New Medicaid signup site opens as Kynect starts to wind down

As the new administration of Gov. Matt Bevin continues to move toward dismantling the state's Kynect health-insurance exchange, it has launched an online portal for Kentuckians to apply for Medicaid and other public assistance.events 

Benefind will also provide access point for the Kentucky Children’s Health Insurance Program, a sort of Medicaid for minors; the Supplemental Nutrition Assistance Program, once known as food stamps; and the Kentucky Transitional Assistance Program, or cash assistance. SNAP and KTAP applications will still require an interview with county-level staff of the Department for Community Based Services.

“With a one-stop spot like benefind, families across the commonwealth can create an account and access it 24/7,” Cabinet for Health and Family Services Secretary Vickie Yates Brown Glisson said in a news release. “For customers and eligibility staff, Benefind is truly modernizing the registration and data management process.”

The service launched Monday, Feb. 29 at https://benefind.ky.gov. Customers can use it to renew benefits, check benefit amounts, report changes, upload verification documents, check claim status, make claim payments and receive electronic notices. They can still apply for services by phone, by visiting their local DCBS office or submitting paper applications.

Enrollment for federally subsidized health insurance through Kynect has ended, except for life-changing events such as changes in family size (marriage, divorce or a new child), but Medicaid enrollment is open year-round.

Big Pharma lobbying rises as firms defend costly biologic drugs

By James McNair
Kentucky Center for Investigative Reporting

Drug companies and drug industry groups, flush with money to spend on lobbyists, are flocking to Frankfort like never before. In just four years, the number of registered lobbyists hired by pharmaceuticals employers has nearly doubled, from 46 in 2011 to 83 today. Their annual spending has more than doubled, to $824,196 in 2015.

“They fight hard at the federal level and they fight hard at the state level,” said Peter Maybarduk, director of global access to medicines at Public Citizen, a nonprofit public advocacy group in Washington, D.C. “Collectively, the pharmaceuticals and healthcare industries spend even more on lobbying than the military industrial complex. They’re tremendously powerful.”

What brings "Big Pharma" to Kentucky in 2016 is a bill that would allow pharmacists to dispense interchangeable versions of biologic drugs, or drugs made from living tissue. Name-brand biologics, used to treat arthritis, cancer and psoriasis among other things, are heavily advertised and can cost thousands of dollars per month.

Express Scripts, the pharmacy benefits manager, estimates that while biologics accounted for only 1 percent of all prescriptions in 2014, they accounted for 32 percent of all prescription-drug spending.

Interest in cheaper substitutes is high. Already 18 state legislatures have passed biologics-substitution bills. Another 11, including Kentucky, have bills before them.

The irony is that the U.S. Food & Drug Administration has yet to approve a single biologic substitute that meets the federal test for interchangeability.

In other words, a new Kentucky law would have no immediate benefit. The drug industry is pushing for legislation anyway. Brandishing its preferred legislative language and lobbyists, the industry appears anxious to see the bill enacted.

At least nine drug companies and groups have stated an interest in the Senate bill, according to the Kentucky Legislative Ethics Commission. Three are interested in that alone. One group making its lobbying debut in Kentucky is the Biotechnology Innovation Organization, which represents companies that develop new biologic drugs. It has six lobbyists, including one of its own and five from Top Shelf Lobby in Frankfort.

BIO spokesman George Goodno said it hired Top Shelf to “keep an eye on” the bill. “Generally speaking, BIO isn’t going to draft a piece of legislation and hand it to a legislator. That’s not really how it works,” Goodno said. “We do provide them materials such as our principles document and say, ‘This is BIO’s position, and we feel that any bill that goes forward should represent these positions.”

As in other states, the Kentucky bill would give doctors and patients the option of sticking with name-brand drugs. Because they are made from living tissue, biologic drugs differ from conventional drugs. Some of the most common are Humira and Remicade for arthritis and Enbrel for psoriasis.

Biosimilar drugs are clinically similar to biologic drugs, but aren’t necessarily “interchangeable.”

While the FDA approves drugs, state laws let pharmacists dispense generic drugs. The proposed Kentucky law would allow them do the same with interchangeables.

One of the main hangups, though, is an industry-backed requirement that pharmacists tell doctors that they’ve switched patients to biosimilars. Opponents in other states say it would have the effect of casting doubt on the advisability of a switch.

UPDATE, March 4: The Kentucky Pharmacists Association says the notice requirement would discourage patients from accepting biosimilars. Senate Majority Whip Jimmy Higdon of Lebanon "supported the KPhA position and cast the lone opposing vote Wednesday," March 2, when the Senate sent the bill to the House on a 36-1 vote.

Doctors, meanwhile, would like more than mere notification of switches to interchangeables. The Kentucky Medical Association, in a letter to the General Assembly, said pharmacists should be allowed to dispense a substitute only when doctors authorize it or don’t forbid it.

Bevin helps lead governors' push to fight opioids; McConnell pressures new FDA boss on issue before his confirmation

The epidemic of opioid abuse, which is running strong in Kentucky, got a good deal of attention in Washington last week, in Congress, at the White House and at a meeting of governors.

Republican Gov. Matt Bevin and Democratic Gov. Peter Shumlin of Vermont "led an effort to press states to take action," Robert Pear reports for The New York Times.

"Alarmed at an epidemic of drug-overdose deaths, the National Governors Association decided over the weekend to devise treatment protocols to reduce the use of opioid painkillers. The guidelines are likely to include numerical limits on prescriptions, or other restrictions," Pear writes. "Governors said they had decided to act because they had not received enough help from doctors or from drug companies that make the addictive prescription pain medications."

Bevin said the root of the problem is economic, and that the solution must involve “the people who develop, sell, profit from and approve these drugs.” He also said that if the problem is to be taken seriously, the nation must consider whether the drugs should even be prescribed. For an NGA video of the 80-minute discussion, click here.

The governors took their concerns to a Monday meeting with President Obama, who turned the tables later in the week by saying that "a lack of access to basic health care, particularly in rural areas, has contributed to the increase in opioid addiction and deaths," Mary Ellen McIntire writes for Morning Consult.

“I think short-term, the opioid problem really has more to do with the fact that a lot of people don’t have basic health care,” Obama said at a White House meeting Thursday on the Precision Medicine Initiative.

"Obama’s comments came a few hours after Majority Leader Mitch McConnell said the Senate will be working to more forward on an opioid bill in the coming days," McIntire notes.

"Overdose deaths in Kentucky were responsible for more than 1,000 deaths in 2014 alone. This is a devastatingly high number, among the highest rates in the nation," McConnell noted in a Senate floor speech.

FDA Administrator Robert Califf and Sen. Mitch McConnell

McConnell noted that he expressed his concerns to Robert Califf, a longtime Duke University cardiologist and researcher whom the Senate confirmed as the next leader of the Food and Drug Administration last week after a long delay.

"I was encouraged by Dr. Califf’s recognition that the opioid epidemic is a serious problem and the FDA must do a better job of addressing it," McConnell said. "I will continue to hold him accountable to lead the FDA in a new direction to help prevent dependence and abuse of prescription opioids.”

Califf said in an interview with Brady Dennis of The Washington Post, "A fundamental issue here is over-prescribing of opioids. I think our [drug] labels are pretty clear and strong, but for reasons that are well known, doctors have gotten in the habit of prescribing more opioids than they should. That’s not an issue FDA can control, but we have a voice in it, and we’re going to work with other federal agencies to help that happen. We’re also aware that there are 10 to 12 million Americans with severe, chronic pain that needs treatment. So, we’ve got to work with NIH and the industry to develop non-addictive, more effective treatments. And we have to work with [the Centers for Medicare & Medicaid Services] and payers to create practice environments where you can actually use non-opioid, behavioral treatments. It turns out, that’s complicated and it’s hard to do. 

Patients, other policyholders and providers will have to wait to see how much of their bills failed Ky. Health Cooperative will pay

The co-op's headquarters in Louisville still bears its name.

Thousands of patients and thousands of providers will have to wait until Oct. 15 or later to find out how much of their medical bills sent to the failed Kentucky Health Cooperative will be paid.

The state Department of Insurance, which is wrapping up the non-profit insurer's affairs, says it has received about 2,000 "proof of claim" forms. Spokeswoman Ronda Sloan said the forms were filed by policyholders and providers, but she did not provide a breakdown. "Processing has just begun and no dollar amount is available at this time," she wrote in an email.

The co-op "left thousands of providers waiting for payment," Stephanie Armour reports for The Wall Street Journal. It covered about 51,000 people through the end of 2015. Franklin Circuit Judge Phillip Shepherd will decide how much will be paid to whom.

Asked how many dollars will be available to pay claims, Sloan wrote, "We are waiting on decisions regarding possible reinsurance and additional risk-corridor funds. We will be able to release a more complete picture of available assets once those issues are resolved."

Risk-corridor funds are federal subsidies for insurers who wound up with a costlier group of policyholders under the federal health-reform law. Co-op officials said they were forced to close because Congress drastically cut the funds, a move for which Florida Sen. Marco Rubio is taking credit in his presidential campaign though the final arbiter was Kentucky Sen. Mitch McConnell, the majority leader.

The co-op was one of 23 created under the law to provide competition for for-profit insurers; 12 have failed. The others are in Arizona, Colorado, Iowa, Louisiana, Michigan, Nevada, New York, Oregon, South Carolina, Tennessee and Utah. The Oregon insurer has filed a class-action lawsuit seeking risk-corridor money, which could help other co-ops, Nick Budnick of the Portland Tribune reports.

"Experts and analysts have said the ACA's co-ops faced multiple barriers to success being new entrants to health insurance," notes Bob Herman of Modern Healthcare. "They had to build networks of hospitals and doctors from scratch while competing with large carriers with well-known brands and more financial resources. They also faced several political hurdles, including severe restrictions on their loans, reduced initial funding and major stonewalling from Congress.

The Centers for Medicare and Medicaid Services "said almost three-quarters of consumers in shuttered co-ops moved to a new marketplace plan in 2016," Herman reports. Co-op policyholders had until Feb. 28 to find another plan.

Study finds Medicaid managed care works, even with expansion; providers still struggle with it, prompting legislation

By Melissa Patrick
Kentucky Health News

After an additional 400,000 Kentuckians signed up for Medicaid under health reform in 2014, it wasn't certain that the Medicaid managed-care system started in late 2011 could handle them, but a recent study found it managed quite well.

The study, in three annual stages, looked at the impact of managed care on health care access, quality, costs and health outcomes in Kentucky between 2010-13. It was conducted by the Urban Institute, the University of Kentucky and Georgia State University. It was funded by the Foundation for a Healthy Kentucky.

"Our aim was to foster candid conversations about this important transition and to use what has been learned to support more effective functioning of Medicaid managed care in the commonwealth," foundation CEO Susan Zepeda said in a news release.

Kentucky changed to managed care from a traditional fee-for-service model to save money and improve care. In managed-care systems, states pay companies a negotiated fee for each Medicaid client they handle.

The study of the first year found "significant problems," including financial difficulties for plans, increased administrative and financial burdens on providers, and not enough oversight of the program.

The second year found that many of these issues had been resolved and noted a stronger financial position for the remaining plans, fewer provider-payment problems, implementation of case management, increased state oversight and increased patient access to care. It also found that lack of access to behavioral health services continued to be a problem.

The third year of managed care came with major policy changes. Through the Patient Protection and Affordable Care Act, Kentucky expanded Medicaid to include those with incomes up to 138 percent of the federal poverty level, which added about 400,000 people (a fluctuating number) to the Medicaid rolls. It also added several new managed-care organizations, and the nonprofit, Louisville-based Passport Health Plan expanded to the entire state.

The final study report, released Feb. 23, found that Kentucky managed the expansion "with little disruption." The study found there was a reduction in Medicaid spending for both adults and children who had been covered for a year or more, and fewer emergency-room visits, which managed care is supposed to discourage.

The study also found reductions in inpatient hospital stays and some increases in outpatient hospital units and and community health centers. It also found increases in preventive care among adults and a reduction in avoidable hospitalizations and hospital readmissions.

Surprisingly, the research found mixed results in preventive visits for children, with one report showing a decrease in these visits, which it says "runs counter to the theoretical predictions typically associated with managed care."

It also found mixed results for quality measures of mental health: positive results for mental health services, but a decrease in prompt follow-up following a mental-health hospital discharge for adults.

"These findings indicate both potential improvements and declines in care through 2013 under Medicaid managed care relative to the prior fee-for-service delivery system," Genevieve Kenny, co-director of the Urban Institute's Health Policy Center and lead researcher for this study, said in the news release. "However, because 2014 was a time of substantial change in Kentucky's Medicaid program and in the behavioral health system, the measures tracked in this report may have changed since 2013. Moving forward, these results suggest the need for continued monitoring of enrollee utilization patterns."

Providers are still complaining

The report said providers still complain of late payments, denial of services and increased administrative fees in the reimbursement process.

And though the second report says that many of these issues were resolved, ongoing complaints from providers prompted the Cabinet for Health and Family Services to renegotiate the managed-care organizations' contracts last July. Those contracts are up July 1 but are eligible for four renewals.

State Sen. Ralph Alvarado, R-Winchester, a physician, says providers are still struggling with the same issues that they have had from the beginning.

"I would venture to say that things are not better for medical providers since the new contracts were signed in July, 2015," Alvarado said in an e-mail. He said he believes Health Secretary Vickie Yates Brown Glisson "is aware of the dissatisfaction from the Medicaid provider base and she appears to be taking the necessary initial steps to begin holding Kentucky's Medicaid insurers accountable."

For the second year, Alvarado has sponsored bipartisan legislation (Senate Bill 20) that would allow a provider who has exhausted the internal appeals process of a managed-care organization to request an administrative appeals hearing by the cabinet. SB 20 has passed the Senate and now resides in the House Health and Welfare Committee.

House Bill 118, sponsored by House Speaker Greg Stumbo, D-Prestonsburg, is a similar bill that has passed the House and now resides in the Senate Appropriations and Revenue Committee.

Alvarado said HB 118 "has old language that will draw opposition from the cabinet. Senate Bill 20 is more of a compromise that has the approval of all stakeholders. . . . I certainly hope that House leadership appreciates the urgency and need for an MCO appeals process in Kentucky. I hope they will expedite the passage of Senate Bill 20."

A fiscal note from the Office of the Attorney General, originally named to adjudicate the appeals in SB20, says, "According to data from the CHFS Division of Administrative Hearings, there were 62 Medicaid provider appeals between February 1, 2015, and December 16, 2015. Data from the Department of Insurance demonstrates that the year-to-date number of Medicaid prompt pay complaints for the last six months is 294."

Study of oral health in Ky. shows progress and challenges, reminds us of connections between oral health and overall health

By Melissa Patrick
Kentucky Health News

More Kentuckians than ever have access to dental care because of Medicaid eligibility for dental insurance, and the state has made some gains in oral health, but finding a dentist can still be a problem, especially in rural Kentucky. And even though children on Medicaid have dental insurance, more than half of them don't get any dental care.

Those are among the findings of a study on the oral health of Kentucky by researchers at the State University of New York at Albany's Center for Health Workforce Studies. It also points up the connections between oral health and overall health.

The study noted that under federal health reform, more than 425,000 Kentuckians, mostly adults, gained dental insurance through expansion of Medicaid to households with incomes up to 138 percent of the federal poverty level.

"Kentucky's support for an adult dental benefit is huge," Margaret Langelier, project director for the study, said in an interview. "When you have significant oral disease, it can impact your overall health in major, major ways."

She went on to say that including adult dental benefits in Medicaid makes for a small part of the budget, but is often something that lawmakers cut out, which is a mistake.

"What they don't understand is that these adults are still going to show up, but with a much greater progression of the disease and likely in the emergency department," Langelier said. "So you (end up) paying for it through your health insurance."

Graphic adapted from America's Health Rankings Spotlight: Prevention report

The study found that 100,000 more Medicaid-eligible Kentuckians got an oral health service in 2014 than in 2013. But because many of them had multiple cavities and complicated oral-health issues, there is now a clearer need for more general and specialty dentists, both of which are hard to find in rural Kentucky, especially in eastern and western parts of the state.

In 2014, only half of Kentucky's 22 federally qualified health centers provided dental services directly to patients, with most dental services provided by private practice dentists. And while the report found that about 40 percent of general dentists in the state provided at least one oral health service to a Medicaid patient, most of them do not participate in a "meaningful" way.

Graphics are from the report; click on them for larger versions.

The report found that "in 24 of the 120 counties, mostly in Eastern and Western Kentucky, there were fewer than 1.7 dentists per 10,000 population. There was no dentist in four counties, only one dentist in 13 counties and only two dentists in 12 counties."

"Although the oral-health workforce in Kentucky appears to be adequate on a per-population basis, it is not evenly distributed compared to the population of the state," Langelier told the House Health and Welfare committee Feb. 25.

The report also found that the poorest and least educated Kentuckians who live in rural areas have the highest rates of cavities, gum disease and oral cancer. "Oral health disparities in Kentucky are similar to its health disparities in the state," Langelier said.

Kentucky ranks 10th in the percentage of adults who haven't been to the dentist in the past year (39.7 percent); eighth in adults with permanent teeth extraction because of tooth decay or gum disease (50.3 percent); fifth in adults having six or more permanent teeth extracted (51.5 percent); and fifth in adults ages 65 and older who had all their natural teeth extracted (24.8 percent), according to the report. These rankings are from 2012, the latest available.

And while the percentage of Medicaid-eligible children in Kentucky who received a preventive oral-health service each year increased to 38.1 percent in 2014, from 14.7 percent in 2000, more than half of them haven't received annual oral health care, says the report. Among all of Kentucky's children, almost a fourth received no dental care in 2012, the study found.

A separate Pew Charitable Trusts report found that in 2014 fewer than 25 percent of high-need Kentucky schools had tooth-sealant programs. The Healthy People 2010 Sealant goal is for more than 75 percent of these schools to have these programs. Dental sealants are clear plastic coatings that are applied to permanent molars to prevent cavities and school based sealant programs are proven to reduce cavities by 60 percent over five years, says the report.

Langelier told the committee that Kentucky has "made notable efforts to address oral health disparities in the state," including: expanding Medicaid and choosing to include a dental benefit; expanding the roles of dental hygienists; implementing several programs to encourage dentist to practice in Appalachian Kentucky; and its addition of fluoride to its community water sources. In addition, she said, many regional and local initiatives work to improve the oral health of Kentuckians.

"It is widely held that there is no single solution to address all oral-health access barriers. It is also thought that oral-health service delivery must be designed to accommodate the needs of the specific local population that is undeserved; thus local solutions are preferred," Langelier said. "However, local programs can only succeed if state payment, insurance, and workforce policy support local innovation in oral-health service delivery."

The report recommends continuing support for an adult dental benefit in Medicaid; further utilizing federally qualified health centers to integrate primary care and oral health care needs; increasing Kentucky school-based oral health services; looking at a team based approach model that includes dental therapists; and to look at removing some of the existing barriers on dental hygienists.

The study was funded in part by The Pew Charitable Trusts. Click here to view the public hearing on the report held on the Senate Floor Feb. 25

Medicaid is in a bigger hole than she expected, Glisson says

Kentucky's Medicaid program is $124 million over budget and faces a $611 million deficit over the next two years due to its expansion under federal health reform, the impending end of full federal funding for the expansion, and an aging population, the state health secretary told a legislative committee Feb. 24.

Glisson appeared with Deputy Secretary
Tim Feeley (Herald-Leader photo)

Secretary Vickie Yates Brown Glisson said she was surprised to find when she took over the Cabinet for Health and Family Services that "traditional Medicaid is hemorrhaging. It's not bleeding, it's hemorrhaging."

In addition to the 420,000 people covered by the expansion, promotion of the program "also brought in more than 60,000 people who were already eligible for Medicaid," Adam Beam writes for The Associated Press. "Those people were added to the traditional program, where Kentucky taxpayers must pay 30 percent of the cost."

Those people may cost even more in the two-year budget that begins July 1, and the state will also have to pay 5 percent of the expansion cost beginning in 2017. That will rise in annual steps to the law's limit of 10 percent in 2020. Gov. Matt Bevin is negotiating with the federal government to reshape the program to cut costs.

As for the current shortfall, "Glisson could not tell lawmakers how she planned to make up the deficit," and promised to have details in a week or so, Beam reports.

Kynectors tell why they're important to keeping Kentuckians signed up for coverage; Stivers says they're making assumptions

L-R: Kynectors Kathy Oller, Cara Stewart, Mike Wynn, Laken
Daniels, Jennifer Gates, Miranda Brown, Ashley Shoemaker

By Melissa Patrick
Kentucky Health News

Kynectors, who help Kentuckians sign up for health coverage through Kynect, the health-insurance exchange that Gov. Matt Bevin plans to dismantle, gathered in Frankfort Feb. 23 to argue that Kynect is much more than a website and to ask the governor to reconsider.

Five Kynectors shared stories of how they not only help Kentuckians sign up for health insurance or Medicaid, but do so at times and locations that are convenient to their clients. They said they answer questions about health insurance, help clients find providers, keep them informed about changes in their plans and also help them navigate the system throughout the year, helping them change their plans if their income levels fluctuate.

"A Kynector wears many hats: case manager, outreach worker, advocate and entrepreneur for the language of health insurance," said Ashley Shoemaker, a Kynector for Family Health Centers Inc. in Louisville. "We reach the hardest to reach groups to ensure that all Kentuckians have access to affordable health care coverage without barriers."

Bill Wagner, head of Family Health Centers, has said that the number of people offering the help that the 500 Kynectors now give would be cut to about 125 if Kynect is closed and the state uses the federal exchange.

Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of pro-reform interest groups, estimated afterward that under the federal exchange, there will be one-third of the funding for navigators, which is what the federal exchange calls those who are paid to help others sign up for health insurance.

Cara Stewart of the Kentucky Equal Justice Center said federally funded navigators have more restrictions than Kynectors. For example, they can't go to people's homes and have less ability to follow up with their clients. She also said Kynectors actively interact with Kynect to find ways to improve the system to best suit the needs of Kentuckians.

The news conference was held by Keep Kentucky Covered, a coalition focused on sustaining access to affordable health care in Kentucky through Kynect and the expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level.

Shoemaker, who works with the homeless, noted some of the barriers that make it hard for her clients to sign up for health insurance without a Kynector: lack of transportation, no access to the Internet, poor health literacy and health concerns such as depression or substance abuse.

"Without the assistance of Kynectors, many of our most vulnerable neighbors would not be able to access or maintain their healthcare coverage," she said.

Mike Wynn, Kynector for Grace Community Health Center in Knox County, said, "We meet people daily who come to us in tears, in frustration because they just don't understand the system or they just can't make it work and they don't know who to call or where to go."

Miranda Brown, Kynector with the Kentucky Equal Justice Center, expressed concerns that loosing Kynectors would cause Medicaid recipients to drop out or that those on federally subsidized health plans would have trouble finding providers and would give up.

Mary Volkerding of Caresource said it has built its business model around Kynectors, instead of agents and brokers, to promote its products and this is what has allowed them to have some of the lowest premiums in the areas that it serves. She noted that the loss of Kynectors would likely cause them to have to raise their rates.

Are Kynectors and their allies tilting at a windmill?

Bevin notified federal officials Dec. 30 that Kentucky plans to shut down Kynect, which he says is redundant because the federal exchange serves the same purpose. He has also said that it isn't fair that all Kentuckians with health insurance pay a 1 percent fee on their policies for something that relatively few use. The federal exchange charges a 3.5 percent fee on policies it sells.

It was also announced Feb. 16 that after Feb. 29, Kentuckians will sign up for Medicaid through an online-only program called Benefind.

Beauregard said after the meeting that it is not too late to save Kynect. "We haven't gotten so far along that we can't change our minds," she said. She also noted that just because Kynect was established by an executive order doesn't mean legislators can't weigh in on it and said, "We think they should."

"It is important that legislators hear from the more than 500,000 Kentuckians who have gotten coverage through Kynect because that is when we will see some pressure put on this situation," she said. However, she said, "We only have so much time for this to happen."

Beauregard said that if the governor goes through with his plan to shut Kynect, then the state will need two systems, one for subsidized health plans and another for Medicaid.

As for Bevin's claim that it is not fair for all Kentuckians to pay for something only a few use, she said, "I don't know that 30 percent of Kentuckians is a small percentage. I think that is a good portion of our state." She is including Medicaid recipients in her figure; Bevin does not.

Beauregard said Kynect is a public benefit to all Kentuckians because it maximizes the number of them who enrolled in coverage.

Stivers says Kynectors are making assumptions about their work

In an interview, Senate President Robert Stivers said the Kynectors' belief that they play a vital role in helping decrease barriers to health care for Kentuckians is an "assumption" on their part.

"It seems like the people who have been involved with the assumptions related to Kynect have generally been wrong in all of their numbers and in all of their assumptions," he said.

He then fired off some statistics not directly related to Kynect, including: 51,000 people lost their health insurance when the Kentucky Health Cooperative folded, and it was estimated that 200,000 would sign up for Medicaid expansion by now, but the number is over 400,000.

"I truly appreciate the direction that Gov. Beshear was trying to go, but ... we are far in excess of the numbers they initially provided to us, except for jobs," Stivers said. "So, I don't know how you can argue numbers or facts when they are so wildly disproportionate to what they have told us would happen and it hasn't."

Meanwhile, Stivers said Bevin, Chief of Staff Blake Brickman, Health Secretary Vickie Yates Brown Glisson and Mark Birdwhistell, who has been charged with changing the Medicaid program, met this week with U.S. Health and Human Services Secretary Sylvia Burwell about this issue and Brickman had told him they "thought it was a very, very beneficial meeting and very productive."

Health-committee leaders say policy decisions being driven by focus on pensions, with no consideration of tax reform for revenue

L-R: State Reps. Joni Jenkins, Rep. Tom Burch,
Sens. Ralph Alvarado, Sen. Julie Raque Adams

By Melissa Patrick
Kentucky Health News

Four legislators told a group of health advocates Feb. 22 that health-policy decisions in the legislative session are being driven by Gov. Matt Bevin's emphasis on funding state pensions, and both Republican panel members said no one in their party is talking about revenue as a possible answer.

"We are in such precarious financial times relative to our overall budget and our obligations that we have to look at the cost associated with any bill that comes through the Health and Welfare Committee," said Sen. Julie Raque Adams, R-Louisville, chair of the Senate Health and Welfare Committee.

Adams and three other lawmakers spoke in Frankfort at the annual meeting of Kentucky Voices for Health, a coalition of interest groups that support health-care reform.

Democratic Reps. Tom Burch and Joni Jenkins of Louisville said they recognized the importance of paying for pensions, but argued that shouldn't be done at the expense of everything else.

Jenkins, chair of the House Budget Review Subcommittee on Human Resources, said that she was "very concerned" about Bevin's plan to "cut everything" by 4.5 percent this year, and then 9 percent in both 2017 and 2018, all while putting $1.4 billion into a "rainy-day fund" for pension funding to be determined after an audit of pension systems.

"I look at that plan as [if] your kids are hungry and the roof is leaking ... but you are still going to put so much money in your savings account no matter what. I don't think any of us would do that," Jenkins said. "We need a comfortable amount in the permanent fund, or the rainy-day fund, we need to fund the pension. ... We need to systematically work at dwindling down that pension debt, but we can't let the health and education of our children and citizens suffer because of that."

Burch, chair of the House Health and Welfare Committee, said the General Assembly needed to use a business approach to solve the pension crisis, noting that it could take several years to fix.

"We have to take this on as a business approach," Burch said. "We have to attack the problem and you attack the problem by finding the problem. ... but you don't do that by cutting everybody's health care or by making co-pays so high that we are back to where we were prior to Kynect," the insurance exchange that Bevin wants to close.

As for tax reform or finding other revenue sources to fund the pension, Adams said, "There isn't an appetite to talk about it. Not at all."

She said to applause, "We've been talking about cuts and cuts and cuts and rolling back and this and that, but I think we need to really get into revenue discussions as well. I mean we are not talking about that at all and ... if we don't start talking about revenue options then we are missing a huge piece of the puzzle."

Toward this end, Adams said she has co-sponsored a bill with Sen. Morgan McGarvey, D-Louisville, for a constitutional amendment to expand gaming in the state, which has a provision in it that 90 percent of state revenue would be used to shore up the pension shortfall. She also suggested possible privatization options as ways to find money, but said, "That is going nowhere."

Adams continued, "It is our responsibility to be creative and innovative and not just keep saying, 'We can't do it that way.' or 'It's never been done that way.' or 'Woe is us, we've got to cut.' It is our job to say, 'OK, we are looking at precarious financial situations. What can we think of? What can we do differently?'"

Sen. Ralph Alvarado, R-Winchester, chair of the Senate Budget Review Subcommittee on Human Resources, agreed with Adams and said tax reform, "which we need to have in this state desperately," wasn't getting any discussion. Alvarado said he had brought up the subject behind closed doors, but because it is a "philosophy thing" with so many Republicans he didn't make any headway.

Alvarado didn't offer much hope for the advocates when one asked him what it would take to convince his fellow partisans to support tax reform, to not dismantle Kynect, and to support Medicaid expansion.

"Guys, it is not a logic discussion," he said. "First of all, you've got to understand it is a philosophy discussion." Later adding that if advocates are trying to use logic on a philosophy issue, "You are not going to make that argument well enough to get there."

He offered the example of his smoking-ban bill that didn't make it out of committee last session. He said that despite all of the logic and facts that support such a bill, it still didn't have the support it needed to pass because legislators were making their decision based on their philosophy.

Burch, the longest serving member of the legislature, reminded the advocates that policy change is often a slow process and that educating legislators takes time.

Alvarado agreed with Jenkins that the preventive approach was the best way to improve the health of Kentuckians, but said it was difficult to convince legislators of that because the results aren't immediate.

PAC ad calls for 'no more Obamacare' though Bevin and Stivers say they want to keep covering people in Medicaid expansion

By Al Cross
Kentucky Health News

A pro-Republican political committee that doesn't reveal its contributors is running a television commercial in response to former Gov. Steve Beshear's effort to preserve the programs he established under the federal health-reform law.

"Steve Beshear and the Frankfort liberals won't stop in their sad attempt to keep Obamacare," begins the ad from the Kentucky Opportunity Coalition, showing Beshear and House Speaker Greg Stumbo in black and white video. "Kentuckians rejected Obamacare, yet they won't listen."

The basis for the latter assertion is unclear. Polls have shown that Kentuckians have a negative opinion of "Obamacare" but a positive view of the two elements of the law that Beshear implemented: the Kynect exchange for federally subsidized health insurance, and expansion of the federal-state Medicaid program to Kentuckians with incomes up to 138 percent of the federal poverty level.

Scott Jennings, who calls himself a "senior adviser" to the coalition and is its spokesman, couldn't be reached for comment Tuesday night.

The unsupported assertion is followed by a color clip of Gov. Matt Bevin, perhaps suggesting that his election amounted to a rejection of Obamacare. He ran on a promise to close Kynect, which Beshear used as the substitute brand for Obamacare in a state where President Obama is unpopular. Bevin says the exchange is redundant and the 90,000 people with Kynect policies can use the federal exchange.

The larger part of Obamacare in Kentucky is the Medicaid expansion, which covers about 400,000 people. Bevin originally promised to eliminate the Medicaid expansion, but backed off that vow in July and said he would scale it back in ways that would save money and require at least some beneficiaries to have "skin in the game" through premiums, co-payments, deductibles or similar measures.

The federal government is paying the entire cost of the expansion through this year. States will pay 5 percent of the cost next year, rising in annual steps to the law's limit of 10 percent by 2020. Bevin argues that the state can't afford the program as structured and that it is not, contrary to Beshear's claims, paying for itself through expansion of health-care jobs and generation of tax revenue.

The ad continues with color clips of state Senate President Robert Stivers, House Republican Leader Jeff Hoover and Lt. Gov. Jenean Hampton and says, "Governor Matt Bevin and conservative lawmakers are working to get Kentucky's finances back on track, replace Obamacare and cut wasteful spending."

The "replace Obamacare" line appears to contradict what Bevin and Stivers have said about the Medicaid expansion. Bevin had said he wants to cover as many people as possible, and Stivers has said he wants to keep the same people covered. However, polls suggest that the line may be politically popular, and the ad asks viewers to sign a petition calling for "no more Obamacare. We want fiscally responsible government."

The coalition is a "super PAC," or political action committee, that is organized as a nonprofit corporation and does not have to reveal its contributors. It supported U.S. Sen. Mitch McConnell's re-election bid in 2014 and is supporting Republican candidates for the state House in special elections on March 8. The ad is titled "Go Home," its message to Beshear.

Mercury levels prompt warning to eat top-predator fish no more than once a month, other Ky. fish no more than once a week

All Kentuckians should limit consumption of fish from the state's waters because they are too contaminated with mercury, according to the latest official advisories.

Previously, only children 6 or younger and women of childbearing age were advised to take care eating Kentucky fish. "State officials have found more fish in more waterways with higher levels of mercury, so they've tightened up their consumption warnings," explains James Bruggers, environmental writer for The Courier-Journal. Mercury comes largely from coal-fired power plants; Kentucky gets about 90 percent of its electricity from coal.

“Contaminants, like mercury, can be harmful to the brain and nervous system if a person is exposed to too much of them," Kathy Fowler, director of the Division of Public Health Protection and Safety, said in a news release. "We ask that Kentuckians be mindful of the kinds and amounts of fish they consume, particularly more sensitive populations such as infants, young children and pregnant women.”

The advisories are not as strong for panfish (bluegill, crappie, rock bass and sunfish) and bottom-feeders (buffalo, carp, most catfish, creek chub, drum, redhorse, sturgeon and sucker); as they are for top predators, where mercury can accumulate through the food chain. Those include bass, blue and flathead catfish, gar, muskie, sauger and walleye.

The general public is advised to eat no more than one meal per month of predatory fish and no more than one meal per week of panfish and bottom feeder fish. Sensitive populations (women of childbearing age and children 6 and younger) are advised to eat no more than six meals per year of predatory fish and no more than one meal per month of panfish and bottom feeder fish. A meal for a 150-pound person is considered to be 8 ounces. Here's a chart:

Special advisories remain in effect for certain bodies of water that have been contaminated for years, such as the Mud River, ruined by polychlorinated biphenyls from the Rockwell International plant in Russellville. Here is that chart:

After eight suicides in 2015, Carter County officials host a suicide-prevention forum; other communities are urged to do likewise

By Melissa Patrick
Kentucky Health News

Kentucky is one of the top 20 states for suicide, with nearly 700 Kentuckians taking their own lives each year, and 109 of the state's 120 counties reported at least one suicide in 2013, the latest confirmed figures available.

CARTER COUNTY (Wikipedia map)

However, suicide is often considered a taboo subject, rarely addressed publicly by elected officials, other community leaders and the news media.

That changed in Carter County, when Sheriff Jeff May told state Rep. Jill York of Grayson that that county had eight suicides in 2015, she knew she had a responsibility to do something about it, she said in an interview with Kentucky Health News.

York, May and County Judge-Executive Mike Malone facilitated a suicide-prevention workshop Feb. 13 that attracted about 25 attendees on the "coldest day of the year, all while a University of Kentucky basketball game was going on," she said, leaving the meeting with a shared commitment to hold another one in the summer.

York encouraged other state and local officials to use their "clout to get people to listen" and "ring the alarm bell."

She urged officials "to step forward and be able to pull the resources together and throw the push behind it . . . to say, we're going to talk about this even if it's uncomfortable because it's important, because we've got lives we've got to save," York said. "Stop being polite, stop letting it be something that we don't talk about. To say, if we are losing one person in our community to this, then that is too many."

The workshop was led by local experts on mental health from nearby universities, Pathways Inc., and the Kentucky Suicide Prevention Group.

KSPG Chair Melinda Moore said research shows for every suicide there may be as many as 130 people who knew that person and are affected by their suicide, and 25 are deeply affected. And almost half of us know someone who has died by suicide.

"So, unfortunately, what we know from research going on at the University of Kentucky, which I am a part of . . . we found out that people who had been exposed to suicide, impacted significantly by suicide, had higher depression, higher anxiety scores and thoughts of suicide," she said.

Moore wrote in an op-ed for the Lexington Herald-Leader, "Many are silenced by the shame and confusion around this experience and profound loss, which is reinforced by their community's inability or unwillingness to address it."

Moore, a licensed psychologist and assistant professor at Eastern Kentucky University, joined York in encouraging communities to host suicide prevention forums, noting that suicide is very isolating and very stigmatizing for the loved ones or the family members left behind.

"We need to have more of these community forums so that people who are impacted by these suicide deaths can come and talk to individuals who know something about it," she said. "It is very confusing. People feel responsible. They feel guilty and then they are isolated. They feel very ashamed. It could be that their safe community doesn't quite understand what happened so they may feel blamed as a result."

Moore said that any community that wants to facilitate a forum should call the Kentucky Suicide Prevention Group for assistance in putting it together.

"What we are trying to do is to shed light and provide accurate data, information and resources to the bereaved or resources for people who are suicidal," she said."We have a real suicide problem here in Kentucky and by talking about it publicly, in an appropriate way... it is very important to dispel the misinformation and the stigma that surrounds it... also, just to provide the bereaved with the knowledge that there are resources for them and they should not be alone. They should not be suffering in silence."

For 24/7 assistance and information about local resources or clinicians equipped to deal with suicidal patients, call the National Suicide Prevention Hotline at (800) 273-TALK (8255). To contact the Kentucky Suicide Prevention Group, call (859) 429-1930 or email kspginc@gmail.com. The state Suicide Prevention Program has a website with helpful information.

FOR JOURNALISTS: The Grayson Journal-Enquirer and the Olive Hill Times, sister weeklies, published a story on the forum by their daily parent, The Independent of Ashland. In a later column, reporter Lana Bellamy said the most important part of the forum was "the stigma attached to suicide, families affected by suicide and those contemplating suicide. Perpetuating shame or disgust will only worsen the problem and further stymie the community’s effort in getting more resources to help those affected by suicidal actions."

A broad range of experts, agencies and interest groups, including the Associated Press Managing Editors, have developed a set of guidelines for reporting on suicide. They are available at ReportingOnSuicide.org and appear below.

Kynectors tell The Paducah Sun that they have played a critical role in helping Kentuckians sign up for health coverage

In the midst of the increasingly politicized debate about Gov. Matt Bevin's plan to dismantle Kynect, the state's health insurance exchange, "Kynectors," whose job is to help Kentuckians sign up for health insurance, shared their role with Genevieve Postlethwait of The Paducah Sun.

“With today’s technology, everything is online and on the phone. There’s not really person-to-person interaction that much anymore, and we offer that,” said a Kynector who spoke to The Sun on the condition of anonymity. “We do more than just navigate them through Kynect. We’re familiar with other services in our communities, and we use them. We use them to the max, to assist people in getting the service and coverage they need.”

Kynectors and the call center that supports the exchange are credited with helping more than 500,000 Kentuckians sign up for health insurance, most of them for free coverage under the federal-state Medicaid program, which Bevin also wants to change.

Bevin says he is dismantling Kynect because it is redundant and says it "adds no value" that is not available on the federal exchange. Many states that use the federal exchange have "navigators," which is what Kentucky calls Kynectors, but it is likely that a move to the federal exchange will leave the state with one-fourth as many of them, Bill Wagner, executive director of Family Health Centers in Louisville, told the Friedell Committee in late October.

Postlethwait writes, "Several Kynectors pointed out that not everyone has reliable Internet access or is computer literate. Also, there are times when a call to a Medicaid provider or other insurer can take hours. Some people can’t afford the minutes on their phones to make such lengthy calls, they said. Others may not have the patience or know-how to navigate insurance providers’ phone systems."

“When they’re on their own, they often just give up,” the anonymous Kynector told Postlethwait. “We help them get to the right place.”

Kynectors reach out through monthly events, setting up shop in health departments, clinics and community centers, and making home visits to those who are homebound or don't have reliable transportation, Postlethwait reports. They are equipped with laptops, printers, cell-phones and Internet access to help their clients.

The Kynectors' stories are supported by a Health Affairs study that found consumers who received in-person assistance were more than twice as likely to successfully enroll in health insurance than those who tried to enroll online without any assistance, and those who received local assistance were the most successful.

With most of their contracts ending June 30, the fate of the 500 Kynectors remains unknown. They told the Sun that they hadn't heard anything either way about whether they’d be keeping their jobs. Health Secretary Vickie Yates Brown Glisson told the House Budget Subcommittee for Human Resources Feb. 18 that she did not know how many, if any, will remain after Kynect ends, John Cheves reported for the Lexington Herald-Leader.

Bevin also says Kynect is not fairly funded because all Kentuckians with health insurance are paying for something that relatively few of them use. Kynect is funded by a 1 percent assessment on all health policies sold in the state; the federal exchange charges a 3.5 percent fee on the policies it sells.

Former Gov. Steve Beshear has launched a statewide campaign to "Save Kentucky Healthcare" and there have been several heated discussions during the House budget subcommittee, with Democratic Rep. Jim Wayne of Louisville suggesting that Bevin is "throwing up barriers" to people looking for health coverage.

Also, a newly formed coalition called Keep Kentucky Covered, which supports Kynect and the Medicaid program as expanded by Beshear, held a press conference for farmers to share how important these programs have been to their abilities to farm.

Advocates point to a Gallup Inc. poll that shows Kentucky leads the nation in the reduction of the percentage of its people without health insurance, dropping to 7.5 percent from 20.4 percent before full implementation of the Patient Protection and Affordable Care Act in 2014.

“Let them argue,” the anonymous Kynector told Postlethwait. “In the meantime, we were signed on as Kynectors. We’re going to keep connecting until we’re told not to. We’re going to be out in the community, making people aware of their options, still trying to help every individual we can.”

The Kynectors hope they can stay on and keep working to help individuals obtain health care coverage, as well as help them navigate the federal health care system if that change occurs, noting that "having that human point of contact is crucial," Postlethwait writes.

The anonymous Kynector told The Sun that she’d be happy to stay on as a “navigator” and believes most other Kynectors would be too, saying, “When I think about it, whether it’s Kynect or the federal marketplace, as long as you have Kynectors or navigators to assist individuals, that’s what makes the difference on how well it will go.” (This story is behind a paywall.)

Shelby County reporter tells story of what the heroin epidemic looks like in her county; it's a problem in most of Kentucky

Submissions of samples with heroin have steadily increased since 2010 in the Kentucky State Police laboratory, going from 451 submissions in 2010 to 3,691 in 2015. Heroin ranks only behind methamphetamine, Tamara Evans reports for Louisville's WDRB-TV.

KSP map; image via WDRB-TV

A 2014 KSP map shows that while heroin is primarily in the Lexington, Louisville and Northern Kentucky areas, it has pockets all over the state.

One of those pockets is Shelby County, where Lisa King of The Sentinel-News reports on what that looks like on the ground in her community and what locals are trying to do about it.

Shelby County Emergency Medical Services Director Jeff Ivers told King there were three three heroin overdoses on the same day, Dec. 30, which was more than he had ever seen in one day. Two died and one survived.

The overdoses came on the heels of a heroin bust in the county where more than 7 grams of heroin was confiscated, King reports.

Fatal drug overdoses have been increasing in Shelby County, King writes. The county had five in 2014, two of them heroin-related, compared to 2015's figure of 10, five heroin-related. In addition, there are five cases awaiting determination of the cause of death, with two of them "strongly suspected" from heroin overdose, according to the county's chief deputy coroner.

Kyle Tipton, a sergeant with the Shelby County sheriff's office, told King that police agencies and emergency responders are answering at least two calls per day for heroin overdoses from people of all ages and in every social and economic group. He said people are overdosing in both public and private settings.

"I don't have a number," he told King. "Some are fatal, but the majority of them are overdose illnesses. A good portion are related to heroin. All over the county, heroin is affecting people of all ages - men, women, teenagers... Basically, responding to an overdose is now a routine call for patrolmen."

Shelby County Commonwealth Attorney Laura Witt said her office saw a huge increase in heroin cases in 2015, both in users and those selling the drug. She told King there was a 40 percent increase in cases last year, up 320 from 250 in 2014, and that many of those were related to heroin offenses. She said they were also seeing an increase in other crimes related to heroin, like thefts, burglaries and shoplifting.

Call for action

"So we have to appeal to parents right now to spend time with their children, notice the signs of addiction and don't be afraid to seek help. Don't wait until tomorrow; the time is now." Tipton said.

"The common signs of heroin addiction is stealing, if jewelry or other items in the home come up missing, money, electronics, that could be a sign of an addiction. Also, track marks on arms, although that's not the only way of ingesting it - you can snort it."

Kelly McNew, director of Shelby Prevention, an organization that focuses on preventing addiction, mostly among youth, told King that she is putting together a parenting class that will focus on improving communication between parents and their children and will include some red flags for parents to look for when dealing with possible addiction. She is also planning another town-hall meeting to address the community's challenges from heroin.

Renee Blair, county director of the North Central District Health Department, told King she is working on getting a needle-exchange program for addicts, but has not been able to make much progress yet. Needle exchanges were approved by the 2015 anti-heroin law and are meant to thwart the spread of hepatitis C and HIV and to provide counseling when the addict seeks it.

Tipton told King that it will take everyone in the community to combat this problem, including parents, the public, prosecutors, judges and health officials.

A place to go for help

Deputy Sheriff Mark Moore told King the heroin epidemic happened because of the government's efforts to make narcotic pain pills harder to obtain. And the reason so many people are overdosing, he said, is because heroin is so unpredictable.

"With hydrocodone, you know what you're getting because it's laboratory-produced," he said. "So the next time you get it, it's the same as the one you had before. However, with heroin, you don't know the potency, you don't know what you're getting. Are you getting a very weak dose that someone has already cut, or are you getting some that's the real deal?"

Moore encouraged people who are considering turning to heroin because pills are too hard to obtain to think twice and offered the police department as a place to come for help. He told King that he realized people are afraid to come to the police for fear of reprisal from traffickers, but wanted people to know that if they want help, police are not going to try to force them to give information on traffickers.

"My plea is, if you know you have a pill problem and you think you're going to get sick if you don't have that pain pill, and you are considering going to heroin or you already have, don't wait," he said. "Contact law enforcement. We will hook you up with somebody, somewhere, to try to get you help."

UK HealthCare's nursing program regains 'magnet' status

The University of Kentucky medical center has regained magnet status, which is the highest institutional honor for nursing care, after four years without it, according to a UK news release.

The honor comes from the American Nurses Credentialing Center’s Magnet Recognition Program. The award is based on both written evaluations and on-site visits and must be applied for every four years, according to the release. Fewer than 7 percent of health-care organizations have the designation.

UK first received the award in 2001, then lost it in 2011, when the ANCC restructured the criteria from process-based to outcomes-based, according to the release. These changes prompted the program to restructure itself.

“From a nursing practice perspective, we used the loss of magnet as a call to action for us to really focus on quality outcomes, patient experience and staff experience,” UK HealthCare chief nursing executive Colleen Swartz, said in the release. “The end goal for us was superb clinical care; magnet status is a byproduct of that goal and we should embrace it as such.”

“Magnet recognition is a mindset and an approach in patient-centered care,” Swartz said. “Our team has been extremely dedicated, focused and committed in achieving this goal, and it shows in every interaction we have with patients and their families.”

UK HealthCare has 4,473 nursing services employees including 2,006 full-time registered nurses.

“Our nursing staff have worked very hard to achieve this important distinction and have been committed to this goal and truly deserve this magnet recognition,” said Dr. Michael Karpf, UK executive vice president for health affairs.

UK medical school says it will establish satellite in Bowling Green, expand Morehead program, add Ashland hospital to it

Citing doctor shortages in rural areas, the University of Kentucky is starting a satellite medical school in Bowling Green and expanding its medical-education program in Morehead.

UK will partner with Western Kentucky University and The Medical Center at Bowling Green and continue its collaboration with Morehead State University and St. Claire Regional Medical Center, UK President Eli Capilouto announced Thursday. The Morehead program will expand to include King's Daughters Hospital in Ashland.

"The Commonwealth of Kentucky has a shortage of physicians, and especially primary care physicians, throughout the state, but particularly in rural areas," Capilouto said. "This is an acute health-care need and an economic one as well."

The university said in a news release, "The UK College of Medicine is at its capacity at the Lexington campus and although there is a deep applicant pool for medical students, the college can’t expand enrollment without the help of regional partners."

UK has 521 medical students, 139 in its most recent class. The satellite programs, which will focus on the early part of medical education, will increase enrollment by about 30 percent. For several years, UK and Morehead have had a program in which 32 students have completed their "third and fourth years of medical training with rural-centered clinical experiences primarily at St. Claire," the release noted. That will now expand to the Ashland hospital.

The new programs could start as early as 2018. details are still being worked out, the release said.

Laura Ungar of The Courier-Journal notes, "A 2013 study by Deloitte Consulting found the state needed 3,790 more doctors, including 183 additional primary-care physicians, to meet demand even before the Affordable Care Act. Kentucky currently has 9,936 active physicians, according to the Association of American Medical Colleges, or AAMC. That works out to 225.1 active physicians per 100,000 people in 2014, ranking the state 36th in the nation."

"These shortages reflect a national issue," Ungar notes. "AAMC expects the nation will face a shortage of 46,000 to 90,000 doctors by 2025 – even as the U.S. population grows by 31 million and the number of Americans over 65 goes up 46 percent. Compounding matters, more than a quarter of active physicians nationally are 60 or older and likely to retire soon. Seeing these trends, the association in 2006 called for expanding the number of medical school graduates by 30 percent. A January report in The American Journal of the Medical Sciences said medical schools have so far increased enrollment by 23 percent."

Bevin administration seeks maximum fines against Planned Parenthood, alleging 23 abortions at Louisville facility were illegal

The administration of Gov. Matt Bevin has filed a lawsuit seeking fines against Planned Parenthood of Indiana and Kentucky, alleging that it performed 23 abortions without proper authorization in December and January.

PPINK says an official of the previous administration allowed it to start offering abortions as part of the licensing process, but the lawsuit by the Cabinet for Health and Family Services says any pre-license authorization was contrary to state law, and six abortions were performed before the supposed authorization was given on Dec. 7.

The suit also says the facility's patient-transfer agreements with other health-care facilities "were a complete sham" and didn't identify the hospital involved, and that PPINK was "attempting to accelerate the process" before Bevin took office Dec. 8.

The suit asks Jefferson Circuit Judge Mitch Perry to fine PPINK $684,000, based on state law allowing a fine of up to $10,000 for each violation and $1,000 a day for continuing violations. The suit was signed by Bevin's general counsel, Steve Pitt, as attorney for the cabinet.

PPINK said in a statement Thursday that it had complied with directions from the cabinet's Office of Inspector General. "We ask that the executive branch continue the licensure process rather than continue to make politically motivated accusations."

"Planned Parenthood said cabinet officials directed it to begin providing all its reproductive health services including abortions so the clinic could be inspected prior to final issuance of a license," Deborah Yetter reports for The Courier-Journal. "The inspection was not scheduled because it is supposed to be unannounced."

Grant is eighth county to approve needle exchange; op-ed calls for N. Ky. to take a vote; and Louisville opens its third site

By Melissa Patrick
Kentucky Health News

Grant County is the eighth county in the state to approve a needle-exchange program, nearly 11 months after the legislature paved the way to do so, while much of Northern Kentucky is still talking about it. Meanwhile, Louisville has opened its third site amid controversy.

The Grant County Fiscal Court agreed to the needle exchange Feb. 15, almost six months after the Williamstown City Council had unanimously approved the exchange Aug. 18, Terry DeMio reports for the Cincinnati Enquirer.

"I am grateful to the elected officials who took the time to educate themselves and their constituents on the necessity of not only helping to stop the transmission of disease but also to provide assistance to a vulnerable population," Jim Thaxton, coordinator for the Northern Kentucky Heroin Impact Response Task Force, said at the meeting.

The Northern Kentucky Health Department will operate the program,which will be located in the department's Williamstown Health Center. The opening date has yet to be decided.

Needle exchanges were approved under the state's anti-heroin law passed in 2015, and require both local approval and funding. They are meant to slow the spread of HIV and hepatitis C, diseases that are commonly spread by intravenous drug use and to provide testing and treatment for those who are ready to seek it.

Kentucky leads the nation in hepatitis C, which is especially prevalent in Northern Kentucky with a rate that is 19.5 times higher than the rest of the nation, DeMio reports.

The other needle exchanges in the state that are either operating or have been approved are in Louisville and Lexington and the counties of Pendleton, Carter, Elliott, Franklin and Jessamine.

Northern Kentucky

Meanwhile, several Northern Kentucky counties continue to debate the issue with no action, prompting Mark Hansel, the NKyTribune's managing editor, to write a detailed op-ed that says it is time for Northern Kentucky to make a decision on a regional needle exchange program.

"It’s becoming pretty clear that if there is to be needle exchange in Northern Kentucky, it is going to have to be region-wide," he writes.

He says that the local-decision part of the law has allowed local elected officials in the region to "dodge the issue by not bringing it up for a vote" and that it's time for them to take a vote on this issue so voters know where they stand, noting that "elected officials in several Northern Kentucky municipalities are up for reelection in November."

Hansel explains, "At this point, it appears Covington, Kenton County, Newport and Campbell County are ready to support needle exchange," but "have indicated they will not move forward without assurances that Boone County and Florence will participate as well." He notes that Florence also has "increasing support," but requires Boone County's Fiscal Court to make a decision first. He says that it is unclear if Boone County has enough votes for it to pass, "but most observers believe it does not."

Hansel suggest these counties "could move the needle forward" by approving their needle exchanges "contingent on implementations by all cities and counties eligible to participate."

Louisville

Meanwhile, Louisville is opening its third site for a needle exchange, and reaction to the new site has been mixed, Danielle Lama reports for WDRB-TV.

Rev. Owen Sheroan, who is with nearby Churchman Chapel Ministries, told Lama he was concerned that it would create more drug activity in the area, while other neighbors said they weren't concerned with it being there.

"About 20 percent of our participants right now that are driving all the way up here to our main site are coming from that ZIP code and surrounding areas," Public Health and Wellness Interim Director Dr. Sarah Moyer told Lama.

Allison Martin, spokeswoman for Jefferson County Public Schools, told WDRB that the district has expressed concerns to the city that the site is so close to Hazelwood Elementary School.

Lama reports, "When asked about the school's proximity, Moyer said the needle exchange will help get dirty needles off the street and that could in turn make the neighborhood safer. She also says the department hasn't had any problems at their other sites."

The exchange will be in an empty lot along Bicknell Avenue and will be open on Wednesdays from 11 a.m. to 2 p.m. Health officials told Lama that so far, more than 2,000 people have used the city's needle-exchange program.

Three Kentucky farmers praise Kynect and Medicaid expansion

Ben Abell, Carolyn Gahn and Rae Barr

Three Kentucky farmers praised Medicaid expansion and Kynect, the state health-insurance exchange, at a news conference Feb. 16, saying the programs have helped them to follow their dreams to become farmers, to not have to work two jobs just to have health insurance, and allowed both them and their spouses to work full-time on the farm.

One of the farmers, Ben Abell, called for lawmakers and the agriculture commissioner to "fight to keep Kynect" despite Gov. Matt Bevin's plans to close it and shift users to the federal exchange created by the Patient Protection and Affordable Care Act of 2010.

"Family farmers and other small business owners are the foundation of Kentucky's economy, but I'm afraid our needs are being drowned out by political clamor and the ideological divides over the ACA," Abell said. "If agriculture is to continue playing a major role in Kentucky's economy, then we must ensure the next generation of Kentucky farmers have access to quality affordable health insurance. Kynect was our tool to achieve this."

 Bevin notified federal officials Dec. 30 that he plans to shut down Kynect. And today Health Secretary Vickie Yates Glisson told the House Budget Review Subcommittee on Human Resources that after Feb. 29, Kentuckians will sign up for Medicaid through an online-only program called Benefind, Ryland Barton reports for WFPL. She also noted that the Benefind program would refer those who don't qualify for Medicaid to the federal exchange.

The news conference was held by Keep Kentucky Covered, a coalition that is "focused on sustaining access to affordable healthcare in Kentucky through Medicaid expansion and Kynect," Emily Beauregard, executive director of Kentucky Voices for Health, said at the event. "Farming is one of the industries that has benefited the most from Medicaid expansion."

Bevin has said Kynect is redundant because the federal exchange does everything the state exchange does and it isn't fair that all Kentuckians who buy health insurance are paying for something that relatively few of them use. The federal exchange charges a 3.5 percent fee on the policies it sells; Kynect is funded by a 1 percent assessment on all health-insurance policies in the state.

Keep Kentucky Covered was also formed in response to the governor's plan to change Medicaid in a way that will likely require participants to "have some skin in the game." Bevin said during his budget speech that if the state and the federal government can't come to some agreement on this, then the state will no longer cover the 400,000 people helped by the expansion.

Bevin wants to change how Kentucky serves this population because he says the state cannot afford to pay for them. The federal government is paying the full cost of the expansion through next year. In 2017 and 2018, Kentucky will be responsible for 5 and 6 percent of the cost, respectively. This cost will rise to the health-reform law's cap of 10 percent in 2020.

All of these possible changes are making farmers unsure of what to expect, said Martin Richards, executive director of the Community Farm Alliance.

He said they are asking questions: "Without Kynect, how many more obstacles will be placed between me and my family and getting health insurance? Will I be able to continue to farm, raise a family without affordable healthcare insurance?"

"Until the Affordable Care Act and Kynect, a whole generation of Kentucky farmers often struggled with getting affordable healthcare, myself included," Richards said. "Somebody had to work off the farm to provide the family with access to health care."

All three farmers who spoke at the news conference attributed their affordable health insurance to the expansion of Medicaid, which covers those with incomes up to 138 percent of the federal poverty level; having access to Kynect, the state's health insurance exchange; and having access to their Kynectors, who have not only helped them choose the best plans for their families, but have also answered their questions and helped them adjust their plans along the way.

Abell said he and his wife, Bree Pearsall, became farmers in 2010 in Oldham County. He said they have had both good years and bad years on the farm and as a result have participated in both private Kynect plans and Medicaid.

"Kynect has provided us with a seamless platform that understands our families' changing economic situation and has been able to offer different insurance plans based on how that farming season has gone," he said.

One advantage of Kynect is that it can help Kentuckians sign up for both federally subsidized policies and Medicaid. The federal exchange only signs people up for policies, so Kentuckians who qualify for Medicaid will have to sign up for it on a different website.

Rae Strobel said she and her husband, Adam Barr, are seventh generation farmers on Barr's family farm in Meade County, and she too had worked off the farm for both income and health insurance in the early years. She said they signed up for insurance the first year it was offered through the ACA, which allowed her to also become a full-time farmer and stay home with their son.

"Adam and I will be the first in three generations to make a living by farming the land full time, assuming that we continue to have access to affordable health insurance," Strobel said.

Strobel sang the praises of their Kynector, who helped them navigate the system and choose a health plan. She noted that their Kynector continues to help them as they face different life-changing events.

"If Kynect is taken away, what will that mean for us?" she asked. "My fears are that it will mean less choice and health insurance options that would work for our family and a system that is not as easy to navigate and most important for us is no help from a Kynector that would guide us through when we have questions."

Bill Wagner, executive director of Family Health Centers in Louisville, told The Courier-Journal that a move to the federal exchange would leave the state with one-fourth as many Kynectors. Glisson estimated at the subcommittee meeting that Kentucky has 500 Kynectors.

Carolyn Gahn said that she and her husband Jacob were a typical young couple that didn't worry about not having health insurance in their 20s, but in 2012 Jacob was diagnosed with a health condition and "our world was turned upside down." They are farmers in Garrard County.

"We were grateful when the ACA was enacted and Jacob was now able to get full coverage regardless of his pre-existing condition," she said.

They have since added two children to their family and she noted how easy Kynect was to update the changes in both income and family size over the years. Her family has been on both subsidized policies and Medicaid.

"With this security we have been able to focus on building our business full time," she said. "Without the support for our health coverage, we would not be financially able to run our own business."

None of the farmers interviewed said they knew much about the federal exchange, but Abell said "Kynect was built by Kentuckians for Kentuckians and it's a Kentucky agency. It is responsible to the needs of Kentuckians."