Appalachian Kentucky has much of what it needs to improve its poor health status, key federal officials agree

By Al Cross
Kentucky Health News

Appalachian Kentucky has the enthusiasm, creativity, people and facilities needed to greatly improve its dismal health status, two high-ranking federal officials said after looking at the problem on a recent tour.

Dr. Thomas Frieden, Rep. Hal Rogers

"I want to stir up our people to get involved in a grass-roots effort," U.S. Rep. Harold "Hal" Rogers, R-Somerset, who hosted Dr. Thomas Frieden, director of the federal Centers for Disease Control and Prevention, on a four-stop tour of his Fifth Congressional District in early August.

Rogers and Frieden were guests on KET's "One to One" Sunday afternoon, in a program recorded right after they returned from their trip, where Frieden said he saw much creativity and enthusiasm.

Using one of Rogers's favorite sayings, Frieden said, "If you plan your work and work your plan, you may very well have tremendous success."

Rogers said what struck him most about the trip was "the infrastructure we already have in place," including hospitals, health departments, doctors and other health providers, and he wants to "talk about enhancing them.

Rogers is in a position to do that with federal money, because he is chairman of the House Appropriations Committee. He is also co-founder, with Democratic Gov. Steve Beshear, of Shaping Our Appalachian Region, an initiative to improve the economy of Eastern Kentucky.

Asked by "One to One" moderator Bill Goodman where the role of government begins and personal responsibility for health begins, Frieden said, in an apparent reference to smoking bans, "You don't want to go to your job and get cancer as a result."

"We don't tell people what to do" at the CDC, he said, but offer communities choices from a list of proven programs. Earlier, he said smoke-free laws not only reduce smoking, but heart attacks among non-smokers.

Rogers said he asked Frieden what one thing he would recommend for improving personal health in the region, and the doctor replied, "Walk."

Frieden said walking is an especially good option for Kentuckians because they have such a beautiful state. However, many rural areas in the state lack sidewalks or other easily accessible places to walk.

"Physical activity is the closest thing we have to a wonder drug" for all sorts of ailments, Frieden said, "but you have to do something you love to do" in order to stick with it. He said it also helps children be good students: "The more physical activity they get, the better their minds will work."

That point was made a few days before the two men's trip, at the Kentucky Summit on Childhood Obesity and Physical Activity at the University of Kentucky.
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As nurse practitioners enjoy their new, state-granted authority, The Paducah Sun looks at the issue in far Western Kentucky

Kentucky law has expanded the rights of nurse practitioners, Laurel Black notes for The Paducah Sun: "Local practitioners say the move will provide patients with better access to care, but not everyone in the medical community embraces the idea."

The new law "gives nurse practitioners who have worked with a physician for four years the right to prescribe routine medications, such as those used to treat diabetes and blood pressure, without a doctor's involvement," Black writes. But nurse practitioners want it to go farther.

The American Association of Nurse Practitioners says "19 states and the District of Columbia allow nurse practitioners full autonomy. This means they're allowed to evaluate patients, order and interpret diagnostic tests, and initiate and manage treatments, including prescribing medications," Black reports. "As the population in the United States grows and ages, providers worry over a physician shortage -- as many as 130,600 by 2025, according to the Association of American Medical Colleges -- and some providers believe nurse practitioners could fill that gap if granted more independence."

"We want to be as independent as we can, because that gives better access to patients," said Amy Fennel, a nurse practitioner at the Paducah Neurosurgical Center, told Black.

"But the idea has met with opposition from organizations such as the American Medical Association," Black notes. "The AMA argues in support of physician-led teams, stating that nurse practitioners lack the education and training to practice on their own."

Black writes, "Local practitioners say their roles are different from those of physicians, and that practicing independently is well within the scope of their training. Elizabeth Scheidler, a nurse practitioner with Mercy Primary Care in Lyon County, who was a nurse for 12 years, told Black that her training was more patient-focused.

"That makes them a good fit for the current health care climate, where primary care physicians are at a premium, particularly in rural areas," Black writes. "Kentucky's law addresses only prescription of non-scheduled medications; controlled substances still require a collaborating physician. And there's still a ways to go before nurse practitioners are able to practice with complete autonomy in the state. For the time being, Scheidler says, the new law 'is a good compromise'." The legislature wrestled with the issue for years before passing the compromise this year. (Read more; subscription required)

School nutrition beat keeps busy: Ketchup returns to Anderson County, more students eating at school in Allen County

School meal programs continue to make news, as schools, students and parents adjust to the latest round of federal guidelines to combat childhood obesity and make sure no child goes hungry.

The second and third Kentucky counties in the alphabetical list were two of the latest in the news.
In Allen County, expansion of a free-meals program means that almost all children are getting breakfast at school.

Following parental complaints in Anderson County, the schools are again offering ketchup, which had been removed because of its high salt content, Shelley Spillman reports for The Anderson News.

The problem, Food Service Director Ronnie Fields told Spillman, was the unavailability of low-sodium ketchup. All the cafeteria offerings had been configured with it, but there wasn't any available. Regular ketchup pushed the allowable sodium limits too high, so it was removed.

Signs were posted to explain, but this didn't set too well with the parents, who "flooded the Anderson County Schools' office and The Anderson News with questions," Spillman writes.

“They’re micromanaging our children,” Paul Coffey, who has grandchildren in the schools, told Spillman. “A parent knows what’s good for their child and ketchup is not going to hurt them.”

Low-sodium ketchup packets are 10 calories and contain 25 mg of sodium. Regular ketchup packets are 11 calories and 85 mg of sodium, Spillman reports.A teaspoon of salt has 2,300 mg. of sodium, according to the American Heart Association. It adds up quickly, with all the added salt in processed foods, so lunches and breakfasts for middle-school students are supposed to have less than 1,360 mg and 600 mg, respectively. Limits for elementary- and high-school students are slightly lower and higher, respectively.

“A lot people don’t realize how it’s this complicated to feed kids,” Fields told Spillman. There were rumors that the schools wouldn't let students bring their own lunches or condiments. “We’d never ban that,” Fields said. “Kids are always welcome to bring their own lunches and condiments.”

Meanwhile, Allen County reports "promising statistics" in after its elementary and middle schools joined the free-meal program offered by U.S. Department of Agriculture, Rachel Herrington reports for The Citizen-Times of Scottsville.

Of the 1,600 students enrolled in both centers, 95 percent are eating breakfast this year, compared to around 60 percent last year, Food Services Director Mary Hobdy told Herrington.

Hobdy said unclaimed breakfast food does not go to waste. Non-perishable foods are kept in elementary classrooms for students to eat during breaks, and are placed in the Family Resource Center for middle-school students who need extra food during the day. Leftover food is donated to the center's backpack program, which sends easy-to-prepare food home with needy kids on Fridays.

Students in Allen County are allowed to refuse meals if they have eaten breakfast or have brought their lunch.

Henderson County Schools post videos to explain changes in meals, snacks and school fund-raisers involving food

Student Nibre Fortune chose food items at Henderson's

Jefferson Elementary School last April. (Gleaner photo

by Mike Lawrence)

To help parents and students understand the federally mandated changes in school lunches, the Henderson County Schools have posted three videos on YouTube, Erin Schmitt reports for The Gleaner.

“We decided a video would reach a wider audience and actually show parents what has changed,” Child Nutrition Director Sabrina Jewell told Schmitt. “The biggest challenge with this has been with side items of what we would typically see as a la carte items,” which were affected by the last round of changes. The "Smart Snacks" rules also apply to vending machine sales, Jewell said.

"School fundraisers involving food must also meet the federal requirements," Schmitt reports. "The Kentucky Department of Education has not given any waivers for fundraisers, Jewell said."

“We are working with the schools to meet these requirements without causing undue hardships on the various programs,” Jewell told Schmitt. “This section is very much a learning process.”

Schmitt lays out the changes in her story, which begins, "There has been less ice cream and more brussels sprouts served in school cafeterias nationwide since a federal child nutrition act was passed." To see the videos, visit www.henderson.kyschools.us and click the YouTube icon.

Medicare ratings for nursing homes rely heavily on self-reported data; recent inspection data are available elsewhere

Next time you look at Medicare's ratings for nursing homes, be aware that most of the information used to make the ranking is based on self-reported data and is not verified by the government.

Consumers and investors make critical decisions based on these misleading "gold standards" that are doled out by Medicare, Katie Thomas reports for The New York Times.

"Only one of the three criteria used to determine the star ratings - the results of the annual health inspections — relies on assessments from independent reviewers," Thomas writes. "The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value."

ProPublica, the nonprofit, investigative journalism enterprise, offers a program, Nursing Home Inspect, that allows consumers to search and analyze the details of recent nursing home inspections, featuring tools the federal government's Nursing Home Compare doesn't have, including the ability to search using any keywords and the ability to sort results based on the severity of the violation and by state. (Read more)

The Medicare ratings also do not account for fines and other enforcement actions by state, rather than federal, authorities,Thomas reports, or complaints filed by consumers with state agencies.

Starting this year, Medicare will use this same type of rating system not only in nursing homes, but also in hospitals, dialysis centers and home-health-care agencies, Thomas writes. And federal officials told Thomas that "while the rating system can be improved — and that they are working to make it better — it gives nursing homes incentives to get better." They cite the homes' reduced use of physical restraints, and fewer reports of bedsores, as examples of improvement.

But current and former nursing home employees, lawyers and advocacy groups say some nursing homes have "learned how to game the rating system," Thomas writes. Nursing home ratings have risen steadily since the program began, she notes. "In 2009, when the program began, 37 percent of them received four- or five-star ratings. By 2013, nearly half did."

The Times analysis also shows that even if a nursing home has a history of poor care, it self-reports better. "Of more than 50 nursing homes on a federal watch list for quality, nearly two-thirds hold four- or five-star ratings for their staff levels and quality statistics," Thomas writes. These same homes received one or two stars for the health inspection, which is conducted by state workers.

“These are among the very worst facilities, and yet they are self-reporting data that gives them very high staffing and very high quality measures,” Toby S. Edelman, a senior policy lawyer with the Center for Medicare Advocacy,told Thomas. “It seems implausible.”

Pediatricians say middle and high schools shouldn't start class before 8:30 a.m., as a way to help sleep-deprived teenagers

The American Academy of Pediatrics recently recommended that middle and high schools not start of classes until 8:30 a.m. at the earliest.

An estimated 40 percent of high schools in the U.S. start classes before 8 a.m.; only 15 percent start at 8:30 a.m. or later. The median middle-school start time is 8 a.m., and more than 20 percent of middle schools start at 7:45 a.m. or earlier, according to the AAP release. The Kentucky Department of Education doesn't track school start times, but those are locally available.

When children become adolescents, their sleep-wake cycles begin to shift up to two hours later, meaning their bodies naturally want to go to bed and get up two hours later than before puberty hit, says the release. This makes it hard for teens to fall asleep before 11 p.m., and even more difficult to get to class by 7:30 or earlier the next day.

“The research is clear that adolescents who get enough sleep have a reduced risk of being overweight or suffering depression, are less likely to be involved in automobile accidents, and have better grades, higher standardized test scores and an overall better quality of life,” said Judith Owens, pediatrician and lead author of the AAP policy statement. “Studies have shown that delaying early school start times is one key factor that can help adolescents get the sleep they need to grow and learn.”

Pediatricians "urge middle and high schools to aim for start times that allow students to receive 8.5 to 9.5 hours of sleep a night," the group says. In most cases, that means a school start time of 8:30 a.m. or later, depending on average commuting times and other local factors.

Many studies have documented that "the average adolescent in the U.S. is "chronically sleep-deprived and pathologically sleepy." Reasons listed for this lack of sleep include homework, extracurricular activities, after-school jobs and use of technology that can keep them up late on weeknights.

And while students, parents, and all those involved need to learn about healthy sleep habits for adolescents and about the biological and environmental factors that contribute to insufficient sleep, schools should also adjust their start times, AAP said, citing studies showing that a too-early start time "is a critical contributor to chronic sleep deprivation among American adolescents."

“By advocating for later school start times for middle and high school students, the AAP is both promoting the compelling scientific evidence that supports school start time delay as an important public health measure, and providing support and encouragement to those school districts around the country contemplating that change," Owens said in the release.

Mental-health coverage now required, but access is limited; Medicaid share of all new Ky. enrollments is 85 percent

More people in Kentucky and the nation have access to mental-health care than ever, because of the Patient Protection and Affordable Care Act, but that doesn't mean the care is quick or abundant, especially for those on Medicaid, Abby Goodnough reports for The New York Times.

In the latest of a series of stories Goodnough is doing about health reform from the Louisville area, she gives a new figure for the share of Medicaid patients in the rolls of the 521,000 newly insured Kentuckians: 85 percent. When the regular enrollment period for private insurance ended this spring, the figure was 75 percent, but Medicaid enrollment is open year-round.

The reform law requires mental-health treatment to be covered by Medicaid and every private plan sold through the state's online insurance marketplace, The intent of that, Advocates told Goodnough, is to not only reduce suffering, but also to reduce other health problems and the resulting expense and lost productivity.

Kentucky recently allowed private psychologists and social workers to accept Medicaid patients, adding more than 1,000 private mental health providers to the Medicaid list, state officials told Goodnough. Previously, only "quasi-governmental agencies" were approved to treat Medicaid patients in Kentucky.

"But shortfalls in care persist," Goodnough writes, telling several stories of the successes and challenges that people on Medicaid in the Louisville area who now have mental health coverage are facing. One of the people she interviewed is Terri Hall.

Hall suffers from depression and anxiety that "often consumed her," Goodnough writes. Since she got Medicaid coverage, she is now getting therapy for the first time, but she "just wished she could go more often." She tells Goonough that she has had to wait up to seven weeks between appointments at Seven Counties Services. This is a common story among the people Goodnough interviewed.

Another challenge to mental-health access is that many private therapists, like some of their physician counterparts, refuse to accept Medicaid. Medicaid pays, on average, about 66 percent of what Medicare does, and some therapists say "the paperwork takes too much time and the poor — who often experience more violence and trauma than those who are better off — are too challenging to treat," Goodnough reports.

In addition to low reimbursement, private providers struggle when they take on Medicaid patients because they have to wait to be approved by the managed care companies that provide benefits to Medicaid recipients, Goodnough writes.

With nearly one in five Americans having a diagnosable mental illness, according to the Department of Health and Human Services, but most getting no treatment, Goodnough writes, the new health law offers "a big opportunity for mental health providers to reach more people of all income levels," especially the poor in states that have expanded Medicaid.

Health-board smoking bans that Supreme Court struck down are still being obeyed: 'Everybody loves it,' advocate says

By Melissa Patrick
Kentucky Health News

Three counties in Kentucky with unenforceable smoking bans continue to be smoke-free by the people’s choice.

Clark, Madison and Woodford counties have smoking bans that can’t be enforced because they are regulations of county health boards, which the Kentucky Supreme Court ruled in June do not have the power to ban smoking in public places. But officials in each county reported that most of the establishments in these counties continue to be smoke-free by choice.

“We are finding, in general, public spaces and restaurants are still complying with regulations as if it is still enforceable,” said Christie Green, public-information officer for the Madison County Health Department. “It seems as if the general public prefers this.”

In Versailles, the city council “hadn’t heard from one single tax-payer who is opposed to it,” recently resigned city council member Sonny Jones said in an interview before his resignation.

Scott Lockard, director of public health in Clark County, said likewise. “The community has remained smoke free. The public has demanded this, ” he said, and as far as he was aware “No businesses have gone backward in this.”

That doesn’t surprise Ellen Hahn, director for the Kentucky Center for Smoke-Free Policy and the state’s leading smoking-ban advocate. “When communities go smoke free, everybody loves it,” she said.

The anti-smoking regulations can’t be enforced, advocates said. “If enforced, a lawsuit might result,” Lockard said. “We have no active enforcement right now in Clark County.”

The court ruled in a case from Bullitt County, where a local judge had blocked enforcement.

Each of the other counties is handling the issue somewhat differently.

Woodford County, out of “respect for the cities” of Midway and Versailles, will let them determine whether they want to reinstate their previously enacted smoking bans before the county fiscal court makes a decision for the unincorporated area of the county, County Attorney Alan George said, “because the bulk of the affected business is in the city.”

Midway passed a new anti-smoking ordinance Aug. 18 and Versailles plans to hold its first reading on one Sept. 2.

Madison County plans second reading and passage of its smoking ordinance for Sept. 9. Berea is scheduled to do likewise Sept. 2.

Clark County has “no forward actions” or “no ordinance drafted” at this time, Lockard said. Asked if officials are waiting on the Nov. 4 election to move forward, he said that “no one had come out and said the election will play a role,” but he noted that the Winchester mayor and the county judge-executive have opponents.

The Supreme Court ruling was a great disappointment to smoke-free advocates. Betsy Janes, coordinator for Smoke Free Kentucky, said several health boards had been ready to implement smoke-free regulations, but were waiting on the Supreme Court. These plans obviously have had to change.

“It was a major blow, but the good thing is that it is very clear who has the authority to do this now,” Janes said. “Fifty-five percent of Kentuckians want to be smoke free. We are losing 1000 Kentuckians a year to second hand smoke,” based on research that has determined its effects.

While Hahn said the decision was a “step backwards for Kentucky,” she also said her center is “busier than ever” working with fiscal courts to create smoke-free laws on the local level. She said there are 35 city or county ordinances in effect, covering 31 percent of Kentuckians.

The Kentucky Chamber of Commerce supports statewide smoking ban, which has never come to a vote in either chamber of the legislature.

“Twenty-four other states have statewide smoke-free laws and we want to not be the last to join them,” said Ashli Watts, the chamber’s public-affairs manager.

While Clark County is not pursuing a smoke-free ordinance now, the health department is actively educating the public about the benefits of such laws and plans to be a strong advocate to get something passed, Lockard said.

“We are finding overwhelming positive response to smoke-free,” he said. “The Board of Health and health department will work in any way possible to get a law on the books.”

Lockard also voiced his hope that school boards will pass smoke-free policies in schools, which he said should be attainable because no legislation is needed.

“There are 174 school districts in Kentucky and less than 40 of them have smoke-free policies on their campuses,” Lockard said. “If we could have all schools smoke-free, that would have a major impact on our communities.”

Lockard reflected on what Tom Frieden, director of the federal Centers for Disease Control and Prevention, said in his recent visit to Kentucky, that the most important changes Kentuckians need to make to improve their health are to stop smoking, decrease secondhand smoke exposure, and to exercise.

Logan Co. schools work to keep kids and bus drivers hydrated during hot, humid days; here are tips for dealing with heat

With temperatures soaring into the high 90s and the heat index over 100, the new Logan County school superintendent made sure the students and bus drivers were well hydrated last week, O.J. Stapleton reports for the Russellville News Democrat & Leader.

Dr. Kevin Hub and other members of the central office staff delivered bottled water to all schools for students who would be riding buses in the extreme heat, Stapleton writes.

“I think it’s important to recognize that it’s hot and we do not have air conditioning on our school buses,” Hub told Stapleton. “That makes it hard on our drivers and students. This just falls under the category of ‘a good thing to do’ when it comes to taking care of our students and staff.” He said the gesture was appreciated by both the staff and students.

Signs and symptoms of heat exhaustion, according to the Centers for Disease Control and Prevention, are heavy sweating; weakness; cold pale clammy skin; fast, weak pulse; nausea or vomiting; and fainting. The CDC suggests that if someone has these symptoms they should be moved to a cooler location, lie down and loosen their clothing, apply wet, cool cloths to as much of the body as possible, be offered sips of water and seek medical attention immediately vomiting occurs and continues.

The CDC reports the signs and symptoms of heat stroke, a much more serious condition, as: body temperatures above 103 degree Fahrenheit; hot, red, dry or moist skin; rapid and strong pulse; and possible unconsciousness. These symptoms require immediate medical attention. Call 911 immediately, move the person to a cooler environment, reduce the person's body temperature with cool cloths or even a bath and do NOT give fluids.

Prevention is the best way to avoid these heat-related illnesses, Stapleton reports. He offers some suggestions below on how to protect yourself during these extreme temperatures.

Here are some suggestions to prevent heat stroke:

• Drink more fluids, regardless of your activity level.
• Avoid alcoholic beverages and high-sugar beverages as they can cause you to lose more body fluid.
• Don't wait until you are thirsty to drink.
• Seek the advice of your doctor if you have fluid restrictions or are on water pills.
• Avoid very cold drinks as they can cause stomach cramps.
• Stay indoors in an air-conditioned place if possible.
• Go to the mall or the library for some air-conditioned relief if you do not have home access.
• Seek a heat-relief shelter in your area. Contact your local health department for information.
• Fans do not prevent heat-related illness when the temperatures are in the high 90s.
• Take a cool shower or bath.
• Wear lightweight, light-colored, loose-fitting clothes.
• NEVER leave anyone in a closed, parked vehicle.

Every person is at risk of heat-related illnesses in these extreme temperatures, but some people are at greater risk and need to be checked on regularly, Stapleton writes. High risk adults should be checked on at least twice daily and monitored for signs of heat exhaustion or heat stroke. Infants and children need more frequent watching.

Those at high risk of heat-related illness are:

• Infants and young children
• People aged 65 or older
• People who are ill, especially with heart disease or high blood pressure.

Some advice for being outdoors in the heat:

• Limit your outdoor activities to the morning and evening hours.
• Minimize your outdoor exercise.
• Drink two to four glasses of cool, non-alcoholic fluids each hour if you exercise.
• Drink sports beverages to replace the salt and minerals you lose in sweat. Consult your doctor about the use of sports drinks if you are on a low-salt diet.
• Rest often in shady areas.
• Wear a wide-brimmed hat, sunglasses, and sunscreen.

W. Ky. elementaries use Baptist Health grants to join national program to fight childhood obesity; results encouraging

Two more West Kentucky schools have joined Project Fit America, a fitness program that targets childhood obesity, to help its students become more fit, reports The Paducah Sun.

East Calloway County and Calvert City elementary schools are the seventh and eighth schools in the area to win a $16,500 grant from Baptist Health Paducah for indoor and outdoor fitness equipment, teacher training and curriculum material, all included with the Project Fit America program.

"We believe as educators it is our responsibility to help our young population begin healthy lifestyles that will follow them into adulthood," Kathy Crouch, East Calloway principal, told the Sun.

Kentucky ranks eighth in child obesity, and U.S. adult obesity is expected to grow from 30 percent of the population now to 60 percent by 2030.

Benton Elementary, which joined the program only last year, has already documented improvement in students' fitness, showing a a 27 percent increase in cardiovascular endurance, 18 percent increase in upper body strength, 12 percent increase in abdominal strength and a 38 percent increase in students who could perform pull-ups.

Project Fit America is a national non-profit group that has worked with nearly 900 schools in 45 states to motivate students, parents and faculty to choose fitness over sedentary lifestyle habits. (Read More. This article is behind a pay wall.)

Beshear cites examples of health reform's benefits, while McConnell keeps up criticism, at Farm Bureau's ham breakfast

By Al Cross
Kentucky Health News

Democratic Gov. Steve Beshear and Republican U.S. Sen. Mitch McConnell squared off on health-care reform for the second straight year at the Kentucky Farm Bureau Federation's annual Country Ham Breakfast at the Kentucky State Fair last week.

Beshear, who spoke first, noted that a year earlier he had called for politicians to stop "partisan bickering" about the law and told Kentuckians that they didn't have to "like the president or the Congress" to investigate its benefits. "Over half a million Kentuckians took my advice," he said. "Young and old, black and white, singles, families, Democrats, Republicans, city folks, country folks -- you went looking for the facts, and what you found was high-quality, low-cost health insurance."

Beshear noted that Kentucky is second in the nation in the estimated reduction of uninsured population, and gave the reductions in four counties: Christian, from 17 percent to 12 percent; Montgomery, from 18 to 9.5; Laurel, from 18;7 to 10.1; and heavily Republican Monroe, from 21 to 11.5.

He also cited two individual examples: Casey County farmers Frank and Renee McAninch, who couldn't afford insurance but now pay nothing, who skipped doctor visits, ignored health concerns and paid "outrageous out-of-pocket costs;" and Joe Paul Mattingly of Marion County, a state Farm Bureau director who found "cheaper, better insurance" on the state health-insurance exchange.

Beshear said Frank McAninch had skin cancer removed, and Mattingly is not receiving a subsidy but is paying 20 percent less for coverage than before. "As Joe Paul said, he chose to be part of the solution, not part of the problem," Beshear said, adding that critics of the law should do likewise.

McConnell was having none of it. Noting that Beshear didn't use the word "Obamacare," the senator said, "He just doesn't want to say it, and I don't blame him."

McConnell delivered his usual litany about the law -- its cuts in payments to health-care providers, its taxes on medical devices and insurance policies, and the higher premiums, co-payments and deductibles being paid by many people.

Citing a study by the Congressional Budget Office, McConnell said Obamacare “will cost 2.5 million jobs.” The study says the predicted reduction, through 2024, will come “almost entirely because workers will choose to provide less labor,” not because jobs will be eliminated.

As for the Medicaid expansion that is responsible for about three-fourths of the 521,000 people with Kynect coverage, McConnell said, "I do worry about our state government and its ability to meet these commitments in the future."

Beshear has cited studies predicting that the expansion will pay for itself by expanding the health-care industry and creating jobs. Republicans have said they don't believe those predictions but generally have been unwilling to say that the expansion should be ended, which would leave hundreds of thousands of people without coverage. McConnell has said his criticism of the law is "not connected" to the state insurance exchange.

Montgomery County board OKs free meals at most schools

In a microcosm of discussions taking place all over Kentucky and much of America, a divided Montgomery County Board of Education decided Aug. 19 to offer free meals to all children in the county's elementary schools and its Early Learning Center.

By another 3-2 vote, the board defeated a motion to offer free meals at those schools and the county's intermediate school, one of the two options recommended by the district's food-services director.

It did not vote on a much more expensive option of offering free meals at all the county's schools, including Montgomery County High School, or on the other recommended option, to offer the meals at only one elementary and the Early Learning Center. Board Member Sharon Smith-Breiner, who supported the program generally, said she couldn't support singling out one elementary, Tom Marshall reports for the Mount Sterling Advocate.

Board Member Kenny Gulley, who opposed all the options, "told fellow board members that he couldn’t support the decision because it provides free meals to students whose parents have been deemed capable of paying and there is no evidence that they are not being fed," Marshall reports.

Board Member Alice Anderson, who voted yes on both motions, "responded that at least this way the board can ensure that they are fed," Marshall writes. "Smith-Breiner cited as one of the advantages of the move being the potential to boost the school attendance rate and test-score improvement."

Under guidelines of the federal National School Lunch Program, the district must commit for a period for four years with the ability to opt out," Marshall notes. "Food services director Julie Tuttle . . . said the board can reevaluate the success of the program next April."

KET will look Monday night at why lack of sleep is bad for your health, and offer advice on improving sleep quality

We live in a country where a third of adults report that they get less than six hours of sleep a night, which doesn't seem like a big deal until you consider the health risks that are associated with insufficient sleep.

The next edition of KET's "Health Three60" will explore these risks and advise how to improve your sleep quality. The program, "Sleepless in Kentucky," will air Monday at 10 p.m. ET.

Host Renee Shaw and guests will explore links between sleep deprivation and weight gain, diabetes, heart disease, cancer, skin issues, anxiety, concentration skills and impaired motor abilities. They will also look into how screen time (TVs and computers) affects sleep.

The show will discuss sleep apnea, treatments and what to expect in a sleep study. These issues will be examined by Jay McGuire, manager of the University of Louisville Physicians Sleep Center, and Dr. Egambaram Senthilvel, pediatric sleep specialist with University of Louisville Physicians.

The program will also examine how to improve sleeping habits by changing our sleep culture, including discussion about what can be done in schools and the workplace.

Other guests will include Dr. Phillip W. Bale of Glasgow Primary Care; Dr. Barbara Phillips, professor and medical director of the University of Kentucky Sleep Laboratory; and Dr. Mohamed A. Saad, director of the University of Louisville Physicians Sleep Center.

The series is funded in part by the Foundation for a Healthy Kentucky. (Read more.)

Owensboro commissioners drop pre-existing bars from draft of smoking-ban ordinance

The Owensboro City Commission compromised to gain the support of all five members to vote for a smoking ban, which will come up for a vote on Sept. 2, Steve Vied reports for the Owensboro Messenger-Inquirer.

The original draft of the ordinance eliminated smoking in all public places in the city, and was favored narrowly. The compromise allows smoking to continue in establishments that are already in operation and don't allow entry to anyone under 18, thus exempting bars, as a county ordinance does.

"New bars that open after the ordinance goes into effect, whether they allow customers under 18 or not, will not be permitted to have smoking," Mayor Ron Payne said.

"Thank you so much," said Ashley Oberst, an employee of Rocky's Bar and Grill at Ninth and Crittenden streets. "It means more than you know."

"I'm not here to make choices for adults," Commissioner Jeff Sanford said, but if smoking "is around kids, I can't support it."

Payne told the audience at a meeting, "First and foremost, this commission wants to act in unison. We did not want a split vote. No. 2, we have listened to you. You made some good points that we have considered. We all have wrestled with this. This is a toughie. I have three younger brothers, all gone, two from lung cancer."

The new version also deleted regulation of electronic cigarettes. (Read more; this article is behind a paywall)

Grimes and McConnell lay out differences on health reform

By Al Cross and Megan Ingros
Kentucky Health News

U.S. Sen. Mitch McConnell kept attacking federal health-care reform and challenger Alison Lundergan Grimes gave her strongest defense of it yet as the candidates held the closest thing to a debate Wednesday, Aug. 20, at Kentucky Farm Bureau headquarters in Louisville.

Grimes was the most detailed she has been in a public discussion about health-care reform. Grimes indicated that she supports Kynect, the state health-insurance exchange, created by Gov. Steve Beshear and funded by Obamacare, where people sign up for Medicaid or buy insurance.

“For the first time ever, because of our governor, 500,000 Kentuckians are able to go to the doctor, their kids get checkups before school, and many of them are farm families in rural Kentucky,” she said. “The law isn’t perfect but we have to work to fix it. . . . We have to work to streamline the Affordable Care Act, to make sure there aren’t over-burdensome regulations on our businesses, especially our small businesses.”

Grimes endorsed President Obama’s delay in the law’s employer mandate and suggested that he should also live up to his promise that “If you like your doctor, you can keep it.”

She actually appeared to be referring to keeping old insurance policies, because her next words were, “We should be working to extend that grandfathering clause so we live up to that promise that Washington politicians made to Kentuckians. . . . It requires a senator, though, who doesn’t want to repeal root and branch the access to health care that Kentuckians just got for the first time.”

McConnell answered, “She won’t use the words, but she supports Obamacare, he single worst piece of legislation that’s been passed in the last half-century.”  He said Obamacare is going to cost jobs and it “ought to be pulled out root and branch and we ought to start over.”

McConnell said what should have been done is “truly national competition among health-insurance companies to keep prices down and quality up,” as well as “a national medical malpractice standard to bring some sanity to the litigation lottery that’s confronting every health-care provider in America; and thirdly, we need to allow small businesses to form groups for the purpose of more purchasing power on the open market.”

Citing a study by the Congressional Budget Office, McConnell said the law will only cover 10 million of the 40 million people who were uninsured, and will “cost 2.5 million jobs.” The study says the predicted reduction, through 2024, will come “almost entirely because workers will choose to provide less labor,” not because jobs will be eliminated.

McConnell said Kentucky will not be able to afford its expansion of the Medicaid program, which covers about three-fourths of the newly insured. “She applauds it,” he said. “It’s fine for the governor because the first three years the federal government will pick up 100 percent of the tab, but after that, the state’s going to be in serious financial problems.”

Beshear has cited studies showing that the Medicaid expansion will pay for itself by expanding the health-care industry and creating jobs, but Republicans say they are skeptical of that.

A video of the debate is available on the Farm Bureau website, www.kyfb.com, until Sept 20. The specific site is http://new.livestream.com/accounts/7542430/events/3309694.

Hopkinsville paper gives detailed description of federally mandated changes in Christian County school lunches

Five years ago Christian County Public Schools served a dessert with every meal, white rolls, and vegetables with plenty of salt, Margarita Cambest reports for the Kentucky New Era in Hopkinsville.

Shift to 2014: Dessert is considered an occasional treat, fruit is a staple, the rolls are whole grain and there are vegetables galore, with a lot less salt.  Students are adjusting to these changes as school meal programs shift to comply with new federal guidelines, Cambest reports.

“They want to be healthy, but they don’t always want to eat healthy,” Sandra McIntosh, the schools' food service coordinator, told Cambest. “This makes it easier.”

The Healthy, Hunger-free Kids Act, which passed in 2010, initially required schools in the federal meal program to decrease fat and sodium and increase whole grains. This year, strict sodium and calorie limits have taken effect. McIntosh told Cambest that this was the first major change in the program's law in 30 years.

Specifically, fruits and vegetables must be offered, with a choice between two meats, two vegetables and two fruits at each meal, Cambest writes. Whole grains have replaced white bread, and only fat-free or low-fat milk may be served, including chocolate milk. Calorie limits vary between grades, but all students must take at least one serving of fruit or vegetable at breakfast and one of each at lunch.

So what does a typical meal look like?  The New Era sampled lunch at Hopkinsville Middle School and reported a menu of breaded and baked chicken (with or without barbecue sauce), a cheeseburger on a whole-grain bun, or a chef's salad. Green beans, mashed potatoes with gravy, or veggies with low-fat ranch dressing were served on the side, and a choice of a banana or mandarin orange slices rounded out the meal.

“A lot of times, kids aren’t offered this kind of variety at home,” schools spokeswoman Heather Lancaster told Cambest.

This year, all Christian County public-school students are eligible for free meals under the federal Community Eligibility Program, which applies to schools that serve mostly low-income students. The middle school and the district's two high schools were the last in the district to be added to the program, Cambest reports. In the first 10 days of school, the three schools served 1,690 more breakfasts and 595 more lunches than in the same period last year. (Read more; this article is behind a paywall)

Doctors of osteopathy are an increasing answer to the doctor shortage, as more osteopathic medical schools open

Doctors of osteopathy could be part of the solution to Kentucky's well-documented primary care doctor shortage, Laurel Black reports for The Paducah Sun.

"The American Association of Medical Colleges predicts that a growing population of aging people, health insurance expansion, and a freeze on Medicare funding for residency training positions will lead to a physician shortage of more than 90,000 by 2020," Black reports.

Rural areas are expected to be most affected by the shortage of physicians, especially in the area of primary care, Black writes. Kentucky is already experiencing this problem. A presentation at the 2013 Kentucky Rural Medical Educators Conference said Kentucky had a 1,287:1 primary care physician-to-citizen ratio, 557 short of the national average.

Despite this "looming doctor shortage," little attention has been given to osteopathic medicine as a possible solution, Black writes. But enrollment in osteopathic medicine, "which puts a focus on primary care and works to place its doctors in under-served regions," is growing.

"There are a lot of osteopathic schools. It's definitely a growing field," Griffin Bicking, a doctor of osteopathy and a vascular surgeon at Baptist Health Paducah, told Black.

"Graduates in osteopathic medicine have increased by more than 250 percent between 1980 and 2005, according to a study by the medical colleges' association. In 1980, there were 14 schools with fewer than 5,000 students in America; there are now 30 schools with more than 30,000 students," Black reports. "It's estimated that today nearly 30 percent of all medical school graduates are estimated to be doctors of osteopathy," or D.O.s.

The University of Pikeville's Kentucky College of Osteopathic Medicine has graduated more than 800 physicians since its inception in 1997, with 60 percent of these graduates serving primarily in rural healthcare facilities in Eastern Kentucky and other regions of Appalachia, according to its website.

New or relatively new osteopathic medical schools near Kentucky are in Harrogate, Tenn.; Lewisburg, West Virginia; and Blacksburg, Va.  Other adjoining states with such schools include Ohio, Illinois, Indiana and Missouri.

Black reports that the stigma associated with D.O.s is fading as people seek a more holistic approach to their health. She also notes that the most notable difference between D.O.s and a doctor with traditional training is a required 300 to 500 hours of training in osteopathic manipulative treatment. This training, known as OMT, involves the movement of patient's bones and muscles to treat illness and injury and is part of the controversy surrounding D.O.s, Black reports.

However, more than half of D.O.s "used OMT on less than 5 percent of their patients," according to a study reported in Academic Medicine, the journal of the medical colleges' association, Black writes.

"Curriculum-wise, it's pretty much the same," Bradley Albertson, an internist and pediatrician at Mercy Primary Care in Benton, told Black of osteopathic medicine, which also requires four years of training followed by an internship and a residency. "The differences are more political and social."

Albertson opted for a non-osteopathic residency after attending a college of osteopathy for medical school, telling Black it "would add legitimacy to his practice."

And while osteopathic schools try to push primary care, D.O.s can go into any field a traditional doctor can, and it usually pays more to specialize, Black writes.

Albertson told Black that he is not sure that osteopathic schools will be the solution to the predicted patient-doctor gap and suggest it will take a "variety of solutions," including giving nurse practitioners more privileges.

Busy Woodford County girl is one of 20 youth ambassadors in national campaign against childhood obesity

Genna Ringler of Woodford County has been named to the youth advisory board of the Alliance for a Healthier Generation, a national anti-childhood obesity group, John McGary reports for The Woodford Sun.

Geena Ringler, Alliance for a Healthier Generation
youth ambassador (Woodford Sun photo)

"I  see a lot of kids at my school every day.  They want to be healthier, but they don't know how, so I'm hoping that when I serve on the board, and even after that, that I show them ways that they can lead a healthier lifestyle," Ringler told McGary.

The 12-year-old's life is already full.  She peer-tutors children with special needs, teaches special-needs children to swim, runs cross-country, is on the local swim team and enjoys bicycling, McGary reports.  She has also led a fundraiser that generated nearly $2,800 for the Muscular Dystrophy Association, to honor a friend and classmate who passed away.

She applied for the ambassador position in Febuary, was selected in May and was off in July for training in Utah, where she met the 19 other selected ambassadors, received media and interview training, and consulted with the adult ambassadors to develop goals for her project.

"I didn't know that it wasn't just playing video games," she told McGary, referring to the causes of childhood obesity. "It's so much more.  It's your economic background and how your parents raise you ... and all that kind of stuff."

Ringler told McGary that childhood obesity is an epidemic and that "it takes a lot of people to help change one person's lifestyle and I thought that one more person could help make a difference." (Read more) Kentucky ranks eighth nationally in child obesity.

Women leading Ky. Health: With less than 16 months left, Haynes tries to 'bake in' health reform, managed care, more

This is the last in a series of stories about four high-ranking female state officials who have guided the state's embrace of the Patient Protection and Affordable Care Act.

By Melissa Patrick
Kentucky Health News

How does a person create lasting change in an ever-changing political environment? “Bake it in,” says Audrey Tayse Haynes.

Secretary Audrey Haynes

As secretary for the Cabinet for Health and Family Services since 2012, Haynes has led the state's efforts to implement the federal health-reform law, dealt with the controlled chaos that was the transition to managed-care Medicaid and faced controversies in the social-services system. Now, with less than 16 months left in Gov. Steve Beshear's administration, she wants to make big improvements in the state’s behavioral-health system.

“We want to get as much (done) as we can get and we want to get it baked in,” Haynes said, “so hopefully the next person that comes will be as enthusiastic about building on the foundation that we have laid.”

Haynes brought more than 25 years of leadership experience to her job, including appointments under three earlier governors. From 1997 to 2001, she was deputy assistant to President Bill Clinton and director of the Office for Women’s Initiatives and Outreach, then special assistant to Vice President Al Gore and chief of staff for Tipper Gore. For the next decade, she was senior vice president and chief government affairs officer for the YMCA of the USA in Washington, D.C.

  

She says her personal style of leadership – “collaboration, inclusion and transparency” – took her staff a while to get used to, but is paying off with results.

“I’m all about forcing people to work together and trying to figure it out because you get a better product,” she said. “We don’t sign things around here unless it’s been vetted through the agency that it is going to impact. It took a while for people to get used to that.”

At her recommendation, Beshear named Carrie Banahan to run the state insurance exchange, Kynect, which has enrolled 521,000 people and become the nation’s model of how to run a successful exchange.

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“We all collaborate and all work together,” Banahan said in a separate interview. “Audrey has comprised a good team in the cabinet and we support her 100 percent.”

“I couldn’t get a better boss,” Public Health Commissioner Stephanie Mayfield said in a separate interview.  “She is genuinely concerned about not just her employees, but the health of the public.”

Haynes said the expanded access to coverage under health reform will improve the health of Kentuckians and the state's health statistics, something employers consider when choosing sites.

“Kentucky has worked so long and hard on building a better, more educated citizenry, so that we (can) recruit more industry and have a stronger economic development base. I believe that is important,” she said. “But equally as important is that we have healthy employees. … I do believe that our state will see many, many benefits from this.”

Health reform has been the most controversial domestic issue of the last few years, but for many people in the health-care industry, there has been more tooth-gnashing over the managed-care Medicaid system that began several months before Haynes became secretary.

Managed care, in which insurance-company subsidiaries get a certain sum per patient and increase their profits by controlling costs, “has not been a walk in the park to implement,” Haynes acknowledged. Providers have complained about slow payment and rejection of claims, and one managed-care firm left Kentucky, saying the state gave it misleading financial information.

She said all involved had to “stop, take a breath and stop screaming long enough to sit down and honestly work through the problems. . . . We have just forced people to the table month in and month out to work out these issues.”

Haynes began collaboration with providers and managed-care firms, and held public forums for all stakeholders to ask questions and get answers. It recently started a second round of forums, and she says things are much calmer now, almost three years after managed care began.

“Our first series of forums for health providers were so successful in opening the lines of communication and making connections that allow us to work better together,” she said in a press release. “We decided to not only repeat but expand the scope of the forums this year, bringing new topics to the forefront like behavioral health, which is particularly timely due to improved access allowed by the Affordable Care Act.”

The next big frontier in managed care is integrating behavioral health with physical health, she said. Noting that more behavioral-health providers are now eligible to receive Medicaid reimbursements, she said that increases accountability toward better outcomes for such patients.

Haynes has little more than a  year left to “bake it in,” because Beshear cannot seek re-election. She acknowledges that the changes in health care are “turning people’s worlds upside down.”

“There are a lot of changes going on, and they are not going to be able to just move on a dime,” she said. “So we have to be able to push, cajole, be patient, teach and then repeat all of that constantly.”

Women leading Kentucky health: State health commissioner sees 'stars aligned' for Kentucky to finally get healthier

Health Commissioner Stephanie Mayfield Gibson

This is the third in a series of stories about four high-ranking female state officials who have guided the state's embrace of the Patient Protection and Affordable Care Act.

By Melissa Patrick

Kentucky Health News

“The stars have aligned” and Kentucky has at last “created an infrastructure” to make the state healthier, says Dr. Stephanie Mayfield Gibson, commissioner of the state Department for Public Health.

“What a great time to be in my position,” Mayfield said in an interview, in which she enthusiastically ticked off a list of aligned stars:

• Her bosses, including the governor and lieutenant governor, who are “extraordinarily supportive of health care;”
• The expansion of the federal-state Medicaid program to households with incomes up to 138 percent of the federal poverty level;
• The Kentucky Health Benefits Exchange, branded as Kynect, where Kentuckians sign up for Medicaid or subsidized private insurance;
• The Kentucky Health Information Exchange, an electronic network that makes a wide range of health information easily available; and
• Programs that enhance the quality of care to get better outcomes and decrease costs, such as the programs to stop over-use of emergency rooms.

Mayfield says her top priority is to decrease exposure to tobacco, because so many of Kentucky’s health issues are related to its most famous crop. About 28 percent of Kentuckians smoke, and “The single most important factor that negatively impacts the health of the commonwealth . . . is exposure to tobacco smoke,” Mayfield said. “I want people well.”

She said Kentucky must also address the epidemic of painkiller abuse, which has made it one of the top three states in deaths related to abuse of opioids; and obesity, which is connected to cancer, diabetes and cardiovascular disease. Kentucky ranks in the top five in each of those diseases, and is in the top 10 for child and adult obesity.  

“Who wants the reputation for being number one in cancer deaths?” Mayfield asked. “We know we can do better. These are winnable battles.”

These and other issues are included in Kentucky Health Now, a plan Gov. Steve Beshear has set forth to improve the health of Kentuckians, with specific goals to be reached by 2019, the end of the next gubernatorial term. Beshear’s term ends in December 2015.

Mayfield is vice-chair of the team overseeing the effort, led by Lt. Gov. Jerry Abramson.  She seems to have the full confidence of Audrey Haynes, the secretary of the Cabinet for Health and Family Services, who lit up when asked about her, but Haynes said she had to make sure that Mayfield, a pathologist who ran the state health lab for seven years, was cut out to be the state’s top doctor.

“It’s a job where … you have to kind of have a better understanding of politics,” Haynes said.  “But I wanted her to rise above all that because she is the public health commissioner. Hers is more about the science.  I need her to be honest and tell the truth.”

Haynes said she told Mayfield, “You are going to tell people what they don’t want to hear sometimes, but always stick with science.  You have to rise above the rhetoric, no matter what.”

“And so I recommended her to the governor and they also fell in love with her.” She became commissioner on Oct. 1, 2012.

Kentucky’s health problems have mounted for decades, but Mayfield is optimistic that they can be overcome because of the Medicaid expansion and increased access to health insurance under the federal health-reform law. Thousands of people have sought care for problems that went untreated because they had little or no money or no insurance.

The federal government is paying the entire cost of those newly eligible for Medicaid until 2017, when the state will begin paying 3 percent, rising to the law’s cap of 20 percent in 2020.  Republican legislators and candidates for governor have voiced concern about the state’s ability to pay its Medicaid bills.

Mayfield said the state is working on controlling costs, through the managed-care system that began in 2011.  One target of cost control is the “super-utilizers” of emergency rooms, or those who come to hospital emergency departments 10 or more times per month.

Mayfield, who was put in charge of finding a way to reduce super-utilizers, said 80 percent of them have mental-health issues, so she is working on the problem with Medicare, the state Department of Behavioral Health and Kentucky’s three medical schools. Kentucky is one of six states accepted into the National Governors Association Policy Academy to address super-utilization.

Dr. William Hacker, who preceded Mayfield as commissioner, said her broad training and deep experience in the department uniquely qualified her to succeed Dr. Steve Davis, who was interim commissioner after Hacker retired.

“She is multidisciplinary and thinks beyond the public-health world,” Hacker said. “She has done an excellent job.”

Mayfield, who has been nationally recognized for her contributions to the state’s electronic health information exchange, also stresses the importance of using technology to improve the health of Kentuckians – especially those who live in rural areas, far from specialists.

Mayfield describes her style of leadership as one of action.  “If we say we are going to do something, then let’s build that infrastructure and let’s get it done,” she said.

Hacker said, “Dr. Mayfield is a thoroughbred.  She is on the go at 90 miles per hour.  She is focused on accomplishing goals.”

Haynes said Mayfield “led massive change at the lab” and knows “how to cajole and support and lead” – and when to be firm. “There are times you have to stick to your guns. You have to choose sort of your poison and you have to say ‘I’ll give you this, but I’m not giving this.’ I needed somebody that didn’t feel the political pressure to give in, and that would stick with it. And really just be a great public face of public health.  And she is all of that.”

Fort Thomas joins other wealthy school districts in U.S. that have dropped federal school-lunch program

The wealthy Fort Thomas school district in Northern Kentucky is dropping out of the federal school-lunch program because "Kids didn't like their healthful lunches," Jessica Brown reports for The Cincinnati Enquirer.

"The 2,800-student district joins a small but growing number of school districts across the country – mostly wealthy districts who can afford to forfeit the money – who have dropped out of the federal program in the wake of stricter nutritional standards," Brown writes. "Schools said students don't like the unsalted potatoes, low-fat cheese or the mandatory fruits and vegetables. They throw food away or decide not to eat at all."

Forsaking federal funding will cost the district an estimated $260,000 a year, Brown reports. "Children who get free or reduced-price lunches – about 17 percent of the student body – will still get them at that price." (Read more)

UPDATE, Aug. 25: About 150 school districts nationwide have withdrawn from the federal program, Bloomberg BusinessWeek reports.

Women Leading Kentucky Health: Insurance Commissioner Sharon Clark is key player in making health-reform law work

This is the second in a series, Women Leading Kentucky Health, of stories about four high-ranking female state officials who have guided the state's embrace of the Patient Protection and Affordable Care Act.

By Melissa Patrick
Kentucky Health News

The day after the Patient Protection and Affordable Care Act was signed into law, a reporter called the state Department of Insurance and asked what it all meant. The reply? People in the agency had to read it first – all 2,700 pages of it, Commissioner Sharon P. Clark recalled.

Commissioner Sharon P. Clark

“We hit the ground running on March 24, 2010 and have continued since then,” Clark said in an interview. “It has been a lot of strain on the resources here and people’s time just to get a grasp of it. I am not exaggerating when I say there have been thousands of hours involved with it.”

Clark’s department is not in the Cabinet for Health and Family Services, but she is chair of the 19-member advisory board for Kynect, the brand the state uses for the health-insurance exchange Gov. Steve Beshear created under the law.

That strategic appointment was made by Cabinet Secretary Audrey Haynes, who said she realized early on how important it was to have the Insurance Department “at the table.” Haynes said the committee has had a “united front” since the beginning.

Clark attributes the success of Kynect, which has enrolled 521,000 people in health coverage, to collaboration and communication. “Everybody has just had to roll up our sleeves,” she said. “It has been the governor’s expectation that we work together and we get the job done. I don’t think any of us ever had any hesitancy with it.”

Clark, who was the Insurance Department’s director of consumer protection and education from 1998 to 2003, has seen the disruption and disasters that can happen to people without health insurance.

“I can’t tell you how much financial devastation there has been for people that did not have insurance coverage,” she said. They “have had, due to medical conditions, had to file for bankruptcy. … . I think anything that gives people the opportunity to get insurance has a significant impact on their lives.”

But the reform law and its implementation have been controversial, and Clark said, “The times continue to be challenging.”

One of the early challenges was making sure everyone was on board. Clark said it was important to the committee to make sure all stakeholders, such as hospitals, insurance agents and companies, doctors and the Kentucky Chamber of Commerce, were able to offer input and be involved in the process.

“The first collective voice was that Kentucky needed its own exchange” for people to sign up for health insurance or Medicaid, Clark said. She laughed and said, “I have been involved in government for over 20 years and it is rare that you get everybody saying the same thing.”

A more recent challenge has been President Obama’s decisions to allow states to extend existing health-insurance policies that don’t meet the requirements of the law for two more years, or policy years beginning on or before Oct. 1, 2016. Beshear allowed insurance companies to make such extensions.

Clark said the extensions created confusion in the marketplace. She said it is difficult for insurance companies to make such changes in mid-stream, because policy and technology systems have already been put in place toward compliance with the law.

The department’s major role in the new system is approving insurance companies’ rates, policies and forms. “We must approve the product or there is nothing out there to be sold,” Clark said.

Clark, like Beshear a longtime Democratic Party activist, says insuring Kentuckians will not only improve their health, but to also make a difference in their lives. “Health care is for all of us,” she said. “It is for all of us, society as a whole.”

Poll: Kynect considered a success, but voters haven't embraced it, and they still disapprove of the Affordable Care Act

By Al Cross
Kentucky Health News

A new poll again indicates that Kentuckians marginally approve of the state health-insurance exchange created under the federal health-reform law, but clearly disapprove of the law itself.

The poll, taken Aug. 7-10, surveyed Kentuckians who said they were likely to vote in the Nov. 4 election for the U.S. Senate. After questions about the Senate race, President Obama and the 2015 governor's race, would-be voters were asked, "Do you approve or disapprove of the Affordable Care Act?" then "Do you approve or disapprove of Kynect?" The terms were not defined; the Patient Protection and Affordable Care Act is widely known as Obamacare, so opinion of the president influences opinion of the law.

Fifty-one percent said they disapproved of the law, while 34 percent said they approved and 14 percent said they were not sure. But regarding Kynect, the brand for the insurance exchange, 34 percent said they approved, 27 percent said they disapproved and 40 percent said they weren't sure. The poll's error margin, which applies to each figure, was plus or minus 3.1 percentage points.

The more liberal voters were, the more likely they were to approve of the reform law and the insurance exchange. Among moderate voters, 47 percent approved of both, while 36 percent disapproved of the law and only 17 percent disapproved of Kynect. The remainders were undecided.

Women and Democrats were more likely to approve of both measures. Independents disapproved of the reform law more strongly than Republicans did, and were evenly divided about Kynect, but they were only 10 percent of the total, so the error margin for their results is almost 10 percentage points.

When asked about "implementation of the Affordable Care Act," 41 percent of self-described likely voters said it has been very successful or somewhat successful, while 54 percent said it had been very or somewhat unsuccessful. Six percent were undecided. The detailed percentages were: very successful, 15 percent; somewhat successful, 26 percent; somewhat unsuccessful, 20 percent; and very unsuccessful, 34 percent.

Asked about "implementation of Kynect," 21 percent said it has been very successful and 24 percent said it has been somewhat succcessful, for a total of 45 percent. Sixteen percent said it has been somewhat unsuccessful and 13 percent said it has been very successful, for a total of 29 percent. The other 26 percent said they were not sure.

The survey was taken by Public Policy Polling, a North Carolina firm that usually polls for Democrats but produces results that have leaned only slightly Democratic. Eighty percent of the respondents were contacted by an automated telephone call and 20 percent were contacted through the Internet. The online respondents were more likely to approve of the law and Kynect. The main poll results are at http://www.publicpolicypolling.com/main/2014/08/mcconnell-leading-in-re-election-bid.html#more and the details are at http://www.publicpolicypolling.com/pdf/2014/PPP_Release_KY_8121205.pdf.

Nationally, opinions about the reform law "have been locked in partisan stasis, occasionally moving slightly up and down," since it was enacted in March 2010, Kaiser Family Foundation President Drew Altman writes for The Wall Street Journal., citing the foundation's polling. Altman adds that opinions of the law "are stuck in neutral because the law is a proxy for people’s feelings about the president and the direction of the country, which are similarly divided along partisan lines. For many voters, it is almost impossible to tell where opinion on Obamacare ends and opinion on its namesake begins." Obama is unpopular in Kentucky, getting a 32 percent job-approval rating in the latest public, statewide poll.

Fayette County Board of Health wants to regulate electronic cigarettes, raising some questions

The Lexington-Fayette County Board of Health is discussing ways to restrict the use of electronic cigarettes in public places and strategies to inform people about their potential dangers, Mary Meehan writes for the Lexington Herald-Leader. This continues not only the debate about whether or not e-cigarettes should be regulated the same way as traditional tobacco products but also how much power health boards may have in such matters.

E-cigarettes are battery-powered, and the liquid nicotine turns to vapor that can be inhaled. Though they don't contain tobacco, nicotine is sometimes used as a pesticide and can be harmful to humans as well. The General Assembly recently passed a law regulating e-cigarette sales, making them illegal to minors. The Danville City Commission has already banned the indoor use of e-cigarettes. “The state now classifies them as a tobacco product. What makes them different? By our ordinance, there is no distinction,” City Manager Ron Scott said.

Sometimes advertisements make it seem as though e-cigarettes are a safe alternative to traditional smoking, Meehan writes. Fayette Health Board Chairman Scott White, an attorney, noted that some e-cigarette flavors, such as bubble gum, target children. "If marketing a deadly product to children isn't evil, I don't know what is," he said. "We have enough history with the tobacco industry to know we need to get ahead of this."

Some think e-cigarettes can help people quit smoking, but that hasn't been proven. More research is still needed. Also, even if e-cigarettes help some people quit smoking, they may be a "gateway drug" to others.

The board may change "Lexington's current smoking ban to include e-cigarettes" and create "a public education campaign," Meehan reports. It's unclear how the board would do that, since the ban was passed by the Urban County Council. Also, the state Supreme Court recently ruled that health boards couldn't pass smoking bans, and it's unclear whether that decision would come into play.

Ellen Hahn, director of Kentucky Center for Smoke-Free Policy, told Meehan it would be best to "include electronic cigarettes in smoke-free laws because they are a tobacco product, and they pollute the air," Meehan writes. "E-cigarettes give off tiny particles that can lodge in the lungs and cause disease."

Though public health departments are helping reduce smoking rates in Kentucky, the "rates remain high, with about 29 percent of adults smoking and approximately 18 percent of people younger than 18," Meehan reports. "The state has also reported a leap in nicotine poisonings, and that leap has been tied to e-cigarettes." (Read more)

UK researchers find surprising differences in teens' concussion symptoms and physical and emotional effects

University of Kentucky researchers have discovered surprising differences in symptoms student athletes experience following a concussion, a particular concern as high-school football season nears.

Lisa Koehl, a doctoral candidate in the university's Department of Psychology, and Dan Han, director of the Multidisciplinary Concussion Program at UK HealthCare, drew from a UK database of patients with brain injury and drew a sample of 37 athletes aged 12 to 17.

Koehl said in a press release that 22 of the 37 participants had emotional symptoms after suffering concussions. Among those with such symptoms, 23 percent also had sensitivity to light, while 14 percent had sensitivity to noise. Of the teens who did not have emotional symptoms, 13 percent had light sensitivity, but none of them had noise sensitivity.

Han said said participants who reported anxiety were 55 percent more inclined to have attention difficulties than those who didn't report anxiety. Teens who were irritable or aggressive were 35 percent more likely to report issues with attention those those who were not irritable.

The two groups did not show differences in how many experienced "loss of consciousness, amnesia, nausea and/or headaches, indicating that the groups were likely comparable in the level of the severity of concussion," the press release says.

Koehl said the research helped them understand how physical and emotional symptoms in concussion patients interact, with each causing the other in different cases. "Identifying factors that affect a teen's experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school during recovery," Han said. (Read more)