategy, Estep writes.

Dee Davis, president of the Center for Rural Strategies in Whitesburg, told Estep: "People realize if we've got any chance at all we've got to seize the reins; we've got to diversify the economy." (Read more)

Republicans wait for elections and chance to roll back Medicaid expansion; few Kentucky Democrats defend Obamacare

Though thousands of their constituents have benefited from it, Republican state legislators say they are planning to roll back Democratic Gov. Steve Beshear's expansion of Medicaid under the Patient Protection and Affordable Care Act if they take control of the state House this fall or win the governorship next year.

In other words, the "wildly successful" rollout of the health-reform law in Kentucky has not changed the politics of it in the state, reports Louisville native Perry Bacon Jr., political writer for Yahoo! News.

Stivers and Beshear

Bacon starts his story by focusing on the home county of state Senate President Robert Stivers, a Republican from Manchester: "In one of the poorest areas of Appalachia, about 2,500 people have signed up to get health insurance over the last six months — a number that represents more than a tenth of Clay County’s residents. One hundred and twenty miles way, the county’s state senator, Robert Stivers, is laying out his plans to gradually gut the Affordable Care Act in Kentucky, which provided his constituents with insurance."

Stivers acknowledged that the Medicaid expansion has benefited his neighbors, but told Bacon that it is “unsustainable” in the long run. For the first three years, the federal government is paying the entire cost of the expansion, but starting in 2017, the state will have to pay 5 percent, rising in steps to a cap of 10 percent in 2020.

Beshear cites a study showing that the expansion will pay for itself, largely by creating jobs in health care, and Health Secretary Audrey Haynes told Kentucky Health News that the expansion brought $45 million to health-care providers in the state in January, the first month it was in effect.

Republican Rep. Robert Benvenuti of Lexington, a former state health official, doesn't buy the Democratic sales pitches. “I think it’s immoral to give you something you know we can’t pay for,” he told Bacon. “Why are you creating dependency you know you can’t afford?”

Stivers suggested that Republicans could gradually reduce the income limit for Medicaid eligibility, now 138 percent of the federal poverty level, to reduce costs, but "The Obama administration has long said it would not support such a partial expansion of Medicaid," Bacon reports.

Also, "Some Republicans privately concede it will be difficult to roll back expansion of health insurance to so many," Bacon reports, quoting a "top GOP operative" as saying, "Three hundred thousand people are on this now. It's going to be hard to take this away from people." And since that anonymous person spoke, the number is close to 400,000.

House Republicans tried to force a floor vote on Obamacare in the current legislative session, but Democrats foiled that through a parliamentary maneuver.

"Steve Robertson, chairman of the Kentucky Republican Party, said the GOP statehouse candidates would run this fall on the mantle of repealing the health care law, looking to gain five seats and the House majority," Bacon reports. "And a Republican could replace Beshear," who can't seek re-election in 2015. Robertson said, “It’s a question of when, not if, when Kentucky will become just truly a red state.”

Bacon writes, "Democrats acknowledge the political challenge in defending the law. They say the policy success has done little to shift the politics because anything associated with Obama is unpopular in Kentucky. . . . The stories of the newly insured are drowned out, politicians in both parties here say, by the enduring unpopularity of Obamacare and the man it is named after, concerns (often unfounded) that the law has caused premiums to increase for people who previously had insurance and general confusion about the law, particularly the individual mandate" to buy insurance.

"Other than Beshear, many of the state's leading Democrats, aware of the lingering tensions around the ACA, avoid speaking about it publicly, wary of being seen as too supportive of 'Obamacare'," Bacon reports.

'Stars are aligned' for making Ky. healthier, and let's start with schools, health commissioner tells County Health Rankings event

Kentucky is poised to make itself healthier, and one key push needs to be making schools smoke-free, the two top officials in charge of the effort told a gathering of state and local health leaders and activists in Frankfort on Wednesday.

Mayfield

"We know our health statistics are bad, but the stars are aligned for Kentucky, and the time to get healthy is now," Dr. Stephanie Mayfield, the state commissioner of public health, said at a gathering held to highlight "Signs of Progress" in conjunction with the national release of the fifth annual County Health Rankings.

"We're seeing changes that we haven't seen in a generation or multiple generations," Mayfield said, such as the expansion of Medicaid under federal health reform; the enrollment of almost 400,000 Kentuckians in the program or private coverage through the state insurance exchange, Kynect; and a coordinated effort by state agencies to make specific improvements in Kentucky's health statistics.

"I can't stop smiling about this," Mayfield said of the effort, called Kyhealthnow. "This is public health at its best," using accountable strategies to reach measurable goals. "These are strategies we need to implement across our state," she said, "but we need to do it in a  way that's not condemning to people and helps them make healthy choices."

Mayfield is co-chair of the effort, headed by Lt. Gov. Jerry Abramson under appointment from Gov. Steve Beshear. Both of them said it must include a stringer effort to ban smoking on school grounds.

Abramson (cn|2 image)

"Only 33 of our 173 school districts have tobacco-free policies," Abramson said with a touch of incredulity, repeating the line for impact. "We have areas where the government has stepped up [with a smoking ban] and the school districts haven't; we have areas where the school districts have stepped up and the governments haven't; and unfortunately, we have lots of areas throughout the commonwealth of Kentucky where neither has occurred"

Mayfield said, "It is disgraceful that all of our schools are not smoke-free. . . . We need to target our children," because the tobacco companies are.

In a national County Health Rankings video, Grant County School Supt. Sally Skinner said, "We have for some time realized the connection between healthy students and strong academic results." Grant County was recognized nationally for focusing on its health ranking as a motive for improvement, and for raising it from 89th to 60th out of 120 counties.

The program also featured videos of three other counties (Floyd, Franklin and Todd) that have used the rankings and associated data to motivate their efforts. The counties are representative of many others "that are doing something" to improve community health, said Dr. Connie White, clinical director for the state Department of Public Health.

Floyd County was recognized for its work against diabetes; Franklin County was noted for its creation of smoke-free environments; and Todd County was recognized for starting a farmers' market to make more fresh produce available.

"There are so many exciting efforts under way in Kentucky," said Katie Wehr of the Robert Wood Johnson Foundation, which funds the County Health Rankings and Roadmaps. She praised the three health departments that have won national accreditation: Franklin County, Three Rivers and Northern Kentucky. "You are demonstrating to the rest of the nation what's possible."

The foundation held similar events in Rockingham County, North Carolina, and Amherst, N.Y., a Buffalo suburb, to mark the fifth anniversary of the rankings and the importance of the roadmaps, which give communities guidance on campaigns to improve community health.

"The rankings are the starting point for the conversation," said Kitty Jerome, director of the Roadmaps to Health Action Center at the University of Wisconsin. "The number is not as important as the people in this room."

Abramson said it's unfortunate that so many Kentucky counties are chronically at or near the bottom of the rankings. "Many areas simply aren't getting the message," he said, "and anything we can do to spread that message and beat that drum is very important. . . . "We've got to do something in a coordinated, collaborative way to bring about an enhanced environment of health for our citizens."

"We are all on the same page," said Jane Chiles, chair of the Friedell Committee for Health System Transformation, which co-sponsored the event and is working with other groups on a statewide, county-by-county campaign to improve the state's health. "It is a winning collaboration going forward that will result in a healthier Kentucky."

Former University of Kentucky president Lee Todd, who emceed the event, said the state needs to declare war on what he calls "Kentucky's uglies" to get citizens and communities motivated to improve their health. He acknowledged that the term "war" is "a little tough-sounding, but I think it's time we get mad enough about some of the statistics. . . . If we had one one-hundredth the interest in moving our health rankings as we do our basketball rankings, we would be a top-ten state."