Events, trends, issues, ideas and independent journalism about health care and health in Kentucky, from the Institute for Rural Journalism at the University of Kentucky
Dr. Hiram Polk, a prominent surgeon from Louisville, has been appointed as the commissioner for the state Department for Public Health. He will report to Vickie Yates Brown Glisson, a Louisville lawyer who is secretary of the Cabinet for Health and Family Services.
Polk, 80, is a graduate of Harvard Medical School and received his surgical training at Washington University in St. Louis. He was a fellow at the Lister Institute of Preventive Medicine in London and the Pasteur Institute in Paris. He served as an endowed professor and chairman of the Department of Surgery at the University of Louisville from 1971 to 2005, where he trained more than 330 surgical residents and started one of the world's first hand-transplant programs. He remains a professor emeritus and in March called for the resignation of U of L President James Ramsey.
Polk is a native of Jackson, Miss., and a graduate of Millsaps College and Harvard Medical School. He is internationally recognized as a surgeon and is editor emeritus of the American Journal of Surgery, according to his Wikipedia biography. He has been Kentucky chair of the American Cancer Society and a director of the Thoroughbred Owners and Breeders Association. He is a steward of The Jockey Club and a director of the Biomedical Research Foundation, which funds research on veterans' health.
“Many health issues plague the commonwealth, from chronic diseases such as heart disease and diabetes, to the serious substance abuse and addiction crisis, especially in pregnant women,” Polk said in a state news release. “Meanwhile, we must be vigilant and prepared to respond to emerging public health issues such as the Zika virus or a potential hepatitis C outbreak from intravenous drug use. I am excited to take on the role of public health commissioner because it gives me an opportunity to direct policy and implement pilot programs to address these very serious issues.”
Supporters of the current Medicaid expansion sat on the front row of a packed hearing room in Frankfort.
By Al Cross
Kentucky Health News
Supporters were few and far between at the first two public hearings on Gov. Matt Bevin's plan for changes in the Medicaid program.
In Bowling Green on Tuesday and in Frankfort on Wednesday, critics of the plan said it would put too many obstacles between the poor and health care. A third and final hearing will be held in Hazard next Wednesday.
"What you're proposing to do here is more cumbersome than average folks find the insurance process now," said A.J. Jones of Louisville, identifying himself as a former Medicaid enrollee now on private insurance. He said in Frankfort that fiscal responsibility, a stated reason for the plan, is "important, but not when you're talking about people's health."
The plan would require enrollees to pay premiums of $1 to $15 a month, based on income. It would also require able-bodied adults without jobs to take job training or counseling, or do community service for nonprofit organizations.
Miranda Brown of Lexington, who helps the poor navigate the health-insurance system, said a homeless person she helped get on Medicaid told her that she would probably drop out of the program if she had to pay premiums.
Bevin and other Republicans say Medicaid enrollees need to have "skin in the game," but Harriet Seiler of Louisville said, "It's a concept that will scrape a pound of flesh from Kentuckians. . . . The sick, the poor and the unemployed are not naughty children who need to be incentivized, scolded or humiliated."
K.J. Owens of Louisville won applause from the overflow crowd in Frankfort when he said the plan "seems motivated by the concern that poor people are defective morally . . . that poor people just aren't trying hard enough. The people on Medicaid are in no more need of moral guidance than the governor and the people on the governor's staff."
Emotions peaked when Molly Shaw of Louisvile-based Parents for Social Justice predicted, "More people will be sick and more people will die. This waiver will kill people."
The plan is a request to the federal government for a waiver of normal Medicaid rules. Asked afterward to reply to Shaw's comment, Health Secretary Vickie Glisson said, "We're trying to maintain the expansion."
Bevin has said if federal officials don't approve his plan, he would end the expansion of Medicaid under federal health reform by his predecessor, Democrat Steve Beshear, that added to the rolls more than 400,000 Kentuckians earning up to 138 percent of the federal poverty level.
Emily Parento, who was Beshear's chief health-policy adviser, predicted that federal officials would not approve the work-oriented requirements or the plan's increase in premiums for enrollees between 100 and 138 percent of the poverty line. "This amounts to a penalty for poverty," she said, adding that the plan has "minimal detail" on the projected cost savings, other than reduced enrollment.
The only unequivocal endorsements of the whole plan, other than written statements from Republican legislators, came from the Kentucky Hospital Association and the state's largest hospital system, Baptist Health. KHA official Nancy Galvagni said the plan improves on those in other states "by using more carrots than sticks" to influence enrollees' behavior, and "does inject some personal responsibility into the system."
In Bowling Green, Diane Amos said her elderly mother couldn't
afford premiums. (Daily News photo by Miranda Pederson)
In Bowling Green, "A few speakers expressed support for smoking cessation programs or a pilot substance abuse treatment plan included in the proposal. But most of the about 20 people who spoke appeared passionately opposed to the changes, with comments that prompted frequent applause from the about 60 people at the hearing," reports Deborah Yetter of The Courier-Journal.
"Cara Stewart, a legal-aid lawyer who represents people on Medicaid, said Bevin’s application for a waiver conflicts with the federal government’s requirements for waivers," Yetter reports. "The goal generally, she said, is to enhance or expand coverage." Stewart said, “I don’t see anywhere in here where we’re increasing coverage I only see cuts in service and taking away access to care.”
The Frankfort hearing was part of a meeting of the state advisory council for Medicaid, chaired by nurse practitioner Elizabeth Partin of Columbia. She was among the speakers who questioned the removal of annual vision and dental exams from regular Medicaid coverage. "That's how you catch problems before they become huge problems," she said. Given the small cost, "It's not gonna break the bank either way, and it may help improve people's health."
The issue was also big in Bowling Green. “We’re No. 1 in toothlessness; so we’re not going to provide dental care for those who need it the most?” asked Chris Keyser, executive director of Fairview Community Health Center.
Franklin optometrist Steve Compton said optometrists often are the first to identify other health problems, such as high blood pressure or diabetes, during a routine eye exam. In Frankfort, Richmond optometrist Matt Burchett said optometrists discovered 15 percent of diabetics insured by United Health.
Under the plan, enrollees could earn coverage for vision and dental exams, as well as non-prescription drugs and gym-membership subsidies, by enrolling in job training, volunteer work or health-related classes.
Speakers at both hearings questioned the proposed six-month suspension of enrollment for failure to pay premiums. "It seems rather harsh," said council member Barry Whaley of Louisville, executive director of Community Employment Inc.
Bevin's deputy chief of staff, Adam Meier, noted that suspended enrollees could re-enroll sooner by paying premiums and taking a health-literacy or financial-literacy course. "We want to mirror commercial insurance coverage," he said, "to teach people how to be engaged in their health insurance plan."
The cost of in-home, long-term care in Kentucky is less than it was a year ago, an insurance company study says. That should come as good news to Kentucky seniors, who are some of the unhealthiest in the nation.
"Although home-care costs are much less expensive than those in facility-based settings, the costs can add up to as much as $42,900 per year in Kentucky, which is why it's imperative for consumers to begin planning now for how they will pay for that care should they need it," Tom McInerney, president and CEO of Genworth, the company that conducted the study, said in the a news release.
McInerney said 70 percent of Americans over age 65 will need some form of long-term care and support during their lives.
Genworth's 13th annual Cost of Care Study found a cost decrease in most of the in-home care categories measured in Kentucky, with the only increase found in adult day services, which were up 2.9 percent. Nationally, cost for long-term in-home care increased.
Homemaker services, which cost an average of $3,432 a month in Kentucky, showed the largest decrease: 5 percent. There was a 4 percent cost drop in private nursing home care, which runs about $7,000 per month.
The state also showed decreases in cost for home health aides (down 2.3 percent), assisted living (1.5 percent) and semi-private nursing homes (1 percent).
In addition, the report broke down cost trends in the state's major metropolitan areas.
For example, the cost of private nursing-home care is about 10 percent less in Bowling Green than the national average, at $6,905 per month; and homemaker services in Lexington are about 8 percent less than the national average, at $3,527 per month.
The latest study gathered data from more than 15,000 long-term care providers nationwide and includes 440 regions, including all metropolitan statistical areas. It was conducted in January and February.
As cost for long-term care services rise, it is important for consumers to plan ahead, Genworth said.
Options for paying for long-term care include self-funding, government assistance and long-term-care insurance.
Genworth says you need to start saving early if you plan to self-fund. "Saving for long term care on your own can be difficult and take years to accumulate funds," says the release.
Government assistance options include Medicare and Medicaid. "Medicare pays for long-term care if you require skilled services or rehabilitative care such as in a nursing home (max. 100 days) and at home if you are also receiving skilled home health or other skilled in-home services (provided for a short period of time)," says the release. Visit longtermcare.gov for more information.
"Medicaid covers a large share of long-term care services, but to qualify your income must be below a certain level and you must meet minimum state eligibility requirements and be in a Medicaid-approved facility," says the release. Visit Medicaid.gov for more information.
The other option is long-term care insurance, which provides a "guaranteed lifetime source of income" to pay for long-term care and other expenses, says the release.
Seventy Kentucky school districts, local governments, health departments, businesses and other organizations have joined the Step
It Up, Kentucky! campaign to encourage walking and build the demand for walkable communities as a way to better health.
Public-health experts recommend 30 minutes of physical
activity five days a week to improve health, which can easily be achieved by
walking. People are more likely to make the decision to walk when they have
places, programs and policies that provide opportunities and
encouragement, says a news release from the state Cabinet for Health and Family Services.
“Getting people to move more starts with improving the
places we live, learn, work and play,” Obesity Prevention Program Coordinator Elaine Russell said in the release. “Communities can be built for people to be active
in their everyday life. By providing safe, attractive and convenient places to
walk, anybody can incorporate exercise into their daily routine.”
Step It Up, Kentucky! represents the state's response to the U.S. surgeon general’s recent Call to Action to Promote Walking and Walkable Communities,
which calls on Americans to increase walking by designing communities that
encourage physical activity in order to address rising rates of chronic
disease.
From adding sidewalks to developing parks and recreation sites, there are a number of things communities can do to become more walkable. Winchester created a mile-long circular path in the middle of town simply by mowing a stretch of undeveloped land. Rockcastle County paved a one-mile path along a roadway in Mount Vernon, now used by walkers, runners and bikers. The path also served as the site for an eight-week walking challenge in the community.
“Creating a culture that supports healthy lifestyles starts
with building support at the local level,” said Dr. Connie White, acting
commissioner of the state Department of Public Health. “All Kentuckians deserve safe, inviting places to be
active.”
The state is investigating whether patient care is unsafe at University of Louisville Hospital because of staff cuts, particularly in nursing, made by KentuckyOne Health.
The Courier-Journalreported June 9 that Dr. J. David Richardson, a prominent surgeon and current president of the American College of Surgeons, said cuts in nursing and other staff had caused a “major patient safety issue” and were “destroying the hospital.”
Richardson said in an email to university officials that Intensive Care Unit patients often cannot be moved to a more appropriate setting because there are “no available beds,” even though there are dozens of empty beds around “but they are simply not staffed,” The C-J's Andrew Wolfson reported. Richardson also said the hospital is poorly staffed at night, requiring patients to be held in the emergency room until 9 or 10 the next morning, when more nurses are available.
Beth Fisher, a spokeswoman for the Cabinet for Health and Family Services, confirmed Friday that its Office of Inspector General has an open investigation of the hospital. The office investigates hospitals in the state for the Centers for Medicare and Medicaid Services, which can terminate a hospital’s federal reimbursements in case of serious offenses.
KentuckyOne spokesman David McArthur said the company is awaiting the inspector general's report and has already assembled a group that will "evaluate and address any specific points and recommendations as soon as they are received," Wolfson reports. McArthur said the company is committed to quality and safety and has been investing “significant resources to continually improve key areas of hospital performance.” He also noted that staff reductions occurred more than two years ago.
Nevertheless, other physicians and hospital officials have confirmed Richardson’s assertions, including Dr. Susan Galandiuk, who told Wolfson that layoffs and cuts have forced the hospital to hire temporary “traveling nurses” unfamiliar with procedures.
“You are in the operating room with nurses who have no idea what equipment you are using or what they are supposed to be doing,” said Galandiuk, a colorectal surgeon who is editor-in-chief of a leading scientific journal in that specialty. “It is sad to see the deterioration.”
McArthur insisted that traveling nurses are trained on equipment and procedures unique to U of L Hospital.
The investigation is the latest problem for the hospital and KentuckyOne Health, whose parent company, Catholic Health Initiatives, lost $125.9 million in the last quarter of 2015 and has run up $9 billion in debt.
The Joint Commission, which accredits U.S. hospitals, found 31 deficient areas at U of L Hospital in January. They include problems with infection prevention and transfusion errors, as well as in broader categories. The hospital was accredited, but with the requirement of a follow-up survey. McArthur told Wolfson that none of the problems were considered serious and all have been addressed and corrected.
The hospital received a “D” grade in April from the Leapfrog Group, an independent organization founded by employers and medical experts. Two of KentuckyOne’s other hospitals in Louisville – Jewish and Sts. Mary & Elizabeth Hospital – got the same marks. The organization, which assigns letter grades to more than 2,500 U.S. hospitals based on medical errors, accidents, injuries and infections, says selecting the right hospital can reduce a patient’s risk of avoidable death by 50 percent.
KentuckyOne partnered with the University of Louisville in 2012. Former Gov. Steve Beshear blocked a full merger partly because of concerns about applying the Roman Catholic Church'sEthical and Religious Directives for Catholic Health Services at a public hospital, Maria Castellucci reported in Modern Healthcare.
Rural areas are too often underserved by the medical community, but a Madisonville program targeting high-school seniors as prospective health-care providers is helping change that.
There are many programs in rural areas for students in the medical field, but most require students to relocate for six weeks during the summer to an urban area with a medical school, Jenny Smith reported in the Madisonville Messenger.
Baptist Health'sHigh School Rural Scholars Programreverses that requirement by allowing students entering their senior year of high school to gain experience in the medical field without leaving their home county.
HSRS students divide time between shadowing medical professionals and preparing for college entrance exams. They have access to a virtual classroom with college professors available via the internet to improve their knowledge base, as well as test-taking skills. It is held during the same time as the Governor's Scholars Program, targeting the "second tier" of students most likely to benefit from the virtual classroom.
Baptist Health's Trover Campus in Madisonville serves as the central support site for the program, program officials said in a release. Students from Hopkins County and its adjacent counties are considered for the program. The students work 30 hours each week and receive a small stipend for participating in the three-week program.
To date, 226 students have participated in the program; 75 percent of former HSRS participants are enrolled in or have have completed a health career training program, HSRS officials say. Dr. Jonathan Moore is an HSRS alumnus who is currently finishing his residency in Madisonville.
"My time with the High School Rural Scholars showed me the value of a physician to their community," Moore said in the Messenger. "It inspired me to become a physician so that I could improve the lives of others."
The Trover Campus was established in 1998 as a branch of the University of Louisville School of Medicine. The HSRS program was founded two years later.
Campus Associate Dean Dr. Bill Crump told Smith that he shares the same vision for rural health as did Dr. Lowman Trover, who founded Trover Clinic, now Baptist Health Madisonville, in 1953.
"When I moved here 18 years ago, it was because I saw the potential to realize Dr. Trover's dream of 'growing our own doctors,'" Crump said, "but as we began, we just weren't being successful in getting students from the small towns in our area admitted into medical school. We knew we had to begin early to raise their expectations and sharpen their academic skills.
"When I had the initial idea for this program, we had well-meaning adults tell us high school seniors just aren't mature enough to benefit from such a program," he continued. "Our students have proven the concept valid, and I've been fortunate to see many of them develop into remarkable health care professionals."
The University of Kentuckypartners with Morehead State University and several hospitals and clinics for a similar initiative, the Rural Physician Leadership Program. Much like HSRS, the UK program also strives to provide rural areas with qualified doctors.
Kentucky's most reliably liberal editorial voice and one of its most reliably conservative are, not surprisingly, on opposite sides of Gov. Matt Bevin's plan to change the Medicaid program.
Bevin has proposed changes that would transition 86,000 Medicaid recipients to private insurance within five years, according to estimates from his administration. His proposal would require "able-bodied" recipients to pay a monthly premium of between $1 to $15, depending on income. If a person wanted dental or vision insurance, he or she would have to do such things as enroll in a community-college course, get a job or enroll in a smoking-cessation program.
The Lexington Herald-Leader published an editorial Sunday that calls Bevin's proposed changes a "red-tape tangle of penalties, incentives, premiums and cutbacks in coverage." The newspaper argues that the plan would create new administrative costs while caring for fewer Kentuckians.
The Herald-Leader does not reject the governor's plan wholesale. It applauds certain aspects, such as creating rewards for quitting smoking. It also backs Bevin's pilot program that would expand access to residential treatment for addiction and mental illness in 20 counties in an effort to quell the state's drug abuse epidemic and prevent the spread of hepatitis and HIV.
And the paper likes Bevin's renegotiation of contracts with Medcaid managed-care companies, which administration officials say will save taxpayers $280 million over the next six months. The state's five managed-care firms earned far higher profits than their counterparts in every other state in 2015, the research group Millimanreports.
Jim Paxton, publisher of The Paducah Sun, welcomes the governor's proposed changes. His editorial, which is behind a membership paywall, in Sunday's Sun says change is needed because then-Gov. Steve Beshear added more than 400,000 Kentuckians to the program, something that Bevin, Paxton and many other conservatives see as unsustainable. Paxton says one of every four Kentuckians now qualifies for Medicaid, which he implicitly deems unacceptable.
The federal government is picking up the full tab for the expansion under through this year, under federal health reform. Next year, the state will begin paying 5 percent of the cost, rising in annual steps to the law's limit of 10 percent (expected to be more than $360 million) in 2020. Paxton says Bevin was elected to clean up Beshear's mess and calls his plan "a creative, fair and rational step to do so."
The public may send comments on Bevin's plan to Medicaid Commissioner Stephen Miller or email kyhealth@ky.gov by July 22. A public hearing was held Tuesday in Bowling Green. Hearings will also be held Wednesday in Frankfort and July 6 in Hazard.
A forum on Medicaid, featuring the officials who oversee it and are trying to change it, was made public after The Courier-Journal was first denied admittance to it.
The 90-minute forum is to be held Thursday morning in
Louisville by the Health Enterprises Network, a business group. It "had been billed as an
exclusive event for its members, about 1,300 people from 210
organizations or businesses," Deborah Yetter reports for The C-J.
"Admission
was to be restricted to the members who purchased tickets to the event,
$35 each, and the organization declined a reporter's request to attend. But
after the Courier-Journal inquired about the event Monday, Doug Hogan, a
spokesman for the Cabinet for Health and Family Services, which
oversees Medicaid in Kentucky, said media would be welcome."
Yetter notes that Gov. Matt Bevin said in announcing his plan for Medicaid changes last week that "as part of this administration's continuing commitment to transparency, we are taking every step to ensure the process is open and accessible to the public."
The speakers are to include Health Secretary Vickie Yates Glisson, Medicaid Commissioner Steve Miller, Adam Meier, Bevin's deputy chief of staff; and Mark Birdwhistell, a former health cabinet secretary
and University of Kentucky health vice president who is Bevin's special adviser for Medicaid.
"The
forum comes amid intense public interest over proposed changes to
Medicaid, which covers nearly one-third of the state's residents and is a
major source of payment to doctors, hospitals and other health
providers," Yetter notes. More information about the forum is on the HEN website, Healthenterprisesnetwork.com.
Fewer than 8 percent of the Kentucky children who qualify for a summer meal program got such meals last summer, despite the availability of federal funds for it, according to a report from the Food Research & Action Center.
The report says that for every 1,000 children who ate school lunch during the regular school year, only 77 low-income children in Kentucky ate summer meals last year, based on average daily participation. That was 48th among the states, beating only Mississippi and last-place Oklahoma.
However, among the low-performing states, Kentucky was the only one to improve last year, based on figures for July, the middle month of the program. It served 10.3 percent more children and was one of 29 states to improve, the report said.
The report said the average daily participation in Kentucky last year was 25,437, compared to 23,057 in 2014.
“It’s very positive news that summer meals have been reaching more children,” Tamara Sandberg of the Kentucky Association of Food Banks said in a news release. “Kentucky can build on this progress by redoubling outreach efforts throughout this summer to make sure that children — and their parents — are aware of this valuable program. The summer nutrition programs can make a huge difference for the hundreds of thousands of children in our state whose families struggle to afford enough food.”
More school districts took part in the program last year than the year before. "The state had 149 sponsors in 2015 (up 8.8 percent from 2014) and 1,812 sites (up 69 percent)," reports Jonathan Greene of The Richmond Register.
In Madison County, schools have about 21 locations, and Berea College and Grow Appalachia have a five-location program for Berea children. “We have a lot of students in need,” County Schools Food Service Director Scott Anderson told the Register. “We see a lot of kids coming to school hungry. A lot of students tell us that this (school lunch) might be their only meal.”
Mike Sullivan, who manages the program for the Kentucky Department of Education, said, “Just as learning doesn’t end when the school year ends, neither does a child’s need for good nutrition. Without the Summer Food Service Program and the wonderful sponsors, thousands of children would not get the nutrition they need during the summer months. The development of these children depends in large part on making sure they get nutritious meals all year long.”
The human papilloma virus vaccination is proven to prevent cervical cancer and genital warts, but many pediatricians and family doctors still don't strongly recommend it, and they need to do better.
That was the main message at an HPV conference in Lexington June 21, where more than 100 people, mostly health-care providers, came to learn about the cancer-causing virus and the under-utilized vaccine that prevents it.
Dr. Alix Casler, medical director of pediatrics at Orlando Health Physician Associates in Florida, stressed the importance of teaching everyone in a health-care organization about why HPV vaccinations are so important.
"Every year that we fail to reach our goal, there are thousands of children who are going to go on to develop cancer," Casler said. "It is one of the most lifesaving things we do," but because it isn't mandatory and the diseases that it causes aren't ones pediatricians deal with, it often falls to the bottom of providers' priorities, she said.
Studies show that a "clear recommendation" from a physician is the most important factor in whether children get the HPV vaccine. Casler noted that a 2013 survey found that 80 percent of mothers who received a same-day recommendation had their son or daughter vaccinated that day.
The three-dose HPV vaccine was approved by the federal government 10 years ago and is recommended for 11- and 12-year-old boys and girls.
Kentucky falls in the bottom 10 states for HPV vaccinations, with 37.5 percent of its girls and 13.2 percent of its boys aged 13 to 17 vaccinated as of 2014. Nationwide, fewer than half of girls and only one-fifth of boys are getting immunized, and vaccination coverage did not increase substantially from 2011 to 2014.
HPV is spreading. About 79 million people in the United States are infected with it, and about 14 million more become infected each year. It is estimated that half of these new infections occur in people 15 to 24 years old.
Though most HPV infections will clear up on their own, the most persistent strains of the virus are directly linked to 27,000 new cancers a year. About 30 women per day in the U.S. are diagnosed with cervical cancer caused by HPV, and every year, there are about 324,000 new cases of genital warts caused by the virus.
Lois Ramondetta, a gynecologic oncologist at MD Anderson Cancer Center in Houston, who is on a mission to educate health-care providers about the vaccine, told clinicians in southern Texas, “If you are not recommending the vaccine, you are not doing your job. It’s the equivalent of having patients in their 50s and not recommending a colonoscopy — and then having them come back with cancer.” So reports Laurie McGinley for The Washington Post.
HPV infections cause more than 90 percent of anal and cervical cancers and 70 percent of vaginal, vulvar, penile and middle throat cancers, and two of the HPV strains are associated with more than 90 percent of anal and genital warts.
HPV is most commonly transmitted through sexual intercourse, but it can also be transmitted through any skin-to-skin contact, including genital contact of any kind or simply kissing.
Doctors and parents alike have struggled with the idea of giving young children a vaccine for a sexually transmitted disease. And some parents hesitate because they say the vaccine encourages sexual promiscuity, though research says otherwise.
Caslir said that just like putting on a seat belt to protect yourself before you turn on the engine, the most effective time to vaccinate for the cancer causing HPV virus is prior to exposure. In addition, it is important to vaccinate pre-teens early because they have the best immune response to the vaccine and are more likely to keep coming in for annual visits.
Dr. Daron G. Ferris, a speaker at the conference who works at the Georgia Cancer Center in Augusta, said that a mother of a 21-year-old woman with cervical cancer caused by HPV asked him, "So you mean if my daughter had received the Gardasil shots, she probably would not be having this surgery today?" and that he told her, "Yes. She would not have been there if she had been vaccinated."
Kirk Forbes, whose daughter Kristen died at the age of 23 from cervical cancer caused by a high risk strain of HPV, told the story of his daughter's battle. He and his wife have founded the Kristen Forbes EVE Foundation, whose mission is to eradicate cervical cancer and significantly reduce HPV infection rates. One of the foundation's efforts is a nationally acclaimed documentary that profiles five women, including Kristen, called "Someone You Love: The HPV Epidemic."
"We have the means to stop 90 percent of cervical cancers and who know how many versions of oral cancer, anal cancer, penile cancer... and could literally wipe out genital warts," Forbes said."We've got all the tools we need, now we've got to go out and get the job done."
Public hearings on Gov. Matt Bevin's plan to change the Medicaid program will be held Tuesday in Bowling Green, Wednesday in Frankfort and next week in Hazard.
The Bowling Green hearing will be held Tuesday, June 28, from 10 a.m. to noon Central Time at Western Kentucky University's Knicely Conference Center Auditorium, 2355 Nashville Road. Speakers will include Health
and Family Services Secretary Vickie Yates Brown Glisson, Medicaid Commissioner Steve Miller and Adam Meier, Bevin's deputy chief of staff. For
those unable to attend, it will be live online via https://connect.wku.edu/medicaidpublichearing/.
The Frankfort hearing will be a special meeting of the state Advisory Council for Medical Assistance. It will be held Wednesday, June 29, from 1 to 2 p.m. EDT in the State Capitol Annex.
The Hazard hearing will be held Wednesday, July 6, from 11 a.m. to 1 p.m. EDT in Room 208 of the Jolly Classroom Center at Hazard Community and Technical College, 1 Community College Drive.
The Cabinet for Health and Family Services will accept written comments on the proposal until Friday, July 22, 2016 at 5 p.m. EDT. Comments can be mailed to: Commissioner Stephen Miller, Department for Medicaid Services, 275 E. Main St., Frankfort KY 40621, or sent by email to kyhealth@ky.gov.
Require able-bodied adults on Medicaid to pay monthly premiums, on a sliding scale based on the federal poverty level. Those with incomes under 25 percent of the FPL would pay $1 per month; those at 25 to 50 percent of the FPL would pay $4 per month; and those from 51 to 100 percent of the FPL would pay $8.00 per month. Those from 101 to 138 percent of the FPL would pay $15 per month during the first two years; $22.50 in the third year, $30 in the fourth year and $37.50 afterward. Co-payments for doctor visits and other services would be eliminated.
Remove dental and vision care from the basic Medicaid package but allow enrollees to earn access to such coverage, as well as non-prescription drugs and gym-membership subsidies, by enrolling in job training, volunteer work or health-related classes.
Require working-age adult enrollees without dependents to have a job, look for one, take job training or participate in volunteer work, on a gradually increasing scale.
Fund inpatient substance-abuse treatment, something Gov. Matt Bevin said no other state has done with Medicaid, in 10 to 20 "high risk" counties that have not been chosen.
Bevin's proposal says it "represents the terms under which the Commonwealth will continue Medicaid expansion," and he said that if federal officials don't approve it, he would end the expansion, which provides largely free health care for about 400,000 Kentuckians.
But he said he was confident that federal officials would approve the request.
Bevin's special adviser for Medicaid, UK HealthCare Vice President Mark Birdwhistell, said the administration hopes to submit the proposal for federal approval by Aug. 1 and start the program by Oct. 1. That appears to be an ambitious schedule. "Past negotiations with states that have used alternative methods to expand Medicaid have taken months, and the department says they will keep talking with state officials for as long as it takes to have a policy that is acceptable to both parties," Morning Consultreports.
Kentucky Voices for Health, which has been critical of the plan and the early scheduling of hearings, has issued a "fact sheet" for distribution to Medicaid enrollees.
"The sooner everyone understands that addiction needs to be treated as a disease, the sooner communities will make progress in battling the problem." So says Dr. Mike Kalfas of Northern Kentucky "who treats over 300 addicts in his family practice," Don Weber reports for cn|2's "Pure Poliics."
Kalfas told Weber that doctors are frustrated, and discouraged from treating addicts, by the lack of an easy solution, unlike many diseases and disorders. “You have to understand their disease and see where they are in it, and you have to be able to roll with the punches in that disease,” Kalfas said. “It’s not simply something that you treat once and it goes away. It's not strep throat.”
Kalfas worries about the growing use of the terrifically potent fentanyl, but "sees some good things happening in response to the heroin epidemic in northern Kentucky," Weber reports. "He points out that jails in Boone, Kenton, and Campbell counties have instituted substance abuse programs, which, in some circumstances change inmates into patients. He says the continued key will be to revamp how addiction is looked at, and learn to treat it as a disease."
"Shares of Aetna and Humana plunged Thursday afternoon after the insurance commissioner of the country’s most populous state said he opposes the proposed merger of the two health insurance giants," Boris Ladwig reports for Insider Louisville.
California Insurance Commissioner Dave Jones said in a conference call and a news release that the Justice Department should oppose the merger because it would reduce quality and consumer choices while increasing prices. "Shares of Humana dropped 1.6 percent, or more than $3, within two minutes after the announcement," Ladwig reports. "Aetna’s shares fell about 0.5 percent within three minutes. Trading volume also spiked for both companies around the time of Jones’ statement."
Aetna noted that Jones has no official authority over the merger, and the only California agency that does, the Department of Managed Health Care, approved it Monday. The agency said it had negotiated commitments, including almost $50 million in health-related expenditures, as part of the approval.
Gov. Matt Bevin's plan for Medicaid might not be approved by the Centers for Medicare and Medicaid Services as readily as he suggested, because CMS hasn't approved any plan that has a work requirement.
Bevin's plan would require participants to have what he calls "skin in the game" through premiums and a higher level of involvement in their health care, but it also includes a work requirement.
"All able-bodied working age adult members will be required to participate in community engagement and employment activities to maintain enrollment," says the state's Medicaid waiver proposal.
“There’s nothing in this that is going to be a surprise to them. There’s nothing that we have not talked to them about,” Bevin said at the news conference. “This has been a good, open dialogue. It’s been in good faith. I’m encouraged by that. This is the kind of thing that makes me confident that they will, in fact, support the waiver that we are requesting.”
But that seems to conflict with background information provided by the U.S. Department of Health and Human Services in response to the announcement. HHS says, "States may not limit access to coverage or benefits by conditioning Medicaid eligibility on work or other activities. This requirement is not new."
Indiana and other states have made similar requests to require Medicaid recipients to be employed or actively seeking work, and have been denied. Most recently, Arkansas, which is in the process of submitting its new waiver with a "work referral" program, had originally asked about a work requirement and were told that it would not be approved.
"As we have discussed previously, some of your proposals are neither allowable under federal Medicaid law nor consistent with the purposes of the program. . . . Consistent with the purposes of the Medicaid program, we cannot approve a work requirement," HHS Secretary Sylvia Burwell wrote Gov. Asa Hutchinson in a letter dated April 5."We can, however, support referrals to programs that can help supplicants increase their connection to the workforce and improve their economic outcomes, goals that we support."
Arkansas's new demonstration waiver application says a "work referral" to job training and job search programs will be provided "outside the demonstration" to every Arkansan with no income. In addition, the state will provide information about "work training opportunities, outreach and education about work and work training opportunities through the Department of Workforce Services" to all of the eligible state program beneficiaries. The proposal says this program should help individuals move from the state insurance program to an employee sponsored insurance or private plan.
"You just simply cannot have work requirements in the Medicaid program. It is a safety net program," said Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of groups that favor federal health reform and the state's embrace of it. "I don't expect HHS to accept this waiver as it is written now."
Jessica Ditto, Bevin's spokeswoman, stood firm on the administration's stance that HHS can legally approve Kentucky's plan under Section 1115 of the Social Security Act.
"1115 demonstration waivers give broad authority to HHS to make changes to the standard Medicaid program," Ditto said in an email. "No other state has requested what we are requesting, which is a phased in pilot that is not merely a ‘work requirement’, but rather a community-engagement requirement that can be easily satisfied with several activities, including work, volunteer, job training and education."
The HHS background statement also called into question the monthly premiums that Bevin's plan would require: "States may not impose premiums or cost sharing at levels that prevent low-income individuals from accessing coverage and care."
A threat or a promise?
Bevin, who initially opposed then-Gov. Steve Beshear's expansion of eligibility for Medicaid, boldly said that its continuation depends on whether CMS approves this new plan, saying "If they do not approve this, there will not be expanded Medicaid in the state of Kentucky."
"In fact, that decision is his decision," said Rich Seckel, executive director of the Kentucky Equal Justice Center. "States get to decide whether they have Medicaid expansion or not. The scariness of the threat should not be a factor in evaluating the waiver."
Under federal health reform, Beshear expanded Medicaid to those with incomes up to 138 percent of the federal poverty line, adding more than 400,000 Kentuckians to its rolls. If Bevin holds firm to his statement and the proposal isn't approved, that many Kentuckians would lose their health coverage.
HHS says it will evaluate the waiver based on the law, and suggests that it might take some time to come to an agreement.
“We are hopeful that Kentucky will ultimately choose to build on its historic improvements in health coverage and health care, rather than go backwards," Ben Wakana, national press secretary at the U.S. Department of Health and Human Services, said in a prepared statement. "As in other states, we are prepared to continue our dialogue for as long as it takes to find a solution that continues progress for the people of Kentucky.”
Mark Birdwhistell, a University of Kentucky health-care vice president who is Bevin's special adviser for Medicaid, said the administration hopes to finalize and submit its proposal to CMS around Aug. 1 and get approval by Sept. 30. HHS said that other state's waivers have taken up to seven months of negotiations after submission to CMS to be finalized.
That long a wait would push the decision well past the November election, in which Republicans are trying to take control of the state House, which would give them full control of the General Assembly as well as the governorship. Abolition of the Medicaid expansion before the election could hurt their chances.
The proposal opens a 30-day comment period, in which the state will hold three public hearings: in Bowling Green June 28, Frankfort June 29 and Hazard July 6.
By Melissa Patrick and Al Cross Kentucky Health News Reactions to Gov. Matt Bevin's plan to change Medicaid were predictably mixed, from health-reform advocates saying it is "paternalistic," too complex, removes benefits and adds costs that will create barriers to care, while leading Republicans and the Kentucky Hospital Association sang its praises. Critics predicted that the Obama administration will reject the plan's requirements that Medicaid recipients have a job, look for one, take job training or do volunteer work. "You just simply
cannot have work requirements in the Medicaid program. It is a safety-net
program," said Emily Beauregard, executive director of Kentucky Voices for Health, a coalition of groups that favor federal health reform and the embrace of it. Judith Solomon, health-policy vice president at the liberal-leaning Center for Budget and Policy Priorities in Washington, D.C., noted that Health and Human Services Secretary Sylvia Burwell told Arkansas this year, “We cannot approve a work requirement.” Joe Sonka of Insider Louisvillewrote that an unnamed HHS official told him "the agency has been clear that states may not limit access to coverage or benefits by conditioning Medicaid eligibility on work or other activities." The plan has several elements modeled after private insurance, and Mark Birdwhistell, Bevin's special adviser for Medicaid, said it is "commercial insurance on training wheels." That didn't set well with some critics. "Training wheels are for kids. Right there, that struck me as an inappropriate analysis,"said Rich Seckel, executive director of the Kentucky Equal Justice Center.
"I have heard words like condescending, patronizing. Even if one doesn't use those kinds of
adjectives, I do think there is perhaps an inappropriate model of envisioning
people as welfare dependents when that's not really who they are and it's a
little unfair to them to act on a stereotype," Seckel said. "A theory of welfare dependency kind of pervades this, and yet we know that more than more than half of the people who qualify and got covered were working people."
Seckel and others said the plan, which would seek a waiver of various federal rules, is too complex.
"People on Medicaid have a lot of responsibilities. They have a lot of things they are dealing with on a daily basis," Beauregard said. It is going to be more difficult to navigate, more difficult to keep up with all of the requirements. And it really is just going to place additional burdens on low-income working Kentuckians and their families."
She added, "Navigating the healthcare system is
difficult for anyone, but certainly for people who may not be familiar with
commercial insurance. I don't think that our goal should be for that people
know how to use commercial insurance. I think our goal should be
that people use their coverage to improve their health."
The plan removes dental care from the basic Medicaid program but allows members to qualify for it by engaging in a range of activities that could help them improve their health.
"That is the heartbreaker as far as the benefits that are in jeopardy," Seckel said. "We know how closely related that is to the rest of physical health. We know that people have seized upon that opportunity and used that benefit by the thousands. It is something that does affect your confidence in looking for jobs and acting in the workplace and maybe your hire-ability, and yet we've moved that further away and given you a bunch of things that you have to do to get it back."
KVH Chair Sheila Schuster said, "We're talking about a Medicaid expansion population
that has been without coverage for years and years and years and just got it for two years, and now you are saying, 'No, you don't get to have oral health,' which is huge. We have one of the worst toothlessness problems in the country
and it is very correlated with physical health."
The sharpest criticism came from Democrat Steve Beshear, who as governor expanded eligibility for Medicaid under health reform, adding more than 400,000 people to the rolls.
In a statement issued under the name of Save Kentucky Healthcare, a group he formed, Beshear said Bevin had "declared war on Kentucky’s working families" and "threatened to kick hundreds of thousands of working Kentuckians off of health care. Gov.
Bevin seems woefully unaware of what Kentuckians on expanded Medicaid -- and
that's construction workers, substitute teachers, nurses’ aides, farmers, our
neighbors, friends and family -- do every day to support their families while
still being able to take their children to the doctor."
Perhaps anticipating such criticism, Bevin's office had ready a string of quotes praising the plan.
“The Kentucky Hospital Association applauds Governor Bevin for his leadership in presenting a comprehensive plan to transform Kentucky's Medicaid program to achieve better health outcomes for Kentuckians, while also focusing on its financial sustainability," President and CEO Michael Rust was quoted as saying. “We look forward to working with the Bevin administration in helping to implement this innovative plan.” Bevin's office also quoted several leading Republicans, including state Senate President Robert Stivers of Manchester, whose district has a large Medicaid population: "I am glad to see Governor Bevin and his administration putting an emphasis on personal responsibility with regard to Medicaid expansion. These are some ideas we have been talking about in the Senate for several years. I agree that the idea of making individuals have some 'skin in the game' will make for a more sustainable and better health-care system for Kentucky." The Foundation for a Healthy Kentucky issued a statement from President and CEO Susan Zepeda, which said in part: "There are areas to applaud in the proposal, including aligning Managed Care Organization practices for greater efficiency, incentives for evidence-based healthy behaviors such as quitting smoking and obtaining a health risk assessment, expansion of presumptive eligibility sites (including local health departments), and commitment to drug use disorder and mental health services." "The proposal also raises concerns, including the exclusion of dental and vision benefits in the standard benefits package, anticipated significant drops in Medicaid enrollment, elimination of retroactive eligibility and re-enrollment requirements and penalties for those who fail to pay mandated premiums."
"It's not about the money for the premiums, it's about the learning experience." --Mark Birdwhistell, Medicaid adviser to Gov. Bevin (Lexington Herald-Leader photo by Charles Bertram)
By Al Cross and Melissa Patrick
Kentucky Health News
FRANKFORT, Ky. -- Most Kentucky Medicaid recipients would have to pay premiums of $1 to $15 a month, and be more actively involved in their health care, under Republican Gov. Matt Bevin's proposal to maintain his Democratic predecessor's expansion of the program.
If federal officials approve, the program would no longer include some benefits, such as dental and vision care. However, recipients could gain access to those benefits, as well as non-prescription drugs and gym-membership subsidies, by enrolling in job training, volunteer work or health-related classes.
The changes would apply only to able-bodied adults, not pregnant women, the disabled or those deemed "medically frail." Working-age adult members without dependents would be required to participate in volunteer work, have a job, look for one or take job training, on a gradually increasing scale, phased in by county.
At a 50-minute press conference in the Capitol rotunda, Bevin said the program would be "transformative."
"There is nothing good or healthy or productive, long-term for the individual or for society as a whole, that comes from able-bodied, working-age men and women with no expectation of their involvement and no opportunity for that involvement," he said. "So we are providing an expectation and an opportunity and a reward. . . . When they get out there and they get engaged and they start to realize the value that they add, it will change people's lives."
The proposal also asks for Medicaid funding of inpatient substance-abuse treatment, something Bevin said no other state has done, in an effort to address the state's growing drug-abuse problems. This would be a demonstration project limited to 10 to 20 "high risk" counties that have not been chosen.
Bevin's proposal says it "represents the terms
under which the Commonwealth will continue Medicaid expansion," and he said that if federal officials don't approve it, he would end the expansion, which provides largely free health care for about 400,000 Kentuckians.
But he said he was confident that federal officials would approve the request, which seeks a waiver of a wide range of Medicaid rules, because he and his aides have been in frequent contact with the Center for Medicare and Medicaid Services and its overseer, Health and Human Services Secretary Sylvia Burwell.
He said nothing in the proposal should be a surprise. “There’s nothing we’re asking them to do that has not been done or is not a stated goal of theirs in other programs,” he said. However, in granting some waivers, CMS has said it would not approve them in other states.
Bevin said during his campaign last year that the expansion was unsustainable, but his plan estimates a modest savings of $300 million to Kentucky taxpayers over the next five years, most of that apparently from tightening up on the managed-care organizations that deal directly with Medicaid members.
"This has been the most lucrative state in America for MCOs to operate," with profit margins four to five times the national average, Bevin said. A recent report said MCOs in Kentucky turned an aggregate profit of 11.3 percent, much higher than any of the 38 other states with managed care.
The federal government is paying all bills for Medicaid expansion enrollees through this year. Next year the state would pay 5 percent, rising in annual steps to the federal health-reform law's limit of 10 percent in 2020. The estimated cost of the state share in the two-year budget that begins July 1 is $257 million.
Bevin said saving money in near-term budgets is not as important as the long-term savings and quality-of-life improvements that can come from improving the health status of one of America's least healthy states.
"It's important to make sure that we have something that, above all else, creates better health outcomes," he said, citing some of Kentucky's poor health statistics. "Number two, we want to familiarize participants with the commercial insurance program" and be more engaged in their communities.
Proposed premiums for first two years. Those above FPL would pay $22.50 in Year 3, $30 in Year 4, $37.50 afterward.
The premiums would be based on income levels, designed to be less than 2 percent of income, and could be paid by third parties. For non-payment, members above the federal poverty line would be dropped for six months but could re-enter earlier by bringing their payments up to date and taking a financial or health literacy course. Those below the poverty line would incur lesser penalties.
Bevin's proposal would eliminate $3 co-payments for doctor visits and other routine services. Advocates for the poor had said they liked premiums better, because they can be budgeted.
Bevin acknowledged that it would probably cost more to collect the premiums than they would generate, but he said "The savings come from having people who are healthier, who are more engaged. . . . It's not about trying to save money. The money will come from doing the right thing. Better, healthier outcomes result in cost savings on health expenditures."
Medicaid would have a $1,000 deductible, but it would be paid from a state-funded account. At the end of each year, half of the unused amount would be transferred into the recipient's "My Rewards" account. That account would be built by enrollment in classes, job training or volunteer work and could be used to buy additional benefits.
"The deductible account and the My Rewards account empower individuals to be active
consumers of health care and make cost-conscious decisions, while simultaneously providing
incentives for members to improve their health and be active members of the community," the proposal says.
If Medicaid members are employed and their employer offers health insurance, they and their children would be required to go on it after one year. The state would continue to cover services that are covered by Medicaid but not by an employer's plan.
The plan also calls for a specific enrollment period for Medicaid, which now accepts enrollees year-round. It says making Medicaid more like private insurance will help the many people whose incomes fluctuate, making them eligible for Medicaid one year and federally subsidized health insurance the next.
The proposal opens a 30-day comment period, in which the state will hold three public hearings: in Bowling Green June 28, Frankfort June 29 and Hazard July 6. The administration hopes to finalize and submit its proposal to CMS around Aug. 1 and get approval by Sept. 30, said Mark Birdwhistell, a University of Kentucky health-care vice president who is Bevin's special adviser for Medicaid.
U.S. Rep. Hal Rogers of Somerset and other Republican leaders in Congress "are closing in on a $1.1 billion funding deal to combat the
Zika virus, but Democratic leaders are threatening to oppose it over
cuts to crucial health-care programs," Sarah Ferris reports for The Hill.
Rogers, the chair of the House Appropriations Committee, and his Senate counterpart, Mississippi Republican Thad Cochran, are trying to meet GOP leaders' goal to approve a Zika funding bill by the July 4 holiday recess. They "expect to finalize a deal on the long-awaited funding package sometime Wednesday evening, according to their offices," Ferris writes.
A Democratic aide told Ferris that the deal would use the Senate’s figure of $1.1 billion, more than double what the House approved, but "would use many of the controversial offsets used in the House Republicans’ bill, such as money for the Ebola virus response and programs under Obamacare.
It would also include politically thorny restrictions targeting funding for women's health programs." President Obama has asked for $1.9 billion.
Senate Democrats threatened to block the bill, saying "they’ve been frozen out of the talks," Ferris reports. “There is no bipartisan 'deal' on Zika. The only 'deal' is House and Senate Republicans agreeing to launch more attacks on women's health,” Adam Jentleson, a spokesman for Senate Minority Leader Harry Reid, tweeted Wednesday.
Jentleson also called the GOP proposal “deeply unserious.”
If Kentucky's future lies in the well-being of its children, there's reason to worry, because a recent report shows that Kentucky consistently remains in the bottom one-third of states for this measure.
The 2016 Kids Count report ranks Kentucky 35th in the overall well-being of its children, down from 34th last year. The state showed a significant improvement in its health ranking and a further drop in its teen birth rate, but otherwise didn't show much change from last year's report by the Annie E. Casey Foundation and Kentucky Youth Advocates.
"The real issue is not a drop or increase of one position, but rather that Kentucky continues to be in the bottom one-third of all states," KYA Executive Director Terry Brooks said in a news release. "Are we really content with the idea that two-thirds of America's children are better off than Kentucky kids?"
The annual report offers a state-by-state assessment that measures 16 indicators to determine the overall well-being of children. The latest data are for 2014, and is compared with data from the last six or so years earlier. The report focuses on four major domains: economic security, education, health and family and community security.
Kentucky continues to rank highest in health, climbing to 16th from 24th in 2015, 28th in 2014 and 31st in 2013. Contributors included a continued drop in the number of children without health insurance (4 percent); a 15 percent decrease in child and teen mortality, fewer teens abusing alcohol or drugs (4 percent) and improvements in the percentage of low-birthweight babies (8.8 percent).
The state's greatest drop among the rankings was in economic security, going down to 37th from 32nd last year. Education (27th) saw a slight improvement from the past two years and the family and community (38th) rankings remained similar to the past three years.
The release notes that the state now ranks 10th for the percentage of children with health insurance.
"We are seeing better outcomes for kids in Kentucky, and expanded health coverage and access to quality care play a vital role in making that happen," Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, said in the release. "Research shows that when parents have health coverage, their children are more likely to also be signed up for health insurance."
Another bright spot in the report is that the state's teen birth rate continues to drop. It declined 34 percent from 2008 to 2014. While Kentucky still has one of the nation's highest teen birth rates, it dropped to 35 births per 1,000 girls aged 15-19 in 2014, down from 39 per 1,000 in 2013 and 53 per 1,000 in 2008. The national average is 24 per 1,000, an all-time low.
Kentucky consistently ranks lowest in the "family and community" domain, with 35 percent of its children living in single-parent families; 12 percent living in families where the household head lacks a high school degree; and 16 percent living in high-poverty areas, which are neighborhoods where more than 30 percent of residents live in poverty.
"Kentucky will thrive when policies that support the whole family, caregiver and child, are implemented," Adrienne Bush, executive director of Hazard Perry County Community Ministries, said in the release.
And though the state's education ranking improved to 27th from 30th, not much has changed in these indicators since the foundation started doing this report. The bottom line is that more than half of fourth graders (60 percent) still can't read at a national proficiency level and that the majority of eighth graders (72 percent) still aren't proficient in math. (In 2007, these indicators were 67 percent and 73 percent respectively.)
"Student performance should alarm parents and business leaders and jolt Kentucky leaders into making fundamental education reform a policy priority to ensure college and career readiness," Brooks said.
In addition, more than half the state's three-and four-year-olds (58 percent) don't attend pre-school and 17 percent of its high school students don't graduate on time.
Perhaps the direst message from the report is about the state's economic well-being. One in four Kentucky children live in poverty (26 percent), a rate that has remained higher than it was pre-recession when it was 23 percent, says the release. Nationally, the child poverty rate is 22 percent.
"Growing up in poverty is one of the greatest threats to healthy child development," says the report. "Poverty can impede cognitive development and a child's ability to learn."
The report also says 35 percent of Kentucky's children live in homes with parents who don't have secure employment, which places the state in the bottom 10 states for this indicator. It also found that 28 percent live in households with a high housing-cost burden.
The release suggested "bipartisan solutions" to improve the well-being of Kentucky's children, including expanding oral health coverage; supporting school-based health centers; education reform that includes public charter schools, expanded child care assistance and family-focused tax reforms.
The growing use of heroin and the abuse of prescription painkillers in Kentucky also mean that the state "is being ravaged by the diseases that follow in their wake: hepatitis and HIV. These dangers also reach far
beyond addicts and their families, threatening a wide swath of the
population," Laura Ungar reports for The Courier-Journal.
Kentucky has one-fourth of the 220 U.S. counties that the U.S. Centers for Disease
Control and Prevention had judged to be at high risk for outbreaks of HIV and hepatitis C among intravenous drug users, Ungar notes in the second installment of a three-part series on heroin in Kentucky and adjoining states.
"Acute hepatitis B rose 114 percent in Kentucky, Tennessee and West Virginia
from 2009 to 2013, even as incidence remained stable nationally, according
to one study," she reports. "According to another study, the rate of new hepatitis C
cases among people 30 and younger more than tripled from 2006 to 2012 in
Kentucky, Tennessee, Virginia and West Virginia. More recently, cases of
acute hepatitis B and C in Kentucky reached 281 last year, up from 120
in 2003."
Dr. Nora Volkow, director of the National Institute on Drug Abuse, told Ungar that hepatitis C has become the top cause of death from reportable infectious
diseases in the U.S., and an HIV outbreak in Austin and Scott County, Indiana, “was a wake-up
call” for the country. Ungar notes, "Addicts may also be spreading both diseases without knowing it. Up to
three in four people with hepatitis C, and one in eight with HIV, don’t
know they have it, experts say."
Dr. William Cooke, an Austin physician "who treats dozens of patients with HIV and hepatitis, said many
communities are ill-equipped to handle the threat," Ungar writes. "All over the region
and nation, he said, there’s too little substance abuse treatment, too
little emphasis on the poverty that often accompanies addiction and too
little compassion."
Kentucky has authorized needle exchanges where addicts can get clean syringes to avoid the threat of infection from contaminated needles. "Officials say needle exchanges are an important part of a comprehensive strategy to control disease," Ungar notes. "But
critics argue these programs enable drug use, and many area residents
reject the idea of using public money to fund them. So the prospect of
more syringe exchanges in the region remains uncertain."
Ungar gives the basics of how the diseases spread: "HIV, which can be transmitted
through semen and other bodily fluids in addition to blood, is mainly
spread by having unprotected vaginal or anal sex with someone who has
HIV, or sharing used needles, which can harbor live viruses for up to 42
days. But it also can be transmitted to health care workers by needle
sticks, or from mother to child during pregnancy, birth or
breastfeeding, especially if the mom isn't taking medicine.
"Hepatitis
B and C, which are caused by separate viruses, are easier to catch than
HIV because there are higher levels of virus in the blood. Hepatitis B
is more often contracted through sex or accidental needle sticks than
hepatitis C, but both types are commonly spread by sharing tainted
needles."
The American Medical Association, led by a Kentucky emergency-room physician, declared gun violence a public-health crisis last week and endorsed waiting periods an background checks for purchases of all firearms, not just handguns.
"The AMA, the country's largest doctor group, also vowed to lobby
Congress to overturn a decades-old ban on gun violence research by the
Centers for Disease Control and Prevention," two days after the Orlando shooting that left 49 dead and 53 wounded, reports Kimberly Leonard of U.S. News and World Report. "The AMA joins the American College of Physicians in its position, which has been calling gun violence an epidemic since 1995."
Dr. Steven Stack
AMA President Steven Stack of Lexington said the research "is vital so physicians and other health providers, law enforcement and society at large may be able to prevent injury, death and other harms to society resulting from firearms. . . . With approximately 30,000 men, women and children dying each year at
the barrel of a gun in elementary schools, movie theaters, workplaces,
houses of worship and on live television, the United States faces a
public-health crisis of gun violence."
Leonard notes, "Federal law doesn't technically outlaw the CDC from studying gun
violence, but prohibits the agency from using federal dollars to
advocate or promote gun control. Though President Barack Obama lifted
the research ban through executive order nearly three years ago,
Congress has blocked funding for these studies."
The National Rifle Association has called the public-health approach a back-door path to more gun control, Leonard writes, and "has said that doctors shouldn't be asking patients about gun ownership because they are not gun safety experts."
"Who will Congress listen to now: the healers or the merchants of death?" Lexington Herald-Leader columnist Tom Eblen asked to start his Sunday column. "The AMA's stand is unlikely to change anyone’s mind about gun control. But it
underscores the absurdity of Congress’ two-decade effort to block
legitimate scientific research that could reduce gun deaths and injury."
Suicides accounted for about two-thirds of the 33,390 firearms deaths
in the U.S. in 2014. The CDC "said 627
people were killed in Kentucky that year with firearms, a rate of 13.8
per 100,000 population, higher than the national average of 10.2," Eblen reports. He said research on gun violence could reduce those figures, just as research into auto accidents has reduced such fatalities.
Read more here: http://www.kentucky.com/news/local/news-columns-blogs/tom-eblen/article84482382.html#storylink=cpy
Read more here: http://www.kentucky.com/news/local/news-columns-blogs/tom-eblen/article84482382.html#storylink=cpy
Representatives from five groups involved in mental health offered legislators solutions June 15 for ending the revolving door between hospitalization, incarceration and homelessness that often exist for those with severe mental-health conditions.
Many who spoke at the three-hour meeting of the Interim Joint Committee on Health and Welfare said judges should be able to order mentally ill adults who meet strict criteria into an "assisted outpatient treatment" program. Others said that would add costs and a burden to the judicial system, and infringe on personal liberties. But all agreed that the state lacks resources to care for such adults.
Shelia Schuster, executive director of the Kentucky Mental Health Coalition, voiced strong support for the idea. She said its main goal would be to create a narrowly defined program "to access supported outpatient treatment under a court order, again without having to be involuntarily committed or coming through criminal justice system."
Now, a mentally ill person who needs care but does not want it can only be court-ordered into treatment after being released from a hospital or jail.
Various versions of this legislation have have been filed in the General Assembly since 2013. Last year's version, House Bill 94, passed out of the Democrat-led House, but died in the Republican-led Senate. The bills are often referred to as "Tim's Law," named for Tim Morton, a schizophrenic who was hospitalized involuntarily 37 times by his mother because this was the only way she could get him the treatment he needed. Morton died in 2014.
“We do want to make sure that those individuals, like Tim Morton, who are very ill and who are unable to recognize it, who spend much of their lives in the revolving door of hospitalization, homelessness, or incarceration, are afforded a new opportunity to stay in treatment long enough to see the positive effects and the road to recovery,” Schuster said.
Steve Shannon, executive director for the Kentucky Association of Regional Programs, said the state needs assisted outpatient treatment to keep those with mental-health conditions out of the criminal justice system.
"If we can keep a person out of criminal justice involvement, it is better for them, " he said. "Folks have enough challenges already; why add that piece to it? . . . It affects housing, it affect employment."
Shannon also proposed that the state seek a Medicaid waiver to help pay for housing and supported employment for such adults, and a spend-down option to allow the poor on Medicare to also get Medicaid, which offers more services.
Jeff Edwards, division director of Kentucky Protection and Advocacy, who supportsdoes not support Tim's Law said "assertive community treatment" teams are already available to this population, but only on a voluntary basis. He also noted that the ACT program is laden with issues, including geographical access, wait times to get services, and frequent staff turnover.
"Right now, you have to live in one of 56 counties to get the ACT services," he said. "We have to expect quality services, no matter where a person lives in the state."
Ed Monohan of the Department of Public Advocacy, a long-time opponent of the court-ordered treatment model, said he supports enhancing the ACT teams, which provide a comprehensive array of community supports to this population through individual case managers who are available 24 hours a day.
"Long-term, engagement with clients, with people, is a far superior long-term strategy than coercion through a court system," Monohon said. "The mental-health system, rather than the court system, is the better place to really address this long-term. ... Their liberty is at stake with this coercion."
"I know it is about civil liberties and the rights of individuals, but for them, in the disease process, they have lost the ability sometimes to make those decisions clearly for themselves," said Rep. Addia Wuchner, R-Florence, after sharing deeply personal stories about a family member who had severe mental illness.
During an impassioned plea of support for Tim's Law, Kelly Gunning, director of Advocacy National Alliance on Mental Illness in Lexington, told the story of how her son, while under the care of an ACT team, "brutally assaulted" both her and her husband in January. She emphasized that while the ACT program does offer a "robust array of services," it is based on voluntary compliance.
"They are voluntary. Do you hear me? They are voluntary! If my son doesn't want to open the door for his ACT team, or his doctor who comes to his home, he doesn't have to," she said. "And (as) we were cleaning out his home, we found a years stockpile of medication untouched, untaken because he doesn't believe he has an illness."
Allen Brenzel, clinical director with the state Department for Behavioral Health, Development and Intellectual Disabilities, along with many others at the meeting, acknowledged that a lack of resources is a large part of the problem.
"I mostly hear unity around the issue that we must do better," he said, adding that not only assisted outpatient treatment is needed: "It's going to be the allocation of resources and the moving of resources to appropriate places."
Committee Co-Chair Sen. Julie Raque-Adams, R-Louisville, encouraged the group to examine this issue "holistically" and committed to working on a solution. "Across the board, this is one of those issues that we can no longer stick our heads in the sand and ignore,"' she said.
