Only 1/4 of estimated number eligible for subsidized, private health insurance through Kynect have signed up for it

While 85,000 people are covered by private health plans through Kynect, that's only one-fourth of the 340,000 that state officials estimated would be able to buy subsidized coverage through the state insurance exchange. That "underscores some of the challenges" of the federal health-reform law, Abby Goodnough reports for The New York Times, in the latest of series of stories using Kentucky as a bellwether for Obamacare.

"People earning between 138 and 400 percent of the poverty level — between about $16,000 and $47,000 for a single person — can get subsidies to help with the cost," Goodnough explains. "Even with that incentive, only about 76,000 Kentuckians signed up for these plans in 2014 and have renewed the coverage for next year. Since the enrollment period for 2015 began on Nov. 15, an additional 9,000 people have selected exchange plans."

2015 is the first year taxpayers will have to report on tax returns whether they had health insurance in the prior year. Unless they qualify for one of about 30 exemptions, mostly involving financial hardships, the health-reform law requires them to pay a penalty: $95 per adult and $47.50 per child, or 1 percent of the family’s modified adjusted gross income that is over the threshold the requires it to file a tax return. The penalties will increase next year, but for most people will remain below the cost of insurance, so many are expected to pay a penalty.

Kentucky is considered one of 13 states where people in the individual insurance market are better off under Obamacare than they were before, and compares well with other states, so why are so few getting coverage? "National polls have found that many people simply consider the exchange plans unaffordable, even with subsidies," Goodnough notes. Several thousand Kentuckians signed up for coverage but didn't pay the premiums.

David Elson gets dialysis. (NYT photo by William DeShazer)

One was David Elson, who "decided he could not afford the $350 monthly premium for a plan that included his doctors," Goodnough reports. "His poor health got worse, and in October, he landed in the hospital with end-stage kidney disease."

That enabled him to get special Medicare coverage for dialysis. But Elson, 61, of Louisville, told Goodnough, “The president gets up there and says, ‘We’ve got to get affordable health care for our people. It’s not.”

While Kentucky's private-plan enrollment is probably more modest than most states because it has more people living in near-poverty, the unwillingness of the near-poor to spend money on health insurance — something many of them have never or rarely done — may be the greatest long-term challenge to the new health-insurance system.

"Supporters say the private insurance exchanges will need robust business, including young and healthy customers that help balance the cost of sicker ones, to thrive," Goodnough notes. But her story also looks at people like Amanda Mayhew, 38, of Louisville, whose income is low enough for her to get free Medicaid coverage: "She has been to the dentist five times to begin salvaging her neglected teeth, has had a dermatologist remove a mole and has gotten medication for her depression."

Kentuckians with health insurance are more likely to have heard about Kynect than those without insurance, poll finds

The 10 percent of Kentuckians who remain without health insurance are less likely to have heard much about Kynect, the state health-insurance exchange created under the federal health-reform law, than those who have insurance.

But overall, the uninsured are only a little less likely than all Kentucky adults to have heard anything about the online marketplace, according to the latest Kentucky Health Issues Poll. The survey, taken Oct. 8 through Nov. 6, found that 77 percent of Kentucky adults said they had heard about Kynect. Among the uninsured, the figure was 70 percent.

However, the uninsured were much less likely to say they had heard "a lot" or "some" about Kynect, and more likely to say they had heard "only a little." And only 17 percent of the uninsured said they had tried to get more information about Kynect, suggesting that efforts to reach the uninsured to get them to sign up for coverage have not reached a substantial part of the population the exchange was designed to serve.

Kynect can be used to sign up for private health insurance or the federal-state Medicaid program, which the state has expanded to include people in households with annual incomes up to 138 percent of the federal poverty level, which in 2013 was $32,500 for a family of four. Among Kentucky adults with such incomes, 19 percent said they had sought more information about Kynect.

The poll was conducted by the Institute for Policy Research at the University of Cincinnati for the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati. It interviewed 1,597 adults throughout Kentucky, 1,086 by landline telephone and 511 by cellphone. In 95 of 100 cases, the statewide estimates will be accurate to ± 2.5 percent. The error margin for smaller samples is larger. For details about the poll, go to www.interactforhealth.org/kentucky-health-issues-poll.

U.S. study finds Medicaid patients may have hard time finding doctor; half not taking new patients or not at given location

By Melissa Patrick
Kentucky Health News

The expansion of Medicaid in Kentucky and other states under federal health reform has provided more people than ever with health coverage, but finding a doctor who will accept Medicaid patients could be a problem, a study has concluded.

The inspector general of the U.S. Department of Health and Human Services found that half the doctors who are supposed to see Medicaid patients either aren't taking new patients or couldn't be found at their last known address.

Kentucky has not received "many such complaints" from Medicaid participants saying they could not find a doctor, but they're in a clear minority, Gwenda Bond, spokeswoman for the state's Cabinet for Health and Family Services, said in an e-mail.

"We survey Medicaid members annually and they report a high (approximately 90 percent) satisfaction rate with finding a doctor," Bond said. She noted that customer-service lines of Medicaid managed-care organizations "can help members find doctors and new members are also assisted with finding a physician when they sign up."

As of Nov. 1, more than 1.2 million Kentuckians were on Medicaid, including 358,703 who were newly eligible because of the expansion under the Patient Protection and Affordable Care Act. Approximately 20,000 more adults who had been eligible but never enrolled are now on the program, presumably because of publicity about the expansion.

Cabinet for Health and Family Services spreadsheet

Kentucky's directory of physicians who accept Medicaid is updated monthly, but it does not indicate those who are not taking new patients, Bond said. As of December, the directory listed 14,593 physicians; 1,835 physician groups; 3,470 advanced registered nurse practitioners; 615 ARNP groups; 810 physician assistants; and 204 PA groups. The list does not include specialists.

In the federal study, 8 percent of the doctors located in the survey participated in Medicaid but were not accepting new patients. Another 8 percent who were found at the locations listed said they did not participate.

The study was based on phone calls to a stratified random sample of 1,800 doctors listed by health plans under contract with Medicaid in 32 states. It found that 35 percent of the providers could not be found at the location listed by a Medicaid managed-care plan.

“In these cases, callers were sometimes told that the practice had never heard of the provider, or that the provider had practiced at the location in the past but had retired or left the practice. Some providers had left months or even years before the time of the call," the study report says.

“When providers listed as participating in a plan cannot offer appointments, it may create a significant obstacle for an enrollee seeking care,” the report says. “Moreover, it raises questions about the adequacy of provider networks. It suggests that the actual size of provider networks may be considerably smaller than what is presented by Medicaid managed-care plans.”

The study also found long wait times for the doctors who accepted Medicaid patients.

The median wait time was two weeks for providers who offered appointments, but more than one-fourth of providers had wait times of more than a month and 10 percent had waits longer than two months. Specialists were more likely to offer appointments than primary-care providers, but had a median wait time of 20 days.

The study recommended that the Centers for Medicare & Medicaid Services assure that each state's provider network is accurate and adequate, and to make sure that states are complying with the existing state standards for wait times. CMS agreed with these recommendations.

Beshear says Medicaid expansion is creating thousands of health-care jobs, but study will look at state's future costs

Gov. Steve Beshear says the expansion of Medicaid in Kentucky under federal health reform appears to be creating thousands of health-care jobs, as predicted in a study that he used to justify his decision, he said in a special "One to One" on KET Friday, Dec. 26.

The study by the PriceWaterhouse Coopers accounting firm and the Urban Institute at the University of Louisville predicted that the expansion would put add $15 billion and 17,000 jobs to Kentucky's economy in the first eight years. "They said, Governor, you can't afford not to to do this," Beshear told interviewer Bill Goodman.

Cabinet for Health and Family Services graphic

However, the cost will be greater because Medicaid enrollments under the expansion have been more than double what was expected in the first year, raising the amount that the next governor will have to pay. In the first three years, the federal government is paying 100 percent of the expansion's cost; in 2017, it will pay 95 percent, and that figure will gradually drop to the reform law's floor of 90 percent in 2020.

"We're going to have an outside source go back to look at it again," Beshear said. "There's about 11,000 more jobs in the health-care industry and administrative support for the health-care industry than there was just a year ago, so that seems to be proving out." He added, "Where better to spend the state's money than to get a healthy population, a healthy workforce, and education?"

Governor renews call for statewide smoking ban; Courier-Journal hammers on the issue with a series of articles

Pressure for passage a statewide smoking ban in the legislative session that begins Jan. 6 is increasing, with recent statements by Gov. Steve Beshear and a package of articles in Kentucky's largest newspaper.

Bill Goodman and Gov. Steve Beshear

Beshear said on a special edition of KET's "One to One" Friday night and Sunday that a statewide smoke-free law would spur economic development in Kentucky by making its workforce more productive and employees' health less a burden for employers.

"A productive workforce depends on a healthy workforce," Beshear said. "We can't attract business and jobs unless we show them we've got a healthy workforce."

He said federal health reform "gave us an opportunity to get our people healthy" by expanding Medicaid coverage. "We've got all that moving in the right direction, but so much of our statistics comes out of smoking. . . . We've got to attack that particular cause."

Beshear said he smoked in college and "I understand the issue, but we've just got to get people healthier and get them off cigarettes." He said that is one reason he banned smoking on most state properties.

Asked what he would say to those who say smoking bans should be local issue, he said, "It's very simple. Those health statistics are statewide. They're horrible. This is an issue that costs you and me and every Kentuckian a whole lot of tax money," so a ban would "be to everybody's benefit."

The same point was made in The Courier-Journal by editorial writer Deborah Yetter, who wrote in a column, "The financial toll in medical costs statewide is staggering — about $1.9 billion a year. The emotional costs of disease, suffering and death are incalculable. Yet Kentucky has failed to adopt proven measures to cut smoking and improve health, particularly among youths. . . . It's the smoke-free law that appears to be getting the most traction as supporters regroup to fight for a law in a state where nearly 1,000 people die each year from exposure to someone else's cigarette smoke."

The Louisville newspaper's opinion section has been packed with smoking-ban articles lately, including op-eds from a mother who lost her son to complications from asthma, an entertainer who no longer sings due to damage to her lungs from secondhand smoke, the House sponsor of the bill, the president of the Kentucky Hospital Association, and the president of the Kentucky Chamber of Commerce, both of which support a smoke-free law.

The paper's Sunday editorial noted, "In a state where more than one in four adults smoke, it's not hard to run into unwanted cigarette smoke unless citizens are fortunate enough to live in one of 23 Kentucky communities that already have adopted local smoke-free laws, including Louisville and Lexington." But it said a smoking ban should be followed by a higher cigarette tax "and putting far more money into public education programs to help people stop smoking and keep young people from ever starting. . . . Kentucky ranks 39th in the amount of money it puts into smoking cessation and education programs."

Liberty City Council rescinds smoking ban that had passed with mayor's tie-breaking vote weeks earlier

Liberty city council members voted 5-1 to repeal a city-wide smoking ban in public buildings that was passed narrowly in November. The law was to go into effect Jan. 1, Larry Rowell reports for The Casey County News.

The ban had passed in November when Mayor Steve Sweeney cast the deciding vote because the council was split 2-2. Two council members were absent at the meeting, Rowell reports in a separate article.

A special meeting was called Dec. 17 for first reading of an ordinance to to rescind the ban and a new restaurant tax; both passed on second reading Dec. 22, but Sweeney vetoed the restaurant measure, which passed 4-2. He could not veto the smoking measure because it passed 5-1. Council Member Brian Beeler stood by his original vote for the ban, but Member Andy Lawhorn switched to oppose it.

“I stand by what I voted for,” said Lawhorn, who lost the November election for mayor to Council Member Steven Brown. “We sit here and say that second hand smoke is not harmful. I smoke. If we can actually say it's not harmful to us or other people and 'other people' being the key word, we're in denial. That's just a fact.” But he said he changed his vote because of public opinion.

“I've heard a lot of outpouring conversations from the public that's come to me that was against it. And I feel that maybe I voted my conscience and what I believe kind of before I got any feedback, good quality feedback, from the public on what they wanted,” Lawhorn said.

Several Liberty residents attended the meeting and voiced their opinions about the issue, Rowell reports. One woman whose husband died from complications of smoking said public places should be made safe, and Jelaine Harlow, a health educator from the Lake Cumberland District Health Department, said it's a public health issue, much like keeping sewage out of water supplies.

But County Attorney Tom Weddle, a smoker, objected that the ordinance would not allow him to smoke in his office after hours, when no one else is around. Councilman Doug Johnson, a non-smoker who has made two businesses smoke-free, agreed with Weddle and said to people who don't like secondhand smoke, “You should boycott that place until they yield to no smoking but we should not mandate that to the owner. If we mandate that, we can mandate anything. It’s their personal space, they own it even though it’s open to the public. It is privately owned.”

Studies have found that 65 percent of Kentuckians support banning smoking in indoor public places, but despite this support only 23 Kentucky communities have smoke-free policies that cover all workplaces and enclosed public places, according to the Smoke-Free Kentucky website. This breaks down to 32 percent of Kentuckians covered by strong local smoke-free laws.

Holiday stress can make former smokers relapse; here are ways to keep that from happening

People often smoke when they are stressed, and despite the famous holiday song that claims "It's The Most Wonderful Time of the Year," the season often brings stress that makes many former smokers relapse.

Smoking doesn't really relieve stress, even though many smokers believe it does, The Cleveland Clinic says on its website. In fact, it actually causes a great deal of stress to the body.

The reason smokers think it relieves stress is because nicotine, the mood-altering drug in tobacco, causes the body to release a chemical called dopamine, which creates an initial sense of calm in the body. It also makes the body crave this sensation again and again. "This is a cruel illusion," says the website, because even though the body feels calm, it is really under a great deal of stress. Blood pressure and heart rate increase, muscles become tense, blood vessels constrict and less oxygen is available to the body when you smoke.

Kentucky has many former smokers; 26.5 percent of adults in the state smoke, down from 29 percent two years ago, according to America's Health Rankings. The NYU Langone Medical Center offers these tips to help those who have quit stay smoke-free:

• Remind yourself of the reasons you quit in the first place. Write down the top three reasons you quit smoking and put them somewhere you can see daily.
• Make an action plan for how you are going to handle your holiday triggers. Have a plan for every trigger.
• If you feel the urge to smoke, don’t give in, and remember the 5Ds: Delay. Drink water. Do something else. Deep breathe. Discuss feelings with a friend or family member.
• Reward yourself for staying tobacco-free.

If you relapse, take the immediate steps to get help. Talk to your health-care provider about nicotine replacement therapy. Quit Now Kentucky also offers one-on-one counseling for tobacco users who are ready to quit using tobacco products, call 1-800-784-8669.

Tips on getting around or through the 'holiday blahs'

The holidays are supposed to be the happiest time of the year, but for many it is a time of sadness and anxiety, Sarah Elizabeth Richards writes for the Daily Burn.

"There's so much emphasis on family and celebration, but it's hard if you're dealing with difficult memories or reminders that you're not close to your family,"  Sharon Melnick, author of Success Under Stress: Powerful Tools for Staying Calm, Confident and Productive When the Pressure's On, said, writes Richards. "It can feel like there's a big gap between what other people are experiencing and what you're experiencing."

Not only do holidays provide normal stresses like added financial burdens, gift giving and family and social expectations, add in cold weather and a lack of sunlight and you have created perfect conditions for a "world-class funk," she writes.

But there is a difference between seasonal affective disorder (SAD), which is estimated to affect up to 20 percent of Americans and the "holiday blahs," Richards notes.

"It's important not to classify all winter doldrums as SAD," Sarah Eckfeldt, a psychotherapist in New York City, told Richards. "Many people experience a drop in mood in anticipation of the holidays because they might be sad over a recent breakup or spending the first holiday after the death of a loved one and could benefit from talking to a therapist."

The good news is that the "holiday blahs" tend to go away after the season is over. Richards offers some tips to survive the season if you find yourself with a case of these "blahs."

• Seek social support. Make plans with a small group of friends, put a few events on your calendar to look forward to or explore a new activity that you have been interested in.
• Get to the gym. Make yourself go, even if you don't feel like it.
• Don't look at Facebook. Connect with your friends via phone or text message, talking only to the people who will lift you up.
• Reframe your thinking. Find opportunities to volunteer. Spend time doing what you enjoy.
• Remember that the holiday season will soon pass, You just have to make it to Jan. 2 and the season will be over.

"If you struggle with serious and continuous depressive symptoms, be sure to reach out to a healthcare provider to discuss your condition," Richards writes.

Study finds students with heavy fast-food diets have test scores about 20% lower than those who don't east fast food

Eating fast food may cause lower test scores in school, says a recent study of U.S. school children.

The study, published online in the journal Clinical Pediatrics, found that "The more frequently children reported eating fast food in fifth grade, the lower their growth in reading, math and science test scores by the time they reached eighth grade," says an Ohio State University news release.

Specifically, the study found that children who ate fast food four to six times per week, or every day, had test-score gains in all three achievement areas that were about 20 percent less than those of children who did not eat any fast food in the week before the survey.

“There’s a lot of evidence that fast-food consumption is linked to childhood obesity, but the problems don’t end there,” said Kelly Purtell, lead author of the study and assistant professor of human sciences at Ohio State. “Relying too much on fast food could hurt how well children do in the classroom.”

The study included 11,740 students who were tested in reading/literacy, mathematics and science in both fifth and eighth grades. They were also given a food consumption questionnaire in fifth grade.

The researchers tried to accounted for many other reasons that might have influenced the results, including how much children exercised, how much television they watched, what other foods they ate, their family’s socioeconomic status, and characteristics of their neighborhood and school, according to the release.

While this study establishes a correlation between fast-food consumption and lower grades, it does not establish the cause of lower grades. However, Purtell said she and the other authors are "confident fast food explains some of the difference in achievement gains over time."

Other studies have suggested that it may be related to a lack of nutrients found in fast food, such as iron, and another study suggests that diets high in fat and sugar, found in most fast food, hurt immediate memory and learning processes, the news release says.

“We’re not saying that parents should never feed their children fast food, but these results suggest fast-food consumption should be limited as much as possible,” Purtell said.

Flu makes UK HealthCare tighten visitation rules

UK HealthCare has temporarily changed its visitation policy to help protect its patients and health care workers during the flu season, the University of Kentucky said in a news release. The measures include:

• No visitors under the age of 12
• No visitors with any symptoms of flu-like illness
• Only two visitors will be permitted in a patient’s room at one time
• Visitors may be issued masks or other protective clothing for use when visiting
• Additional restrictions may be in place in special care units such as women's and children’s units, critical care and oncology units.
• Compassionate visitation exceptions will be made on a case-by-case basis.

These measures are for all UK HealthCare inpatient units, which include UK Chandler Hospital, Kentucky Children's Hospital, UK Good Samaritan Hospital and Eastern State Hospital.

Kentucky is among 29 states and territories reporting widespread flu, which is the highest level and means at least half the regions in the state have reported confirmed cases of the flu. Last year at this time four states had reported widespread flu, says the release.

Flu symptoms can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue.

While the Centers for Disease Control and Prevention has reported that some of the nation's circulating flu viruses have not been covered by this years vaccine, it is still recommended that everyone six months of age and older get a flu shot.

"A flu vaccine is still the first and best way to prevent influenza," Kim Blanton, enterprise director for infection prevention and control at UK HealthCare, said in the release.

Flu antiviral drugs are available and work best for treatment when they are started within two days of getting sick. However, starting them later can still be helpful, especially if the sick person has a high risk health condition or is very sick from the flu, says the release.

It is also important to wash your hands often, avoid people who are sick and stay home if you are sick to help prevent it from spreading.

Supporters of statewide smoking ban push for floor votes; opposition in Senate may not be as strong as before

By Melissa Patrick
Kentucky Health News

While the advocates of a statewide smoking ban might have been “preaching to the choir,” as one put it during a legislative committee meeting Wednesday, Dec. 17, they heard a passionate call to go out and persuade their fellow legislators to pass a smoking ban in the 2015 legislative session, or at least give it a vote on the floor of a chamber.

“Go to our members in leadership, both the majority and the minority, and tell them this needs to be a priority this year. We cannot afford to wait any longer,” Rep. Susan Westrom, D-Lexington, longtime sponsor of the House legislation, told the Interim Joint Committee on Health and Welfare. “It will have to begin with us here pressuring them to make sure that this is the number one priority.”

Westrom has sponsored the legislation in the last four sessions. It came close to a floor vote in the full House last year, but has never gotten out of committee in the Senate, even though polling shows that 65 percent of Kentuckians support banning smoking in indoor public places.

Westrom said after the meeting, "There is a large increase in the number of people at the local level who support a statewide smoke-free law. Their soft speech has now turned into a roar."

Rep. Susan Westrom

Westrom said at a recent meeting of the Kentucky Chamber of Commerce, which supports the ban, that her main lobbying adversary is the Kentucky Farm Bureau Federation.

The chamber's support was noted by board member Brent Cooper, president of C-Forward Inc., an information technology firm in Northern Kentucky. He said the law would help improve the health of Kentuckians, which would decrease the cost of insurance for businesses.

“For businesses, that is one of the most compelling reasons to support the smoke-free law,” he said. “Most of my group is a relatively young, relatively healthy group and our insurance premiums went up 30 percent last year and we are facing a huge increase again this year. Why? Because we absorb the state of Kentucky now. We absorb all of the workers in the state of Kentucky and guess what, Kentucky is an unhealthy place," forcing insurance rates up.

Cooper said some legislators who have told their constituents that they would not vote for a smoking ban may now feel differently, but don't know how to tell them they have changed their mind. He said those legislators should educate their constituents.

“Convince them, show them the latest data,” he said. “Show them that blowing toxic fumes in somebodies face impacts their health. Convince them of that. Tell them it is the right thing to do.”

Wayne Meriweather, chief executive officer of Twin Lakes Regional Medical Center in Leitchfield, also representing the Kentucky Hospital Association, gave the legislators an arsenal of facts to educate with:

• 26.5 percent of Kentuckians smoke;
• Kentucky leads the nation in lung cancer and lung cancer deaths;
• Kentucky is the 47th unhealthiest state in the nation;
• Kentucky leads the nation in smoking;
• 7,900 Kentuckians die each year due to active smoking;
• 27 percent of Kentucky's blue collar workers are exposed to second hand smoke at work;
• second hand smoke exposure increases the risk of heart and lung disease by 20 to 30 percent;
• 950 Kentuckians die each year from second-hand smoke.

He then provided facts on how much smoking costs the state of Kentucky:

• $1.92 billion a year for annual health-care expenditures directly as a result of tobacco use;
• $106 million a year in annual health-care expenditures in Kentucky from second hand smoke;
• $487 million a year in state Medicaid expenditures due to tobacco use (this was before the expansion of Medicaid);
• $988 million a year in total taxpayer cost from smoking-related expenses, or $591 per household; and
• $2.3 billion is lost each year because of lower productivity.

Rep. Julie Raque Adams, a Louisville Republican who will be joining the Senate in January and sponsoring the smoking-ban bill there, said it should not be a partisan issue, and "Saving taxpayers' dollars is one of the most conservative things we can do."

Incoming Senate Majority Whip Jimmy Higdon, R-Lebanon said that he supports smoke-free laws on a local level. Sen. Joe Bowen, R-Owensboro, said that while he would likely vote for a statewide smoking ban if it comes to a floor vote, he thinks it should be addressed at a local level.

Senate President Robert Stivers, who has said he does not favor a statewide ban, was less vocal about his opposition in a statement to cn|2's "Pure Politics."

“Sen.-elect Julie Adams has been very upfront concerning her support and sponsorship of a statewide smoking ban and she makes some good points; however, other senators voiced concern that this is a local issue for communities to address and enforce rather than having the state take on another regulatory role at this time,” said Stivers, R-Manchester. “So I see this as one of the issues this session that is going to have to go through the legislative process of discussion and debate and we will see where it goes from there.”

Stivers has previously been more vocal about his opposition to smoking bans, saying they don't offer personal choice and that he believes businesses should have the right to set their own policies.

Westrom said that when she was first asked to sponsor a Smoke-Free Kentucky bill 11 years ago, she also thought that it should be a local decision and declined, but not enough local leaders have stepped up. As of October 2014, 23 Kentucky communities have smoke-free policies that cover all workplaces and enclosed public places, according to the Smoke-Free Kentucky website. This breaks down to 32 percent of Kentuckians covered by strong local smoke-free laws.

With two-thirds of Kentuckians supporting a statewide smoking ban, it is time for statewide leaders to do it, Westrom said.

Some say that public opinion will drive Republicans or leaders of the House's Democratic majority to act this year. House Speaker Greg Stumbo, D-Prestonsburg, reiterated his support for a statewide smoking ban through his spokesman and told Pure Politics that “it may be time for an up-or-down vote” in the House.

The General Assembly's session begins Jan. 6. After a few days devoted to election of leaders, organization of committees and mandatory ethics training, the legislature will recess until early February. The session of 30 legislative days must end by March 31.

Kentucky Health Cooperative, largest private provider on state insurance exchange, gets $65 million loan to keep going

The Kentucky Health Cooperative, a non-profit, consumer-governed health insurance company, received a $65 million federal loan last month to keep it afloat just days before the second open-enrollment period began, reports Adam Beam of The Associated Press.

The cooperative received the loan from the Centers for Medicare & Medicaid Services on Nov. 10, five days before Kentuckians resumed purchasing private health plans on Kynect, the state health-insurance exchange.

Republican U.S. Sen. Mitch McConnell claimed the loan "raises serious questions" about federal health reform in Kentucky, Beam reports. "If Obamacare were really such a success story in Kentucky, why did this co-op need a taxpayer bailout?" asked McConnell, the incoming Senate majority leader. "Even more disconcerting, why was that bailout kept a secret from the very people who were about to enroll in it?"

CMS officials told Beam they waited until all the loans to state-based health cooperatives had been awarded before announcing them. These loans are competitive and must be applied for. The officials said it is not uncommon for nonprofit co-ops to receive "solvency loans" from the federal government because these new insurers need help meeting their cash requirements.

"To date, co-ops in seven other states have received more than $355 million in additional solvency loans, according to the CMS website. Co-ops have 15 years to repay the loans, with interest, to the federal government," Beam writes.

The first federal loans for the Kentucky Health Cooperative were based on how many customers it expected to have. The co-op predicted it would have about 30,000 customers, but has 57,000, Janie Miller, its chief executive officer, told Beam: "Therefore we needed additional capital sitting there from which we would, of course, pay claims."

The Kentucky Health Cooperative sold three-fourths of the qualified health plans sold on the exchange in the first round of enrollment.

Since enrollment reopened Nov. 15, more than 9,200 people have used it to purchase a private health insurance plan. Of those, more than 6,000 qualified for a federal discount on their premiums. Another 75,700 people have renewed the private health insurance they purchased last year.

The Kentucky Health Cooperative received a federal loan to expand into West Virginia this year, but concerns about its infrastructure not being ready to handle the demands of the state has since delayed the launch for one year, until Jan. 1, 2016, Lydia Nuzum reports for The Charleston Gazette.

Ten common myths about diabetes busted

Kentucky ranks 17th in diabetes, and many Kentuckians are newly diagnosed every year with the disease, usually Type 2 diabetes. The diagnosis can be overwhelming, especially if you don't have your facts straight. A report by Healthgrades on the CNN website dispels 10 common myths about Type 2 diabetes.

The first myth is that eating too much sugar causes Type 2 diabetes. Doctors don't really know what causes it, Healthgrades writes. The body becomes resistant to insulin, the hormone that helps the body use blood sugar for energy, or stops producing enough insulin. This is what causes blood sugar to rise. 

The second myth is that only overweight or obese people get Type 2 diabetes. Being overweight or obese doesn't cause diabetes, but is a risk factor, so it's important to remember that at least one out of every three Kentuckians, those considered obese, are at risk to get the disease.

The third myth is that Type 2 diabetes always causes symptoms. In fact, symptoms may develop slowly and are often not easily recognized at first. The federal Centers for Disease Control and Prevention estimates about 8 million people with diabetes don't even know they have it.

Common symptoms of Type 2 diabetes are frequent urination, feeling very thirsty, feeling very hungry (even though you are eating), extreme fatigue, blurry vision, cuts and bruises that are slow to heal, weight loss, and tingling, pain or numbness in the hands or feet, says the American Diabetes Association.

The fourth myth is that pre-diabetes is nothing to worry about. Healthgrades reports that if you have pre-diabetes you are at "very high risk of developing Type 2 diabetes." But research shows that you can cut your risk with exercise and weight loss. Kentucky has an estimated 233,000 adults with pre-diabetes, according to the Kentucky Cabinet for Health and Family Services.

The fifth myth is that Type 2 diabetes is not as serious as Type 1 diabetes. "Left uncontrolled, both types of diabetes can cause serious complications and even be deadly," Healthgrades writes. Complications from Type 2, which can be avoided with careful management of the disease, include: kidney disease, vision loss, neuropathy, amputations, heart attack and stroke.

Another myth is that people with Type 2 diabetes don't need insulin. This is true for most of them, but Type 2 is a progressive disease, which causes "most people to eventually need insulin," Healthgrades reports. "Starting insulin for Type 2 diabetes does not mean you have failed to manage your disease. It means your disease is changing."

The seventh myth dispelled by Healthgrades is that Type 2 diabetes can be cured. "There is no cure for Type 2," it says bluntly. Remission is possible, but in those cases doctors consider the risk of relapse very high.

Another myth is that people with Type 2 diabetes can't eat sugar, sweets or starches. This isn't true. What is true is that you need to manage carbohydrates, which are in sugar, sweets and starches, because that's what makes glucose. With proper portion control, no food is off limits, Healthgrades reports.

Some think that people with Type 2 diabetes have to eat a special diet. In reality, they need to eat a "healthy diet," Healthgrades says. It is best to consult with a dietitian, or take a diabetic nutrition class, when learning how to eat as a diabetic.

The last myth Healthgrades dispels is that people with Type 2 diabetes can't lead an active life. In fact, exercise is important to controlling the disease and should be made part of the daily routine. However, it is important to consult with your doctor before you begin exercising to determine what is safe for you.

Ky. ranks 8th in the number of high-prescribing Medicare physicians for powerful narcotic painkillers and stimulants

Kentucky ranks eighth in Medicare physicians who are considered "high prescribers" of Schedule 2 medications, drugs that have the highest potential for abuse like oxycodone, fentanyl, morphine and Ritalin, according to an analysis of Medicare data analyzed by ProPublica, Laura Ungar reports for The Courier-Journal. About 1,000 Kentuckians die each year from drug overdoses.

Medicare's drug program, Part D, covers about 38 million seniors and disabled and pays for more than one of every four prescriptions dispensed in this country, Charles Ornstein and Ryann Grochowski Jones report for ProPublica, a non-profit investigative news organization.

Further analysis by The Courier-Journal found that Kentucky doctors prescribed narcotic painkillers to a "much larger percentage of their elderly and disabled patients" compared to other states, and that Kentucky had 11 of the 269 prescribers who wrote more than 3,000 prescriptions for Schedule II drugs under the program, Ungar reports.

"One in five doctors who wrote at least 3,000 prescriptions for Schedule 2 drugs have faced some kind of sanction or investigation, according to the ProPublica analysis," Ornstein and Jones write.

Kentucky's top prescribers, those with the largest numbers of Medicare patients who received at least one prescription for a narcotic painkiller in 2012, include three pain doctors, an adult-medicine physician and an internal-medicine doctor, Ungar reports.

In 2012, 12 of Medicare's top 20 prescribers of Schedule 2 drugs faced disciplinary actions by their state medical boards, Ornstein and Jones report. In Kentucky, only one of its top prescribers, Dr. Gregory Mick, a Lexington adult-medicine physician, has been disciplined by the Kentucky Board of Medical Licensure, which ordered him to stop prescribing controlled substances, Ungar reports.

The other four top prescribers told Ungar that "they are practicing good medicine and have legitimate reasons for having more than 1,000 Medicare patients each who received at least one narcotic painkiller prescription."

Beginning in mid-2015, Medicare will have the authority to kick doctors out of the program if they prescribe in abusive ways, Ornstein and Jones report. Medicare sent letters to 760 high prescribers in September "in hopes that they will examine their prescribing and make changes."

ProPublica obtained the data under the Freedom of Information Act to update its online Prescriber Checkup tool with the most recent numbers available and shared it with The Courier-Journal and other Gannett Co. news organizations. A Courier-Journal reporter further analyzed the information about Kentucky doctors.

Spending bill allows schools that show 'hardship' to vary from requirement to serve 100 percent whole grains

By Melissa Patrick
Kentucky Health News

The massive 2015 spending bill signed by President Obama Dec. 16 includes a provision to help schools struggling with the whole-grain and sodium requirements that are part of the Healthy, Hungry-Free Kids Act. It did not allow, as House Republicans had hoped, schools to opt out of the healthier school meal standards if they lost money on meal programs over a six-month period.

Beginning with the 2014 school year, schools had to serve 100 percent whole grains in their meals and snacks, and also follow the first restrictions on sodium, or salt. The sodium restrictions were scheduled to get progressively stricter over the years, with the next move set for 2017.

The law allows schools that demonstrate the rule is a "hardship" to continue serving 50 percent whole grains. It also says sodium standards cannot be tightened until the "latest scientific research establishes the reduction is beneficial for children," Mary Clare Jalonick reports for The Associated Press.

Some schools say they have had trouble complying with these requirements because many of the affordable whole grain pastas have proven difficult to cook en masse and the whole-grain versions of many foods, like biscuits and tortillas, simply don't taste the same.

On salt, schools say budgeting the allowed amounts among meals, snacks and a la carte items is often a challenge. The issue hit Anderson County schools earlier this year when they couldn't find a low-sodium ketchup; their solution was to not offer ketchup. Parent and student complaints prompted a reversal of that move, but to do that, sodium had to be removed elsewhere in the menu.

The new law won't have much effect on Fayette County Schools, Director of School Nutrition Michelle Coker said in a telephone interview. "Basically, we use 100 percent whole grains in everything," she said. "But there are products, like tortilla shells, that aren't as flavorful and this gives us some flexibility."

Fayette County has transitioned slowly to whole grains over the last five to six years to help students adjust to them, Coker said, and as whole-grain products have become "tastier" the transition has not been an issue.

"Whole grain pasta products have come a long way," Coker said. "Three to four years ago they were dark, but now it is difficult to tell the difference. Kentucky has really good vendors."

Coker, a registered dietitian, welcomed the possible delay in lower salt limits, saying most students are active and involved in sports and shouldn't need such low sodium restrictions. "These kids are growing and need electrolytes," she said.

The School Nutrition Association, a group that represents both school nutrition directors and the food companies that produce foods for schools, wanted even deeper rollbacks than the spending bill included, but said it "strongly supports" the budget-bill language.

Alabama Rep. Robert Aderholt, chairman of the House subcommittee that oversees nutrition issues, said the whole-grains waiver is "the best bill that we are going to get" as long as Democrats are in control the Senate, Jalonick reports.

Republicans will control both houses of Congress next year, so the battle is far from over, and the overall law governing child nutrition policy, including school lunches, expires next year and will require legislation to be renewed, Jalonick notes.

First Lady Michelle Obama, champion for improving school's nutrition and decreasing child obesity, said this summer that she would fight "to the bitter end" to make sure kids have good nutrition in schools.

Tennessee's Republican governor will use Obamacare Medicaid money to expand coverage

One of the longest and starkest boundaries in health care for the last year has been the border of Kentucky and Tennessee, because the Bluegrass State expanded Medicaid under the federal health-reform law and the Volunteer State did not. That is about to change, because Republican Gov. Bill Haslam of Tennessee will use federal Medicaid money to expand health insurance in his state.

Kentucky, Arkansas and West Virginia expanded Medicaid; Tennessee and Virginia haven't yet.

"Like most other Republican governors who want to take the health-care law's generous federal funding, Haslam is now offering a plan that deviates from the Medicaid expansion envisioned under the Affordable Care Act," writes Jason Milliman of The Washington Post. "Haslam, who made the announcement almost a month after his re-election, said the Obama administration has verbally approved the approach."

The Tennessee plan includes a two-year waiver program with two tracks. "It will offer vouchers to people earning up to 138 percent of the federal poverty level—or about $16,100 for an individual—to help purchase employer coverage they would otherwise struggle to afford," Milliman reports. "Other newly eligible individuals can sign up in health plans modeled after health reimbursement accounts, with people earning above the poverty level required to pay premiums and copays. Haslam's administration didn't immediately offer details about how those payments are structured."

In November the Kaiser Family Foundation estimated that Tennessee has "about 142,000 low-income adults fall into what's known as the coverage gap—people who earn too much to qualify for the existing Medicaid program but not enough to qualify for subsidies to purchase private coverage on the Obamacare health insurance marketplaces," Millman writes.

"Nine Republican governors have expanded Medicaid so far, while Indiana Gov. Mike Pence is still negotiating with the feds on leveraging an existing state program to expand coverage," Millman reports.

Dec. 15 is deadline for Jan. 1 Kynect coverage; final deadline in second open enrollment is Feb. 15

Kentuckians can sign up for coverage under the Patient Protection and Affordable Care Act through Kynect, Kentucky's health insurance exchange, through Feb. 15. But to be covered on Jan. 1, you must sign up by Dec. 15.

Coverage for those who miss the Dec. 15 deadline and sign up between Dec. 16 and Jan. 15, will begin on Feb. 1. Those who enroll between Jan. 15 and the Feb. 15 deadline will have a March 1 effective date.

Nearly 18,000 new applications have been filed since open enrollment began Nov. 15, with more expected to sign up in the coming days, state officials told Chris Kenning of The Courier-Journal. It has not yet been determined how many of these applicants were for Medicaid and how many were for private plans.

This year, the penalty for not having coverage in 2015 will rise from $95 per adult, or 1 percent of household income, to $325 per adult or 2 percent of household income, whichever is greater.

And if you are one of the 80,000 Kentuckians who purchased private plans last year that will be automatically re-enrolled, changes in subsidies and premium amounts may cause an increase in your plan cost so it is important for this group to re-evaluate their plans this year, Kenning writes.

 "You could get a bigger subsidy, a lower monthly cost, or more network options if you shop again,"  Carrie Banahan, executive director of Kynect, told Kenning.

Officials estimate 290,000 Kentuckians are potentially eligible for subsidies with the Affordable Care Act, Kenning reports. Subsides are based on income, but are capped at $46,680 for individuals and $95,400 for a family of four.

He offers these examples of how subsidies might work: a 35-year-old single parent of two who earns $35,000 per year could get a monthly subsidy of $240; or a retired couple with $50,000 in income could get a $526 monthly subsidy.

To examine Kynect options, visit https://kynect.ky.gov or call 1-855-4kynect (459-6328)

Flu activity becomes widespread, closing schools

Kentucky's flu activity level has become widespread, which means at least half the regions of the state have reported confirmed cases of influenza.

Schools are a testimony to this increase in activity, as they have been swamped with absences related to illness, many reporting flu or flu-like symptoms. Several of them have closed their doors Friday hopes for recovery over the weekend.

One of the first big episodes came several weeks ago when Lexington's Paul Laurence Dunbar High School Band cancelled its appearance in the Lexington Christmas Parade because of widespread illness. They had just returned from marching in the Macy's Thanksgiving Day Parade in New York City. Kathy Jaeger, president of the band boosters, told WKYT-TV that nearly 100 band members and two band directors were sick with strep throat and flu-like symptoms.

WKYT reported that up to 20 percent of students were out sick last week at some Central Kentucky schools. Paris Elementary reported 20 percent of its students out, most with flu-like symptoms.

Toliver Elementary in Danville cancelled classes for Friday, Dec. 12 because of the number of sick students and teachers, sending a note home to students that said: "The staff has worked overtime to keep the doors open, wiping noses, taking temperatures, and teaching. Worn down by the effort and in such close contact with students, significant numbers of staff are now ill as well. The number surmounts resources available."

Harrison County Schools also cancelled classes Friday because of the rising number of reported student illnesses, Donald Richie reported for The Cynthiana Democrat.

Greg Hollon, Clark County director of pupil personnel student support services, told WKYT that parents should keep their kids at home if they are sick.

"If your child is exhibiting symptoms, they're nauseous, they're coughing, they have a high fever, any of those symptoms, symptoms that would warrant taking them to the doctor. We always would encourage parents to exercise good judgment," he said.

The flu is highly contagious and because it is spread from person to person, it is easily spread in school environments. And this year a strain of the flu  (H1N1) that is especially hard on children and young adults is circulating, according to a state press release.

“In this flu season so far, H1N1 has continued to circulate and there have been reports nationally of severe illness in young and middle-aged adults,” Health Commissioner Stephanie Mayfield said. “We strongly recommend vaccination of children, teenager and young to middle-aged adults, even if they are healthy, to prevent the spread of and complications from the flu this year. All forms of flu vaccine available in Kentucky this year provide protection against the pandemic H1N1 influenza virus.”

The most common symptoms of the flu are high fever, chills and shakes, extreme tiredness, headache and body aches, sore throat, headaches, a dry hacking cough, and vomiting and belly pain.

The federal Centers for Disease Control and Prevention says that the best way to prevent the flu is to get a vaccine, and it recommends a vaccine for everyone 6 months of age and older.

People who are especially encouraged to receive the flu vaccine, because they may be at higher risk for complications or negative consequences, include:

 • Children age 6 months to 19 years;
 • Pregnant women;
 • Young and middle-aged adults for the 2013-2014 influenza season;
 • People 50 years old or older;
 • People of any age with chronic health problems;
 • People who live in nursing homes and other long-term care facilities;
 • Health care workers;
 • Caregivers of or people who live with a person at high risk for complications from the flu; and
 • Out-of-home caregivers of, or people who live with, children less than 6 months old.

Fulton hospital says it will close by March 31 due to shrinking population and patient counts

Citing population losses and lower patient counts, Community Health Systems has announced that it will close Parkway Regional Hospital in Fulton by March 31. The hospital has 70 beds, larger than most rural hospitals that have closed recently.

The closure will cost 192 jobs, and hurt the city and county directly. "The hospital pays nearly $256,000 in utility, payroll and property tax to the city, making up 18 percent of city revenue," Rob Canning reports for WKMS in Murray. "Fulton is one of the poorest communities in Western Kentucky."

Patients who would have gone to Fulton are now likely to go to Martin or Union City, Tenn., both 12 miles away, or Mayfield's Jackson Purchase Medical Center, 22 miles away. Fulton County Judge-Executive David Gallagher is "in negotiations with the Fulton, South Fulton, Tenn., and Hickman city governments to extend a one-year contract with Tri-City Ambulance, a paid EMS service, to keep it active despite the closing," WKMS reports.

Kentucky drops two spots in America's Health Rankings, based on data since 2012 or earlier

Kentucky dropped two spots in the 25th annual America's Health Rankings report this year and finds itself once again as one of the bottom five healthiest (or unhealthiest) states.

Since the rankings were first released in 1990, with the exception of 2008 when it ranked 39th, Kentucky has ranked in the bottom 10 states for health. This year it ranks 47th.

The rankings are based on data gathered in the last two to three years, or even earlier, a fact state officials noted as they mentioned the Patient Protection and Affordable Care Act.

"While we have made much headway in the last year, we still have much work to do," said a statement from the Cabinet for Health and Family Services. "We expect that Kentucky’s statistics will begin to improve over time as the full effect of the ACA is reflected in future rankings. However, this change may take time, as Kentucky will be compared to other states that may more quickly see their health outcomes improve.”

Gov. Steve Beshear has made changing health behaviors to create a healthier population a priority for the state. He initiated the Kyhealthnow initiative, which established seven major measurable goals to improve the health status of Kentuckians over the next five years. He has also banned the use of tobacco products on most state properties.

Kentucky's latest ranking should come as no surprise since the state ranks in the bottom five states for eight of the measures: smoking, drug deaths, obesity, children in poverty, preventable hospitalizations, poor mental health days, poor physical health days and cancer deaths. Additionally, it ranks in the bottom 10 states for physical inactivity, air pollution, cardiovascular deaths and premature deaths.

Kentucky has already shown an improvement in smoking. While Kentucky still ranks second in smoking, fewer Kentuckians are smoking. In the past two years, smoking has decreased by 9 percent to 26.5 percent from 29 percent. In 1990, 35.3 percent of Kentuckians smoked.

"The decline in smoking rates stands out as a significant health improvement over the past 25 years," says the American Health Rankings news release. "Cigarette smoking is still associated with one of every five deaths in the United States, making it the leading cause of preventable death in the country."

Kentucky, like the rest of the nation, is getting fatter and becoming more sedentary.

Kentucky ranks fifth in obesity, with 33.2 percent of its adults having a body mass index of 30.0 or higher. In 1990, only 12.2 percent were obese. Kentucky doesn't fare much better with physical inactivity, ranking ninth with 27.4 percent reporting inactivity in the last 30 days.

Nationwide, obesity rates increased by 7 percent to 29.4 percent from 27.6 percent and the percentage of adults reporting inactivity in the last 30 days increased to 23.5 percent from 22.9 percent.

Kentucky has also seen a steady increase in the percentage of its adults with diabetes. Kentucky ranks 33rd in diabetes, with 10.6 percent of its adults reporting they have been told by a doctor that they have diabetes. In 1996, 3.6 percent of Kentuckians reported having diabetes.

Drug deaths have increased by 30 percent in the last two years, to 24 per 100,000 population from 18. Kentucky ranks third in this measurement.

Kentucky ranks first in four measures: children in poverty (31.8 percent), preventable hospitalizations (94.4 per 1,000 Medicare beneficiaries), poor mental health days (4.5 days reported in the previous 30 days), and cancer deaths (228.3 deaths per 100,000 population).

The number of children in poverty has increased by 36 percent in the past two years (31.8 percent from 23.3 percent).

Kentucky does have a few bright spots on the evaluated health measures including a low prevalence of binge drinking, a low violent crime rate and high immunization coverage among children.

Hawaii, Vermont, Massachusetts, Connecticut and Utah are ranked as the top five healthiest states. Mississippi is ranked 50th this year, preceded by Arkansas (49), Louisiana (48), Kentucky (47) and Oklahoma (46). West Virginia and Alabama moved out of the bottom five.

The report, published by United Health Foundation in partnership with American Public Health Association and Partnership for Prevention, uses data from well-recognized outside sources, such as the Centers for Disease Control and Prevention, American Medical Association, FBI, Dartmouth Atlas Project, U.S. Department of Education and Census Bureau.

To see the Rankings in full, visit www.americashealthrankings.org.

Kentucky 's spending of tobacco settlement on tobacco-prevention programs fall far short of what CDC recommends

Kentucky ranks 39th in the country in funding programs that prevent kids from smoking and help smokers quit, according to a national report from a coalition of public-health organizations.

Kentucky ranks sixth in high-school smoking in the 2013 Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System report, with 17.9 percent of high schoolers reporting they smoke cigarettes. Nationwide, the rate is 15.7 percent. The report challenges states to get their rates as low as Florida's 7.5 percent.

"If Kentucky reduced its high school smoking rate from 17.9 percent to 7.5 percent, it would prevent 148,150 kids from becoming adult smokers, saving 52,290 lives and $2.6 billion in future health care costs," the Campaign for Tobacco-Free Kids says in a press release.

The campaign says it's not that the state lacks the money to spend on such programs.

"Kentucky will collect $347.3 million in revenue this year from the 1998 tobacco settlement and tobacco taxes but will spend only 0.7 percent of the money on tobacco-prevention programs," says the release. "Kentucky spends $2.5 million per year on tobacco prevention and cessation programs, which is 4.4 percent of the $56.4 million recommended by the Centers for Disease Control and Prevention."

Soon after the settlement, the Kentucky General Assembly decided to spend half the settlement on diversifying and improving the state's agricultural economy, with the rest going to health, early-childhood development and other programs. The legislature later began using the fund for water and sewer projects in rural areas.

Kentucky is not alone in scrimping on such programs. Collectively, states have budgeted just 14.8 percent of the $3.3 billion the CDC recommends. States will collect $25.6 billion this year from the tobacco settlement and tobacco taxes but will spend only 1.9 percent of it ($490.4 million) on tobacco prevention programs, the campaign says.

Meanwhile, kids get plenty of tobacco-company marketing enticing them to smoke. "Tobacco companies spend $271.1 million per year to market their products in Kentucky – 109 times what the state spends on tobacco prevention," says the release.

The campaign says tobacco annually claims 8,900 Kentucky lives and costs the state $1.9 billion in health care bills. "Right now, Kentucky is also putting its children at risk and costing taxpayers money by failing to properly fund tobacco prevention efforts that are proven to save lives and health care dollars," says Matthew Myers, president of the campaign for Tobacco-Free Kids. "We need elected leaders in Kentucky to enact a comprehensive smoke-free law and increase funding for proven tobacco-prevention programs,"

The report is titled "Broken Promises to Our Children: A State-by-State Look at the 1998 State Tobacco Settlement 16 Years Later." It was also released by the American Heart Association, the American Cancer Society Cancer Action Network, the American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers' Rights.

Anti-obesity program targets preschoolers, will expand to rural Kentucky next year

By Melissa Patrick
Kentucky Health News

The latest America's Health Rankings report ranks Kentucky as the 47th healthiest state, a fall from 45th last year. With the exception of one year, Kentucky has found itself ranked as one of the bottom 10 states since the rankings began in 1990.

How does Kentucky even begin to dig itself out of this hole?

The long-term answer will likely be found in changing the health habits of our children, which is exactly what the Kentucky Department for Public Health is trying to do by participating in the National Early Care and Education Learning Collaborative Project, a childhood obesity-intervention program that targets child-care and education providers for preschool children.

Kentucky is one of a few states in the program, and will be expanding next year to locations in southeastern and western Kentucky.

“Sustained well-being is made possible when people learn the lessons of a healthy lifestyle early on,” Health Commissioner Stephanie Mayfield said in a press release. “By working with the early-care and education community, we are able to reach many of Kentucky’s young children and help them build the foundation for being healthy and active.”

Child obesity has been considered a national epidemic, with 17 percent of U.S. children considered obese and almost 32 percent considered overweight. Kentucky ranks eighth in child obesity, with 19.7 percent between the ages of 10 and 17 obese, according to the Trust for America’s Health and the Robert Wood Johnson Foundation’s annual "The State of Obesity" report.

The same report says nearly 16 percent of low-income children under the age of 5 in Kentucky who are enrolled in federally funded maternal and child health programs are characterized as obese. That is the target population for the project.

The project, which is part of a multi-state pilot funded by the federal Centers for Disease Control and Prevention and managed by Nemours Children’s Health System, aims to fight back against this epidemic by placing a focus on improving nutrition, increasing physical activity, reducing screen time, and providing breast-feeding support through a national curriculum and learning collaborative method with early care and education providers, according to a Nemours press release.

Kentucky received a $275,000 grant from Nemours to be a part of this project. Currently, nine states participate in the National ECELC Project.

The first phase of the Kentucky Early Care and Education Learning Collaborative includes 65 early care environments in Jefferson County, Fayette County and Northern Kentucky. The programs represent Head Start classrooms, non-profit and commercial child care, private preschool and public preschool settings and has reached 7,559 children.

Phase II of the project allows funding to launch four more collaboratives in 2015. The first two will launch in March: a second one in Jefferson County, and one in Laurel County, which will include an invitation to the early-care programs in the surrounding counties to participate. The second launch will happen in October, but these locations, which will be located west of Interstate 65, have not yet been determined.

Child-care centers in the program "participate in group learning and action planning and have access to technical assistance, tools, materials and resources to aid in their continuous improvement. Information is shared within and between teams," the state press release said.

The project is not designed to measure child outcomes, which would add tremendous cost in both time and money to this project, Rebekah Duchette, Kentucky's project coordinator, said in an e-mail. But they are seeing positive results from the program.

"We are seeing changes in environments, policies and practices around nutrition, physical activity, screen time, breastfeeding, family engagement and juice consumption," she said.

One of the missions of the project is to implement and influence policy around childhood obesity. Kentucky has taken this charge to heart both at the program level as well as the state level.

"We are working on some exciting policy changes and equally exciting clarifications for programs. At the program level we see programs implementing policies that go above what the state of Kentucky requires in child-care regulations: centers that are incorporating fresh fruits and vegetables, changing to seasonal menus that expose children to a larger variety of foods, eliminating pre-fried and fried foods from menus, adding more physical activity to the daily schedules and using physical activity time as learning time," Duchette said.

"As part of our sustainability planning we are working with early education stakeholders to develop a proposed list of child care regulations that support the best practices in healthy behaviors. Additionally, we are working with various branches of the state that regulate child care to clarify some existing regulations and send a consistent message to early care programs about how to implement best practices and stay in compliance with all state and local regulations."

“Reaching kids early is the key to combating childhood obesity,” Debbie I. Chang, vice president of policy and prevention at Nemours, said in the press release.

Kentuckians rank high in colorectal cancer deaths; study will use emergency rooms to promote screening to save lives

University of Kentucky College of Nursing Associate Professor Jennifer Hatcher has received a two-year $359,528 grant for her project, “Promoting Colorectal Cancer Screenings in Rural Emergency Departments.”

The grant, given by the National Cancer Institute, will be used to study how effective motivational interventions are in helping non-emergency patients in rural Appalachian emergency departments to get screened for colorectal cancer, Hatcher said in an interview. Patients' companions in the emergency rooms can also participate in the interviews.

Of cancers that affect both men an women, colorectal cancer is the second leading cause of cancer-related deaths in the United States and the third most common cancer in men and in women, according to the Centers for Disease Control and Prevention.

Kentucky leads the way in these national health statistics.  It has the highest rate of colorectal cancer in the nation at 55.1 per 100,000 and is the fourth highest in the nation for deaths caused by colorectal cancer at 19.8 per 100,000. And those in Kentucky's Appalachian counties have a higher incidence rate than the rest of the state and nation overall at 57.2 percent, according to a Kentucky Colon Cancer Screening Program annual report.

“Residents of rural Appalachia have a higher incidence and mortality rate from colorectal cancer than residents of any other region of the country," Hatcher said in the release. "In light of the fact that colorectal cancer is one of the few cancers that can actually be prevented by screening, this grant presents a tremendous opportunity for us to address one of the key factors affecting this disparity for rural Appalachians—limited access to the health care system."

The interventions for the study will be conducted by lay health workers, trained local people who are interested in the health of the community and helping their neighbors get screened. They will talk to the patients or their companions about their perceived barriers related to colorectal screening and help them work toward resolving those barriers. All interactions are voluntary, Hatcher said in an inteview.

The lay health workers act as connections between the patients and whatever resources they may need to get screened, or helps alleviate fears they may have about colorectal screening. They are also trained to provide education on what types of screenings are available and discuss what is best for each individual.

Patients who agree to the intervention will get a follow-up call one week after the emergency room intervention to see if they need further assistance in setting up a screening and will receive yet another call in three month.

The project will be the first to address the disproportionate incidence and mortality from colorectal cancer in rural Appalachia utilizing the emergency department as an access point, says the release.

"We believe that using an emergency department as an access point for this project will allow us to reach more individuals who are at risk for developing colorectal cancer, thereby reducing the disparate mortality rates that rural Appalachians suffer from this disease,” Hatcher said in the release.

KET program to host authors of "Life Lessons from Cancer" to discuss inspirational messages of book

"One to One" with Bill Goodman will feature the authors of Life Lessons from Cancer, Keen Babbage and his sister-in-law Laura Babbage, on Sunday, Dec. 21 at 1 p.m. ET to discuss the book and its inspirational messages, especially the importance of family when facing life's challenges.

Keen Babbage, a teacher and native Lexingtonian, was diagnosed with cancer in his late 50s, despite a lifetime of healthy habits. He felt moved to share his experience in print.

With the help of his sister-in-law, a registered nurse and chaplain at the Chandler Medical Center at the University of Kentucky, they wrote Life Lessons from Cancer, published in September.

Keen told an audience at the first promotional event in October that he hoped the lessons in the book would be an inspiration and offer guidance for other patients with cancer as well as a resource for health-care providers.

The show will also air on Tuesday, Dec. 23 at 7:30 p.m. ET on KET2.

Study: Secondhand smoke and road pollution contribute to obesity in children more in combination than separately

Diet and physical activity aren't the only causes for the obesity epidemic that is sweeping our nation; a recent study finds that secondhand smoke and roadway pollution are also contributors, Ryan White writes for Reporting on Health.

Photo by ctvnews.ca

Researchers at the University of Southern California have found that secondhand smoke and roadway pollution contribute to body-mass-index increases and obesity in children. The study is published in Environmental Health Perspectives.

“Our findings strengthen emerging evidence that exposure to tobacco smoke and [near-roadway pollution] contribute to development of childhood obesity and suggest that combined exposures may have synergistic effects,” the study’s authors write.

The study collected data on 3,318 students through home questionnaires about tobacco exposure in homes, and scientifically estimated each student's exposure to roadway pollution, White reports. Meanwhile, the student's BMI was measured annually between ages 10 and 18. "BMI levels estimate body fat based on height and weight. “Normal” weight scores range from 18.5 to 24.9, with higher figures considered overweight and 30 the threshold for obesity"

The study allowed for a long list of "confounding variables," or other factors that might be responsible for these elevated BMIs, including: team sports participation, asthma history, social makeup of family and neighborhood, parents’ education, neighborhood walkability, recreation facilities, population density, unemployment rates and so forth, White reports.

"After crunching the data, researchers found that exposure to high levels of roadway pollution alone was associated with average increases of 0.80 BMI units over the eight-year study, while children with secondhand smoke exposure and low roadway pollution averaged 0.85 units higher, compared to similar peers. But when investigators looked at children with high exposures to both tobacco smoke and air pollution, their BMIs were on average 2.15 higher over eight years," White writes.

This is the first study to look at tobacco smoke and air pollution in combination. Other studies have looked at each of these contributors independently and found "secondhand smoke is associated with increased obesity risk in children and patterns of overweight children from mothers who smoked during pregnancy are well documented," White writes. Another study associates "prenatal exposure to roadway pollution with higher BMI and obesity by age 7."

But White notes that socioeconomic status, while ruled out as a "confounder," must still be considered as those who have a lower socioeconomic status are more likely to smoke, live in neighborhoods bisected by busy roadways, have less access to healthy foods and fewer places to exercise.