Beshear says Ky. rural hospitals 'have a positive cash flow' but he can't prove it; industry says it sees 'some improvement'

By Al Cross
Kentucky Health News

FRANKFORT, Ky. -- Gov. Steve Beshear says Kentucky's rural hospitals are profitable again, thanks to his expansion of Medicaid, but he offers little evidence to support his claim, and the hospital industry disputes it.

In a long, joint interview with Colorado Gov. John Hickenlooper at the Brookings Institution in Washington, D.C., Feb. 20, Beshear said, “Our rural hospitals have a positive cash flow for the first time in a long time, so it’s working, it’s going to work, and my job is just to get it so embedded that nobody can do anything about it.”

Kentucky Health News asked Beshear's office for evidence of rural Kentucky hospitals’ positive cash flow, but the office cited only a news story about Carroll County Memorial Hospital in Carrollton, which said it turned a small profit in 2013 (thanks to federal health-reform grants for digitizing medical records) and a much larger one in 2014.

"Some of them have improved and some of them have not," said Mike Rust, president of the Kentucky Hospital Association. As a result of Medicaid expansion, he said, "Some have benefited greatly but others are still struggling."

The association's vice president of health policy, Elizabeth Cobb, said, "In general we’re seeing some improvement in rural hospital finances," largely from a decline in the number of charity cases as a result of previous patients having coverage. "We were already taking care of most of those," she said.

State figures show Medicaid payments to rural hospitals rose 20 percent in the state fiscal year that ended June 30, 2013, but only 6 percent in the next year, when the Medicaid expansion began; and that the payments to urban hospitals rose 4 percent and 10 percent the last two years.

Based on claims from July through September, the state forecasts that Medicaid payments to rural hospitals in the current fiscal year will increase 26 percent, and payments to urban hospitals will rise 15 percent. (The state has estimates for each hospital.)

Cobb said the expansion hasn't generated as many new patients as might be expected for rural hospitals because of the shortage of primary-care physicians who admit patients: "We're not seeing a huge expansion of utilization as a result of Medicaid expansion."

That keeps patients coming to hospital emergency rooms for care, some of which is deemed non-emergency by managed-care organizations, the insurance-company subsidiaries that have overseen the care of Medicaid beneficiaries since 2011. Two MCOs pay only a $50 "triage fee" in such cases, regardless of what diagnostic tests the hospital performs; that was the topic of a legislative hearing last week.

And that is just one part of hospitals' problems with the MCOs. "What we're seeing generally is that while hospitals are receiving payment for some patients who may have been uninsured previously and are now insured by Medicaid, we're still seeing the challenges of hospitals being paid by managed-care organizations," Cobb said. "There's an increase in the administrative burden for small hospitals to work with five different MCO plans that all have very different rules and criteria."

Clinton County Hospital Administrator J.D. Mullins cited MCO problems is explaining his facility's decision to file for bankruptcy last year, mainly to restructure payments on the federal loan for a $14.7 million addition completed a few years ago, the Clinton County News reported.

"These companies’ polices have restricted access to the hospital’s services and reduced our reimbursement even more," Mullins told the Albany paper. "When the idea of a new hospital facility was first proposed, no one could have foreseen the condition of health care today."

The hospital is in the district of Sen. Max Wise, R-Campbellsville, who told fellow members of the Senate Health and Welfare Committee Feb. 26, "I would love to take the governor's report to the six of my seven counties out in rural Kentucky that are struggling right now in their hospitals. . . . What I'm hearing from them is the system is broken and it continues to be broken."

Wsie was referring to Beshear's recent report that Medicaid expansion is generating more money, jobs and tax revenue than forecast. Another committee member, Sen. Ralph Alvarado, R-Winchester, said, "Almost every senator here has received letters that say: This stinks, we are not getting paid, we are going under."

Cobb said some rural hospitals are reporting cuts in jobs and services. That is probably reflected in U.S. Bureau of Labor Statistics data compiled by Paul Coomes, emeritus economics professor at the University of Louisville. It shows hospital employment trending down while other health-care jobs have been going up.

While Carroll County and others are benefiting from federal digitization grants, "That funding’s going to go away," Cobb said, and "Every year you've got to pay for upgrades, and the requirements continue to increase at the federal level." Federal officials say digitization should make hospitals more efficient.

Of the Carrollton hospital, Cobb said, "That’s a special situation. That’s not a typical one." She said the facility "put in place a lot of measures to try to improve their management" and has partnered with larger hospitals to offer more services, such as cardiology, "and that’s breathed some life back in."

Rural hospitals in Nicholas and Fulton counties have closed in the last year, and state Auditor Adam Edelen, who is preparing to issue a report on rural hospitals, has warned that others are in danger, threatening to put new obstacles between rural Kentuckians and health care. "Not acknowledging the looming access issue is a disservice to the low-income and elderly Kentuckians who are depending on an intact provider network,” Edelen spokeswoman Stephenie Hoelscher said.

Bill would require Medicaid managed-care firms to pay contracted fees for ER visits; Senate hearing targets two companies

This story has been updated with comments from Wellcare of Kentucky.

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Managed care is touted as a way to achieve value-based care in the Medicaid program, but hospital emergency rooms in Kentucky aren't finding much value in not being paid the contracted price for their services by two of the managed care organizations.

Officials of two Kentucky hospitals told the Senate Health and Welfare Committee Feb. 25 that Wellcare of Kentucky and CoventryCares of Kentucky are denying payment for as many as half of their emergency-room patients who seek care in their facilities, reimbursing the hospital a flat $50 "triage fee," less the patient's $8 co-payment, regardless of diagnostic tests performed in the ER.

Cheri Sibley, CEO of Clark Regional Medical Center in Winchester, noted that emergency rooms are required by law to screen patients with appropriate diagnostic tests to rule out an emergency condition if they come to the emergency room and ask for care.

Wellcare and Coventry are two of the five Medicaid managed-care organizations that oversee care for the state.

Wellcare said in an e-mail that it is required by the Department of Medicaid Services to "have an affirmative program to address the high cost of emergency room treatment for conditions that do not require this level of care." The company said the triage fee is just one measure it has taken; it said an "emergency room prudent layperson program" has helped "identify and sometimes prevent payments as much as 500 percent to 1,300 percent more in an emergency room as compared to a physicians office for common ailments such as ear aches and sore throats."

Sen. Ralph Alvarado, a physician from Winchester, has sponsored a bill that would require MCOs to pay the previously negotiated rate for emergency-room examinations and allow the ER doctor to determine whether a patient's condition is an emergency or not,.

"This bill is an attempt to keep our Medicaid managed-care organizations accountable," Alvarado said at the meeting. "MCOs have been shortchanging our providers and our hospitals -- and, I would argue, purposefully -- for the past three years. . . . MCOs are basically managing health-care cost by non-payments to providers."

Since the advent of managed care in 2011, hospitals have complained about late and denied payments and difficulty dealing with MCOs. "The problem has reached critical mass, threatening the survival and financial viability of our hospitals, and almost every legislature has been contacted by their local hospital provider regarding these (issues)," Alvarado said.

Kentucky implemented managed care as a way to save money. Basically, insurance company subsidiaries get a certain sum per patient and increase their profits by controlling costs. The Cabinet for Health and Family Services maintains that managed care focuses on quality and provides better accountability for care as opposed to the traditional fee-for-service model, but provider complaints about slow payments and rejections of claims have persisted since its inception.

Hospitals bill insurance and Medicaid based on the level of complexity of emergency-room care provided based on the symptoms the patient presents, regardless of the final diagnosis. Payment has typically been based on a fee that was pre-negotiated between the hospital and the MCO.

Wellcare and Coventry have since implemented a non-negotiated "triage policy," which allows these organizations to determine, after the fact, whether a patient had an emergency. If they determine that a patient was a non-emergency, regardless of presenting symptoms and cost of diagnostic procedures (X-rays, CT scans, lab tests, and so on), they only pay $50 minus the $8 co-payment, or $42. Wellcare implemented this policy in September 2012 and Coventry in April 2013.

The legislaure's Administrative Regulation Review Subcommittee found last May that the triage policies did not follow federal standards, according to Sibley and Alvarado.

"One side seems to be meeting their contractual obligation, while the other side seems to be deficient in meeting their contractual obligations," said Sen. Julie Raque Adams, R-Louisville, chair of the committee.

Hospitals can appeal MCOs' decisions, but "hospitals report that only a small number of these are overturned with no explanation of decision given," Sibley said.

Sibley gave an example of a claim that had been determined a non-emergency by one of these companies at her hospital: An 18-month-old girl was brought to the ER because she was blue in color, wheezing and short of breath. She had an X-ray, other diagnostic tests and a breathing treatment, but the hospital was paid $42 by the MCO plus the $8 co-payment, if the patient paid it.

"The two MCOs in question should not be deciding which patients are non-emergencies," Sibley said. "They should be abiding by their negotiated contract and paying the contract rate," 95 percent of allowed cost.

Sibley presented Kentucky Hospital Association data from 64 hospitals affected by these triage policies. The report found that during calendar year 2014, the hospitals reported submitting nearly 380,000 emergency room claims to Wellcare and Coventry, of which 140,000 were denied except for the $50 fee. The overall denial rate was about 37 percent; Wellcare's was 48 percent.

The KHA report said the difference in the flat fee and the contracted rate totaled $37.4 million, and that the more complex visits (and this likely the more expensive) were the ones most often denied payment.

"With one in four Kentuckians now on Medicaid, this problem is only going to get worse, if this is not corrected by this Senate Bill 88," Alvarado's legislation, Sibley said.

Georgetown Community Hospital CEO William Haugh said almost 30 percent of its ER visits in 2014 were Coventry or Wellcare clients. Wellcare classified almost 60 percent as triage cases and paid only $50 each. The hospital appealed 92 percent of those cases, with a success rate of 16 percent, or 285 patient encounters. Haugh said that amounted to a $334,258 underpayment, plus an estimated $40,000 cost for preparing and prosecuting the appeals.

Haugh said Coventry classified 26.4 percent of its clients' Georgetown ER visits as triage and paid only $50 each. The hospital appealed 94 percent of those and had a success rate of 36 percent, or 366 patient encounters. He estimated an underpayment of $148,000 plus $22,000 in labor for appeals, and said the overall financial impact to the hospital was $543,894.

Wellcare said its appeals process allows three opportunities for review, with at least two independent medical directors.

The state Medicaid program's chief medical officer, Dr. John Langefeld, said the emergency-room problems are not a "straightforward, easy issue," He said many patients go to ERs for reasons beyond medical care. The cabinet has said that some hospitals have relied too much on ER revenues.

Sen. Reginald Thomas, D-Lexington, said rural hospitals need to change their business models and wondered if the bill was an attempt to mask that problem. Meanwhile, he added later, there is "documentation that hospitals have benefited from Medicaid expansion" under the federal Patient Protection and Affordable Care Act, in a recent report from Gov. Steve Beshear.

Adams replied that Beshear says, ""It is great, and it's putting all this money back in the system," but in fact we are not seeing it on the provider level."

Alvarado said, "There is a difference between what actually happens and what the governor's office wants to show you. So when you have KentuckyOne [Health] coming out publicly declaring a $218 million dollar loss in one year, that is hardly a profitability for them based on the ACA."

Alvarado said Citibank reported the companies have made $155 million in profits off of Kentucky Medicaid. "I'd get rich, too, if I didn't pay my bills," Alvarado said. "It is an outrage."

Most Kentuckians don't communicate with doctors electronically; most are confident about access to pricing information for care

Most Kentuckians don't communicate with their doctor electronically, according to the latest Kentucky Health Issues Poll.

The poll, taken Oct.8-Nov.6, found that 73 percent of Kentuckians have not communicated with their doctor using text, email or a website during the last year. A national poll found similar results.

This finding was consistent in all age groups, but there was a difference among socioeconomic groups.

Seventy-nine percent of those whose incomes are 200 percent of the federal poverty level or below said they had no electronic communication with their doctor in the past year, but only 66 percent of those above this level said they had had no electronic contact. In 2013, 200 percent of poverty level was $47,100 for a family of four.

Electronic communication with doctors was most common in Northern Kentucky and least common in Eastrern and Western Kentucky.

The Kentucky Health Information Exchange, the hub that connects participating providers with each other to share health information via certified electronic health records, is now working to connect patients to their electronic health records via a pilot program.

Research has found that patients who are better informed about their health and health care cost are more engaged with their health, according to the release.

Patients at UKHealthCare who have access to their "patient portals" seven days after discharge are an example of how few Kentuckians are engaging with their health care provider via electronics.

“About 8 to 10 percent of hospitalized patients look at their patient portals, of our inpatients,”Dr. Carol Steltenkamp, chief medical information officer at UKHealthCare, said in a phone interview “We would love for that to increase.”

Steltenkamp said that patients often don't understand how to use their portals and that the hospital is working diligently to educate them.

The poll also found that most Kentuckians think they can find out what doctors charge for treatments and procedures if they need this information, finding 36 percent extremely or very confident that they could find out how much treatments and procedures cost; 34 percent moderately confident and 28 percent not too confident or not confident at all. These answers did not vary by income, age or region.

The poll is conducted by the Institute for Policy Research at the University of Cincinnati and was funded by the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati. It surveyed a random sample of 1,597 adults via landline and cell phone, and has a margin of error of plus or minus 2.5 percentage points.

Kynect opens special enrollment period March 2-April 30 to give people without health insurance a chance to avoid tax penalty

The state health-insurance exchange, Kynect, is reopening enrollment in March and April to allow signups by Kentuckians who discovered that not having health insurance means they have to pay a federal tax penalty.

“We believe that many Kentuckians did not realize those who do not obtain health coverage could face significant penalties when they file their taxes,” Gov. Steve Beshear said in a news release. And given that the personal risks of not having health coverage are even greater than the penalties, we have decided to continue a special enrollment period to allow those individuals more time to sign up.”

The penalty for not having health coverage last year is 1 percent of income, or $95 for each adult in the household and $47.50 for each child, whichever is greater. For 2015, the penalty will be 2 percent or $325 for each adult and $167.50 for each child.

"Individuals taking advantage of this special enrollment period will still owe a fee for any months they were uninsured and did not qualify for an exemption in 2014 and 2015," the news release warns. "This special enrollment period is designed to allow such individuals the opportunity to get covered for the remainder of the year and avoid additional fees for 2015."

If your household income is between 100 and 138 percent of the federal poverty level, which makes you eligible for expanded Medicaid, you will still be charged a penalty if you don't sign up. Medicaid enrollment is open year-round, but the special enrollment for private insurance will end April 30.

Visit https://kynect.ky.gov or call 1-855-4kynect (459-6328) to learn more.

Humana plan members can join Weight Watchers free for six months, get 'a significant discount thereafter,' companies say

Humana Inc. and Weight Watchers International Inc. are teaming up to help employers attack the rising level of obesity and its health-related impacts.

Employees in Humana-managed, employer-sponsored health plans now have free and discounted access to Weight Watchers through an integrated wellness program built into their health plan, the first program of its kind, the two companies said in a news release.

Plan members who want to lose weight can join Weight Watchers free for six months, "and at a significant discount thereafter," the release said. "Weight Watchers helps people adopt a healthier lifestyle that results in achieving and learning to maintain a healthy weight."

Remke Markets, a family-owned grocer with 12 locations in Kentucky and Ohio, is offering the program to its 900 employees.

“What I like about this program is that it actively connects people who want to get to a healthy weight with a trusted, well-known and effective program, and then helps make it affordable,” President Matthew Remke said. “The health risk that extra weight poses for our associates and their families is reason enough to want to attack the problem, but there are also serious consequences of an unhealthy workforce for an employer trying to compete in a tough marketplace.”

Harrodsburg Herald, a weekly newspaper, does three-part series on tobacco issues in Mercer County and statewide

In a state where more than one of every four adults smoke, tobacco is an issue in every county, but it's rare for weekly newspapers to take a detailed look at the issue. The Harrodsburg Herald did that recently, in a three-part series by Robert Moore.

Moore explored why Mercer County and the state have relatively little money for tobacco prevention, writing, "Kentucky doesn't seem all that interested in fighting tobacco. In 2014 the state will receive $158.7 million in tobacco settlement money and spend only $2.5 million to help smokers quit and prevent kids from starting, according to the Kentucky Center for Smoke-free Policy."

The states' lawsuit against cigarette manufacturers, and the Master Settlement Agreement that followed, was ostensibly to recover their costs for treating illnesses due to smoking. However, most of the money has gone to general purposes, and in Kentucky half the money was dedicated to improving the agricultural economy — but the legislature steered some of that money elsewhere, mainly for rural water lines, Moore noted.

"The largest single use of tobacco funds now is debt service," he wrote. "Every year, $28 million of the MSA payment goes to pay interest on $434,883,200 in outstanding municipal bonds. The bonds financed various construction projects over the last decade—$20 million for construction of the UK Veterinary Diagnostic Center in Lexington and $2 million for renovations to the FFA Leadership Training Center in Hardinsburg, both in 2008."

Another story explored the growing phenomenon of electronic cigarettes, and the other looked at efforts to curb smoking, statewide and locally. Moore looked at lobbying and campaign-finance reports from Altria Group, the leading cigarette manufacturer, and wrote about efforts by the Burgin High School chapter of Teens Against Tobacco Use to have smoking banned on their campus.

In a more recent story, Moore updated the Burgin issue, concluding, "Until something changes in the state legislature, schools like Burgin will be the most important battlegrounds in the fight against tobacco-related deaths."

Beshear, in D.C., speaks bluntly about state's health issues and 'rank politics' that keeps some states from expanding Medicaid

Beshear at the Brookings Insttitution

By Al Cross
Kentucky Health News

An interesting thing sometimes happens to governors when they travel to Washington; they speak a little more freely than they do in their states, and that appeared to be the case when Gov. Steve Beshear and Colorado Gov. John Hickenlooper, another Democrat, did an 85-minute interview at the Brookings Institution Friday, Feb. 20.

Asked to describe how he expanded Medicaid under federal health reform, Beshear said, "As you can imagine, the president is not popular in Kentucky. He’s got about a 30 percent approval rating, and if you mention Obamacare, the negative numbers skyrocket because the critics ran a very successful negative campaign against the whole idea of the health-care law, the Affordable Care Act.

"So I had to put all that politics up against the fact that Kentucky has some of the worst health rankings in the country, just like most Southern states. We’re too fat, we smoke too much, we eat the wrong stuff, we’re way up there in cancer, and you name it, and we don’t look good in it." He said the reform law was the "transformational tool" needed to attack Kentucky's health issues "in a systemic way."

Most Republican-controlled states have rejected Medicaid expansion, but several Republican governors did it and others are trying to do it. Beshear said he hoped they succeed "in spite of the fact that President Obama is the one that advocated for it, because that’s kind of crazy at this point, to just allow rank politics to interfere with the health of your people, just doesn’t make a hell of a lot of sense."

Beshear didn't mention that state law allowed him to expand Medicaid and create a health-insurance exchange without involving the legislature, especially the Republican-controlled Senate, but he alluded to the need to tread softly.

"Along came the Affordable Care Act, and as soon as it passed, Kentucky very quietly started taking every dollar we could get from the federal government to plan, and once the Supreme Court finally declared it constitutional, then we really hit the ground running."

When the exchange opened, "The pent-up demand was just amazing. I mean, people came out of the woodwork, wanting affordable health care," Beshear said. "The critics had moved from ‘It’s horrible, it’s terrible, it’ll never work’ – of course, it worked – they moved to, ‘Well, it may be good, but we can’t afford it.’ So I knew that at the end of the first year, I needed to address that, because we’ll have another budget coming up."

Beshear said his original projections, based on a PriceWaterhouse Coopers study, were "wrong," because they estimated fewer jobs and tax revenue would be generated than actually were in the first year, according to a Deloitte Consulting study he released this month.

"So now we’re at the point in Kentucky where, OK, it works; and nobody argues with the idea that people need affordable health care; and now we see we can pay for it; and so the only thing left to argue about is, ‘Are you gonna be against this because of the name of the guy who got it passed?’ And I think, I think everybody is coming to the realization that this is something that’s going to make a huge difference in Kentucky – over a generation."

Beshear noted the "thousands of people taking these preventive measures to take control of their own health. And that’s what we’re really after, educating people to take care of their own health, to keep them out of the emergency room, keep them out of the inpatient days in the hospital."

He said the first year offers hope for Appalachian Kentucky. "Our poorest areas economically are the most insured now because they’ve gone and they’ve signed up and I would hope in the next generation because we’re getting healthier you’re gonna see more jobs in that area," he said, discussing the desires of potential employers.

"While they love tax incentives, while they love good infrastructure, you know, all of these goodies that they can get, they will all agree on one thing, that their biggest and highest priority is a productive workforce. If they don’t have an educated, highly trained, drug-free workforce, then they can’t be successful. And guess what? You can’t have a productive workforce if it’s not a healthy workforce, if everybody’s off sick all the time, or if you’re having to stay home with your kids, you’re not at work and you’re not productive, so all of this really goes together. If you don’t improve people’s health, if you don’t improve their education, then you’re not going to have the kind of economy you’re going to need to move the state ahead."

The interview is available at http://www.brookings.edu/events/2015/02/20-good-governance-states-beshear-hickenlooper.

Proposed nutritional guidelines add sustainability issues, in spite of Republicans' warnings; eggs get a green light

A new draft of the federal government's healthy eating guidelines recommends for the first time that Americans consider the "health of the planet along with the health of their hearts," Liz Szabo reports for USA Today.

For the first time ever, the report recommends that Americans should eat less meat, especially red and processed meat, not only because it is better for their health, but also because it is better for the environment.

The report says that eating fewer animal products and more plant based foods uses less land resources, like land, water and energy, and produces fewer greenhouse gas emissions, which contributes to climate change, Szabo writes.

"We need to think about a sustainable diet that's supportable and accessible for generations to come," Miriam Nelson, committee member and professor of nutrition at the Friedman School of Nutrition Science and Policy at Tufts University, told Szabo. "A sustainable diet is also a very healthy diet."

But this additional consideration is getting push back from the meat industry and members of Congress.

The meat industry has questioned why a nutrition panel is addressing sustainability concerns. The industry also disputes that meat production negatively impacts the environment, Roberto A. Ferdman reports for The Washington Post.

"If our government believes Americans should factor sustainability into their choices, guidance should come from a panel of sustainability experts that understands the complexity of the issue," Barry Carpenter, the chief executive of the North American Meat Institute, said in a statement.

In December, members of Congress discouraged the committee from addressing sustainability, approving language that expressed "concern" that it was "considering issues outside of the nutritional focus of the panel," and instructing them to "only include nutrition and dietary information" in the report, Roberto A. Ferdman and Peter Whoriskey reported in a separate article in the Post.

The committee has since been reprimanded and received a warning from Rep. Robert B. Aderholdt, R-Ala., chairman of the subcommittee that oversees the budget for the Agriculture Department, Ferdman and Whoriskey report.

“Chairman Aderholt is skeptical of the panel’s departure from utilizing sound science as the criteria for the guidelines,” according to Brian Rell, a spokesman, reports The Washington Post. “Politically motivated issues such as taxes on certain foods and environmental sustainability are outside their purview.”

Ferdman and Whoriskey note that numerous studies document the environmental impact of meat and refer to another article in the Post about a study published last year in the journal Climatic Change that says the average meat-eater in the U.S. is responsible for almost twice as much global warning as the average vegetarian, and close to three times that of the average vegan.

The report says that other countries, such as Germany, Sweden, the Netherlands and Brazil, have factored the environment into their dietary recommendations for many years.

The report is updated every five years and is used to set nutritional standards for state and federal programs such as school lunches, food stamps and programs benefiting children and pregnant women. The final report is scheduled to be released by the end of the year.

Another first in the report is the recommendation that "added sugars," or those not naturally found in foods, be included on food labels. The report recommends healthy Americans get less than 10 percent, or roughly 12 teaspoons, of their daily calories from added sugars, but most people, depending on their BMI, should only have between 4.5 to 9.4 teaspoons a day.

In big news for egg lovers, the report has changed its recommendations on foods high in cholesterol, saying that there is no longer a need to avoid them because dietary sources of cholesterol have not been found to affect the amount of cholesterol in the blood.

Szabo notes these nutrition guidelines in the report:

• Saturated fats: This guideline continues to suggest that only 10 percent (or 22 grams) of daily calories come from saturated fat. This can be achieved by choosing low-fat or skim milk; using vegetable oils instead of animal fats such as butter; and eating more plant based proteins, rather than meat.
• Coffee: Healthy adults can drink up to three to five cups of coffee a day without any health risk, saying it may even reduce the risk of type 2 diabetes, heart disease and possibly Parkinson's disease.
• Aspartame: This artificial sweetener, sold as NutraSweet and Equal, is safe at the levels normally consumed, but there is "some uncertainty" about an increased risk of blood cancers in men.
• Sodium: The recommended daily consumption of sodium is less than 2,300 milligrams, which can be largely achieved by eating less processed foods and eating home-cooked foods.

Cleveland Clinic cardiologist Dr. Steven Nissen told Melissa Healy of the Los Angeles Times that the guidelines on cholesterol did not go far enough and that the panel should have reversed the guidelines on saturated fats. He cited a 2013 report from the American Heart Association and the American College of Cardiology that said "limits on dietary cholesterol were unnecessary" and also said that "there was no reason to curtail consumption of saturated fat." He was also concerned about the severe restrictions of sodium, especially for heart patients, and said that the sodium restrictions should also "come under review."

The report also says most Americans eat too few whole grains, too much saturated fat, sodium and refined sugars, and many fall short of particular nutrients, such as vitamin D, fiber, potassium and calcium.

The entire report can be found by clicking here. The public comment period runs through April 8.

UK gets approval to add 120 hospital beds, bringing its total to 945 and long-term building project's cost past $1 billion

The University of Kentucky has received state approval to add 120 beds to its hospital complex, which will bring its total to 945 beds at UK Chandler Hospital, Kentucky Children’s Hospital and UK Good Samaritan Hospital.

The project is "part of the overall strategy to make UK the regional hospital of choice among several states and a powerhouse that will survive when health care is so uncertain," Lexington Herald-Leader higher-education reporter Linda Blackford said Friday on KET's "Comment on Kentucky."

Dr. Michael Karpf

Blackford writes for the newspaper, "The 120 beds are the next phase in the patient tower project that began in 2004 with an estimated cost of $400 million and an original completion date of 2009. The cost of the expansion has risen to roughly $1 billion, and there is no longer a completion date, said Dr. Michael Karpf, executive vice president for health affairs at UK. After the 120 beds are added, the tower still will have several empty floors.

"The shifting timetables are all a part of coping with a fast-growing patient base and ever-changing medical technology, Karpf said. Originally, the patient tower was to be a replacement for Chandler Hospital, which was built in the 1950s. But a rapid increase in the number of patients meant the space now will be used for new beds, he said."

Read more here: http://www.kentucky.com/2015/02/19/3703219_state-approves-uk-hospital-expansion.html?rh=1#storylink=cpy

Karpf said in a UK news release, "About 10 years ago, we committed to develop UK HealthCare into a research intensive, referral academic medical center to ensure all Kentuckians — no matter how complex their medical problem — could be taken care of in Kentucky and not required to leave the state for advanced subspecialty medical care," said Karpf. "This strategy, while crucial to our goal of taking care of patients in the commonwealth, has resulted in substantial growth beyond our initial aggressive projections."

Students in poor Louisville neighborhoods learn healthful behaviors in Farm to Family Initiative

A program to fight childhood obesity and foster healthy habits in Louisville’s under-served youth has seen positive results since its launch in October 2013, says KentuckyOne Health. Results include:

• 41 percent of students now eat at least five servings of fruits and vegetables daily, up from 23 percent.
• 91 percent of students engage in at least 60 minutes of daily physical activity, up from 63 percent.
• 90 percent of students have eaten a vegetable they harvested or picked themselves, up from 59 percent.
• 93 percent of students know how to prepare a healthy recipe, up from 63 percent.

The Farm to Family Initiative is a collaboration between the Food Literacy Project and Sts. Mary & Elizabeth Hospital, part of KentuckyOne. It aims to influence long-term health and food literacy for students at Hazelwood and Wellington elementary schools, where more than 90 percent of students qualify for free or reduced-price lunches.

The project is funded by a $200,000 grant from the Johnson & Johnson Community Health Care Program Award for the Prevention of Childhood Obesity.

Got the winter blues? Many treatments are available

(image from kidshealth.org)

For some, winter is more than just a season characterized by shorter, colder days; it is a time of year that brings on the "winter blues," Jill U. Adams reports for The Washington Post.

Officially, it's called seasonal affective disorder, or SAD, and is a type of depression. It begins during the late fall or winter of each year and disappears with the onset of spring. Common symptoms include: tiredness,even though the person is getting enough sleep; a loss of interest in usual activities; feeling sad, grumpy, moody or anxious; craving carbohydrates, eating more and gaining weight; and trouble concentrating, according to WebMD. Some even have suicidal thoughts.

SAD occurs in 1 to 2 percent of the population, with a milder version, "the winter blahs," occurring in 10 to 15 percent, Raymond Lam, a psychiatrist at the University of British Columbia in Vancouver, told the Post.

Therapy with light is the most common treatment for SAD and has proven effective, although many doctors and insurance companies still don't recognize it as effective. The disorder is also treated with medications and talk therapy, Adams notes.

Light therapy involves sitting near a very bright, broad-spectrum light for at least 30 minutes every morning, Adams reports. WebMd cautions that the fluorescent lights used in light therapy are not the same as ultraviolet lights, full-spectrum lights, tanning lamps and heat lamps, all of which should not be used for this purpose.

Experts are still trying to figure out exactly why light therapy works, but some evidence suggests that not getting enough light is the main trigger for SAD, which is more common in areas where the daylight hours are shorter, Teodor Postolache, a psychiatrist at the University of Maryland School of Medicine, told the Post.

Another study found that healthy people's eyes are more sensitive to light in the wintertime, while those with SAD have less sensitivity, University of Pittsburgh psychologist Kathryn Roecklein told Adams.

Experts told Adams that it is important that SAD not be self-diagnosed and that light therapy not be experimented with. They said a person may have health conditions that mimic these same symptoms or have untreated or under-treated depression that is not seasonally influenced, and some people take medications or have conditions that make them more sensitive to light.

“If your symptoms are severe enough to interfere with daily functioning, get an assessment at a mental health clinic or by a doctor,” Lam told Adams. “There are many causes and lots of treatments.”

Paul Hokemeyer, a licensed marriage and family therapist in Manhattan, offered nutritional suggestions to help those with SAD in an article for Fox News.

He suggests that people with SAD eat foods that will increase their serotonin levels: those high in Omega-3 fatty acids and tryptophan, which he says is "linked to mood regulation, and a deficit leads to depression." Some foods high in Omega-3 are trout, salmon, and walnuts; those high in tryptophan include lean turkey, chicken, milk, eggs, nuts and bananas.

Hokemeyer also suggests that those with SAD supplement their diet with foods rich in vitamin D because studies have found a correlation between depression and low levels of vitamin D. Foods high in vitamin D are egg yolks, fortified dairy products and cereal, beef liver and cod fish oil.

And finally, he suggests those with SAD eat whole, unprocessed foods to decrease mood swings caused by the "spikes and crashes" in blood sugar levels commonly associated with eating processed foods that are high in simple sugars and white flour.

Smoking-ban bills get unfavorable committee assignment in state Senate, but supporters say they'll keep trying to get votes

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The state Senate's Republican leaders have assigned both the Republican and Democratic smoking-ban bills to a committee that appears unlikely to send them to the full Senate.

The Veterans, Military Affairs and Public Protection Committee got House Bill 145, which the House had passed 51-46, and Senate Bill 189, filed by Sen. Julie Raque Adams, R-Louisville.

Adams is chair of the Health and Welfare Committee, and smoke-free advocates had hoped the bills would go there, improving its chances in a Senate that doesn't appear disposed to pass it.

Senate President Robert Stivers defended the assignment, saying the bills relate to public protection. Last year, a smoking-ban bill sponsored by the previous Health and Welfare chair, Republican Julie Denton of Louisville, was sent to the Judiciary Committee and never heard.

Stivers was asked if Adams' bill was sent elsewhere because of her support for it. He acknowledged that it could have been considered a health issue, and "It was a choice." Pushed to answer, he said, "I don't recall anything being made, because we put a lot of bills in chairman's committees that they support whether leadership supports it or not."

Adams did not respond to requests for comment, but Amy Barkley, chair of the Smoke-free Kentucky Coalition, said she had hoped the bill would go to Health and Welfare because it addresses a health issue.

"We hope it gets a hearing in the Senate," Barkley said. "We are hoping that even if those individuals in leadership are not supportive, that they will at least let the bill have a fair hearing and hopefully a vote – and they can vote no if they are not supportive, but we think it deserves to have a vote so we know where people stand."

Sen. Morgan McGarvey, of Louisville, a Democratic co-sponsor of the Senate bill, said he understood how a smoking ban could be perceived as a public-protection matter, but used the assignment as an argument for the legislation.

"There is no bill we can pass this session that would save the state more money than a comprehensive statewide smoking ban," he said. "It will make Kentuckians healthier; it will save the state money."

Advocates' job will be to persuade Republicans, whose policy is not to allow bills to reach the full Senate unless they are favored by a majority of the 26 Republican senators.

The chairman of the Public Protection Committee, Sen. Albert Robinson, R-London, said through his assistant that he wasn't ready to talk about the bills because they had just been assigned to his committee. He told the Lexington Herald-Leader, "I don't know if there is support for it in my committee." He told The Courier-Journal that he opposes the bill.

The legislation has been debated in the legislature for five years. Senate Bill 189 is identical to the original House bill, which was amended. Both bills would prohibit smoking in workplaces and indoor places, and within 15 feet of their entrances, to protect others from secondhand smoke, which is estimated to kill 950 Kentuckians annually.

House Bill 145 passed with three changes: an exemption for cigar bars, cigar clubs, tobacco stores, private clubs and market-research facilities; significantly lower fines for violation; and preservation of any weaker or stronger local bans in effect when the bill would become law, in late June.

The fundamental conflict about the bill, largely along party lines, is whether individual liberties or public health take priority.

Stivers reiterated his stance, siding with those who support individual liberties.

"I do not like smoking. I don't patronize places that smoke. I have allergies," he said. "It costs you money to take your suits to the cleaners and things of that nature, but I just don't think it is the role of government to start telling private businesses what they can and can't do from that perspective."

He suggested that his opposition wasn't decisive. "I am one of 38 [senators] and if you go back and look at respective bills, there have been bills that I haven't voted on that have made it to the floor because they have the support of the body. Actually, I think we voted on one this week or maybe late last week that I did not vote for, but there was support in this chamber for that issue."

Stivers noted that more Republican senators support the ban than last session, mentioning Adams and Sen. Ralph Alvarado, a Winchester physician. Both were elected to the Senate last fall.

Alvarado explained why he values health over liberty on this issue. He said we all have the right to swing punches at another person, but at the point of contact, that person's rights have been violated. "My individual rights to do something ends when it affects the rights of another individual is my perspective, and secondhand smoke is just that," he said.

Alvarado said he continues to talk to senators about why they should support a statewide smoking ban, saying," It would cost nothing to implement and the benefit from a fiscal perspective and lives saved . . . would be tremendous."

As a rookie public official, Alvarado said he still has a "romantic idea" that it is possible to persuade senators to change their positions and "find at least some type of compromise to get more people covered and to reduce (secondhand smoke) exposure."

Sen. Perry Clark of Louisville, a libertarian-oriented Democrat on the Public Protection Committee, said it was too early to say how he might vote on the issue because the bill might be amended. It has been suggested that the bill could pass if local governments could opt out of the ban, but Barkley told The Courier-Journal that would fatally weaken it.

Besides Clark and Robinson, other members of the committee are Republicans C.B. Embry of Beaver Dam, Carroll Gibson of Leitchfield, Ernie Harris of Prospect, Stan Humphries of Cadiz, Chris McDaniel of Taylor Mill, Dan Seum of Louisville, Whitney Westerfield of Hopkinsville, Mike Wilson of Bowling Green and Max Wise of Campbellsville; and Democrats Julian Carroll of Frankfort and Dennis Parrett of Vine Grove.

Prince Charles to keynote Louisville health and food symposium

Prince Charles and Camilla Parker-Bowles

Prince Charles of the United Kingdom will keynote a health symposium in Louisville March 20.

The prince of Wales and his wife Camilla Parker-Bowles, duchess of Cornwall, "will highlight the work being done by members of the local community and charitable organizations to protect, preserve and promote the health and well-being of the people of Louisville through community cohesion, clean air and food literacy initiatives," says a release on his site.

The release says the prince will speak "to an audience of health practitioners, business, faith and community leaders about links between health and the natural environment. Highlighting the same theme, the duchess will visit a food literacy project for young people at a local farm. The project also offers young people an opportunity to experience life on a farm in order to help increase their knowledge of the connection between food and farming."

The speech could include some of the same points that Charles made in a speech at the Future for Food Conference at Georgetown University in Washington, D.C., in 2011, where he said, "We will have to develop much more sustainable, or durable forms of food production,  because the way we have done things up to now are no longer as viable as they once appeared to be."

Kirby Adams of The Courier-Journal reports that the symposium will be held by the Institute for Healthy Air, Water and Soil, chaired by Christina Lee "Christy" Brown of Louisville, who is one of four board members of the England-based Sustainable Food Trust. Her son, Owsley Brown III, is one of three board members of the Sustainable Food Alliance, the trust's U.S. partner.

Nico Hines of The Daily Beast reports that the Kentucky visit is being organized with the help of Gov. Steve Beshear, Louisville Mayor Greg Fischer (who has been active in food issues) and the Owsley Brown Charitable Foundation, named for Christy Brown's late husband, the former chairman of distiller Brown-Forman Corp. Her son-in-law, Matthew Barzun, "is the U.S. ambassador in London," Hines notes.

Hines's story is largely unfavorable. It begins, "Prince Charles is taking his unusual views on health, previously described as 'witchcraft' and 'quackery,' to the United States." Those descriptions came from a professor at the University of Exeter and the British Medical Association, which said in 2010, "Homeopathy is witchcraft."

When the prince became BMA president in 1982, Hines reports, "He advocated a radical overhaul of the medical system in favor of alternative therapies which he said had been successfully practiced for centuries by faith healers using the patient’s 'physical and social environment, as well as his relation to the cosmos.' Rather than laugh off the private views of their new figurehead, the doctors ordered a full inquiry into the efficacy of alternative medicine. After three years and 600 submissions, it concluded any support for the use of these therapies was purely 'unscientific'. . . . Prince Charles has remained resolute in his controversial beliefs." Some commenters on the story defend him.

The future king's Louisville stop will come on the fourth and last day of an American tour that will include "stops at the Armed Forces Retirement Home in Washington, site of the Lincoln Cottage, where it is believed Abraham Lincoln wrote the last draft of the Emancipation Proclamation. The royals will also visit Mount Vernon, home of George Washington, and the National Archives to mark the 800th anniversary of the Magna Carta," The Courier-Journal reports.

Almost 103,000 Kentuckians now on private health insurance through Kynect, state says

More than 158,000 Kentuckians signed up for private health insurance or Medicaid coverage in the second round of open enrollment under the federal Patient Protection and Affordable Care Act.

The signup total of 158,685 as of Feb. 19 included almost 103,000 Kentuckians who renewed or bought private coverage. The state said the total broke down this way:

• 55,855 enrolled in Medicaid coverage (which is open year-round).
• 75,760 individuals renewed enrollment in private insurance.
• 27,070 individuals newly enrolled in private insurance.
• 6,009 individuals enrolled in dental plans.

“We had a tremendously successful second open enrollment period, with many new individuals signing up or continuing their health coverage through Kynect,” the state's health-insurance marketplace, Gov. Steve Beshear said in a news release. “When people get health insurance, they generally take immediate steps to get healthier, which will help our workforce get even stronger.”

State Senate passes bills to lower a barrier to colon-cancer screening and allow patients to synchronize their prescriptions

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Two health-related bills, one to remove a financial barrier for colorectal cancer screenings and the other to allow consumers to synchronize prescriptions so they can get all of their medications on the same day, passed the state Senate Feb. 19.

Senate Bill 61, sponsored by Sen. Ralph Alvarado, R-Winchester, would clarify that a fecal test to screen for colon cancer, and any follow-up colonoscopy, are preventive measures that federal health reform require to be covered by insurance. It went to the House on a vote of 31-3.

"The purpose of this bill is to identify and correct ongoing discrepancies in the coding and billing portion of this screening and prevention continuum," said Alvarado, who is a physician.

The two primary ways to screen for colon cancer are colonoscopy or a non-invasive fecal blood test.

This bill was prompted because patients are being charged for a diagnostic procedure instead of a preventive one if they do a non-invasive fecal test that comes back positive, and then get a follow-up colonoscopy. The non-invasive fecal test is coded as a preventive screening, which is covered by insurance, but the colonoscopy is coded as a diagnostic procedure, which comes with a hefty price-tag, sometimes upwards of $1,000, Alvarado said.

Patients are also being charged for a diagnostic procedure if lesions are removed during the screening process, which is standard procedure to do so, since the patient would otherwise have to return for a second colonoscopy to remove them.

This is ironic, Alvarado said in a news release, because if the patient had chosen the more expensive and invasive colonoscopy initially, the insurance company would have paid for it.

This is a "barrier to screening," he said, in a state that leads the nation in colorectal cancer and until recently led the nation in deaths caused by it.

A sister bill, House Bill 69, sponsored by Rep. Tom Burch, D-Louisville, passed the House Feb. 9 and was assigned to the Senate Health and Welfare committee Feb. 12.

By a 34-0 vote, the Senate passed SB 44, sponsored by Sen. Julie Raque Adams, R-Louisville. It would allow patients with multiple prescriptions, in consultation with their health care provider and their pharmacist, to synchronize them so that they may be picked up from the pharmacy at the same time.

"This bill will allow patients to refill and pick up their prescribed medications for chronic conditions on the same day of the month instead of making multiple trips to the pharmacy," Adams said.

"This bill is not just about convenience," Adams said, but also helps make sure patients take their medication, "improving health outcomes and lowering health care cost overall." She cited a study that found patients who participated in a med-synchronization program at their pharmacy were 30 percent more likely to take their medicine as prescribed.

Some are concerned about the front-end cost of this program, "but fail to see the potential cost savings to the health care system overall," Adams said, saying a Medicare Part D cost-benefit analysis found there was an estimated savings of $1.8 billion to the system, and also showed improved medication adherence.

A sister bill, House Bill 140, sponsored by Rep. Addia Wuchner, R-Florence, was assigned to the House Banking and Insurance Committee on Jan. 9.

Obamacare deadline is extended for those who had technical problems; state may also extend it for those facing a tax penalty

Were you unable to sign up for Kynect health insurance by the Sunday deadline because of technical problems? You now have until Feb. 28 to sign up. "And like other states and the federal government, Kentucky officials are also considering a 'special enrollment period' for those who find out at tax time that they’ll have to pay a penalty if they’re not insured," Laura Ungar reports for The Courier-Journal.

Kynect Executive Director Carrie Banahan said Kentuckians who experienced technical problems and believe they qualify for an extension should contact the Kynect call center at 855-459-6328. Ungar explains, "The Saturday outage of an Internal Revenue Service function for Obamacare enrollment prevented some people from getting their income verified so they could enroll on HealthCare.gov," the federal website used in most other states.

"Officials with the federal government and several other states said they saw a surge similar to what Kentucky experienced in the final days of enrollment — partly from people who realized for the first time they would face an IRS penalty at tax time," Ungar reports. The penalty for not having coverage in 2014 is 1 percent of annual household income, or $95 per adult and $47.50 per child, whichever is higher. Not having coverage in 2015 will incur a penalty of 2 percent, or $325 per adult or $167.50 per child, whichever is more.

Poll illustrates how having insurance and access to a health care provider doesn't mean you can afford the care

Just because a person has appropriate access to a health care provider doesn't mean they can afford to pay for their services, according to the latest Kentucky Health Issues Poll.

The poll found that three out of every four Kentuckians with health insurance now have access to a health-care provider, defined as a usual or appropriate source of care. However, it found that lower-income Kentuckians are choosing to forgo or skip medical care because they still can't afford it. The poll found only about half of uninsured adults have a "typical and appropriate" health care provider.

The poll, taken Oct. 8-Nov. 6, found that 22 percent of Kentuckians said they or a family member needed health care in the past 12 months, but did not get care or delayed it because of cost. That was a decrease from 32 percent in 2009.

Not surprisingly, those with less money are more likely to forgo health care because they can't afford it. The poll found almost one-third, or 32 percent, of people with household incomes at or below 138 percent of the federal poverty level ($32,913 for a family of four) said they were likely to defer medical care due to cost. That figure was 14 percent among people with incomes more than 200 percent of the poverty line.

As for those who did seek medical care, 31 percent reported they or a family member had difficulty paying the bill in the previous 12 months. Among those without insurance, 47 percent said they had trouble paying a medical bill in the past 12 months.

“Being able to afford needed medical care and having access to appropriate usual sources of care are two important challenges that may prevent a person from receiving care,” said Susan Zepeda, President/CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll. “KHIP data indicate lower income Kentucky adults have to forgo treatment more often than their higher income neighbors and are more likely to have problems paying for their care.”

The poll is conducted by the Institute for Policy Research at the University of Cincinnati and is co -sponsored by Interact for Health, formerly the Health Foundation of Greater Cincinnati. It surveyed a random sample of 1,597 adults via landline and cell phone, and has a margin of error of plus or minus 2.5 percentage points.

Opinion: Toward a healthier Kentucky, with a smoke-free law

By the Friedell Committee for Health System Transformation 

It is no secret that Kentucky is among the unhealthiest states in our country. 

Kentucky is No. 7 in cardiovascular deaths, No. 1 in cancer deaths, No. 1 in lung cancer, and No. 13 in asthma prevalence. And Kentucky leads the nation in smoking with 26.5 percent of its adult population.

Even non-smokers are at risk of diseases caused by tobacco. Exposure to secondhand smoke increases the risk of coronary heart disease by 25 to 30 percent among nonsmokers.  It increases the risk of lung cancer in nonsmokers by 20 to 30 percent. 

This means that waitresses and bartenders (most of whom do not smoke) in workplaces that allow smoking risk their lives just to earn a paycheck.  Sadly, 68 percent of Kentuckians are currently exposed to secondhand smoke in public places.  At this rate it is no wonder that Kentuckians suffer serious and deadly consequences.

Fortunately, we have scientific evidence that a smoke-free law will reduce disease rates in areas where such a law is in effect. Communities that pass comprehensive smoke-free workplace laws have experienced a 15 percent drop in emergency-room visits for heart attacks.  ER visits for asthma dropped by 22 percent in Lexington after the smoke-free law was enacted. 

Also, adult smoking rates declined by 32 percent in Lexington, saving $21 million per year in health care costs! While a decrease in smoking rates is not the primary reason for secondhand smoke-free laws, many people express an interest in stopping, and the laws make quitting easier.

Our poor health is a problem that affects us all.  It affects our health-care costs, our community health, and a national perception of us as being an unhealthy place to invest in and live.  That problem can be addressed by smoke-free local ordinances, a state law, and/or local boards of health regulations. 

The Affordable Care Act presents a unique opportunity to look at health differently.  We need to start emphasizing prevention of diseases rather than relying only on treatment.  Smoke-free policy is one effective type of prevention. We know that prevention will save lives and reduce health care costs borne by individuals, private business and the government. 

The Saving Our Appalachian Region effort in Eastern Kentucky reminds us that Kentucky can do better.  Going smoke-free is one way. Imagine a Kentucky where no one is exposed to smoke in the workplace and where fewer people actually smoke.  Lives would be saved, diseases would be prevented, and health care costs would decrease.

Thankfully, most Kentuckians agree. Statewide polls show that 66 percent of likely voters are in favor of a smoke-free law.  This makes sense since most Kentuckians do not smoke.  It is time for the state legislature to implement a policy that will improve our health, save lives and reduce health costs.

The Friedell Committee for Health SystemTransformation is an organization of community leaders across the state that knows that Kentucky is not a healthy state but that working together we can do something about it.

'Medicaid Dashboard' gives county-by-county details on 375,000 who joined program, what screenings they got, what they found

The expansion of the federal-state Medicaid program under federal health reform marks the biggest change in Kentucky health care since Medicare began in the mid-1960s. Almost 400,000 people have joined the program, raising its rolls to more than one-fourth of the state's population. This is an important story in almost every county, and the state has the data to tell it.

As part of the $141,000 study of the first year of Medicaid expansion, Deloitte Consulting created for the state and its citizens a "Medicaid Dashboard" that gives detailed information about the newly eligible Medicaid enrollees in every county, by age, gender and chronic health conditions, along with information about payments to health-care providers in each county. Here's a partial screenshot, with one county highlighted:

And here's an example of how data from that county can be broken down by age and gender:

In addition to these data, and detailed information about payments to providers, the dashboard also reveals how many new Medicaid enrollees have been diagnosed with what chronic conditions, and what screenings and other preventive services they have received. This can also be broken down by county. For the dashboard, go here.

The data are only for people who were made eligible for Medicaid by the expansion, which raised the income limit to 138 percent of the federal poverty line, from 69 percent. The data do not include several thousand people who had been eligible for Medicaid under the old limit but did not enroll until the limit was raised.

Statewide smoking ban passes Kentucky's Democratic House, but its chances don't look good in the Republican Senate

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – A statewide smoking ban passed the Democrat-controlled state House Friday for the first time, but its chances appear grim in the Republican-controlled Senate though a clear majority of Kentuckians support the bill.

House Bill 145, which would prohibit smoking in workplaces and indoor places, passed 51-46 after the narrow defeat of two amendments opposed by its advocates and three changes that may have put it over the top. Nine of the 44 Republicans joined 42 of the 56 Democrats to pass it.

Amendments to the bill added exemptions for cigar bars, cigar clubs, tobacco stores, private clubs and market-research facilities; significantly reduced the fine for violation, to $25 for individuals and $50 for businesses; and would preserve any weaker or stronger local bans that are in effect when the bill would become law, in late June.

House Speaker Greg Stumbo told Tom Loftus of The Courier-Journal that the latter amendment was key to the bill's passage. Rep. Tanya Pullin, D-Greenup, told the House that it won her vote because it creates a "window of opportunity" for localities to enact their own bans. It was proposed by Democratic Caucus Chair Johnny Bell of Glasgow.

The defeated amendments would have exempted electronic cigarettes and well-ventilated adult establishments prominently displaying a "Smoking Establishment" sign. The e-cig amendment, proposed by Republican Caucus Chair Stan Lee, lost 46-49; the other one, offered by freshman Rep. Jim DuPlessis, R-Elizabethtown, lost 44-45. For the roll calls, click here.

"A couple of the amendments are problematic," Amy Barkley, chair of the Smoke-free Kentucky Coalition, said in a phone interview. "The existing laws in these communities may not protect all workers," she said. "And localities can pass weak laws (before this bill becomes law) and have that forever."

Nevertheless, Barkley said, "This is really a historic moment."

More compromise may be necessary to get the bill through the Senate, where Republican Sen. Julie Raque Adams of Louisville filed a similar bill as the House measure was coming up for a vote.

Senate President Robert Stivers told Bruce Schreiner of The Associated Press, "I am personally not a fan of smoking, but I just don't believe it is the government's role to tell [a business] that you cannot have a facility that smoking takes place in — be it a pool hall a bar or restaurant." He added, "I don't see there being that type of support in the Senate to pass a bill like that."

Barkley disagrees. "There is a lot of support in the Senate," she said.

The sponsor of HB 145, Rep. Susan Westrom, D-Lexington, said "I cannot predict what will happen in the Senate. Stivers has said from the beginning that he wouldn't let it have a hearing."

Barkley said advocates are asking Senate leaders to "let your members have the vote and go on record with their position." The next clue to the leaders' attitude will be where they send the bill. If it doesn't go to the Health and Welfare Committee, which Adams chairs, that would be a bad sign for it.

Westrom repeately said that the bill does not ban smoking. "This bill just requests that a smoker step outside 15 feet," she said. "Fifteen feet is not too far to walk to know that 950 people in this state won't die from secondhand smoke related illness." That is the estimated number of deaths each year in Kentucky from secondhand smoke.

Westrom said afterward that she had hoped for a larger margin than five votes, but "I couldn't be happier. This is a historic moment and there is lots to be proud of," referring to the many people and organizations that committed themselves to the cause.

The Kentucky Health Issues Poll last fall found that 66 percent of Kentucky adults favored the ban. It won 57 percent support in last year's Bluegrass Poll for news organizations.

During the House debate, opponents of the bill spoke mainly of private-property rights and individual liberty.

I deplore smoking," said Rep. Brian Linder, R-Dry Ridge, "but my love for liberty is greater than my hate, therefore I vote no."

Earlier, Westrom said, "Our freedoms only extend until they begin to affect others."

Democratic Gov. Steve Beshear hailed the House vote as "an extremely important and significant event," adding, "It sends a very strong statement ... that it is time to move in this direction. It is just such a health problem and health issue in the commonwealth; so many of our chronic conditions relate directly back to smoking."

Highly anticipated report on first year of Medicaid expansion says Kentucky can afford it even with higher-than-expected enrollment

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Kentucky's decision to expand Medicaid under federal health reform is a better deal than previously projected and will more than pay for itself, Gov. Steve Beshear said as he unveiled a top consulting and accounting firm's study of the expansion's first year and projections for the next seven.

"For all the naysayers who claimed that expanding Medicaid was a budget-busting boondoggle, take a look at the facts. It's working, and it's literally paying off. The state is saving money, hospitals are earning more, and our people are getting healthier," Beshear said.

The report was conducted by Deloitte Consulting and the University of Louisville's Urban Studies Institute and cost $140,000, which was paid from Medicaid's administrative budget, half state funds and half federal.

Beshear said a study from Deloitte is "about as reliable as any study can be" and conclusively, with "an avalanche of facts," informs the critics that Kentucky can afford to pay for Medicaid expansion.

"Kentucky can indeed take care of its people, In fact, we can't afford not to do so," he said.

The report says that through 2021, Medicaid expansion will add 40,000 new jobs with an average annual salary of $41,000, putting $30 billion into the state's economy, and adding nearly $820 million to state and local budgets.

That, the report says, will cover the estimated cost of the matching funds that the state will have to pay for care of the newly eligible enrollees, those between 69 percent and 138 percent of the federal poverty level. The match will start at 5 percent of the cost in 2017 and rise to the law's cap of 10 percent in 2020.

For the next two budget years, from July 2016 to June 2018, the report estimates Kentucky will pay $74.4 million and $173.2 million, respectively. The report says this will be offset by $511.8 million of General Fund savings and tax revenues expected from the increased economic activity resulting from additional health care spending.

"These are conservative estimates," Beshear said, without any estimated savings from better health that he said will result from more people getting health care.

A Gallup poll released this summer said that Kentucky saw the second largest decrease of any state in its uninsured rate, dropping to 12 percent from 20 percent.

The study's projections were more favorable than those in a study by the PriceWaterhouseCoopers accounting and consulting firm, which Beshear cited when he announced in May 2013 that he would expand Medicaid. That study estimated the expansion would create 7,600 new jobs in 2014, but Beshear said the actual number was more than 12,000, including 5,400 in health care. Pricewaterhouse estimated 17,000 new jobs through 2021, well under Deloitte's forecast of more than 40,000.

Pricewaterhouse also underestimated the enrollment in Medicaid. In the first year, more than 375,000 people enrolled, about double the number that the firm estimated would enroll by 2020. That means the cost of the state's match will be higher than expected, but covered by jobs and taxes resulting from the higher enrollment.

“People can have whatever opinion they want, but they aren’t entitled to their own facts,” Beshear said. “It’s one thing just not to like [Medicaid expansion] because the president has his name on it, and if that’s the reason they want to take health care away from 500,000 Kentuckians, then that’s their opinion and people oughta know that. This report answers the questions, will it work, and yes it is working in Kentucky, and can we afford it, and yes we can."

The report is online at Governor.ky.gov. For county-by-county data, go to http://governor.ky.gov/healthierky/Documents/medicaid/Medicaid_Hospital_Report.pdf.

Thousands of Kentuckians face federal tax penalty for not having health insurance

"Thousands of Kentuckians might face a penalty this tax season for failing to sign up for health insurance during 2014," Mary Meehan reports for the Lexington Herald-Leader.

The state estimated that 340,000 Kentuckians would buy private insurance through its Kynect marketplace, but only 80,000 have done so. However, Meehan writes, some of those who did "might have qualified for Medicaid under the state's expanded income guidelines, said Carrie Banahan, who heads Kynect."

Jill Midkiff, spokesman for the state Cabinet for Health and Family Services, told Meehan, "There are too many variables at play here to do simple arithmetic for estimated populations. It would be safe to say that thousands of Kentuckians will likely face a tax penalty this year for not obtaining health insurance."

Banahan said, "A lot of people are going to be very surprised." And that will include some people who were eligible for Medicaid, but didn't enroll in it. Medicaid enrollment is open year-round, but private-insurance enrollment closes Sunday, Feb. 15 and won't reopen until next fall unless someone has a life-changing event "such as a birth, divorce or loss of a job," Meehan notes.

"The penalty for not having insurance during 2014 is $95 for each person in a household or 1 percent of the household income, whichever is higher," Meehan notes. "The bill will come due when 2014 taxes are filed, she said. If a person is due a refund, it will be deducted from the tax refund." Next year, the penalty will be 2 percent, with a minimum of $325 per adult or $162.50 per child, under provisions of the Patient Protection and Affordable Care Act.

Economic upturn boosts share of Kentuckians on employer-based health coverage; health reform boosts number on public plans

Half of Kentucky's working-age adults now get health insurance through their employers, up from 37 percent two years ago, reversing a downward trend that began with the Great Recession.

Meanwhile, under federal health reform, many more Kentuckians are on public insurance, mostly Medicaid, and many fewer report being uninsured. Those are among the findings in the latest Kentucky Health Issues Poll, taken Oct. 8 through Nov. 6.

In 2008, when the recession began, 55 percent of Kentuckians reported that they got insurance through their employer. That dropped to 44 percent in 2009 and declined to 37 percent in 2012. But the number rose to 44 percent in 2013, and to 50 percent last fall.

The expansion of Medicaid under federal health reform has greatly boosted the share of Kentuckians on public health insurance, to 29 percent. The number had risen from 11 percent to 27 percent between 2008 and 2012, then dropped to 20 percent in 2013.

Medicaid has been expanded to households with annual income up to 138 percent of the federal poverty level. In the poll, only 12 percent of people with such incomes said they were uninsured, down from 34 percent in 2013.

In the entire population, the percentage of uninsured is the same, showing the impact of Medicaid expansion. Overall, 12 percent in the latest poll reported being uninsured, and another 12 percent said they were insured but had been without health insurance at some point in the previous 12 months.

“This report gives us a snapshot of the changing health insurance situation for Kentucky adults,” ssaid Susan Zepeda, President/CEO of the Foundation for a Healthy Kentucky, which sponsored the poll with Interact for Health, formerly the Health Foundation of Greater Cincinnati. “Having health insurance is an important factor in having access to affordable, quality health care.”

Because 97 percent of seniors have Medicare or some other form of health coverage, the questions were asked only of working-age adults, ages 18 to 64. A random sample of 1,597 adults all over Kentucky was interviewed by telephone, including landlines and cell phones. The poll has a margin of error of plus or minus 2,5 percentage points.

Advocates of smoking ban, including victims of secondhand smoke, rally at Capitol

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Over 500 Smoke-Free Kentucky advocates spent Wednesday, Feb. 11, asking their lawmakers to pass a statewide smoking ban, wrapping up their day with a rally and news conference in the Capitol rotunda, featuring leaders of the effort and people who said they were victims of secondhand smoke.

"Our efforts are paying off; there is going to be a vote very soon," James Sharp of the American Cancer Society's Cancer Action Network said to a cheering crowd. "Keep up the good work, keep up the pressure, keep sharing those personal stories. We will get a smoke-free Kentucky because everyone deserves the right to breathe clean, smoke-free air in this state."

Lt. Gov. Crit Luallen, a colon-cancer survivor, said Kentucky "has some of the worst health statistics in the nation" and conditions like heart disease, lung disease and cancer are all linked to smoking. "If we truly care about our children, and our families and the future health of the commonwealth, it is time to pass House Bill 145 and create a statewide smoke-free law," she said.

"I don't know how any public leader today can sleep at night if they are not committed to help reforms like a statewide smoke-free law," Luallen said to a cheering room. "I don't know how they sleep at night knowing we have more Kentuckians dying of cancer than any other state in America."

"This should not be politically risky," Luallen said after the rally. Saying that many rural towns or businesses will not do this voluntarily and statistics support the correctness of this decision, so "Those legislators who are facing a difficult vote have to look at what is the right thing to do."

Health Commissioner Stephanie Mayfield, who has taken a strong stance against smoking and tobacco since she took office, said the law would be a strong, quick advancement toward better health. "Secondhand smoke can kill you,": she said. "The science is clear, The debate is over."

Joe Geraci, a volunteer for the cancer society and a lung cancer survivor, said he was there to represent those with cancer "who did not make it." He said that he attributed his lung cancer to the smoke-filled capitol building that he worked in as a lobbyist for 10 years.

Geraci said many of the legislators told him that they were getting more calls from people to vote against the bill than to vote for it, so he encouraged calls to the legislature's message line, 800-372-7181.

Denny Nafus of Northern Kentucky said his nonsmoking parents, who volunteered at church bingo for decades, died of lung disease, and Kentucky spends $1.92 billion a year on health care and loses $2.3 billion worth of production because of smoking and secondhand smoke.

Roger Cline of Olive Hill said he was there as a "secondhand smoke victim" because he lost his nonsmoking wife to lung cancer from exposure to smoke at her workplace.

Dr. Erin Frazier of Louisville, a breast-cancer survivor, said that she had no other contributing factors for the cancer other than waiting on tables in smoky bars and restaurants between the ages of 16 and 22. She said wait staff have the highest prevalence of exposure to secondhand smoke of any occupation.

"Young, pre-menopausal women who are exposed to secondhand smoke have a 70 percent greater risk of getting breast cancer than those exposed later in life," she said. "and regardless of the age, women who are exposed to secondhand smoke have a 25 percent increased risk of getting breast cancer."

Sandra Castle described herself as a nurse who loved to sing to her patients. She said she worked for 18 years around secondhand smoke, and blamed it for two different cancers, which caused her to lose a vocal cord and undergo spinal surgery. She said she had lost two of the greatest joys of her life, singing and the ability to lift her grandchildren.

Laura Tarakam said secondhand smoke is a trigger for asthma attacks, and a son died from an attack caused by an unknown trigger. Secondhand smoke is a known trigger for asthma attacks, so this puts her living son, an asthmatic, and others with this condition constantly at risk.

Rep. Susan Westrom, five-year sponsor of the bill, thanked the smoke-free advocates for the work they do and encouraged them to be persistent" saying that as lawmakers became more educated, they better realize their responsibility for improving the health of all Kentuckians, not just in the workplace.

Westrom, D-Lexington, also thanked Dave Adkisson, president and CEO of the Kentucky Chamber of Commerce, for its support of the bill. Adkisson said "92 percent of business leaders support this legislation" not only because "smoking is killing us as a health matter, but it is bankrupting us as a financial one."

Asked after the rally about the bill's chances in the Senate, Westrom said "our numbers are so positive" in the Republican-controlled chamber, and better than they have ever been. She said there aren't enough votes yet to get the bill to the floor, but it was "very, very close." Senate President Robert Stivers has said he plans to follow his policy of not allowing bills to the floor unless they are supported by a majority of the Republican caucus, which has 26 members of the 38-member Senate.