Most registered voters, including 27% of Bevin backers, want to continue the state's expansion of Medicaid under Obamacare

The expansion of Medicaid, the federal-state health program, has solid support among Kentuckians despite being an issue in Tuesday's election for governor.

Most registered voters in the latest Bluegrass Poll said they wanted to maintain the expansion of Medcaid benefits implements by outgoing Gov. Steve Beshear: 54 percent said they wanted to keep it, while 24 percent said they wanted to reverse it and 22 percent said they weren't sure. The error margin for the sample of 1,016 voters, called Oct. 23-26, is plus or minus 3.1 percentage points.

Republican gubernatorial nominee Matt Bevin first said he would abolish the expansion, but for the last three months has said he would seek a federal waiver to revise it. He has offered few details, but generally says he wants Medicaid recipients to have "skin in the game" through co-payments, deductibles, premiums or health savings accounts.

Bevin scoffs at the state-funded study that says so many people have been added to the health-care system that enough jobs and tax revenue will be created to cover the cost of the expansion through 2020. Attorney General Jack Conway, the Democratic nominee, says he believes the study, but acknowledged in their last debate that if he is elected it will be a challenge for him to prove it.

Under federal health reform, the federal government pays the full cost of the expansion, to people in households with incomes up to 138 percent of the federal poverty level ($33,465 for a family of four), through 2016. In 2017 states will pay 5 percent, rising in annual steps to the law's limit of 10 percent in 2020.

The Bluegrass Poll found that 27 percent of those who said they plan to vote for Bevin want to maintain the expansion, while only 7 percent of those who plan to vote for Conway want to reverse it.

As might be expected, most Republicans want the expansion to be reversed, while Democrats and independents want to maintain it. Conservative Democrats appear to support it; the poll found that while voters calling themselves "very conservative" want it reversed, those identifying as merely "conservative" were about evenly divided and all other ideologies strongly supported keeping it.

The expansion is favored in all income, education and geographic groups. Here is a table of the results from the company that did the poll for The Courier-Journal, WHAS-TV, the Lexington Herald-Leader and WKYT-TV (click on image for larger version):

Farm to School program teaches Perry County students how to eat healthier, explores local food as an industry in Eastern Ky.

Image from WYMT Mountain News

Perry County students are learning about nutrition through the Farm to School program, which aims to inform students about healthy food while supporting local food systems, Callie Rainey reports for WYMT-TV in Hazard.

"We teach the kids where the food comes from, how it's produced, how you can do that in Eastern Kentucky," Farm to School teacher Reda Fugate told Rainey. "We try to let them know that there are other industries in Eastern Kentucky that you can do other than just coal mining," which provides half as many jobs in the eastern coalfield as it did three years ago.

About 80 Kentucky school districts and more than 200 farmers participate in the Farm to School program, Tina Garland, the state Department of Agriculture's coordinator for the Kentucky Farm to School program, said in a telephone interview. The latest official data says Kentucky schools spent $1.6 million on local foods in 2011-12.

Several eighth grade students in Perry County told Rainey what they had learned through the farm-to-school program.

"Too make sure that I don't overeat and make myself sick and have the correct serving size," said Jade Neace.

"On my plate you're supposed to only have a certain amount of milk, meat and vegetables," said Cayden Castle.

"I don't eat a lot of sugars and fats and I stay healthy," said Jade Adams.

The Farm to School program has distributed 31, $5,000 mini-grants to schools across the state to either help develop new farm-to-school programs or to enhance existing programs, Garland said.. Eleven of them were USDA Farm to School support service grants and 30 of them from the National Farm to School Network Seed Change pilot grant program, in which Perry County schools were chosen to participate.

"It actually makes you feel really good," Fugate told Rainey. "I have a 12-year-old and knowing that they are listening and are making healthier changes so that they possibly won't have to face some of the health issues that we as adults now have to face."

A preliminary U.S. Department of Agriculture report finds that schools that participate in Farm to School programs show an increase in the number of meals sold, an increase in the consumption of healthier foods and decreases in plate waste.

Beshear talks about health reform in Kentucky in his latest video

By Melissa Patrick
Kentucky Health News

During his time in office, Gov. Steve Beshear has released weekly "About Kentucky" videos on his YouTube channel to inform Kentuckians about policy initiatives and legislative actions. As he prepares to leave office after eight years, he has done a series of videos about major elements of his administration; the most recent is about health.

Kentucky is well known for its poor health statistics, but Beshear says it is now also known for its aggressive embrace of federal health reform, with health experts often calling Kentucky a "national leader" in this area.

"Over the last eight years, we have taken a fundamental overhaul of core elements like how people access care, how that health care is delivered, who can access that care and what services they receive," Beshear says. "This has been reform with a capital R."

Because of health reform, more than half a million Kentuckians now have health coverage and the number of uninsured Kentuckians has been cut in half, Beshear said. Kentucky's uninsured rate is 8.5 percent, according to the U.S. Census.

Emphasizing why improving the health of Kentuckians is so important, he says, "There is a direct line between poor health and almost every challenge Kentucky faces, whether that is poverty, unemployment, lags in education attainment, substance abuse or crime."

The governor lists other reforms implemented under his administration: "wider use of electronic medical records, a new delivery model for Medicaid that focuses on better health outcomes, the expansion of Medicaid eligibility standards, creation of a state-run health-benefit exchange through which families can purchase private health insurance and expanded access to substance abuse and behavioral health treatments."

First Lady Jane Beshear notes that because of these changes, "The number of people who are taking control of their health by getting cancer screenings, physicals and dental check-ups has sky-rocketed."

The video also highlights her efforts to help Kentuckians get screened for cancer through the Horses & Hope program, which will expand next year to include a mobile cancer screening van that is equipped to screen for seven different cancers and will serve at risk populations throughout the state.

The governor noted that Kentucky has made "great progress" on the goals set forth by kyhealthnow, a broad initiative that targets seven major measurable health goals to improve the health status of Kentuckians by 2019, and said that the "impact on Kentuckians has been tremendous."

Beshear said that he and his wife have heard "countless stories" from people who have benefited from these reforms through "improved health, better financial security and most of all hope for the first time in a while."

Jane Beshear thanks the many people, organizations and agencies who have partnered with them in these efforts to improve the health of Kentuckians, and concludes, "But, there is a lot of work left to do."

State to wind up operations of federally funded Kentucky Health Cooperative, says it will not assume liability for losses

By Melissa Patrick
Kentucky Health News

The Kentucky Department of Insurance is taking control of the day-to-day operations of the failed Kentucky Health Cooperative, but will not assume any of its liabilities, according to a state news release.

Franklin Circuit Judge Phillip Shepherd signed the order Thursday to place the co-op into rehabilitation, and makes Insurance Commissioner Sharon P. Clark the rehabilitator. The order also appointed Jeff Gaither and David Hurt, both on contract with the department, as special deputy rehabilitators, department spokeswoman Ronda Sloan said in an e-mail. Glen Jennings has said that he will continue to serve as the acting Kentucky Health Cooperative CEO through Nov. 8, when his contract expires, according to Sloan.

Clark said in the release, “Today’s action placing KYHC into formal rehabilitation was necessary to ensure DOI is in a position to protect consumers and providers. Our central concerns are making certain policyholders receive the services to which they are entitled, and that the providers offering those services honor existing contracts and receive payment.”

The co-op announced in early October that it would be closing, but would meet its obligations to its members through Dec. 31.  Co-op members must apply for coverage with a different insurance company by Dec. 15 to have coverage on Jan. 1. Open enrollment runs between Nov. 1 and Jan. 31.

Two insurers, Anthem and UnitedHealthcare, will offer plans in all 120 Kentucky counties. Some counties will have up to seven choices, with expanded provider networks offering 86 different plans.

Kentucky Health Cooperative lost $50.4 million last year, but had only lost $4 million by the end of June, and said it fully expected to overcome its losses, through payments the federal government makes to companies for insuring sicker populations. But last year's federal budget deal limited those "risk corridor" payments and destroyed that hope. The co-op was hoping to get $77 million in risk-corridor money and got $ 9.7 million. 

Cooperative policyholders and providers with complaints or other issues related to the rehabilitation action should call the Insurance Department at 800-595-6053.

American Academy of Pediatrics calls for systemic changes to decrease climate change because children's health is at stake

The American Academy of Pediatrics has called on pediatricians, the health sector and politicians to solve what it calls "the crisis of climate change" to protect children from its immediate and long-term health consequences, Ashley Welch reports for CBS News.

"There is nothing more important than protecting the health, welfare and future for our children and grandchildren," Dr. Samantha Ahdoot, lead author of the statement and member of the AAP's Council on Environmental Health Executive Committee, told CBS. "Climate change is about the world in which our children are living today and in which they will be raising their own families. Their future is at stake, yet they do not vote and they have no voice in the debate. We have a moral obligation to act on their behalf."

The AAP's policy statement breaks down the health consequences of climate change into direct and indirect effects.

Direct effects of climate change on children

Direct effects include those that result from extreme weather events, including severe storms, floods and wildfires that scientists say are occurring more frequently and on a larger scale because of climate change, the report says.

"Children's unique needs place them at risk of injury, death, loss of or separation from caregivers and mental health consequences due to severe weather events," Ahdoot told CBS News, who is also the assistant professor of pediatrics at Virginia Commonwealth School of Medicine.

For example, about 250,000 children were evacuated and relocated as a result of Hurricane Katrina, and more than 5,000 were separated from their families, with the last one reunited with their family six months after the storm, according to the report. This took "a toll on their academic performance, behavior and mental health," Welch writes.

The report also notes that heat waves are lasting longer and are more severe, particularly putting infants and high school athletes at risk of heat-related illness and death. Annually, 9,237 cases related to heat are reported nationally in high school athletes, Welsh reports.

Indirect effects of climate change on children

Indirect health concerns include respiratory diseases; lengthened allergy seasons; smoke from wildfires; and infectious diseases like malaria, dengue fever, West Nile virus and others that could see more favorable conditions in a warmer climate. Increased transmissions risk of Lyme disease in the northeastern U.S. has been linked to climate warming in that area, says the report.

Climate change also alters agricultural conditions, which affects food availability and cost, further threatening the nutrition needs of children around the world, says the report. Added to that, the nutritional value of foods is changing because of increased carbon dioxide in the atmosphere, says the report.

"The report emphasized that children in the world's poorest countries, where health burdens due to disease and malnutrition are already disproportionately high, are most affected by climate change," Welsh writes.

The authors also note that climate change can cause population displacement and communities to fail, and thus will contribute to global instability and a potential increase in violent conflict.

Call to action

Based on "well-established evidence" that human-generated greenhouse gas emissions are the cause of climate change, the American Academy of Pediatrics calls for pediatricians, the health sector and governments to take action to address these issues, hoping that a universal concern about the health effects of climate change on children will drive this action.

"Failure to take prompt, substantive action, given our current knowledge, would be an act of injustice to all children," says the report.

AAP calls for the promotion of "energy efficiency and renewable energy production, surveillance and research on climate-associated health conditions, public awareness and education campaigns and funding for public transit and urban planning that supports open space, walkability and green building design," Welsh writes.

Mentally ill in personal-care homes, or at risk of going there, will have increased access to behavioral health care in Kentucky

The state Cabinet for Health and Family Services is extending an agreement that provides housing assistance and services to people with serious mental illness has been extended through Septemnber 2018, and is expanding it to provide increased access, according to a state news release

The agreement is with Kentucky Protection and Advocacy, an independent state agency that advocates for the rights of persons with disabilities. Its services are available to those with serious mental illness who reside, or are at risk of residing, in a personal-care home. Such facilities are long-term care facilities that provide care for persons who do not require hospital or nursing-home care, but who do require care beyond solely room and board.

The initial agreement only allowed the 14 regional community mental health centers to provide these services to individuals in their regions, but now they can serve individuals outside their service area. In addition, other behavioral health providers will now be able to provide services to these individuals.

The extended agreement also says that a regulation must be put into place that requires the use of these services to be a routine part of the Department for Behavioral Health, Development and Intellectual Disabilities protocols for those who reside in personal-care homes.

Services provided under the agreement include basic physical and behavioral health and health-related services, personal care services, residential care services, supported employment, case management, peer support services and social and recreational activities.

The extended agreement is expected to help avoid litigation under the Americans with Disabilities Act, which requires providing services to persons with disabilities in the most integrated setting.

It is estimated there are some 2,300 Kentuckians, most with serious mental illness, receiving the state supplement and residing in personal-care homes, according to the release.

Beshear criticizes Bevin for his plans to abolish Kynect and cut back Medicaid expansion, says expansion is paying for itself

Democratic Gov. Steve Beshear "sharply criticized" Republican gubernatorial nominee Matt Bevin for his plans to eliminate the Kynect insurance exchange and scale back the Medicaid expansion if he is elected Kentucky's next governor Nov. 3.

Beshear spoke at an event in Lexington to promote open enrollment in Kynect's subsidized plans, which begins Nov. 1, John Cheves reports for the Lexington Herald-Leader.

"Anybody who today talks about dismantling Kynect and talks about repealing expanded Medicaid, they don't know what they're talking about," said Beshear, who created the exchange and the expansion. "They're ignoring the facts. They're playing political games with the lives of our people. And I think on Nov. 3, the people of Kentucky are gonna rise up against that kind of — stuff. And I said 'stuff.' I was starting to say something else."

In response, Bevin's campaign told Cheves, "Jack Conway wants to keep Obamacare going even though it is breaking down before our eyes. Our state cannot afford another four years of failed liberal policies. A vote for Jack Conway is a vote for more of the same political games that got us in this mess."

After the implementation of the Patient Protection and Affordable Care Act, Beshear expanded Medicaid to include people in households with incomes up to 138 percent of the poverty line, which is $33,465 for a family of four.

Since the expansion, Kentucky has seen the nation's greatest drop in uninsured rates, to 9 percent during the first half of 2015 from 20.4 percent in 2013, according to The Gallup Organization, with the U.S. Census Bureau reporting an even lower uninsured rate of 8.5 percent, More than 400,000 Kentuckians are covered by the expansion, which has also caused a huge decrease in uncompensated hospital care, dropping to $83 million in the last quarter of the year from a high of $288 million about a year ago.

"But the improvement hasn't come cheap," Cheves writes, noting that most of the newly insured are on taxpayer-funded Medicaid and not on private plans. The federal government pays the entire cost of the expansion through next year. In 2017, the states begin to pay 5 percent, rising in steps to the federal health-reform law's cap of 10 percent in 2020.

"Kentucky's share could reach a cumulative $923 million, according to a report issued in February by Deloitte, a consulting firm," Cheves notes. This report also says that Medicaid expansion will pay for itself through 2020 by creating health-care jobs and generating tax revenue. Bevin has called that "nonsense," but Beshear countered him on that, too, saying "Right now, it is paying for itself."

Bevin called the study "bogus" on KET Monday night, in his last debate with Conway. "It assumes, among other things, that there's not a collapse of — oh, I don't know — the Kentucky Health Cooperative, which has 50-plus percent of the people who are participating in the actual qualified health plans" sold on Kynect.

Kentucky Health News asked Bevin after the debate what the co-op's problems had to with Medicaid, since they have no financial connection. He turned the question to the losses of the cooperative, calling its federal loans "our money."

A connection could be made with the co-op's failure and Kynect because it could have a long-term impact on Kynect policyholders, since co-op customers are less healthy and the other insurers will have to pick them up. However, next year's penalty for not having insurance could encourage more healthy people to enroll.

The annual fee for not having insurance in 2016 is $695 per person and $347.50 per child, per year, or 2.5 percent of household income, whichever is greater, with a family maximum of $2,085.

The cooperative, a non-profit insurer, announced this month that it will close Dec. 31. It blamed Republican spending restrictions put into place last December that barred the Obama administration from using other federal funds to make up shortfalls of the 23 state co-ops. The Kentucky co-op was hoping for $77 million in extra federal money and got $9.7 million. The money was designed to compensate insurers who enrolled a disproportionate share of sick, expensive policyholders.

Kentuckians want next administration and legislature to work on reducing health costs and improving the state's health

By Melissa Patrick
Kentucky Health News

Reducing the costs of health care and improving the state's health are two of the top five priorities Kentuckians want their next governor and the legislature to work on in the next year, according to the latest Kentucky Health Issues Poll.

"These results give us a reliable snapshot of the most important issues Kentucky adults want to see the next governor and members of the legislature address," Susan Zepeda, President/CEO of the Foundation for a Healthy Kentucky, said in a news release. "It is important for our policymakers to know what priority Kentuckians place on these issues facing the commonwealth."

The poll asked, " How important is it to you that the next governor and the Kentucky legislature work on each of the following issues in the next year? Is it extremely important, very important, somewhat important, or not that important?"

The top five priorities were the same as in a poll that asked the same question prior to the last election for governor, in 2011.

This year's poll found that Democrats, Republicans and independents agreed that the economy, education and jobs should be the top three priorities, in that order, with health concerns ranking fourth and fifth.

However, Republicans put less emphasis on health. While 88 percent of Democrats said that reducing health-care costs was extremely or very important to them, 78 percent of Republicans said that. The partisan gap was wider on improving residents' health, with 91 percent of Democrats and 71 percent of Republicans saying that this was very or extremely important for the state.

"And so you do the math and you figure out whose attention we might need to get to really sustain health gains in the commonwealth," Zepeda said at the Friedell Committee for Health's annual meeting Oct. 25.

The poll was conducted from Sept. 15 through Oct. 7 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 1,608 adults via landline and cell phone, and has a margin of error of plus or minus 2.4 percentage points.

Impact of Medicaid expansion and Kynect workers are discussed at Friedell Committee for Health's annual meeting

By Melissa Patrick
Kentucky Health News

Medicaid expansion and Kynect, the state's health insurance exchange, have transformed health care in Kentucky by providing health insurance to an additional 500,000 Kentuckians, but that hasn't come without some challenges for both consumers and providers.

The expansion and the exchange for it were parts of a timely panel discussion Oct. 25 at the Friedell Committee for Health's annual meeting in Lexington, as Kentuckians prepared to decide between gubernatorial candidates who are deeply divided on both topics.

Democratic gubernatorial nominee Jack Conway and independent candidate Drew Curtis favor keeping the expansion, at least for the near future, as well as the exchange. Republican nominee Matt Bevin says he wants to change the Medicaid expansion, and would abolish Kynect, sending people to the federal exchange.

"We are truly at a juncture in Kentucky where the results of this November's election could have huge impact on access to care for people throughout the commonwealth," Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, said in her opening statement.

Impacts of health reform

Since the implementation of the Patient Protection and Affordable Care Act, Kentucky has shown the biggest drop in the uninsured rate in the country, now at 8.5 percent, according to the U.S. Census Bureau.

Medicaid expansion, which allows those up to 138 percent of the poverty line to join the program, covers about 400,000 Kentuckians, many whom have never had insurance before.

It has also helped decrease the uncompensated care of hospitals, which have seen a drop to $83 million in the last quarter of the year from a high of $288 million about a year ago, according to a foundation report.

In addition, it has helped provide health coverage to the poorest regions of the state, with Eastern Kentucky recorded as the the greatest beneficiaries of the expansion, followed by Western Kentucky.

But despite these gains, Zepeda said many people who have never had health insurance don't know how to use it, having been conditioned to only seek care in emergencies.

"There is a huge health-literacy task ahead of us," she said, "because people are going to have to learn how to use the system at the right time and the right way so that they get healthy and stay healthy."

Another problem is that Medicaid recipients often have difficulty finding providers, and this is one of the reasons they tend to still use emergency rooms, Zepeda said. She noted that there is an effort being made with state licensure boards to create an accurate, up-to-date data base about who is really accepting Medicaid patients and to what extent.

Medicaid expansion and hospitals

"We have had a huge impact at the University of Louisville Hospital from the expansion of Medicaid," Mark Pfeifer, the hospital's chief medical officer, told the committee.

He said the hospital's share of uninsured patients has dropped to 5 percent from 25 percent in the last two years, calling it a "profound story and change for a safety-net hospital." Emergency department use has dropped 5 percent, Pfeifer said, but the patients they do see are sicker.

Pfeifer said the drop in emergency-room use could be a result of the reform law, as those with less urgent needs seek care elsewhere because they now have insurance. He said he expects ER use to decrease further as the newly insured better manage their chronic illnesses and seek care earlier.

One of the best things about more people having insurance is access to medications, Pfeifer said. "I can give you all the care I want out of my pocket, but if you don't take the medications I prescribe you, I will see you back again in three weeks in the emergency room," he said.

Medicaid expansion also benefits city and state budgets, which have decreased their funding to the hospital this year to less than $8 million, from $30 million. "And it's worked out OK," Pfeifer said. "Financially, it hasn't really changed our books."

Pfeifer said it is a fallacy to think Medicaid expansion allows all Kentuckians access to insurance, because many make too much money to qualify for the expansion but can't afford the monthly premiums for private insurance, even with the subsidies provided by Kynect.

He said that for some people the cost is "easily 15 to 18 percent of their take-home [pay], and that is just not possible for someone making $28,000 a year."

Even for those who qualify for the expansion, "It has been a bit of an uneasy transition," Pfeifer said, because of confusion about how it works; difficulties in dealing with the administrative side of it; limited access to providers; poor health literacy; and a general distrust of the system, he said.

Medicaid expansion and clinics

Bill Wagner, executive director of the Family Health Centers of Louisville, seven facilities that take care of under-served populations, shared the many benefits they have seen from the reforms: a drop in their share of uninsured patients to 17 percent, from 51 percent in 2013; a $5 million decrease in uncompensated care between fiscal year 2013 and 2014, with an expectation of a greater drop this year; a $5 million capital grant used to expand and improve several of their facilities; and the ability to sign up 14,000 of their patients with insurance.

He then noted some of the challenges: Many of the newly insured don't understand the penalties involved if they don't sign up for insurance, not thinking about a year and a half from now when they will be required to file their taxes and pay the penalty.

The annual fee for not having insurance in 2016 is $695 per person and $347.50 per child, per year, or 2.5 percent of household income, whichever is greater, with a family maximum of $2,085.

"They are making decisions about cost without seeing the big picture," Pfeifer said.

He also said many of the newly covered struggle with their failure to maintain eligibility. For example, Medicaid clients have a very short window to change their address when they move or they lose Medicaid eligibility, and those on private insurance don't understand that they have to inform their insurance company if they have a change in income status within the covered year.

The reform law funded "Kynectors" to help people unfamiliar with health insurance navigate Kynect, the official name of which is the Kentucky Health Benefit Exchange. Because patients have created a personal relationship with their Kynectors, they "end up becoming case managers going forward" to help them with these issues, Wagner said.

He said that should be an important consideration when deciding whether to abandon Kynect and adopt the federal exchange, as gubernatorial Matt Bevin has said he would do, because that would cause Kentucky to lose 75 percent of its funding for Kynectors, who are now in every county.

"Having the boots on the ground from the Kynectors, having the close working relationship with the Kentucky Health Benefit Exchange, I think has really helped us provide more ongoing care and coordinated case management around insurance, so I worry about that if that were to change," Wagner said.

He said providers also face challenges, such as administrative complexities, which he expects to get worse with two more Medicaid managed-care organizations being added to the existing five this year; workforce shortages; challenges with electronic health records and inter-operability; and patient turnover.

Medicaid expansion and oral health

Raynor Mullins, emeritus faculty member of the University of Kentucky College of Dentistry, said he is "a tough grader" but gives the Medicaid expansion in Kentucky an A-.

"What has occurred has been monumental," he said, noting that Medicaid dental visits have risen 31 percent, mostly in adults.

But claims paid to dentists went up only 28 percent, and only 24 percent of practicing dentists "participate at meaningful levels in Kentucky Medicaid program," Mullins said, for several reasons: administrative difficulties, poor reimbursement rates for dentists, Medicaid patients not keeping appointments; and the many dental services not paid for by Medicaid.

"We have a very fragile population of participating dentists," Mullins warned.

Mental-health advocate Sheila Schuster said many people who have never been to a dentist, which includes many of those who are newly insured through the expansion, fear doing so. She suggested that dental care and behavioral health care should be integrated to help these patients.

Medicaid expansion and the consumer

Kentucky Voices for Health's "Sustaining Health Gains" campaign has been sharing county-by-county enrollment and preventive service data with Kentuckians, as well as sharing videos online of Kentuckians who have benefited from the reform law. (Read more)

For example, one of their tweets said, "Of #McCracken county's 6,133 folks with new #Medicaid coverage, 637 got preventive dental care. #KeepKyCovered."

One of the many videos features a homeless man in Eastern Kentucky whose Kynector, Jennifer Gates, not only helps him sign up for health insurance and get care, but also helps him continue to get care and make sure he doesn't fall through the cracks.

"Kynectors are so much more than just someone who helps you enroll," KVH Executive Director Emily Beauregard told the committee.

Kentuckians want new governor to focus on health care

Two of the top five priorities that Kentuckians want their next governor and legislature to address involve health, according to a recent poll taken for the Foundation for a Healthy Kentucky.

However, Republicans place less emphasis on health. The poll found 88 percent of Democrats say reducing health-care costs was extremely or very important to them, compared to 78 percent of Republicans. And the partisan gap was even wider on improving Kentuckians' health, with 91 percent of Democrats and 71 percent of Republicans saying that this was very or extremely important for the state.

"You do the math," Zepeda said, "and you figure out whose attention we might need to get to really sustain health gains in the commonwealth."

Candidates for governor make misstatements and questionable assertions in debate, many about health issues

By Al Cross
Kentucky Health News

Many of the questionable assertions and outright misstatements in Sunday night's debate for governor were about health care. Here's a fact check:

Bevin said Conway lied when he said Bevin would kick half a million people off health care. Bevin said in February that he would immediately end Gov. Steve Beshear's expansion of the Medicaid program. He has since denied saying that, and said last night that Democratic videos of his quotes omit the question he was asked, but that is not the case with his February quote. He now says he would seek a federal waiver to change the program. It might be argued that he could issue another executive order to replace Beshear's, but the Medicaid program has certain requirements that must be met unless waived, and waivers are not available immediately. While Bevin has been vague about his Medicaid plans, he has made clear for the last three months that his actions would not be as abrupt as he first said they would be.

Conway said the Kynect health-insurance exchange, which Bevin wants to abolish, is three and a half times more efficient than the federal exchange, to which policyholders would go. Bevin said that is "an absolute falsehood" because Kynect is funded by a 1 percent fee on all health-insurance policies in Kentucky and only 2 percent of the policies are bought through Kynect. Conway said afterward that he was referring to the 3.5 percent fee charged by the federal exchange, which would make those policies more expensive. While the term "efficient" could arguably be applied to the cost of those policies, a more common interpretation of Conway's comment would be that he was talking about Kynect's operating efficiency.

Bevin said the Kentucky Health Cooperative, a non-profit health insurer that is closing due to losses and lack of money, was "a distinct part" of the study that predicted the Medicaid expansion would pay for itself until 2020. The cooperative is not mentioned in the study. Bevin said afterward that the co-op was part of the "inputs" considered by the study. Reminded that the issue was the sustainabilty of the Medicaid expansion, Bevin noted the 51,000 co-op policyholders who will be losing their coverage. Reminded that Kynect has seven other insurers they can select from, Bevin asked, "Where are those taxpayers dollars going to go?" He was reminded that the co-op was funded by federal dollars, and "Those are our dollars." Bevin is running for governor, not president, but he is trying to appeal to people who dislike the entire "Obamacare' system. He appears to be using the co-op's failure to suggest that the system is not sustainable. However, the co-op, Kynect and the Medicaid expansion operate separately and are separately funded.

Conway quoted Bevin as saying that early childhood education, Conway's main issue, "serves no purpose." Bevin said was "another of those Democrat lies" because his full quote was that it serves no purpose after the third grade. That is based on a study that showed the effects of Head Start disappear after the third grade. Head Start is not the same as the early-childhood education program advocated by Conway, but Bevin has equated the two in the past.

Conway said he had cut his budget as attorney general by 40 percent. Bevin said that was a lie because the legislature writes the budget. The governor receives budget requests from agencies and proposes a budget to the legislature, which passes it.

Bevin said the state does not have the surplus that Conway mentioned because it has "tens of billions of dollars in unfunded liabilities." He was referring to state pension funds, which get annual appropriations from the budget but are financially separate. Budgets are for two years and the unfunded liability is for projected payments for current employees for the rest of their lives.

Bevin said, "It's a false idea that coal jobs can't come back." He noted that world coal demand has never been higher, but that ignores the facts that many electric plants in the U.S. have abandoned coal for cheaper natural gas and the coal in Central Appalachia is by far the most expensive to mine in the U.S. The Kentucky part of that coalfield has lost half its coal jobs in the last three years.

'Health Gains Campaign' shows successes of Medicaid expansion as Kentucky Voices for Health plans to deal with a new governor

By Melissa Patrick
Kentucky Health News

Kentucky Voices for Health is planning for the future as Kentucky gears up for a new administration by working on what it calls a "Sustaininged Health Policy  Gains Campaign," which involves a four-phase approach to continue its mission of improving health care and health coverage for Kentuckians, KVH Executive Director Emily Beauregard said at the annual Friedell Committee for Health meeting in Lexington Sunday, Oct. 25.

KVH is in the first phase, which it calls the "Health Gains Campaign," by sharing the many successes of the Patient Protection and Affordable Care Act related to Medicaid expansion, including county-by-county enrollment and preventive service data, and the Kynect health-insurance exchange.

Beauregard said they are sharing stories about the people who have coverage through Medicaid expansion because, "We really do feel like those are the folks who were previously ineligible for coverage and these are the people who really have benefited from the Affordable Care Act."

"We know through the American Community Survey data that the majority of folks who are eligible for Medicaid expansion actually are working at some point throughout the year. ... A lot of these workers just don't have employer benefits that include health insurance," Beauregard said, noting that this information is on their infographic.

The next phases of the the campaign will educate the new administration that takes office Dec. 8; be involved with the next legislative session and budget discussions; and work toward getting an executive order signed for continuation of Kynect. Beauregard said KVH will need to have a "groundswell" of support because the budget will have to include money to pay 5 percent of the Medicaid expansion in 2017 and 6 percent in 2018. The next budget runs from July 2016 to June 2018.

Democratic gubernatorial nominee Jack Conway and independent candidate Drew Curtis favor the expansion and Kynect. Republican nominee Matt Bevin says he wants to change the Medicaid expansion, and would abolish Kynect, sending people to the federal exchange.

Medicaid expansion is "a program that does cost money to insure more people, but it also has some really, really important benefits to Kentucky and we believe the gains outweigh the cost," Beauregard said.

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.

KVH is sharing, sometimes in online videos, stories collected over the last year of individuals who have signed up for health coverage through Kynect and have benefited from the reform law. Laken Gilbert from Flemingsburg is one of those individuals and shared her story.

Laken Gilbert speaks as Friedell Committee Executive Director
Richard Heine listens. (Ky. Health News Photo by Al Cross)

"I guess you don't really realize what coverage is like if you have never had it before," Gilbert said. "And all the work that you all have done is just phenomenal and it really has helped these folks that haven't had coverage."

Gilbert said that more than half of the people who live in Flemingsburg have received coverage through the Medicaid expansion. Medicaid expansion enrollment in Fleming County was 1,773 as of Oct. 8, according to the KVH infographic. That is more than 12 percent of the county's population. "That is amazing to me," she said.

Gilbert told the committee that she had grown up poor and her parents had never had health insurance, unless her mother was pregnant and this qualified for traditional Medicaid. Gilbert said she was raised primarily by her grandparents, who were farmers and also did not have health insurance. So, Gilbert said she grew up with the Kentuccky Children's Insurance Program, another form of Medicaid.

In anticipation of losing her coverage when she turned 19, Gilbert said she had her wisdom teeth removed and got her preventive care before becoming uninsured, because she was afraid of being overwhelmed with the cost of such procedures. She said she was able to get student health benefits while a student at Morehead State University and the University of Kentucky.

Gilbert enrolled in the Medicaid expansion while a law student at UK as soon as it became available, which was important to her because her family still didn't have have health insurance; the federal health-reform law allows children to remain on their parents' insurance until they are 26.

After finding out that she qualified for health coverage through the expansion, Gilbert said, "My first call was to my grandparents who weren't covered, and we got them signed up." Since, she said her grandfather has been diagnosed and treated for diabetes and her grandmother for several heart conditions.

"That to me is the win, that my grandparents are now covered," she said. "I want to say thank you and to let you know that what you do really matters and is touching the lives of Kentucky citizens."

Gilbert has received her law degree and has been admitted to the bar but will continue to sign up for health coverage through Kynect because the law firm she will be working for is so small it doesn't provide health insurance.

Fate of health coverage through Medicaid expansion and Kynect insurance exchange could rest on outcome of governor's race

By Cheyene Miller and Anthony Pendleton

University of Kentucky School of Journalism and Telecommunications

            The fate of health coverage for about half a million Kentuckians could rest on the outcome of the Nov. 3 election for governor. Democrat Jack Conway wants to stick with the state’s embrace of federal health reform while Republican Matt Bevin does not.

            Gov. Steve Beshear expanded the Medicaid program and created an online insurance market known as Kynect. Between the 400,000 in the expansion and 100,000 private insurance plans purchased on Kynect, the percentage of people without health insurance dropped more in Kentucky than any state in the nation, from more than 20 percent to just over 9 percent, according to the Gallup Poll.

            Kentucky was the only Southern state to create its own insurance exchange, and one of only two Southern states to expand Medicaid, along with Arkansas.

Beshear is on his way out of the governor’s mansion, however, and his possible successors have two drastically different stances on the Patient Protection and Affordable Care Act, also known as Obamacare.

Conway’s stance throughout the race has been to keep what is arguably one of the greatest accomplishments of his fellow Democrat, while Bevin has promised to dismantle Obamacare in Kentucky, albeit with an inconsistent stance on the Medicaid expansion.

Bevin told reporters in February that he would immediately end the expansion, but in July he denied saying that and started talking about seeking a federal waiver to receive Medicaid money in a grant and create a system resembling Indiana’s, in which Medicaid beneficiaries pay premiums to get better benefits.

“We can’t afford the current structure as it exists,” Bevin said in September. Beshear questioned Bevin’s knowledge of the system, and said the non-partisan Congressional Budget Office found that such waiver plans “will likely cost more than the expansion as we have implemented it in Kentucky.”

Bevin has said a waiver might allow Medicaid to offer some help to people with incomes above 138 percent of the federal poverty level, perhaps by helping them with health savings accounts.

Before the expansion, only Kentuckians with household incomes at or below 69 percent of the federal poverty level qualified for Medicaid. The expansion doubled that to 138 percent of poverty.

The federal government is paying the full cost of the expansion through 2016, at which point Kentucky would start paying 5 percent of the cost, rising in yearly steps to the law’s limit of 10 percent in 2020. By the 2020-21 fiscal year, the expansion is expected to cost the state $363 million a year.

A state-funded study by Deloitte Consulting predicted in February that the expansion will generate enough jobs and tax revenue to pay for itself through 2020, but Bevin has called the study “nonsense.” Conway has cited the study in saying he supports the expansion but would monitor its costs.

In his speech at the Fancy Farm Picnic in August, Conway said Kentuckians should vote for a candidate who “understands that the truly Christian thing to do is to say that we are our brother’s keeper and health care for our people makes us a healthier and better society.”

            The candidates are playing to their bases Bevin by taking a stance against Kynect and the Medicaid expansion, and Conway by following the footsteps of Beshear in supporting it, University of Kentucky political science professor Stephen Voss said.

“They’ve already managed, without saying very much, to give that basic signaling that each side wanted to hear from them,” said Voss, adding that both candidates are also doing their best to remain vague when discussing health care: “For both candidates, delving more deeply into the specifics is fraught with risk.”

Bevin has been more consistent with his stance on Kynect, saying he would "facilitate the transition of enrollees" onto the federal exchange as he dismantles Kynect. In September, Bevin said he would consider a suggestion from Republican state Sen. Ralph Alvarado to keep Kynect operating and finance it by expanding it to other states, but he was skeptical of the idea.

            Lexington-based litigation attorney Douglas McSwain, who specializes in constitutional and health-care law, said Kynect is one of the reform law’s biggest success stories nationwide. “The main issue is that health-care reform has been a very good success under the Beshear administration,” McSwain said.

Kynect is funded by a 1 percent assessment on all Kentucky health-insurance policies, while the federal fee is 3.5 percent on policies sold on the exchange.

Independent candidate Drew Curtis has said the state can probably afford the first round of expenses from the Medicaid expansion, and should leave it and Kynect “alone as it is” until the state sees the long-term effects. “You can’t drop a massive system change on people, and (then) do it again in two years,” he said.

Kynect Director Carrie Banahan has said that Kynect would cost at least $23 million to dismantle and that most of the seven insurance companies using it would probably not go to the federal exchange.

            Whoever is elected governor will likely have many obstacles on his plate regarding health care, since Kentucky is one of the least healthy states. According to America’s Health Rankings, Kentucky is 47th in overall health, with major issues facing the state including high rates of smoking and preventable hospitalizations. Kentucky also ranks first in the nation for lung cancer deaths, according to the federal Centers for Disease Control and Prevention.

Cheyene Miller and Anthony Pendleton are journalism seniors at the University of Kentucky. They wrote this story for the Covering the Governor’s Race course being taught by Associate Professor Al Cross and Journalist in Residence John Winn Miller.

KET's Clearing the Smoke' explores smoking issues in Kentucky; guests called for smoking ban, note concerns about teens

An old tobacco barn in Magoffin County, seen by thousands daily
on the Mountain Parkway, has found a new purpose – to help people
stop smoking. Tobacco barns It once advertised Mail Pouch tobacco.
Abbie Conley, tobacco coordinator for the county health department,
told KET, “Alot of parents feel like, well, it's not as bad as drug use or
not as bad asalcohol. I've even heard of parents buying cigarettes for
their kids.”Shelia Salyer, the owner of the barn, said that the last
tobacco grownon her farm was 12 years ago and smoking has taken a toll
on thecounty: “I have lost a lot of people I know to smoking, to lung cancer.”

By Melissa Patrick
Kentucky Health News

About one in four Kentuckians smoke, but the habit affects everyone in the state -- if not directly through the many diseases associated with smoking or second-hand smoke, then economically: through increased taxes, higher insurance premiums and decreased worker productivity. The best way to address this is a comprehensive ban on smoking in workplaces.

That was the message of “Clearing the Smoke,” a Kentucky Educational Television "Health Three60" episode that first aired Oct. 19.

Host Renee Shaw opened the program with state Health Commissioner Stephanie Mayfield and Dr. Chizimuzo Okoli, director of the Division of Tobacco Treatment and Prevention at the University of Kentucky.

Smoking in Kentucky

Mayfield told Shaw that while Kentucky's smoking rate has been trending down, it still has the second highest rate in the country at 26 percent, well above the national rate of 19 percent, prompting her to say, “We have a lot of work to do."

At least 70 percent of smokers want to quit, Okoli told Shaw, but said, "It is important to remember that smoking is actually an addictive disorder," and smokers need access to smoking cessation tools to be successful.

Mayfield jumped in and said with enthusiasm, "That is exactly what we have done with enhanced health-insurance access," noting that the state's embrace of federal health reform has allowed more Kentuckians to have access to smoking cessation programs. "Health insurance helps tremendously," she said.

The two also touched on the many diseases linked to smoking: diabetes type 2, rheumatoid arthritis, lung cancer, colon cancer, leukemia, birth defects, respiratory diseases, asthma, breast cancer, oral cancers, other organ cancers, bone loss... with Mayfield noting that these diseases are associated with both smoking and second-hand smoke.

"Second-hand smoke can kill you," Mayfield said.

Okoli pointed out that smoking has a direct impact on unborn children. He said 70 percent of women quit smoking when they find out they are pregnant, and some studies show that those who continue to smoke sometimes have mental illness or addictive disorders.

Mayfield agreed, saying, "Those with pre-existing behavioral health and mental disorders, we find that their smoking rates can be as high as 50 percent compared to our general population."

Support for smoke-free legislation

Mayfield and Okoli said they support statewide smoke-free legislation to ban smoking in enclosed public places.

“I think our people deserve this,” Okoli said, noting that a ban would protect against the preventable diseases associated with smoking, decrease cigarette consumption and discourage young people from starting to smoke.

Ashli Watts, director of public affairs for the Kentucky Chamber of Commerce, said 92 percent of the chamber's members support statewide smoke-free legislation.

“This is not just a health care issue, it is an economic development issue,” Watts told Shaw, noting that businesses look at the health of the workforce, productivity levels and the cost of insurance when they are deciding where to locate.

Watts also pointed out that almost $600 million of Medicaid taxpayer money went directly to pay for smoking related issues and said, "We can simply no longer afford to ignore the issue. Smoking is not only killing us, it is bankrupting us."

The importance of tobacco cessation programs

Audrey Darville, a certified tobacco treatment specialist with UK HealthCare, told Shaw that it is important to get evidence-based help to stop smoking, with only three to five people out of 100 successful when trying to stop “cold turkey.”

Darville said that people who engage in cessation counseling, tobacco cessation medications and individual counseling have a 40 to 60 percent success rate of “staying quit.”

She explained that nicotine hits the brain within 10 seconds of smoking and causes a release of dopamine, which stimulates pleasure, making it hard to quit.

“We tend to place a lot of the responsibility for quitting or being successful with quitting on the person or some personal characteristics, but we have to have a healthier respect for how addictive this drug (is) and how miserable people feel when they don't have it when they are trying to quit,” Darville said.

Bobbye Gray, tobacco cessation administrator for the state Department of Public Health, said the Kentucky Quit Line is available to those 15 and older who are ready to quit smoking. Smoking cessation coaching is also available through the Quit Line for those without insurance, who, Gray said, can get nicotine replacement products free of charge. Smoking cessation programs are also available through local health departments.

Smoking and Teens

“Some people are more addicted (than others), especially young people and teenagers,” Gray said, “They are more sensitive to the nicotine, therefore more susceptible to the addiction.”

About 18 percent of high school students smoke traditional cigarettes, and 24 percent use e-cigarettes, said Elizabeth Hoagland, youth tobacco-policy specialist with the state health department, adding that 30 percent of youth who experiment with smoking will go on to become daily smokers.

Hoagland said that most people aren't aware that even teenagers have health consequences from smoking, even if they aren't daily smokers, including insulin resistance and reduced lung growth.

“You have reduced lung growth. The lung is kind of like the brain, the lungs keep maturing and growing until the age of 25. So, if you are a smoker, your lungs don't grow to their full capacity, and they don't work as well as they would for a non-smoker,” she said.

Hoagland expressed concern about the growing use of electronic cigarettes, saying that there was “a lot of misinformation” out there. She made it clear that the vapor off of an e-cigarette is not a water vapor, but is an aerosol, “And these are completely unregulated products so we don't know what is in them,” she said.

She said that we know e-cigarettes contain nicotine and formaldehyde, in addition to ultra-fine particles, which can cause “lung inflammation and lung damage,” and noted that some flavorings like diacetyl, which is used in microwave popcorn, is used in 60 percent of e-cigarettes and has been proven not safe to breathe.

Programs like Teens Against Tobacco Use at Tates Creek High School in Lexington allow high school students to visit elementary and middle schools and talk to the students about the dangerous effects of tobacco use using hands on activities.

At Bourbon County High School, students brought e-cigarettes to the staff and school board's attention, leading the effort to have them included in their tobacco-free policy at school. Lynlea Kiser, a student in the school who is involved in smoke-fee education, said that many of the staff didn't know what e-cigarettes were until the students brought them to their attention.

Cyndi Steele of the Bourbon County Health Department said that because the schools already had a tobacco-free policy in place, the culture has shifted. “The students were not willing to tolerate the vapor from the second-hand smoke,” she said.

Hoagland said that schools that are smoke-free have a 30 percent reduction in youth smoking, “So every school district should have one,” she said, also noting the importance of a statewide comprehensive smoke-free law, which would “really have a huge impact on our youth smoking.”

New research building at UK will focus on state's health disparities

Artist's rendering of new research center

A new research facility that will focus on addressing the health challenges and disparities in Kentucky is being built on the University of Kentucky's campus and is scheduled to be completed in spring 2018, said to a UK news release.

“This project represents the potential to improve the lives of so many, both within Kentucky where our health outcomes are so poor, and beyond,” Gov. Steve Beshear said. “Our entrenched health problems won’t improve without major investment like this project, which will complement the lifesaving efforts at the Markey Cancer Center and its designation as a National Cancer Institute.”

The $265 million building gets half of its funding from the state and the other half from university resources, including private gifts, according to the release. The facility is considered unique because it focuses on Kentucky’s health disparities, specifically in Appalachia, and fosters multidisciplinary research across numerous fields to develop solutions to these complex problems.

We know that so much of discovery today, whether at the cellular or community level, happens at the intersection of disciplines," Lisa Cassis, UK's vice president for research, said in the release. "This facility is being designed to foster discovery and collaboration so that what happens in labs and in the course of basic research can be translated to answers and solutions at the community level."

Western Kentucky University will gradually become tobacco free; last public university in Kentucky to do so

Western Kentucky University will slowly go tobacco-free by 2018 through a phased-in approach, becoming the last public university in the state to do so, Lisa Autry reports for WKU Public Radio.

"Although I've never smoked, I know how addictive nicotine is, and I think it gives people the opportunity to get help with cessation and to change habits they need to change anyway," Cecilia Watkins, a WKU professor of public health who helped draft the policy, told Autry.

The new policy will begin in January, when WKU will decrease the number of designated smoking areas on its main Bowling Green campus to 12 from 48. It will continue to reduce the number of sites over the next three years until the campus is completely tobacco-free. The policy will also apply to electronic cigarettes, Autry reports.

KentuckyOne Health names new board chair and vice chair

KentuckyOne Health has named Richard A. Schultz chair of its board of directors and Jane J. Chiles as vice chair.

Schultz succeeds Bob Hewett, who served as chair since KentuckyOne’s inception in 2012. Schultz will remain on the board, according to a news release.

“Richard and Jane have been with us from the beginning as we have successfully integrated KentuckyOne Health into a dynamic health system, improved our financial performance, and developed signature programs to improve the health status of citizens across the Commonwealth,” Ruth W. Brinkley, president/CEO, said in the release. “They will provide leadership to our board members as we continue to move forward with the ever-changing health care landscape.”

Schultz and Chiles have served on KentuckyOne Health's board since 2012.

Schultz, a University of Kentucky graduate, has served on many different boards, including one of KentuckyOne's predecessor organizations, Jewish Hospital & St. Mary's HealthCare. He was the president of Paul Schultz Advertising until 2007, according to the release.

Chiles, a graduate of Loyola University in Chicago, co-founded the Friedell Committee for Health System Transformation, which has a mission to improve the health of Kentuckians, and continues to serve on its board. From 1990 to 2002, Chiles was employed by the Catholic Conference of Kentucky, lobbying on the state level and to some degree on the federal level on a wide range of social issues, according to the release.

8 of 23 health insurance cooperatives closing, more likely to follow; they blame Republicans; Republicans blame Obamacare

By Melissa Patrick
Kentucky Health News

One-third of the 23 health insurance cooperatives created under the Patient Protection and Affordable Care Act are closing, with others likely to follow. Republicans say this is yet another failure of "Obamacare," but health co-ops say Republicans denied them the money they needed to stay open. Others say the health co-op model is not sustainable.

Co-ops in Kentucky, Colorado, Iowa, Louisiana, New York, Nevada, Tennessee and Oregon have announced they are closing, and Insurance Business America reports that it expects this number to increase, with reports "suggesting that federal officials have a list of 11 Obamacare health insurance co-ops on the verge of failure," but the officials won't name them.

The co-ops were created under federal health reform as non-profit, consumer-governed health plans, with $2.4 billion in low-interest loans. They were designed to give for-profit companies more competition and to hold down rates. The eight failed co-ops received nearly $900 million, with the Kentucky Health Cooperative receiving over $146 million.

Several of the co-ops, including Kentucky's and Colorado's, fully expected to overcome their losses, but couldn't sustain the hit of not getting these expected subsidies. Kentucky's co-op lost $50 million last year but had reduced its losses to $4 million by the end of June.

"We were on track to reverse direction and begin operating in the black, and we expected this to come about in 2016," Glenn Jennings, who took over as CEO of the Kentucky co-op in June after Janie Miller resigned, said in a news release.

Joe Smith, chair of the cooperative's board of directors, said in an interview, "If we had of been allowed to book the outstanding risk corridor as a receivable, we would have been in compliance with the risk requirements."

These closures will impact almost 500,000 policyholders, according to The Wall Street Journal. That which includes 51,000 Kentuckians, who will have to seek alternative insurance for 2016. Open enrollment begins Nov. 1.

"Republicans say it’s doubtful if the federal government will ever recoup the millions of dollars in seed money the startups received," Stephanie Armour reports for the Journal. She quotes Sen. Cory Gardner, R-Colo., as saying the money "will likely never be repaid. . . . The years since Obamacare’s passage have been marked by crisis after crisis in health care, and it’s far past time for a new plan."

Republican gubernatorial candidate Matt Bevin said taxpayers will be responsible for paying for the losses of the Kentucky co-op, in a statement calling for an Obamacare debate with his Democratic opponent Jack Conway, who declined.

Smith, the co-op board chair, said he didn't know what the future held related to this debt, saying it will likely be a "complicated resolution."

"We plan to meet our obligation to members and the providers with the monies that we have available from now until the end of the year," he said. "What happens after that is . . . who knows?"

Many of the failed co-ops, including Kentucky's, blame their demise on a reduction in expected federal payments through the "risk corridor" program, which is meant to subsidize insurers who take on high-risk customers. These reductions are a result of restrictions that Republicans added to the omnibus spending bill last December that barred the administration from using other federal funds to make up the shortfalls. The Kentucky co-op was hoping for $77 million in risk-corridor money and got $9.7 million.

"Quite frankly, if you go back to the sequestrations, which the Republicans brought into place, it is the cause of all of this," Smith said. "Somebody really needs to sit down and look at what Congress did over the last couple three years that has caused this to happen to most of the co-ops. They set out to destroy the Affordable Care Act and this is a piece that they found they could do."

Insurers had asked for about $2.87 billion in payments based on their 2014 results, but the Centers for Medicare and Medicaid Services said that there was only $362 million available to make those payments, which came from collections from other insurers that had performed well, Armour reports.

Kentucky Health Cooperative sold 75 percent of the policies bought through the state health-insurance exchange and attributed some of their troubles to the fact that they attracted too many unhealthy people and thus had to pay out much more than expected in claims.

U.S. Senate Majority Leader Mitch McConnell says the idea that Republicans should take any of the blame "couldn't be further from the truth," and said Kentucky's co-op, "like the others, collapsed under its own weight." McConnell wrote in rebuttal to a political column by Al Cross in The Courier-Journal and other newspapers that said the GOP helped cause the failure of the co-ops.

On Oct. 21, McConnell said on the Senate floor, "The administration knew beforehand that this plan was not viable and that tens of thousands of people could lose their coverage. They chose to cling fast to a disastrous left-wing experiment with our health-care system over choosing stability and affordable coverage for the many people caught up in Obamacare and these failed health-care co-ops."

Smith, asked if the Kentucky co-op has any hope of getting additional risk-corridor money, said, "I am not sure, quite frankly. From our perspective, they owe us another 60 million dollars. I'm just not sure if it is going to come or not."

Colorado HealthOP said in a statement that the decision to close its co-op was "irresponsible and premature" and that it was “well on its way” to repaying its loans early. The co-op reported a net loss of $23 million last year.

The New York Times reports that some experts have said these new co-ops have been "hobbled" from the beginning because the "federal loans granted to co-ops to get established are typically far below the capital needed to weather the uncertainty of the first years and be able to attract enough members to be successful." It also notes that the regulations attached to the loans make it hard to attract outside money.

In an opinion piece for Forbes, Tim Worstall, who writes that he is "not a great fan of Obamacare," says that the failure of the health co-operatives created under the ACA "isn't really a failure of Obamacare as such. Rather, it's a failure of the cooperative model" in an industry that has large capital requirements, noting that the co-ops that have succeeded typically started small and have grown over time.

Armour also notes that co-ops struggle because they tend to attract younger, healthier people and, "many were required under the risk adjustment formula to pay fees to help cover the sicker patients who signed up with established carriers."

Because of these failures, dozens of surviving health co-ops, smaller insurers and new benefit providers are forming a coalition, Armour reports, writing,"The coalition wants changes to a federal formula known as risk adjustment, which takes money from plans with healthier and younger enrollees and gives it to plans with older and sicker customers to spread out financial pressures on insurers. The health co-ops and smaller insurers say the formula, along with another health law program that aims to offset insurers’ financial losses, is putting them out of business."

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Nationally and statewide, farm-to-school program is a success

With approximately 80 Kentucky school districts participating in the Farm to School program, many of them are finding special ways to celebrate National Farm to School Month, with much to celebrate, as a preliminary U.S. Department of Agricuture report finds that schools that participate in Farm to School programs show an increase in the number of school meals sold, an increase in the consumption of healthier foods and decreases in plate waste.

“By investing in Farm to School not only will the next generation be healthier but they will be more informed consumers who value the farmer and support their local food system, not as a novelty but as a way of life," Tina Garland, procedures division coordinator for the Kentucky Farm to School program, said in a telephone interview.

The Jefferson County Public Schools are celebrating National Farm to School Month with its cafeterias serving a menu full of locally grown food at district elementary, middle and high schools on Oct. 23 and 24, Ja'nel Johnson reports for WFPL Radio.

JCPS began its farm-to-school initiative about eight years ago with apples from a farm in Indiana, but has since grown to include seven local farmers in Kentucky, Indiana, Ohio and Tennessee, Johnson reports.

The district's goal is for 10 percent of its produce to be locally grown, Dan Ellnor, manager of the Nutrition Service Center at JCPS, told Johnson, explaining that because they serve 112,000 meals a day, it is difficult to incorporate locally grown produce into every meal.

"Last year, 3 percent of the district’s produce came from local farmers, and JCPS spent $124,000 on local produce. So far this year, $131,000 has been spent on local foods," Johnson writes.

Ellnor told Johnson that this program helps teach students where their food comes from, which is part of the program's mission.

“There are kids, honestly, who don’t know that ketchup comes from a tomato,” he said.

More schools than ever are participating

Although the farm-to-school initiative has been around for many years, the national Farm to School Grant Program was created more recently through the Healthy, Hunger-Free Kids Act of 2010 to help eligible schools implement programs to improve their access to local foods. To date, the grant program has funded 221 farm to school projects, totaling $15.1 million, according to its website.

The Kentucky Department of Agriculture has been the recipient of a USDA Farm to School support service grants, which allowed them to re-grant 11, $5,000 mini-grants across the state to either help develop new farm-to-school programs or to enhance existing programs, according to Garland.

"Farm to school is one of many tactics and resources that USDA makes available to help schools successfully serve healthier meals to kids," Agriculture Secretary Tom Vilsack said in a news release. "Farm to school partnerships have a proven track record of encouraging kids to try, like and eat more healthy foods and creating new market opportunities for the farmers that grow them."

Preliminary results from from USDA's Farm to School census found that 17 percent of school districts that participate have reduced plate waste; 28 percent are more accepting of healthier school meals; 17 percent have increased participation in school meals; 21 percent have lowered the school meal program costs; and 39 percent have more support from parents and their community for healthier school meals.

The preliminary report also found that since the inception of the grant program two years ago, there has been a 55 percent increase in the local purchase of foods, to $598.4 million in 2013-14 from $385.8 million in 2011-12.

JCPS's goals of increasing its share of locally grown produce to 10 percent fits with the preliminary census findings that found almost half of its respondents said they planned to increase their local food purchases in the coming years.

Nationwide, more than 42,000 schools have farm-to-schools programs,according to the release.

According to the latest official data, in 2011-12 Kentucky schools spent $1.6 million on local foods, which involved 60 school districts and approximately 702 schools, according to Garland. To date, Garland said this number has increased to approximately 80 school districts and over 200 farmers participating in the Kentucky Farm to School program.

Kentucky was also one of three states to receive a National Farm to School Network Seed Change pilot grant, made possible through a generous donation from the Walmart Foundation, that allowed them to distribute 20, $5,000 mini-grants across the state to create or support Farm to School programs, according to Garland, noting that this is a different program than the Farm to School Grant Program.

U of L gets patents for new cancer treatments, spinal cord treatments and a new bone graft product

The University of Louisville Research Foundation has recently been awarded patents for improved cancer treatments, a new bone graft material, and therapies for spinal cord damage, and two of the inventions are already licensed and will soon be utilized by the health care system, according to a School of Medicine news release.

The patent for a new bone graft cement called Trabexus EB is one of the patent's that has been cleared by the Food and Drug Administration for use. This bone replacement cement will be used by orthopedic surgeons to repair bones damaged through injury, tumor or other defects, according to the release.

Another recently patented treatment involves a "revolutionary" new way to treat paralysis following spinal cord injury that incorporates epidural stimulation to activate the spinal cord. This treatment, along with physical training and medications, allows individuals with spinal cord injury to have voluntary control of body movements and improve heart, lung and other autonomic functions. Research participants for this treatment have been able to move and stand unassisted, with some improvements in heart, pulmonary and bladder function, according to the release.

The foundation has also received a patent for an improvement to a cancer therapy that enhances immunotherapies used for the treatment of cancer and chronic viral infections, like HIV. This new method of stimulating the immune system "has significant potential" to make immunotherapies more effective and help protect against recurrence of the disease, according to the release.

They have also received a patent for software that detects areas of depleted lung function during radiation treatment for lung cancer and other lung diseases. This new 4-D computed tomography (CT) image analysis software can be used with existing lung imaging during radiation therapy to detect early changes in lung elasticity, allowing the treatment to be adjusted to prevent permanent breathing problems, according to the release.

U of L also received a patent for a treatment that can repair the spinal cord by taking a tissue biopsy from a patient's nose, isolating the stem cells from it, and then using these stem cells to regenerate the spinal cord to repair an injury. This treatment can also be used in the treatment of Parkinson’s Disease, amyotrophic lateral sclerosis (ALS), multiple sclerosis and type 1 diabetes. This method of generating the stem cells has been licensed from UofL by RhinoCyte Inc. and is scheduled for a concept study at the University of Louisville Hospital with Phase I/II clinical trials beginning in 2016.

More than 16,000 additional Kentucky children have gained health insurance since the federal health-reform law took effect

More than 16,000 Kentucky children gained health insurance since the implementation of the Patient Protection and Affordable Care Act, according to a Foundation for a Healthy Kentucky multi-year study on how ACA implementation is impacting Kentuckians.

The study found that the uninsured rate for Kentucky's children dropped to 4.3 percent in 2014, the first year subsidized health insurance could be purchased under the reform law. More than 10 percent of private insurance on Kynect, the state insurance exchange, covers children. These rates are "much higher than the national averages," says the release.

Researchers attributed the increase in coverage to the tax-credit subsidies that are available to those who make too much to qualify for Medicaid but still can't afford the full cost of private health insurance. They also cited outreach efforts by Kynect, and parents enrolling their children in coverage when they themselves enrolled.

The Foundation for a Healthy Kentucky has contracted with State Health Access Data Assistance Center, a health policy research institute at the University of Minnesota, to conduct the series of studies.