Clinton, Beshear, Humana chief and others discuss Medicaid expansion, other changes in health systems, and chronic illness

By Melissa Patrick and Al Cross
Kentucky Health News

The economic advantages from expanding Medicaid under federal health reform should outweigh any ideology that is holding states back from participating in it.

At least that was the consensus of a panel discussion about economics and health care led by former President Bill Clinton on Jan. 27, the last day of the Clinton Foundation's fourth annual Health Matters Activation Summit in Coachella Valley, Calif.

Gov. Steve Beshear, the leadoff panelist, said the Patient Protection and Affordable Care Act is a "transformative tool" to help change the dire health statistics in Kentucky, and while the decision to expand the Medicaid program to people with incomes up to 138 percent of the federal poverty level was "morally the right thing to do," it was economically the right thing to do, too.

Citing figures from a PriceWaterhouse Coopers study that predicted Medicaid expansion would bring money and jobs to Kentucky by expanding health care, he also said it would help create a healthier workforce to compete for jobs and this would give Kentucky an economic advantage over the surrounding states that didn't expand Medicaid.

"We are going to go past them pretty fast, from an economic standpoint," the governor said.

The study Beshear cited is being replicated to give a fresh forecast of the expansion's economic impact now that the state has a year's experience -- a year in which Medicaid enrolled more people than the first study said would enroll by 2020, and two-thirds as many health jobs were created as the predicted number for 2020. Republicans have voiced doubt that the expansion will pay for itself once the state has to pay for part of it: 5 percent in 2017, rising to the law's cap of 10 percent in 2020.

Clinton, a Democrat, said Republican-run states that had used Republican consultants for their Medicaid studies had found that expansion would pay for itself. Laughing, Clinton said the reports weren't well read because they didn't say what the Republicans had wanted them to say, and the consultants replied that "Yes, they were Republicans, but they also believed in arithmetic."

Trevor Fetter, president and CEO of Texas-based Tenet Healthcare, said that as a provider and member of the Texas business community, "It is a big mistake not to expand Medicaid, not to offer this access." He said many in Texas are "trapped" because the state hasn't expanded Medicaid and they make too much to qualify for it and too little to qualify for the federal subsidies for private insurance.

Meredith Rosenthal, professor of health economics and policy at the Harvard School of Public Health, said, "The most compelling argument for those who resist coverage expansion is an economic one," especially because health care is the largest employer in most communities.

The most talkative panelist was Bruce Broussard, president and CEO of Louisville-based insurer Humana Inc. He said expansion "is a good thing" because it allows access to insurance for people as they move or change jobs, decreases the burden of stress on the under-served and will save businesses money because it costs less to take care of healthy people than sick ones.

In discussing the health-care industry's new focus on patient outcomes, Broussard said outcomes will improve as the U.S. shifts from model built around treating episodic conditions to one that treats chronic conditions.

"It's not about the insurance, it's not about the treatment. It's how do we help people stay healthy no matter where they are in their journey," he said to a round of applause.

Experts say rising levels of chronic disease among baby boomers are a major concern. Clinton asked the panel to name the one thing we need to do that isn't being done now to deal with chronic conditions like diabetes.

Broussard said yearly health assessments "would help people make better health decisions." It is important to tell them what their current health is, relative to where it should be. "When people know their numbers, they make more effective decisions," he said.

Rosenthal said, to a room full of applause, "The biggest thing you could do to prevent diabetes in this country is to look at the agriculture policy." Clinton suggested working directly with all of the stakeholders involved in food production and distribution to create change.

The discussion shifted to the role of transparency and interoperability (different systems working together) in health-care finance as a way to improve health outcomes and decrease costs. Michael Peterson, president of the Peter G. Peterson Foundation, said "We are spending 3 trillion dollars a year without any regard to cost or quality."

Broussard said, "I think interoperability will bring transparency, better data analytics and will empower the consumer."

Beshear said Kentucky has already shifted to a pay-for-performance model by switching Medicaid to managed care, in which insurance companies are paid a flat fee per person as an incentive to limit costs.

"We want people to learn how to take care of themselves and to take responsibility for themselves and stay well," he said. "And if we are successful in doing that, we will bend this cost curve."

As for the reform law, Beshear said that while there is still work to do, "We've got to get past this talk of we're going to throw the whole baby out with the bath water" and make it work.

"The ACA is not going anywhere as far as I'm concerned," he said. "It is going to stay and we are going to implement it and we are going to better the lives of our people."

Newport school board's smoking ban, which includes e-cigarettes, would be 38th among 173 Kentucky school districts

The Newport Independent Board of Education passed the first reading of a proposed smoking ban Wednesday, Jan. 28 after adding electronic cigarettes to the ban.

The ban would prohibit smoking on any school campus, including parking lots, cars and the bus garage, and no smoking will be permitted by any groups who rent or meet on any school properties.

The second reading of the ban will be in February and if passed will go into effect July 1, Patricia A. Scheyer reports for The River City News.

"I do expect that it will pass," Superintendent Kelly Middleton told Scheyer. "I haven't had anyone say anything against passing it, and in fact, I have had a couple of comments in favor of it."

If passed, the "Newport school district will be the 38th school district out of Kentucky's 173 districts to become smoke free, joining Beechwood and Dayton Independent schools locally," Scheyer reports.

Kynect private-insurance enrollment runs through Feb. 15; exchange works to get taxpayers information to prove coverage

With the close of open enrollment coming Feb. 15, state officials are making a final push to get Kentuckians to enroll in Medicaid or buy private, subsidized health insurance on the state's health benefits exchange, Kynect.

The federal health reform law requires most people to have health insurance or pay a penalty, and Kynect says it is working to help Kentuckians get the information they need to prove coverage when they file their tax returns.

Outreach events continue at several campuses in the Kentucky Community and Technical College System. Events are open to the general public and will feature "Kynectors" who answer questions and help people find a plan that fits their needs and budgets. Tthe remaining events will be at:

• Bluegrass Community and Technical College, Leestown and Newtown campuses, 10 a.m.–2 p.m., Feb. 2 and 3.
• Jefferson Community and Technical College, downtown Louisville campus, 10 a.m.–2 p.m., Feb. 4 and 5.
• Gateway Community and Technical College, Covington campus (Two Rivers Building), 10 a.m.–2 p.m., Feb. 9 and 10.
• Gateway Community and Technical College, Boone County campus, 10 a.m.–2 p.m., Feb. 11 and 12.

As of 3:30 p.m. Jan. 29, 50,754 new applications for coverage had been submitted to Kynect; 43,181 people had been newly enrolled in Medicaid; 75,760 people had renewed their private insurance; 18,533 had newly enrolled in a private plan; and 4,914 individuals had enrolled in dental plans.

Kynect Director Carrie Banahan said, “If you or anyone you know remains without health insurance the time to enroll in coverage through Kynect is now. Please don’t delay. Enroll as soon as possible.”

Those who need health insurance are encouraged to log on to www.Kynect.ky.gov, call 1-855-4kynect (459-6328), or contact an insurance agent or Kynector before the Feb. 15 deadline. Medicaid enrollment is open year-round.

Taxpayers, take note

Individuals who qualified for an advanced premium tax credit, or subsidy, through Kynect will receive a 1095-A tax form in the mail. The form provides information for individuals and families who received payment assistance to help them fill out IRS Form 8962 as part of their federal return.

"Kynect has instituted a robust training and information program to help individuals, Kynectors, insurance agents and tax preparers understand the requirements," a state press release said. "Individuals with questions about their Form 1095-A may also call a special Kynect hotline at 1-844-373-2417.

Individuals with Medicaid, KCHIP, Medicare, catastrophic health insurance or insurance through an employer or other agency do not need Form 1095-A to file their federal income taxes. 

Health care changes are driven by more than reform law; Beshear says patients need rewards for changing their behavior

"Your doctor's visits might get longer, you deductibles probably will be higher and you might be paying cash to be treated at a Wal-Mart near you as Kentucky adapts to a vastly changing health care landscape," Mary Meehan reports for the Lexington Herald-Leader. "Nearly everything you know about how health care is paid for and provided will change during the next few years as patients and providers sort out the nuts and bolts of the Affordable Care Act."

But it's not just the health-reform law that's changing health care, Meehan reports from the Health Leadership Summit, held Thursday in Frankfort by state government and the Kentucky Hospital Association. She paraphrases the main speaker, Chas Roades, chief research officer for The Advisory Board Co., a Washington-based health consultant firm:

Read more here: http://www.kentucky.com/2015/01/29/3668247/frankfort-summit-focuses-on-changing.html#storylink=cpy

"Even if parts of the law are dismantled, he said, the health care needs of aging baby boomers are driving a fundamental change in the system. If patients have more choice, he said, it will be important for doctors to make more personal connections with patients. The focus won't be rolling patients through the door at a furious clip but on spending time with them to find out what it is going on."

Roades said the focus is shifting from treatment of illnesses to prevention, so health-care providers will be rewarded for keeping people healthy, and the transition period for health-care providers will be tough. "We need to get from fee-for-service to fee-for-value," he said, but until all government programs pay on that basis, and 75 percent of private insurance does, "We won't break even . . . We have to get everybody moving in the same direction at the same time." But he said the transition will be tough for hospitals that are small, rural and not connected with a larger organization.

State Health Secretary Audrey Haynes, who convened the meeting, said "We have to figure out how to have quality health-care services in the rural area of the state just like we do in the urban area."

One attendee at the meeting asked Roades when providers and payers could expect to see patients changing their behavior and being more responsible about their health. "We have to walk a fine line," he replied, suggesting that the focus needs to be on "rising risk" patients, 15 to 35 percent of the population, who may not have their chronic conditions under control.

Roades said educating people about better health should involve community organizations such as churches. "The average American has a fifth-grade health literacy," he said.

Gov. Steve Beshear said one key will be finding ways to reward patients for making responsible, informed choices: "We will fall short of our goals if we can't find ways to engage our patients in new and effective ways."

Read more here: http://www.kentucky.com/2015/01/29/3668247/frankfort-summit-focuses-on-changing.html#storylink=cpy

Almost as many Kentuckians support health reform as oppose it, but half say they don't know how it may affect them

By Al Cross and Melissa Patrick
Kentucky Health News

The federal health-reform law is gaining support from Kentuckians, to the point that they are almost evenly divided about it.

Those are among the results of the latest Kentucky Health Issues Poll, conducted for the Foundation for a Healthy Kentucky among a random sample of almost 1,600 Kentucky adults Oct. 8 through Nov. 6, the final month of an election season in which the law was an issue.

After two years in which opinion of the law was clearly unfavorable, the poll found that 39 percent view it favorably while 41 percent view it unfavorably. That is well within the poll's error margin of plus or minus 2.5 percentage points, which applies to both numbers.

The findings are similar to a national survey taken at about the same time. The October 2014 Kaiser Health Tracking Poll found that 36 percent of U.S. adults had favorable views of the law; 43 percent were unfavorable, and 20 percent did not know or offered no opinion.

In the Kentucky poll, about as many people reported a negative impact from the law (21 percent) as a positive impact (18 percent). The positive-impact number rose form 7 percent in the 2013 poll, which was taken just after enrollment for expanded Medicaid and subsidized health insurance had opened.

Notably, 51 percent of those polled said they didn't have enough information to know how the law would affect them personally. That was down from 57 percent a year earlier.

Most of those who reported not having enough information, 64 percent, had not graduated from high school. Almost half of Kentuckians (47 percent) said they understood how the law would impact them personally. Sixty-six percent said the law had no effect on them.

“KHIP data trends show overall support for the ACA has risen since 2013 as more Kentuckians have gotten information about the law," Susan Zepeda, President and CEO of the Foundation for a Healthy Kentucky, said in a press release. "More work is needed to educate people about the law’s provisions and potential impacts on families.”

The poll was also conducted for Interact for Health, formerly the Health Foundation of Greater Cincinnati, by the Institute for Policy Research at the University of Cincinnati. It used landline and cell phones.

Opinions of the Patient Protection and Affordable Care Act, often called Obamacare, are still driven partly by politics. The survey found that 58 percent of Democrats had favorable views of the law and 64 of Republicans had unfavorable views. Among independents, 42 percent had unfavorable views and 31 percent were favorable.

Researchers blame Walmart, other bulk suppliers for part of obesity epidemic

Part of the rise of obesity in America can be linked to the availability of cheap food sold in bulk from warehouse stores like Walmart, says a study released this week by researchers from Georgia State University, the University of Iowa, the University of Virginia and the University of Louisville, . Wal-Mart is the biggest retailer in the U.S. and a staple of many rural areas.

"We live in an environment with increasingly cheap and readily available junk food. We buy in bulk. We tend to have more food around. It takes more and more discipline and self-control to not let that influence your weight," Charles Courtemanche, assistant professor of economics at Georgia State, told Danielle Paquette of The Washington Post.

Obesity in America has surged from 1960, when 13 percent of adults were obese, to 2012, when 35 percent of adults were, Paquette writes. The first Walmart store opened in 1962, the first Sam's Club in 1983 and the first Walmart supercenter in 1988. In addition to Walmart, numerous other warehouse-style stores, like Target and Costco, have followed Walmart's lead by selling in bulk.

The study found that opening an additional Walmart store "per 100,000 residents increased an area’s average body mass index by 0.24 units, or 10.8 percent of the sample obesity rate," Paquette writes. Researchers wrote, “These estimates imply that the proliferation of Walmart supercenters explains 10.5 percent of the rise in obesity since the late 1980s.” (Read more) (Growth of Wal-Mart since 1962) (Growth of Walmart since 1962)

Medicare starts to overhaul the way it pays providers, rewarding them for quality, penalizing them for shortcomings

By Molly Burchett
Kentucky Health News

The Obama administration on Monday set a timeline for historic changes in how it pays doctors, hospitals and other health providers under Medicare, shifting away from the program's traditional fee-for-service model and towards a model that rewards care quality.

Rather than give the usual yearly fee increases to Medicare doctors for every procedure or service, the Department of Health and Human Services will tie 30 percent of traditional, fee-for-service payments to models like "accountable care organizations," which base payments (and penalties) on patients' health outcomes. The goal is for half of all Medicare payments to be handled this way by 2018, reports Jason Millman of The Washington Post.

"Today's announcement is about improving the quality of care we receive when we are sick, while at the same time spending our health-care dollars more wisely," said HHS Secretary Sylvia Burwell. "We believe these goals can drive transformative change, help us manage and track progress and create accountability for measurable improvement."

Medicare is the country's largest payer for health-care services, so these payment changes will affect doctors' offices and hospitals across the country. Many experts have viewed this broader shift to rewarding care quality as long overdue, but it's still uncertain how well the approach will work.

"We still know very little about how best to design and implement [value-based payment] programs to achieve stated goals and what constitutes a successful program," concluded a 2014 Rand Corp. study funded by HHS, Millman reports.

Some health-care professionals said Medicare is just aligning with what is already working in the private sector by moving away from fee-for-service, reports Alex Wayne of Bloomberg Businessweek.  “The private sector is further ahead than Medicare right now,” said Justine Handelman, vice president for legislative and regulatory policy at the Blue Cross and Blue Shield Association.

Since Medicare is already limiting payments as part of the 2010 health-reform law, the government must “ensure that only reforms proven to be efficient and effective are put in place,” Chip Kahn, CEO of the Federation of American Hospitals, told Wayne. “Further cuts would undermine our ability to invest in delivery system innovations needed to continue this trend.”

The announcement marks the first time that goals have been set to fundamentally change the way Medicare pays for health care, giving providers incentives to reduce unnecessary services.

Dr. Douglas Henley, CEO of the American Academy of Family Physicians, told CNBC: "We're all partners in this effort focused on a shared goal. Ultimately, this is about improving the health of each person by making the best use of our resources for patient good. We're on board, and we're committed to changing how we pay for and deliver care to achieve better health."

Regan Hunt, executive director of Kentucky Voices for Health, named national Consumer Health Advocate of the Year

Regan Hunt

Regan Hunt, the executive director of Kentucky Voices for Health, has been named Consumer Health Advocate of the Year by Families USA, which calls itself "the national organization for health-care consumers." KVH is a group of organizations and individuals working to improve health and coverage for Kentuckians, and was organized in response to the federal health-reform law. It includes groups that lobby, but it does not lobby.

The award is given to individuals who have made exceptional contributions in the effort to help our nation's health care consumers. Hunt received the award to "recognize and honor her leadership in the expansion of Medicaid in Kentucky, her efforts to bolster health coverage under the Affordable Care Act and her steadfast commitment to building a healthier Kentucky," Nicole Nash reports in a KVH press release.

"Regan is a one-of-a-kind advocate who led the way on Medicaid expansion and health coverage enrollment in the Bluegrass State," Ron Pollack, executive director of Families USA, said. "Thanks to Regan's tireless efforts, thousands of Kentuckians have access to health care. The diverse coalition she has mobilized will continue to benefit Kentucky residents for years to come." (Read more)

Appalachian women are more likely to get cervical cancer and die from it, but pass up vaccine partly because of fatalistic beliefs

By Melissa Patrick
Kentucky Health News

A fatalistic belief that getting or preventing cancer is beyond a person's control is one of many reasons young women in Appalachian Kentucky are likely to not get or complete the series of HPV vaccinations to prevent cervical cancer, according to a study by researchers at the University of Kentucky, published in The Journal of Rural Health.

"Our study found that fatalistic beliefs influenced immunization behaviors, which is concerning, given the high success rates of preventing HPV infection and cervical cancer through HPV vaccination and the elevated burden of cervical cancer in Appalachian Kentucky,” Robin Vanderpool, lead author of the study, said in an email.

The human papillomavirus, or HPV, is the most common sexually transmitted infection in the U.S., affecting an estimated 79 million individuals. Two types of HPV cause two-thirds of all cervical cancers, and unlike any other cancer, there is a three-dose HPV vaccine that can prevent it, according to the federal Centers for Disease Control and Prevention.

The UK researchers found that the women in the study who believed they had limited control over their health generally and limited control over cervical cancer specifically were significantly less likely to complete the HPV vaccine series than those who did not have this belief.

"This is an important finding because rural Appalachian residents often perceive cancer as pervasive, inevitable and mostly hereditary," the authors wrote.

The 344 rural Appalachian women who volunteered for the study were given the first dose of vaccine free of charge, and surveyed about their beliefs regarding cancer. They were followed for nine months after the first dose to determine completion rates.

Other studies had determined that many Appalachian women don't get or complete the HPV vaccine because of cost, lack of transportation, cultural views, lack of knowledge about cervical-cancer prevention and limited support from parents, peers and health-care providers. A belief in fatalism can now be added to this list.

Health advocates are working to get through these barriers because Appalachian Kentucky has the state's highest rates for cervical cancer and deaths from it, according to the Kentucky Cancer Registry. This, in a state that is among the top 14 for the most cases of HPV-related cervical cancers in the nation, according to the CDC.

Kentucky has a low HPV vaccination rate, with only one in four adolescent women initiating the vaccine and less than one in nine receiving the full series, according to The Kentucky Cancer Consortium. These rates are even lower in Appalachia, says the study.

The CDC recommends routine HPV vaccination for females ages 11-12 and catch-up vaccination for females ages 13-26. The second dose should be given one to two months after the first injection; the third dose should be administered six months after the first dose. Males are also encouraged to get the vaccine.

The study acknowledged that future such studies should compare women who have received the first dose of the vaccine, as in this study, against women who had not. It also suggests that these findings indicate a need for future research in how to educate and intervene with Appalachian women in a way that is culturally sensitive to improve HPV vaccination rates and to impact cancer disparities that affect the women in the region.

Are nutrition rules for schools and day-care centers too much regulation, or steps in the right direction, toward better health?

Commentary by Melissa Patrick
Kentucky Health News

The Paducah Sun's editorial on Jan. 20 said the Obama administration has overstepped its bounds by expecting child day-care centers to follow stricter nutrition standards. The newspaper also called for relaxation of the requirements of the 2010 Healthy, Hunger-Free Kids Act, as Republicans hope to to when the law comes up for reauthorization this year. (The editorial is behind a paywall.)

The editorial does what any good editorial should do: stirs up a bit of controversy and makes you think a bit harder. Do you agree with the editorial's views that these nutrition standards impose "too much regulation," or are you thinking,"We have to try something to combat obesity and the best place to change health behaviors is with children?"

What most everyone probably agrees on is that we have a problem: too many fat, unhealthy children who will become fat, unhealthy adults, perpetuating a chronic health epidemic that is sweeping across Kentucky and the nation. "The heaviest children are getting even heavier" and "overweight or obese preschoolers are five times more likely than normal-weight children to be overweight or obese as adults," says the Obesity Society website.

Nationwide, one in five children is overweight and more than one in three adults are obese, according to the Centers for Disease Control and Prevention. Kentucky leads the nation in both adult and child obesity, ranking fifth for adult obesity; first for high-school obesity; eighth in obesity of 10- to 17-year-olds; and sixth in obesity among 2- to 4-year-olds in low-income families, according to the States of Obesity report. These statistics don't even include the number of adults or children who are simply "overweight."

The World Health Organization says chronic disease is the leading killer in our world, with two-thirds of all deaths worldwide a result of conditions such as heart disease, cancer, diabetes and respiratory infections in 2012. Kentucky, once again, leads the way in each of these conditions.

Kentucky ranks eighth in the nation for heart-disease deaths; 17th for diabetes; fifth for high blood pressure; and first for smoking, lung cancer and lung cancer deaths.

The editorial says, "The food police are on the march again." Is it too much regulation, or could these "police" represent a concerned government trying to solve a major health-crisis that is only getting worse?

In making the day-care proposal, Agricuture Undersecretary Kevin Concannon wrote, "Providing children access to nutritious food early in life helps instill healthy habits that can serve as a foundation for a lifetime of healthy choices.”

The Department of Agriculture proposal calls for new nutritional guidelines for child and adult day-care programs, after-school programs and people who live in shelters that are part of USDA's Child and Adult Day Care Food Programs.

The guidelines would follow the Healthy, Hunger-Free Kids Act guidelines followed in schools, which require more fruits and vegetables, more whole grains, less fat and sugar, and limit calories according to age.

What seems to aggravate Sun Editor Jim Paxton the most are the proposal's suggestions to ban on-site frying and the qualification of tofu, a soybean curd, as a meat alternative. It said that while the program was originally set up to combat malnutrition, it now has decided "a little starvation is not a bad thing; ergo, tofu instead of fried chicken."

The editorial suggests that day-care facilities could no longer have french fries or fried chicken, but it fails to mention that both items could be offered with a more healthful preparation in the oven. And tofu, a cheap, low-fat protein source, would be added as an option, not a requirement.

The recommended way to lose weight is to decrease calories, eat healthful foods, and increase activity. The nutritional requirements suggested in this program include two of these efforts.

The editorial reminds us that some students are "turning up their noses at the new offerings," that "student participation in school meal programs is down," and says pre-school programs are concerned that the same thing will happen to them.

However, schools say they are tweaking their menus to find healthful foods that the kids like and purchase newer whole grain products that don't taste any different than the processed grains the kids are used to.

So, is it too much regulation or a new way to improve the health of children that will take time and tweaks to perfect?

The editorial says the Sun supports nutrition education and healthy choices on the school menu, but that the "primary responsibility for combating childhood obesity lies with parents and the rules they set in the home."

But what the editor fails to consider is that one out of three adults, many whom are parents, are obese, and are the ones responsible for teaching these lessons.

Too much regulation or a step in the right direction? You decide.

Scheduling lunch after recess, very unusual in elementaries, may lead to less food waste and better nutrition, study says

Scheduling school lunch later in the day could help children to eat more nutritious foods and reduce food waste, according to a study at seven schools in Utah. Researchers found that children threw away more food when they ate lunch before recess instead of afterward, and much of the food they threw away was fruits and vegetables, Roberto A. Ferdman writes for The Washington Post.

Cornell University and Brigham Young University researchers spent 14 days studying the behavior of children during lunch. Three schools served lunch after recess, and the other four before recess. The researchers kept track of how many fruits and vegetables children discarded and how many they ate.

"Students who ate lunch after recess ate 54 percent more fruits and vegetables than those who ate it before," Ferdman reports. The number of students who ate at least one serving of fruit and vegetables was 45 percent greater at the schools that served lunch after recess than the schools who served it beforehand. This is because students are hungrier for lunch after playing, and if they have already had recess, they will not rush eating their lunch so they can go play.

"If recess is held before lunch, students come to lunch with healthy appetites and less urgency and are more likely to eat their fruits and vegetables," David Just, one of the study's authors, told Ferdman.

A 2014 study also concluded, for about the same reasons, that providing lunch before recess leads to more food waste. It is unknown how many schools currently serve lunch before recess, but in 2011, only 4.6 percent of elementary schools reported serving lunch after recess. (Read more)

Big majority supports domestic-violence orders for dating-only partners, and prospects for passage appear to be much better

By Melissa Patrick
Kentucky Health News

A large majority of Kentuckians say state law should allow domestic-violence protective orders involving dating partners, and the prospects for such a law appear to have improved considerably.

The poll found that 80 percent of Kentucky think dating partners should be allowed to get a protective order against a partner who had made them a victim of violence.

Under current law, such orders are available only to family members, members of an unmarried couple with a child in common, and unmarried couples who either live together or have lived together. All other states allow such orders for partners who are merely in a relationship.

The poll, taken Oct. 8 through Nov. 6, found 83 percent of women and 76 percent of men in favor of the change. Majorities in each political party also supported it: 84 percent of Democrats, 77 percent of Republicans and 75 percent of independents. The poll's error margin is plus or minus 2.5 percentage points.

"Kentucky is the last state in the country not to offer protections to victims of dating violence," said state Rep. John Tilley, D-Hopkinsville, chairman of the House Judiciary Committee. "It is time we changed that."

Tilley has sponsored the change for the past four years, but has failed to get it through the Senate, where President Robert Stivers, R-Manchester, has said dating partners already have ways to get protection from the justice system. But Tilley said in a telephone interview Thursday that he thinks Stivers has "come around."

He said this year's bill is still being drafted, but will have some significant changes from previous bills as supporters have worked to bring all of the stakeholders to the table.

"I am hopeful that this bill will pass because we seem to have key leaders prioritizing this bill, from the Senate president to the speaker of the house to the governor, and that is one difference I can point out from previous sessions," he said. "This bill will expand the current system to include victims of dating violence to be eligible to receive a protective order and be put into a national network that will then protect them wherever they go in this country."

Gov. Steve Beshear called for passage of the bill in his State of the Commonwealth address. First Lady Jane Beshear, a longtime advocate for this bill, told Linda Blackford of the Lexington Herald-Leader, "This is not only a top priority for me, it's a top priority for this office. Steve has been working with leadership to find a bill that is palatable to everyone in hopes we can pass it and then move on to other important things."

Domestic violence affects nearly one out of four American women in their lifetime, and in Kentucky one in three, according to The Center for Women and Families in Louisville.

"Domestic violence is a public health crisis of a staggering multitude," Marcia Roth, executive director of The Mary Byron Project, a non-profit that advocates for domestic violence issues, said in a phone interview. "It leads to $4.1 billion for direct medical and mental health services per year."

Not only is domestic violence a health issue because of its health-care costs, Roth said, "It goes beyond the physical wounds. Victims are more likely to be depressed, have unplanned and premature pregnancies, go to fewer prenatal visits and to miss more well-child visits with their children."

The populations most vulnerable to domestic violence are females between 16 and 19, with the numbers not much better for those 25 to 27. Most of these young women aren't married, don't live with their partner or don't share a child in common and have no immediate protections from dating violence, Tilley said.

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.

Heavy use of e-cigarettes may deliver big doses of formaldehyde, which can be a cause of lung cancer, study suggests

Vapor produced by electronic cigarettes can contain a surprisingly high concentration of formaldehyde—a known carcinogen that can cause lung cancer through prolonged exposure—researchers reported Wednesday in a study published in the New England Journal of Medicine, Rob Stein reports for NPR. (Getty Images by Dan Kilwood)

Use of e-cigarettes among rural teens has risen in recent years, prompting the U.S. Food and Drug Administration to propose rules to give it authority over e-cigarettes, an industry that accounts for about $2.5 billion in annual sales.

"E-cigarettes work by heating a liquid that contains nicotine to create a vapor that users inhale," Stein writes. David Peyton, a chemistry professor at Portland State University who helped conduct the research, told Stein, "We simulated vaping by drawing the vapor—the aerosol—into a syringe, sort of simulating the lungs. That enabled the researchers to conduct a detailed chemical analysis of the vapor. They found something unexpected when the devices were dialed up to their highest settings."

The e-cigarette industry dismissed the report, saying they found formaldehyde only when e-cigarettes were cranked up to their highest voltage levels, Stein writes. Gregory Conley of the American Vaping Association told him, "They clearly did not talk to [people who use e-cigarettes] to understand this. They think, 'Oh, well. If we hit the button for so many seconds and that produces formaldehyde, then we have a new public health crisis to report."

"If you hold the button on an e-cigarette for 100 seconds, you could potentially produce 100 times more formaldehyde than you would ever get from a cigarette," Conley said. "But no human vaper would ever vape at that condition because within one second their lungs would be incredibly uncomfortable." (Read more)

Research suggests eating only during a nine- to 12-hour time period can help maintain healthy weight

For a long time, scientists supposed that eating after midnight was unhealthy, but now a study has provided support for the notion. When scientists prevented mice from eating whenever they wanted, the animals avoided obesity and metabolic issues—even when the diet was unhealthy, Ben Wiseman reports for The New York Times.

In a previous study, researchers at Salk Institute for Biological Studies in San Diego began studying mice eating patterns. The mice in the study that were permitted to eat whenever they wished gained weight and became unwell, while the mice who were only permitted to eat during an eight-hour window didn't gain much weight or develop metabolic problems.

The new study, which was published in the journal Cell Metabolism in December, Salk scientists provided groups of mice with one of four diets: high-fat, high-fructose, high-fat and high-sucrose and regular mouse food. "Some of the mice in each dietary group were allowed eat whenever they wanted throughout their waking hours; others were restricted to feeding periods of nine, 12 or 15 hours," Wiseman writes. The caloric intake for all the mice was the same.

Some of the mice in the time-restricted groups were allowed to eat whenever they wanted on weekends, and some of the eat-anytime mice were moved to the restricted groups halfway through the study. At the end of the study, the mice that ate whenever they pleased became obese and metabolically ill, but the time-restricted mice stayed healthy. The mice switched from the former group to the latter lost some of the weight they'd gained, Wiseman writes.

Though scientists don't know exactly why eating during a designated timeframe helps prevent weight gain, Dr. Satchidananda Panda, who oversaw the studies, and his colleagues think it has to do with the body's internal clock. "Meal times have more effect on circadian rhythm than dark and light cycles," Panda said. Circadian rhythm influences the function of many genes in the body that have to do with metabolism.

These studies have only been performed using mice, but Panda believes the results could apply to humans. He suggests that people only eat within a 12 hour—or shorter—window each day. The clock begins with the first thing a person eats in the morning. (Read more)

Study finds kids eat too much pizza, too often, and it's bad for their health

While pizza consumption is lower than it used to be, kids are still eating too much of it, and it's affecting their health, Roberto A. Ferdman reports for The Washington Post.

The health issues are a result of the extra calories, fat and sodium consumed when children eat too much pizza, too often, according to a study published by the journal Pediatrics from the University of Illinois - Chicago, Ferdman writes.

"When you eat extra calories and don't compensate for it at another point of the day or week, it can lead to weight gain and even obesity," William Dietz, one of the study's authors and the director of the Sumner Redstone Global Center for Prevention and Wellness at the George Washington University, told Ferdman.

Obesity is a real problem for many of Kentucky's children. The state is ranked first for high school obesity, eighth for obesity in children aged 10 to 17, and sixth for obesity among 2- to 4- year-olds from low income families, according to the States of Obesity report.

The researchers tracked the diets of more than 11,000 children and teenagers using data from the National Health and Nutrition Examination Survey and found that "On any given day, roughly 20 percent of all children aged 2 to 11 and adolescents aged 12 to 19 eat pizza," Ferdman reports. The younger children eat roughly 400 calories and teens upward of 600 calories on the days they eat pizza, rarely with a healthy side like salad or vegetables.

This boils down to pizza days being associated with "considerably higher" intakes of saturated and sodium, and an extra 84 calories for children and an extra 230 calories for teens.

"There are a bunch of takeaways from the study. But the biggest thing is that parents are serving their kids too much pizza," Dietz told Ferdman.

It's cheap. It's convenient. It's universally loved. And an estimated 3 billion pizzas are eaten every year in the United States. "What's to be done?" Ferdman asks.

"We're not suggesting that kids avoid pizza altogether,"Dietz told Ferdman. "But when parents serve it, it's important that they understand it's extremely caloric. They should serve smaller pizzas, or at least smaller slices. They might also want to serve it with vegetables instead of sausage on top."

Weekly paper in Carter County runs voluntary-response survey about statewide smoking ban, finds slim majority in favor

Wikipedia map: Carter County

The Journal-Times, the weekly newspaper in Carter County, is running an online "poll" of reader opinions about the proposed statewide smoking ban and finding a slim majority in favor of it. At 4:20 p.m. Sunday, 52.3 percent of the voluntary respondents said they favored the legislation, while 45.4 percent said they opposed it and 2.3 percent said they didn't care.

Despite those numbers, reporter Leeann Akers writes that the idea "seems to be unpopular in Carter County," based on "overwhelming opinion on social media." She cites the Facebook page of the Carter County Citizens For a Better Way and this post from Brandon Boggs: “If a business wants to prohibit smoking they have that right, however, we have the right to support that business or not depending on our personal preferences.”

Some posters on the page favor the ban. Travis Horton wrote: "I as a nonsmoker think people that smoke in restaurants or in businesses are showing disrespect for people with health issues and other things."

A continuing national survey by the federal Centers for Disease Control has found that between 31 and 46 percent of Carter County residents smoke, with the most likely number being 38 percent, well above the statewide figure of 29 percent in the same survey.

Akers reports that the county's two state legislators, "Sen. Robin Webb and Rep. Jill York, both say they remain undecided on how they will vote if it comes to the floor but both have a history of following their voters." She gives the legislators' email addresses and the telephone number to leave a message for them.

"This is the sort of story that most local newspapers with websites can do," said Al Cross, director of the Institute for Rural Journalism and Community Issues, publisher of Kentucky Health News. "But I suggest that they avoid calling any voluntary-response survey a poll, because that word implies that the results are from a scientific, random sample, and that they remind readers of that in giving the results."

New rule will improve reporting of antibiotic-resistant infections in health-care facilities, which are getting worse in Kentucky

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. — Kentucky will have a new weapon, in the form of data, to fight infections acquired in hospitals and other health-care facilities, with legislative approval of a regulation that changes the way antibiotic-resistant infections such as MRSA and C. difficile are reported.

Health Watch USA chart, Centers for Disease Control data

The new rule comes at a time when Kentucky has the third highest rate of MRSA bloodstream infections in the nation, according to the National Healthcare Safety Network. The state was ranked fourth last year.

Kentucky hospitals are 27 percent worse for MRSA (methicillin-resistant Staphylococcus aureus) and 21 percent worse for catheter-associated urinary tract infections than they were two years ago, according to the federal Centers for Disease Control's National and State Health-care Associated Infection Progress report.

The legislature's Administrative Regulation Review Subcommittee approved the regulation, which has been in the works since 2008, at its Jan. 13 meeting. In the meantime, hospitals have succeeded in changing the term "hospital-acquired infections" to "healthcare-associated infections" to indicate that not all such infections occur in hospitals.

"The emergence of these dangerous organisms is really a problem of our entire heath care system and it can't be fixed by any single facility or facility type," Kevin Kavanagh of Somerset, chairman of Health Watch USA, a non-profit organization that promotes health care transparency and patient advocacy, told the committee. For his testimony, click here.

The regulation redefines HAIs and HAI outbreaks for infections, and requires simultaneous data reporting to the CDC and the state Department for Public Health. The CDC already has the data, but has "no authority" to act on it, while the state health department has the authority but not the data, Kavanagh wrote in an opinion piece for the Lexington Herald-Leader. "It is imperative that we know what is happening and where, so effective action can take place."

He told the committee, "Data for action is critical. It is the first step to confront these dangerous organisms."

The regulation also will require electronic reporting via the Kentucky Health Information Exchange beginning 2016. It now goes to Gov. Steve Beshear for final approval, which is expected.

Rep. Tom Burch, D-Louisville, chair of the House Health and Welfare Committee, told the joint House-Senate regulations committee that he had worked on the regulation for many years and that the Kentucky Hospital Association supported it. It had lobbied against such regulations. "There is nobody against it right now," Burch said.

However, Sen. Alice Forgy Kerr, R-Lexington, said "This regulation seems to have caused a lot of indigestion for a lot of people," and asked for a "statement of confirmation" from someone representing a group that might have opposed it in the past.

The hospital association's vice president of government relations, Sarah Nicholson, was at the meeting but didn't speak. Dana Stephens, director of infection prevention and control at St. Joseph East Hospital and St. Joseph Jessamine, told the committee, "I have had the great pleasure and honor of working with this multidisciplinary team for the past many years to really develop legislation and regulatory language that will provide information that will improve the health of those citizens we serve."

Kerr commended the groups on reaching a compromise, but the elements of the compromise were unclear. Nicholson declined to comment after the meeting.

Kavanagh said afterward that the regulation is needed to reverse the apparent increase in hospital infections, based on the CDC data from 38 of the state's 93 hospitals. "We are going in the wrong direction, with Kentucky 27 percent worse than it was two years ago," he noted. "This regulation will help with that."

Centers for Disease Control graphic reports Kentucky data on health-care-associated infections

The regulation is expected to improve the accuracy of Kentucky's HAI data because it requires all health-care facilities to submit reports and more clearly defines HAIs, which Kananagh said will help with under-reporting of infections.

New regulations often raise questions about the cost of enforcing them. Kavanagh told the committee that the CDC had told him that it would be allocating "a lot of federal money" to state health departments through grants to confront infectious disease issues, a result of the lessons learned from Ebola. Better HAI data will support Kentucky's need for these grants, he said.

"So, I do believe the state health department, along with other entities, will have access to funds to implement this regulation change,” he said.

Low-income smokers have a harder time quitting, which helps explain why Kentucky leads the nation in smoking

Lower-income smokers have a harder time quitting than health-conscious middle- and upper-class Americans, Keith Humphreys reports for The Washington Post.

The numbers suggest one reason why Kentuckians lead the nation in smoking. Kentucky ranks 48th among the states and the District of Columbia in median household income in 2011-13, according to the Census Bureau; it ranked 45th in per-capita personal income in 2013, according to the Bureau of Economic Analysis.

The pol'ls margin of error was plus or minus 1 percentage point.

A 2008 Gallup poll of more than 75,000 Americans showed that the rate of smoking among people making less than $24,000 a year was more than double that of those making $90,000 or more. The higher the income category, the lower the smoking rate, except those making less than $6,000 per year, which was skewed because many in this bracket are students, Rob Goszkowski writes for Gallup.

Once health warnings about cigarettes became widely known, better-off Americans were more likely to quit smoking. "High-income families decreased their smoking by 62 percent from 1965 to 1999, versus only 9 percent for low-income families," Humphreys reports. Education may also be a factor; income and education are usually closely related.

Humphreys list three reasons poorer smokers have a hard time quitting:
1. They inhale more deeply on each draw from a cigarette, creating stronger addiction and making it harder to quit.
2. They don't have the same social support from their colleagues and friends as wealthier smokers. For example, a doctor is likely to be encouraged to quit smoking or get social disapproval if he or she is the last of their peers to stop; a person who works at roadside cleanup might "face precisely the reverse social incentives from his smoking coworkers," Humphreys writes.
3. They are likely to have less access to effective smoking-cessation programs and less access to address behavioral health issues, like depression, that make quitting more difficult. Kentucky has addressed those problems recently by having Medicaid cover smoking cessation and behavioral-health care by any licensed provider.

Some suggest that because lower income smokers have a harder time quitting, using higher tobacco taxes as an incentive for them to quit should be re-evaluated. Humphreys writes, "Deeply addicted, low-income smokers may face the choice between spending much-needed income on tobacco or venturing into the black market for untaxed cigarettes, which carries significant risks of its own."

Kentucky's cigarette tax of 60 cents a pack is lower than all but 10 states. New York ranks first at $4.35 per pack, which pushes the price of cigarettes to $10-$15 a pack, according to the Campaign for Tobacco-Free Kids website.

Clark County schools engage students as taste-testers in search for newly required, healthy foods the kids will eat

New federal nutrition standards "are not universally popular with students" in Clark County — some throw away recently required fresh fruits and vegetables — but "participation in school lunch programs has not been greatly affected," Whitney Leggett reports for The Winchester Sun after reading School Nutrition Director Becky Lowery's annual Wellness Report Card.

“This is a way for us to just sort of look at where we are and evaluate what we can do better,” Lowery told Leggett. The report highlights the requirements of the 2010 Healthy Hunger-Free Kids Act, such as a switch to whole-grain products, restrictions on fat and salt, and age-based calorie limits.

The greatest resistance has been to fruits, vegetables and whole-grain bread and pasta, Lowert told Leggett. Despite the complaints, participation in the school lunch and breakfast programs has only decreased by 1 percent since the 2013-14 school year, Leggett reports, along with a localized illustration.

To improve student satisfaction, Lowery implemented a student panel to taste possible new menu items. “It is much more difficult and more expensive to find good quality products that students will accept,” she told Leggett. “We’re just always trying to find good products that will still meet regulations.”

As part of the Farm to School initiative, Clark County strives to use more Kentucky Proud products, such as corn grown in Clark County, green beans from Louisville, and Western Kentucky blueberries, Lowery told Leggett. “As I hear about more things available to us that we can use, I will look into them,” she said. “We try to use as much as we can.”

Officials of hospitals and state government to discuss future of Ky. health care at Jan. 29 'summit' In Frankfort

State government and the Kentucky Hospital Association will co-host a summit for hospital CEOs, hospital board members and other elected officials and decision makers on the future of health-care delivery in Kentucky on the afternoon of Jan. 29 at the Capital Plaza Hotel in Frankfort.

“The health-care market and delivery systems all across the nation are currently undergoing an unprecedented transformation,” Gov. Steve Beshear said in a statement. “The rapid pace of this transition poses challenges to healthcare stakeholders, both rural and urban, that are facing fundamental changes to how they deliver care to patients in our communities.”

State Health Secretary Audrey Tayse Haynes said the state "has been very successful in getting Kentuckians enrolled in quality, affordable health-care coverage," but "We must now translate that coverage into quality, efficient and effective treatment. . . . The methods of treatment delivery must adapt to accommodate this new population of patients.”

Under federal health reform, hospitals are moving from volume-based to value-based reimbursements, and getting a larger share of Medicare and Medicaid patients, and for some that has meant empty beds, lower revenues and in some cases bankruptcy. Many Kentuckians have chronic illnesses, "which result in very low margins for some providers," a state news release said.

Letters of invitation have been sent to all members of the General Assembly and hospital CEOs. Space is limited, so invited guests are encouraged to register soon.

1/4 of Ky. adults say they have tried e-cigs; just over half of adults (but not the e-cig users) want them taxed and regulated

More than four in 10 Kentucky adults under age 30 have tried electronic cigarettes, and the older and better off economically Kentuckians are, the less likely they are to have tried them. Overall, one-fourth of Kentucky adults and 60 percent of current smokers have tried the devices.

Those are major findings of the latest Kentucky Health Issues Poll, which also found that 61 percent Kentucky adults want the U.S. Food and Drug Administration to regulate e-cigarettes and 53 percent want them to be taxed in the same way as traditional cigarettes.

The poll, taken Oct. 8-Nov. 6, has an error margin of plus or minus 2.5 percentage points. It was conducted by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,597 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones.

The poll was conducted for the Foundation for a Healthy Kentucky and the Cincinnati-based Interact for Health nonprofit. “Last year, Kentucky became one of dozens of states to prohibit the sale of electronic cigarettes to minors,” Susan Zepeda, president and CEO of the foundation, noted in a news release.

The poll didn't ask respondents if they were currently using e-cigarettes, but the data offer some interesting details: Men (29%) were more likely than women (20%) to have used an e-cigarette, and college graduates (14%) and were less likely than others (27%) to have done so. So were residents of the Lexington area, at 16%. Among those who said they previously smoked cigarettes, 19 percent said they had tried the electronic version.

As might be expected, current smokers those who had used an e-cigarette were much less likely to say the devices should be taxed like tobacco cigarettes.

Elizabethtown doctors who paid millions to settle claims of bill-padding are sued by chemotherapy patients

"Eight former patients or their estates have sued the Elizabethtown cancer doctors who paid the government $3.7 million last June to settle claims they extended chemotherapy treatments to pad their bills," Andrew Wolfson reports for The Courier-Journal. "The ex-patients or their families say in a suit filed in Hardin Circuit Court that the clinic negligently treated them by diluting treatment drugs and extending treatment periods, which allowed them to bill more to Medicaid and other programs." As a result, the plaintiffs say, they suffered unnecessary pain and anguish, and those who died did so prematurely.

The physicians whom the suit identifies as owners of the clinic, Yusuf Deshmukh and Rafiq Rahman, are under investigation by the Kentucky Board of Medical Licensure. "The clinic's owners agreed to pay $3,739,325 last June to resolve allegations that they submitted false claims for payment to the Medicare, Medicaid and the military's medical provider for extending the duration of chemotherapy infusion treatment to patients, and for inappropriately billing office visits for infusion therapy," Wolfson reports.

Foundation for a Healthy Kentucky lists 2014 grants

The Foundation for a Healthy Kentucky has provided more than $1.3 million in 2014 for community programs, polling and policy initiatives to not only advise policymakers but also advocate for better health and health care across the state.

"Our strategies to address the unmet health care needs of Kentuckians are built on investment at the local and state levels," Susan Zepeda, president and CEO of the foundation, said in a news release.

The foundation said it donated $125,000 to Kentucky Voices for Health, a coalition of lobbying groups that support health reform; $50,000 to Kentucky Youth Advocates, an organization dedicated to the improvement of public policies that influence the lives of children and families and $60,000 to the University of Cincinnati for the 2013 Kentucky Health Issues Poll.

As part of a 2012-17 strategic plan to help school-aged children grow up to be healthier than their parents, the foundation provided three grantees money to set in motion the business plans they developed. Recipients included: Clinton County School District ($158,361), Fitness for Life Around Grant County ($182,033) and Louisville Metro Department of Public Health and Wellness ($161,850). The foundation also funds a multi-year study of Kentucky's transition to managed-vcare Medicaid.

The foundation matched a $3 million federal investment to begin nurse-managed clinics, telemedicine, mobile health services, care navigation and and an activities center. These projects "have improved the quality of life for more than 20,000 Kentuckians and provided training for more than 250 providers," according to the release.

To support the improvement of health literacy in Kentucky, the foundation invested $100,000 in health programming on KET, and $25,000 with the Institute for Rural Journalism and Community Issues at the University of Kentucky , mainly for the publication of Kentucky Health News.

Advocates must sell reform as political winds blow, Luallen says

By Melissa Patrick
Kentucky Health News

Advocates of health reform must arm themselves with information about its success in Kentucky to fight back against its critics as the 2015 gubernatorial election looms, Lt. Gov. Crit Luallen told them at the Kentucky Voices for Health annual meeting Jan. 12.

Lt. Gov. Crit Luallen

"Improving our state's health is not a task that can be accomplished in months. It doesn't fit with the cycles of gubernatorial administrations," Luallen said, alluding to the upcoming election and those for the legislature in 2016.

"I have seen time and again that Kentucky fails to remain on course for the sustained commitment that it takes to successfully tackle our toughest challenges. Too often in the past, we've let political posturing derail our efforts, too often we take the easy course when faced with difficult decisions."

She added, "We have the opportunity to truly change the future of Kentucky if we can cement these reforms in a way that has lasting and sustainable impact. But the key to that sustained commitment is your voices being strong when the political winds make staying strong during the course difficult."

Luallen, who has worked for six Kentucky governors, said governors often slow down during their last year of service, but she said this might be Gov. Steve Beshear's "most important year" as he works to keep his health initiatives moving forward.

She listed many of the results: increased health coverage for children and low-income working families, expanded mental health and substance abuse treatments, increased cancer screenings, 114,000 people already signed up for health coverage in the second enrollment period, and 12,000 new jobs created in Kentucky health care because expansion of Medicaid and subsidies for private coverage have expanded the health-care industry.

In the longer term, she said, "The meaningful reforms we have implemented will lead to a higher quality of life, better attendance at school, a stronger work record and less chance of bankruptcy due to illness or disease, but only if we stay the course."

Luallen reminded the advocates, many of who are paid lobbyists, to also talk about the challenges that remain with the Patient Protection and Affordable Care Act.

One of the biggest concerns critics have about the law is that Kentucky won't be able to pay for its share the care for newly eligible Medicaid patients, which will start in 2017 and reach the law's limit of 10 percent in 2020.

Beshear says the expansion will pay for itself, based on a study by the Pricewaterhouse Coopers accounting firm and the University of Louisville's Urban Studies Institute. However, the newly-eligible Medicaid enrollment last year was more than double the original projection, nearing levels that had been predicted would not be seen until 2020, and the 12,000 jobs are about two-thirds of the total projected by that time.

Beshear has ordered up a new study, using a year's experience, which Luallen said is to be completed by the end of January. She said that the economic impact of the law could be higher than first expected "because we have seen more people sign up, especially in the Medicaid arena, which means more federal dollars flowing to the state."

Luallen said that when critics say, "We can't afford to do it," advocates should say, "Yes we can!"

By virtue of her office, to which Beshear appointed her when Jerry Abramson resigned to take a White House job, Luallen heads Kyhealthnow, an aggressive plan to improve Kentuckians' health, with seven measurable goals, over the next five years. "We will be looking for partners as we work to transition Kyhealthnow's mission beyond this administration," she said.

On perhaps the most pressing health issue of the moment, a proposed statewide smoking ban, Luallen said there is increased interest in the House and more support in the Republican-controlled Senate, where the ban has never even made it out of committee. "We believe that this truly has a chance of passing this session," she said, "if we can all speak with one voice and get behind it and make the case that there is not a single thing we can do that would have bigger impact in this state's health statistics than to lower the rate of smoking and exposure to secondhand smoke."

Luallen is a colon cancer survivor and has lost her mother, two brothers, two aunts and an uncle to cancer. She said that her personal experience gives her a unique perspective in understanding the devastating effects of cancer in Kentucky and has contributed to her passion for health policy. Kentucky ranks first for cancer and cancer deaths.

She said, “I often say that people in Kentucky fall into one of two groups, those who have been touched by cancer and those who have not been touched yet.”

New marijuana product called 'wax' often smoked in e-cigarettes

A new marijuana product on the market called Wax (also called Butter and Honeycomb) that is easily disguised and used in e-cigarettes has found its way to Kentucky, Erica Coghill reports for WLKY-TV in Louisville.

It is called "wax" because its yellow color and waxy texture makes it look like earwax, and that makes it easy to conceal because it looks and feels like lip balm, Raychelle Cassada Lohmann writes for Psychology Today.

"Wax" is made from the oils of marijuana plants and has a high level of THC, the ingredient in marijuana that makes a user high, and while it is easy to make, the ingredients are "highly flammable and dangerous," Lohmann reports.

"What they do is they take marijuana, then take the THC out of it, put it in wax form, stick it in an e-cig, which heats it up, melts it, and you smoke it just like an e-cig, but you get the high off the marijuana," Tim Gividen, Carrollton police officer told Coghill.

"Wax" is much stronger than marijuana,. and can be eaten or smoked. "What's super-scary is that this new substance is equal to smoking 15 to 20 joints and can give a buzz that may last a full day," Lohmann reports.

E-cigarettes are composed of water vapor, flavoring and nicotine.  "You're not going to get the marijuana smell off the smoke, because it is going to be disguised with flavoring, "Gividen told Coghill. Heroin is also being smoked with e-cigs, Coghill said.

Gividen, who patrols schools in Carroll County, learned about "wax" when he confiscated an e-cigarette from a student at Carroll County High School and started asking questions. He found out that it had been popular on the West Coast, but had worked its way across the country.

"Actually, in Trimble County, it has been an issue within their high school, so we know it is something that is surrounding us and a problem," Hayley Franklin, director of Champions For A Drug Free Carroll County, told Coghill.

Gividen and Franklin reminded parents to "keep an eye on their kids and who they're hanging out with, and educate them about the dangers of drugs."

Lohmann suggests that parents keep an eye out for items used in the making of "wax": butane containers, glass/metal tubes, glass baking dishes, isopropyl alcohol and coffee filters.

AMA president-elect, from Lexington, talks with KET host about the myriad issues facing his profession and its patients

Steven J. Stack

The new president-elect of the American Medical Association, Dr. Steven J. Stack of Lexington, covered a range of topics with Bill Goodman on KET's "One to One" in December, including the AMA's advocacy role, health information technology, improving health disparities in Kentucky and medical liability reform.

Stack, an emergency physician in Lexington, told Goodman that his experience as an emergency room physician would bring a unique perspective to his role as AMA president because he has seen first-hand how many people don't have health insurance and therefore a lack of access to routine care.

"As an emergency-room physician, it has been for me a personal hope and aspiration and a great joy to see that we are making strides finally to improve American's access to care because we know that those without access to health insurance and support live sicker and die younger," Stack said. "And that's a tragedy that we should not stomach easily or tolerate in this nation."

Not only is Stack the first board-certified emergency physician elected president, when he takes office in June he will be the youngest person to lead the AMA, the nation's largest organization for physicians. He is a longtime member of the organization and has held many leadership positions. He is the second Lexington doctor in three years to hold the office. AMA's immediate past president is Dr. Ardis Dee Hoven, an infectious disease specialist at the University of Kentucky.

Stack said the AMA as an association is non-partisan and works with people in both partie "to advance policies that we hope will improve patient care and the practice of medicine." That being said, he then said he fully recognized the role of politics in health policy and said he will, "have to advocate strenuously at times for those policies that we think will be helpful."

He talked about the privilege of being an advocate before Congress, federal agencies and the state legislature. "It is an incredible privilege and it is one that I take very seriously," he said.

Stack headed the AMA’s Health Information Technology Advisory Group from 2007 to 2013 and is a member of the federal advisory groups for the Office of the National Coordinator for Health Information Technology.

"Healthcare is one of the last big sectors in the U.S. economy to go digital in its management of information. And there are good reasons for that delay," Stack said. He listed several reasons: the complexity of health care, the varying needs of different types of health-care facilities, maintaining patient privacy, continuing technological barriers, and politics.

Asked why it is taking so long to make advancements with electronic health records, Stack blamed "policy issues, differences in opinion, protecting privacy, a variation across all 50 states and layering on top of that different federal requirements." But he added, "We will get there."

Stack suggested that focusing on improving health outcomes, which is part of the AMA strategic plan, would ultimately help improve many of the health disparities that face so many Kentuckians.

Asked about the continued calls by some to repeal the Patient Protection and Affordable Care Act, Stack said the time to quit arguing about it is long past, it is "the law of the land" and recent polls show that the many people who have received insurance through the PPACA are happy with it.

"It is here to stay and we need to  get to work on fixing the things that have to be fixed," he said.

At the same time, the AMA firmly supports medical liability reform, which was not included in the reform law. Stack told Goodman that this reform is not only important for physicians, but also patients. "Only one in 100 cases actually prevail against the physician at trial," he said, and "Nearly 90 percent of cases are either dismissed or dropped, closed or settled with no payment from the physician to the plaintiff. It is clearly not helping the patients."

He called for "a rational system" that appropriately compensates patients who are "inappropriately harmed" and treats physicians fairly, while not making a "small number" of lawyers rich.

Asked what his overarching goal as president of the AMA would be, Stack said, "I would really like to see all Americans have access to high quality, reliable health care that is affordable and within their means. So the AMA and I will work diligently to that end and it is a great privilege to do that."

Click here to view the program.

Kentucky has recorded 26 flu-related deaths, mostly seniors, and 64 outbreaks at long-term-care facilities; get vaccinated!

Kentucky has reported 26 influenza-related deaths and 64 flu outbreaks in long-term care facilities as of Jan. 8 after five consecutive weeks of widespread flu activity, and is only halfway through the flu season, which runs from October through May, a top state health official said Thursday, Jan. 8.

And with the flu season in full swing and not expected to improve any time soon, Deputy Health Commissioner Kraig Humbaugh said it's not too late to get a flu shot and "Practically everyone 6 months and older should get a flu vaccine." He added, "Even though this year's flu vaccine is not as well matched to covering the circulating strains as we would like to see, it is still the best way to prevent the flu."

"The types of people that are likely to experience severe illness are the young, the elderly, pregnant women and people with chronic illness," Humbaugh said. "That is why we especially want those folks to receive a flu vaccine each year."

Last flu season, there were approximately 50 flu-related deaths. "All areas of the state have been affected by flu deaths and have been affected by the circulating flu this year," Humbaugh said.

He noted that 19 of the 26 reported deaths were among people 65 and older. He encouraged seniors to get vaccinated because they have the highest risk of complications from the flu and are most likely to be hospitalized because of it. Typically,70 percent of seniors are vaccinated. Among the other reported deaths, two were children and five were aged 18 to 64.

Humbaugh also suggested that "the old advice that your mother gave you still applies" to stay healthy: Wash your hands well and often, don't touch your mouth and nose unnecessarily, and avoid large crowds and contact with sick people. He reminded those who are sick to stay home from work or school and to sneeze into their elbow to avoid spreading the flu.

The Centers for Disease Control and Prevention are urging doctors to prescribe more antiviral medication to help patients heal faster, saying in a news release, "Evidence from the current and previous influenza seasons suggests that they are severely underutilized."

Humbaugh said, "People who are sick with the flu can potentially benefit from an anti-viral medication, such as Tamiflu or Rolenza." He noted that the drugs must be prescribed by a health provider and work best if taken during within the first two days of illness. No widespread shortages of these antiviral medications have been reported.

Long-term care facilities across the state have reported 64 flu outbreaks, meaning they have one or more cases of flu in their facility, this flu season. Facilities are working with the state to determine how to control outbreaks, Humbaugh said. He encouraged those with the flu to stay away from these facilities and for the public to respect the rules put in place at these facilities to protect this most vulnerable population from the flu.