Immunizations are a hot topic in Frankfort; comment on updated regulation ends Tuesday; shots-for-college bill looks dead

By Melissa Patrick
Kentucky Health News

A bill to require all college freshmen in Kentucky to be immunized before starting classes is likely dead, but one that allows pharmacists to give immunizations to those aged 9 and up still has a chance in the General Assembly.

Elsewhere on the prevention front, the state has proposed a regulation to require two more vaccines and to change the rules for religious exemptions, among other things. The amended regulation is open for public comment through Tuesday, Feb. 28.

The college immunization bill is opposed by a tea-party group called Take Back Kentucky and the Kentucky Vaccine Rights Coalition around issues of personal rights and changes to the exemption requirements that are in the updated regulation.

Rep. Addia Wuchner

Rep. Addia Wuchner, R-Florence, said she had no idea that her bill to require incoming college freshmen to be vaccinated would meet such resistance. She said most of the resistance stems from misinformation.

Her concerns are reflected by recent spread of the childhood disease pertussis, or whooping cough.

Carolyn Callahan of Louisville's WLKY-TV reported in December that the federal Centers for Disease Control and Prevention said Kentucky had nearly 450 cases of pertussis in Kentucky in 2016, up from 163 reported in 2015.

Another example is mumps. Lena H. Sun recently reported in The Washington Post that federal officials are looking at the benefit of an additional dose of mumps vaccine because of the increasing number of outbreaks since 2006. The U.S. had more than 5,000 reported cases of mumps in 2016, and the CDC reports that in the 2015-16 school year, several university campuses reported a mumps outbreak, with the two largest in Iowa and Illinois, each involving several hundred students.

Unlike outbreaks of measles and whooping cough, which occur primarily among unvaccinated people, mumps outbreaks are occurring among people who have been vaccinated, suggesting that a booster is needed.

Wuchner's House Bill 147 would require incoming college freshmen to submit proof of immunization against measles, mumps, rubella ("German measles") and meningitis. Only a few Kentucky colleges currently have such a requirement. The bill exempts students who have medical and religious reasons not to be vaccinated, as well as online and distance-learning students.

The bill passed readily out of the House Health and Family Services Committee, which Wuchner chairs, but was recommitted to the House budget committee, a likely death sentence.

Dr. Patty Swiney, former president of the Kentucky Academy of Family Physicians, who spoke for the bill in committee, acknowledged that its chances for passage were slim, but said her group would continue to support it.

She told a story about one of her patients who died from meningitis because it wasn't recognized in time. She noted that even though meningitis cases are "sporadic," 10 to 15 percent are fatal and that one out of every five survivors have a permanent disability.

"If you have ever seen a young person actually die in front of you and there is nothing that you can do, and you know it was preventable. . . . That shouldn't happen to anybody," she said.

Vaccination skeptics often note a study that linked the MMR vaccine to autism, but Swiney said the study "has been proven wrong multiple times, and the author has admitted that he skewed his data."

Other skeptics have voiced concern that thimerosal, a mercury-based preservative, causes autism, but this was removed from vaccines in 2001, and autism rates have continued to rise.

"We are listening to people who have no background in medicine, who have no idea whether studies are scientific or not," Swiney said, "and we are listening to what they are telling us about our kids. . . . All we really want, before you just claim an exemption, we want you to sit down with someone and be informed ... of all the side-effects and all the benefits, just like you do before having any procedure done."

Updated immunization regulation

The state Cabinet for Health and Family Services has proposed to update the state's immunization regulation, adding a meningitis booster before 11th grade and the Hepatitis A vaccine, to align Kentucky's requirements with the CDC and the American Academy of Pediatrics.

The amendment also consolidates the immunization certificate and medical exemption form, and revises the religious exemption certificate to include educational materials.

The religious exemption form would have to be signed by a parent or guardian, notarized and submitted to a health-care facility, or submitted to a child care facility or school upon enrollment. No physician signature or approval would be required.

This is a change from the current regulation, which allows Kentucky parents to write their own sworn statement claiming a religious immunization exemption.

In 2016, of the 99,805 students enrolled in Kentucky's schools, there were 202 medical exemptions and 521 religious exemptions.

The bill would also require health-care providers to use the Kentucky Immunization Registry by July 1, 2018.

The cabinet also made changes to require home-schooled students who participate in any school sponsored activities or attend in-school classes to provide proof of immunization or submit an exemption.

The Vaccine Rights Coalition and Take Back Kentucky also oppose this regulation. Take Back Kentucky is encouraging its supporters to oppose HB 147 because "it would force" those entering college to get vaccinations, though the request for action mentions the religious exemption.

Take Back Kentucky also notes that during the April 20, 2015 Lexington Tea Party gubernatorial debate, Gov. Matt Bevin said he would oppose any form of forced vaccination.

Asked if Bevin supports his agency's regulation, Amanda Stamper, his communications director, didn't answer directly, but said Kentucky forces no one to be vaccinated and cited the religious exemption.

Written public comments on the proposed regulation changes should be submitted to Tricia Orme, administrative specialist, Office of Legal Services, 275 E. Main St. 5 W-B, Frankfort KY 40602. You can also call 502-564-7905; fax 502-564-7573 or e-mail Tricia.Orme@ky.gov.

Pharmacist vaccine bill still has a chance

The bill that would allow pharmacists to administer all age-appropriate immunizations to minors aged 9 to 17, still has a chance.

Sen. Julie Raque Adams

Senate Bill 101, sponsored by Sen. Julie Raque Adams, R-Louisville, moved quickly and unanimously through both her Senate Health and Welfare Committee and the full Senate and is in the House.

Current law allows pharmacists to administer flu vaccines starting at age 9, but for all other vaccines, pharmacists can only administer to minors starting at age 14.

Both immunization bills are supported by the Foundation for a Healthy Kentucky.

“By allowing pharmacists to administer immunizations to children beginning at age 9, the bill would give Kentucky moms and dads access to nearly 5,500 more professionals, who often have extended hours and nearby locations, to take care of important childhood shots and other immunizations. Thus, the bill will raise Kentucky’s adolescent immunization rates, which lag behind most surrounding states," Ben Chandler, president and CEO of the foundation, said in a statement.

Longtime Whitesburg doctor, winner of national honor, fears patients will lose Affordable Care Act's preventive care

Dr. Van Breeding (Lexington Herald-Leader photo)

Whitesburg physician Dr. Van Breeding says his patients got "bamboozled" by politicians who tagged their expanded access to health care as "Obamacare."

Barack Obama, who was anti-coal, is deeply unpopular in coal-friendly Appalachian towns like Whitesburg; thus, any program bearing his name was doomed to suffer the same fate, Breeding told Cheryl Truman of the Lexington Herald-Leader.

Breeding, a primary-care physician and clinical director at Mountain Comprehensive Health Corp., was named the 2017 Staff Care Country Doctor of the Year. The Texas-based medical staffing company began awarding the honor in 1992. Breeding is the first Kentuckian to receive the award since 1997, when Claire Louise Caudill of Morehead was awarded the title, Truman notes.

"He takes care of patients from birth to death, from hospital to nursing home," Truman writes. "He is a bit suspicious of 'hospitalists,' because who can take care of you better than the doctor who knows you, your family, your family tree and the ailments that have befallen your kin?"

Breeding, a Letcher County native, got his degrees from the University of Kentucky and was a medical resident there, but he told Truman always knew he wanted to return home to practice medicine. The Patient Protection and Affordable Care Act brought more patients to Breeding and the clinics at which he works.

"We got insurance to patients who have never had care before," Breeding told Truman.

Now Breeding fears his patients will lose that insurance. President Donald Trump campaigned on a promise to repeal the ACA as one of his first orders of business, and Republicans are formulating options for a replacement. Compare some of the proposals here.

The 2010 reform law provided opportunities for free preventive care, to which some of Breeding's patients had never had access before Kentucky expanded Medicaid under the law in 2014.

"In Eastern and southeastern Kentucky, getting patients in for early screenings is crucial," Truman writes. "The area has high rates of breast, uterine, ovarian and colon cancers, and patients benefit from early detection."

Breeding, 55, sympathizes with patients who struggle to stretch money until the end of the month, "so he tries to schedule appointments earlier in the month, when patients can buy gas to get to the clinic," Truman writes. "His patients can’t take a bus, like Lexington patients, and a filled gas tank is required to get just about anywhere in the mountains."

Bevin takes high profile in governors' debates in Washington about future of Medicaid, which covers 1.3 million Kentuckians

Matt Bevin and other governors spoke outside the White House.

As governors debated the future of Medicaid over the weekend in Washington, Kentucky Gov. Matt Bevin was an outspoken participant, according to several news reports.

Bevin is the first governor quoted in a Politico story that began, "Republican governors are split over an Obamacare replacement plan — just like their counterparts in Congress. The big problem is how to make sure a repeal of the health law doesn't penalize red states that took billions of dollars in federal funds to add low-income residents to Medicaid rolls," such as Kentucky, "or those who shunned the extra money," like Tennessee.

The story, by Rachana Pradhan and Brianna Ehley, says Republicans were having difficulty figuring out how to limit Medicaid spending equitably in the repeal and replacement of the Patient Protection and Affordable Care Act.

”This is still fairly gelatinous,” Bevin told Politico. “There's a lot of ideas, a lot of moving parts, a lot of governors with different ideological perspectives — all of that is in the cauldron right now.” He added, “A solution must be there. Repealing alone serves no purpose.”

A plan by House Republicans would eliminate the expansion of the Medicaid program in 2020 and convert Medicaid to a block-grant program, in which states would get limited payments based on their numbers of Medicaid members. A consultant's report to the National Governors Association meeting "predicted that Medicaid reforms being proposed by House Republicans would result in tens of thousands of people losing their insurance coverage in an average-size state," reports The Associated Press.

When Democratic Govs. Jay Inslee of Washington and Terry McAuliffe of Virginia called the report "disturbing," Bevin "said if Democrats were disturbed, they haven't been paying attention," AP reports. Bevin said, “The kind of conversation that's being had now — sobering, shocking, surprising as it might be to some — is the conversation that we must have because the piper has to get paid at some point. People are looking at reality, and that's good.”

Seven Republican governors have offered a plan that "urges Congress to change Medicaid from an open-ended federal entitlement to a program designed by each state within a financial limit," AP reports. They include some who expanded Medicaid, such as Ohio Gov. John Kasich, or who wanted to but were thwarted, such as Tennessee Gov. Bill Haslam.

"It's not clear whether House Republicans will accept the GOP governors' proposal," AP reports. In January, Bevin urged House Majority Leader Kevin McCarthy "to gradually reduce aid to people over the poverty line," notes Kery Murakami, Community Newspaper Holdings Inc.'s Washington correspondent.

Bill Lucia of Route Fifty reports, "Bevin stressed that there had been a good dialogue about health care between Republican and Democratic governors."

Lucia asked the governor if the proposals would hurt the Commonwealth's finances. Bevin replied, “There will be an impact, no question there will be an impact. What I’m saying and what I think other governors are saying: ‘Trust us, we’ll handle the impact’.” He added, “We need to rethink the system. It’s not purely a function of enrolling people and thinking we’ve helped them, giving them coverage if that doesn’t actually lead to anything.”

There is a divide between Republican governors; those who expanded Medicaid under "Obamacare" want to keep what they have, and those who didn't want to be treated equally. Bevin is in an unusual position, as the Republican successor to a Democratic governor who gave Kentucky the greatest reduction of any state in the percentage of people without health insurance, largely by expanding Medicaid to 440,000 people with incomes up to 138 percent of the federal poverty level.

That governor was Steve Beshear, who will give the nationally televised response to President Trump's address to Congress Tuesday night.

Now that states are paying 5 percent of the bills for people covered by Medicaid expansion, set to rise in annual steps to 10 percent in 2020, Bevin says Kentucky can't afford to have 1.3 million people on the program, and has proposed changes that his administration says would leave Medicaid with 86,000 fewer members in five years than it would have without the changes.

Bevin made his proposal during the Obama administration. The Trump administration is expected to approve it or even expand it, since its chief Medicaid administrator was the chief drafter of the main model for Bevin's proposal: an Indiana program that charges income-based premiums and requires most Medicaid recipients to work or look for work.

While several Republican governors have been happy to take billions of dollars from the federal government to improve the health of their people, Bevin has been among those who have focused on a broader fiscal issue. he told Lucia, “No one seems overly concerned about or focused upon the fact that, as a nation, we currently have $20 trillion in debt.”

Helping parents understand kids' body mass index can thwart obesity, but Kentucky doesn't require BMI to be reported

By Melissa Patrick
Kentucky Health News

Parents are more likely to change their child's lifestyle when schools provide educational materials along with the results of their child's body mass index screening, according to a recent study. But Kentucky has declined to require student BMIs to be measured, or to engage with parents about what they mean.

BMI, a ratio of height to weight, is used as a screening tool to indicate whether a person is underweight, a healthy weight, overweight or obese. A minor with a BMI of 30 is considered obese.

The study, published in the journal Childhood Obesity, analyzed 1,500 parental surveys from 31 Pennsylvania elementary schools, some who had only received their child's BMI results, while others got the results along with access to an online tool that helps parents evaluate their home environments and practices as they relate to nutrition and physical activity.

The tool appears to help parents better understand their child's BMI number, and how that relates to lifestyle changes that could improve health, like increasing fruits and vegetables, decreasing screen time, increasing activity levels and ensuring adequate sleep, Greg Welk, a professor of kinesiology at Iowa State University and leader of the study, said in an ISU news release.

Welk said BMI numbers are of little use if not shared with parents. The American Academy of Pediatrics and the Institute of Medicine have endorsed BMI screening for use in school assessments, but it is important to follow recommended practices for assessment and notification, he added.

A bill was introduced in the 2010 Kentucky General Assembly to increase physical activity in the lower grades, with the stated goal of reducing obesity and improving the body mass index of Kentucky's children, but it didn't pass. The bill would have required schools to collect and track the aggregate BMI of students in these grades.

Since then, Kentucky has added an optional box for health-care providers to include a child's BMI on the physical-examination reports that are required to enter children in kindergarten and sixth grade. Middle-school and high-school students are required to get a physical exam only if they participate in a sport.

Reporting of BMI varies widely among school districts, so the state has data for only 17.3 percent of its students.

If a BMI is provided, individual schools can enter it in a statewide database, which is reported collectively for use in developing school wellness programs, but the data entry is a suggested practice and is not required, said Jaimie Sparks, coordinated school health director at the Kentucky Department of Education, said in an interview.

"We wanted to collect the data from a public health perspective and let its usefulness be in guiding decisions, say around chronic disease and obesity. We also wanted to be very careful that discussions around the individual student stayed within the medical home," Sparks said, adding that it was also important to avoid any situation where school personnel might be perceived as health experts.

As of 2012, 21 states were required to measure and collect BMI data, though one-third of the schools in these 21 states had policies that did not require parental notification, said the release.

The Iowa State researchers said their study shows there is potential to increase awareness and access to educational tools related to BMI reports, and if this information prompts parents to make changes, it could help reduce obesity rates. They cited research showing that very few parents identify their own children as having weight problems, though more than 17 percent of American youth are obese.

Former Gov. Steve Beshear will give national Democratic response to President Trump's speech to Congress

Steve Beshear (Herald-Leader photo)

Former Gov. Steve Beshear will give his party's response to President Donald Trump's speech to Congress Tuesday night, "highlighting the Kentucky Democrat's efforts to expand health care coverage under the law Republicans are determined to repeal and replace," The Associated Press reports.

The choice of Beshear, who is 72 and left office almost 15 months ago, was announced by Senate Minority Leader Chuck Schumer, D-N.Y., and House Minority Leader Nancy Pelosi, D-Calif. Their release included other news, that Beshear was recently named a senior leadership fellow at the Harvard T.H. Chan School of Public Health and is working on a book, to be called People Over Politics.

As governor in 2007-2015, Beshear embraced the 2010 Patient Protection and Affordable Care Act, most notably by expanding the Medicaid program to about 440,000 people with incomes up to 138 percent of the federal poverty level. As a result, Kentucky led the nation in reduction of the percent of its population without health insurance.

Republican Gov. Matt Bevin says Kentucky can't afford to pay its 5 to 10 percent share of the expansion's cost and has asked federal officials to let him trim it back, estimating the changes would leave Medicaid with 86,000 fewer Kentuckians in five years than without the changes. Now that Republicans control the federal government, they are expected to approve Bevin's proposal and perhaps other changes. Meanwhile, Republicans in Congress are working on a replacement for the 2010 law.

"The choice of the former governor stands as a counterpoint to Senate Majority Leader Mitch McConnell, R-Ky., who is at the forefront of efforts to repeal the law," AP reported.

Beshear issued this statement: "American families desperately need our president to put his full attention on creating opportunity and good-paying jobs and preserving their right to affordable health care and a quality education. Real leaders don't spread derision and division — they build partnerships and offer solutions instead of ideology and blame."

AP reports, "House Republicans aim to roll out legislation in coming weeks to replace major elements of the Affordable Care Act with a new system involving tax credits, health savings accounts and high risk pools, but crucial details remain unknown. They've had to defend their plans at raucous town hall meetings around the country this week, and a new poll showed support for the law at a record high."

Finnish study finds early birds eat healthier, sleep better and are more active than night owls

                           image: likesuccess.com

People who describe themselves as "morning types" have a more balanced diet and eat earlier in the day, compared to the "evening types," suggesting that Benjamin Franklin was onto something when he said, "Early to bed, early to rise," makes us "healthy, wealthy and wise."

These were the findings of a first-of-its-kind study that was conducted in Finland and published in the journal Obesity. It looked at data from nearly 2,000 randomly chosen adults between the ages of 25 and 74 to determine if their internal time clocks affected what they ate and at what time they ate.

“Earlybirds may have an extra advantage over nightowls when it comes to fighting obesity, as they are instinctively choosing to eat healthier foods earlier in the day,” Courtney Peterson of the University of Alabama at Birmingham, spokesperson for The Obesity Society, said in a news release. "Previous studies have shown that eating earlier in the day may help with weight loss and lower the risk of developing diabetes and heart disease. What this new study shows is that our biological clocks not only affect our metabolism but also what we choose to eat."

The release noted that morning types made healthier choices all day long, whereas the evening types ate less protein overall, ate more sugar in the morning and evening, and ate more fat and saturated fatty acids in the evening, than the morning types.

The study found that differences were even more pronounced on weekends, with evening types having more irregular mealtimes and eating twice as often as the morning types. They also did not sleep as well and were less physically active than the morning types.

The researchers said their work could provide insight into why people who are overweight and working to lose weight make the food choices they do throughout the day.

“Linking what and when people eat to their biological clock type provides a fresh perspective on why certain people are more likely to make unhealthy food decisions,” Mirkka Maukonen, lead author of the study, said. “This study shows that evening type people have less favorable eating habits, which may put them at a higher risk for obesity, diabetes and heart disease.”

The study used data from the national FINRISK 2007 study and was conducted out of the National Institute for Health and Welfare at the Department of Public Health Solutions in Helsinki, Finland.

What Trump voters with Obamacare want in health coverage

By Danielle Ray
Kentucky Health News

Affordability appears to be one of the most important concerns for Donald Trump voters as the president and Congress go about repealing and replacing the Patient Protection and Affordable Care Act.

In particular, cost of premiums and out-of-pocket expenses were top priorities among Trump voters who discussed the potential Republican repeal and replacement of the ACA at focus groups hosted by the Kaiser Family Foundation in Michigan, Ohio and Pennsylvania in December. All focus group participants were Trump voters who obtained coverage through federally subsidized insurance policies or through Medicaid expansion.

President Trump signing an executive
order to rollback regulations on Obamacare

Participants who had subsidized coverage also wanted broader access to doctors and hospitals, simplified health-plan choices, greater cost-and-coverage transparency, and elimination of the individual mandate for coverage. Those participants also said that coverage of pre-existing conditions (which Trump has said he supports) and the ability to tailor coverage to fit their needs, even if that meant sicker people would pay more for coverage, were also important to them.

While some focus-group participants reported positive experiences with the exchanges that sell subsidized coverage, most were overwhelmed by unaffordable out-of-pocket costs associated with high deductibles. Participants also reported frustration with surprise medical bills and the high cost of prescription medicines.

Data from the focus groups showed that the Medicaid participants faced more serious health issues and greater financial challenges than those in the exchange focus groups. Though most participants did not associate their Medicaid coverage with the ACA, they were satisfied with their plan and were concerned about a possible repeal of the Medicaid expansion.

Participants in the Medicaid groups had mixed views of more minor changes, such as charging nominal premiums to enrollees or incentives for healthy behaviors, as Kentucky has proposed. However, they were not supportive of lock-out periods for failure to pay potential premiums on time, another part of Kentucky's waiver request to the Trump administration.

U.S. Sen. Lamar Alexander

U.S. Sen. Lamar Alexander (R-Tenn.), also a former governor of the state, recently told Politico that Republicans in Congress will not only keep the Medicaid expansion, but will broaden it.

Alexander said Congress first needs to fix the subsidized insurance markets, "which are suffering from high premiums and low competition, even if they represent just 4 percent of those insured in the United States," Politico reported. "From there, he wants Republicans to turn to Medicaid expansion — which Republicans will keep and potentially even broaden, he says — before eventually addressing problems with the country’s patchwork of employer-sponsored health care plans. In essence, Alexander is trying to triangulate an approach that can become law." Compare to-date ACA replacement proposals here.

If Congress does expand Medicaid, it's likely to be modeled after Indiana's waiver program, enacted by Vice President Mike Pence when he was governor. The Indiana program is also the model for Kentucky's waiver request.

Poll finds that 22 percent of Kentucky adults say they delay or forgo health care due to cost

By Melissa Patrick
Kentucky Health News

Two in 10 Kentucky adults continue to report that someone in their household has delayed or skipped needed medical care because of cost, according to the latest Kentucky Health Issues Poll. The survey found that such struggles are greatest for the poor, people with the poorest health, and those without health insurance.


The poll, taken from Sept. 11 to Oct. 19, found that 22 percent of Kentucky adults said that did not get the medical care they needed, or delayed care because of cost in the past 12 months. That figure has remained about the same since full implementation of the Patient Protection and Affordable Care Act and Kentucky's expansion of Medicaid in 2014. The differences from year to year were not statistically significant.

"Delaying care is not only dangerous for our residents, it is costly to the state," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll. "Kentuckians who delay care, for whatever reason, are more likely to end up in the emergency room for treatment that costs far more and could be less effective than treatment at an earlier stage."

The poll found that Kentucky adults who reported fair or poor health were more likely to say someone in their household delayed or did without medical health care due to cost, compared to those who reported excellent or very good health, 33 percent and 17 percent respectively. The poll also reflects that Kentucky adults in poor health increasingly struggle paying for their medical care, up to 33 percent in 2016 from 28 percent the year before.

It also found that 34 percent of Kentucky adults who remain uninsured have someone in their household who has delayed or done without health care in the past 12 months due to cost. Among those with health insurance, the figure is 20 percent.

Kentucky's uninsured rate dropped from from 20.4 percent in 2013 to 7.8 percent in 2016, a decline of 12.6 percent, according to Gallup.

The poll found Kentucky adults who were below 200 percent of the federal poverty level ($23,760 for an individual in 2016) were more likely to report that they delayed health care that those who earned more than this amount: 28 percent and 17 percent, respectively.

The poll was conducted by the Institute for Policy Research at the University of Cincinnati for the foundation and Interact for Health, a Cincinnati-area foundation. It surveyed a random sample of 1,580 adults via landlines and cell phones and has a margin of error of plus or minus 2.5 percentage points. The margin is larger for subsamples.

With Obama gone, emphasis is on 'care,' not him; Rep. Guthrie says voters want a replacement 'that creates a better opportunity'

"With President Barack Obama out of office, the debate over 'Obamacare' is becoming less about 'Obama' and more about 'care,' greatly complicating the issue for Republican lawmakers," writes Jonathan Martin, national political correspondent in the Washington Bureau of The New York Times. "Polling indicates that more Republicans want to make fixes to the law rather than do away with it. President Trump, who remains popular on the right, has mused about a replacement plan that is even more expansive than the original."

That's a contrast with the last seven years, when "few issues have animated conservative voters as much as the repeal of the Affordable Care Act," Martin notes. "As liberals overwhelm congressional town hall-style meetings and deluge the Capitol phone system with pleas to protect the health law, there is no similar clamor for dismantling it." Republicans in Congress told Martin that there is "significantly less intensity," as he puts it, among Obamacare opponents now that Obama is no longer president.

Rep. Brett Guthrie, R-2nd

Rep. Brett Guthrie of Bowling Green and Kentucky's 2nd District, who is on two health subcommittees in the House, said “I was here in 2009 and 2010, and we’re not getting the anti-Obamacare calls like that. I think people are going to hold us accountable for making sure we not only repeal, but we have a law in place that creates a better opportunity for people.”

Martin writes, "The demands from conservative-leaning constituents in districts like Mr. Guthrie’s are plainly shifting. In a nationwide CBS News poll last month, 53 percent of Republicans said they wanted to change the law to make it work better while 41 percent said they wanted to abolish it. Overhauling the law, however, is far more politically complicated than simply scrapping it."

The law passed with no votes from Republicans, and they have campaigned against it ever since. Now that they control the government, except the lack of a filibuster-proof majority in the Senate, the debate has "shifted from the theoretical to the tangible," Martin reports.

"It was easy for conservatives to rally against a law identified with a president they despised when he was capable of vetoing any repeal," he writes. "Now that he is gone and the law’s benefits appear to be on the chopping block, the people who stand to lose the most are the most vocal."

The "wild card" in the process is President Trump, who "has said multiple times that he is uneasy about depriving anybody of health insurance, and he may bridle if Democrats attack any Republican plan that may lead to that," Martin writes. "As Democrats note, Mr. Trump owes his victory in part to voters who have benefited from the law."

Kentucky is an example of that. More than half a million Kentuckians, the great majority of them on expanded Medicaid, are among the 20 million Americans who gained coverage under the law. By some measures, the state has had the largest percentage decrease of people without health insurance.

Senate Majority Leader Mitch McConnell said Friday that Republicans will have to repeal and replace the law without Democratic help or votes. “It’s clear that in the early months it’s going to be a Republicans-only exercise,” he said. “We don’t expect any Democratic cooperation on the replacement of Obamacare. . . . Clearly this is not one of those bipartisan ‘Kumbaya’ moments.”

But Republicans may still need Democrats. The GOP can pass budget- and tax-related measures with a simple majority, under budget-reconciliation rules, but it remains to be seen how that can be done with the rest of the law.

State Senate panel OKs bill to deny most taxpayer dollars to Planned Parenthood; Ky. affiliate gave up funding in 2015

Feb. 22 Update : SB 8 passed out of the full Senate with a 31-6 vote and now heads to the House for consideration. 

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – A bill that would effectively deny most tax dollars to Kentucky's Planned Parenthood locations in Louisville and Lexington passed out of a state Senate committee Feb. 17.

Senate Bill 8 would create a three-tier system to direct how federal family planning dollars are distributed in the state, with money first going to community health departments and federally qualified health centers, followed by private organizations that provide comprehensive primary and preventive health services, with Planned Parenthood third in line.

In 2015 Planned Parenthood's Kentucky affiliate stopped accepting its federal funding of about $300,000 per year, but Wise said the law is still necessary because "there is currently nothing in law that should prohibit them from in the future needing access to Title X family funds."

The bill would prohibit Planned Parenthood from receiving state or local funds, but it could still be paid by Medicaid, which is mainly funded by the federal government. Federal money does not pay for abortion.

Sen. Max Wise

The bill passed 8-3 along party lines out of the Senate Veterans, Military Affairs and Public Protection Committee, though Sen. Julian Carroll, D-Frankfort, said his vote was a "reluctant no" because of concern that it would reduce women's access to health services.

Texas, Kansas and Ohio have similar laws. The legislation wouldn't take effect until Congress repeals a regulation that prohibits family planning money from being allocated through a tiered structure. The U.S. House has already scheduled a vote on that, said Sen. Max Wise, R-Campbellsville, the bill's lead sponsor. It passed the measure Thursday.

“I come before you today thankfully more optimistic about the prospects of protecting unborn life than I was last year when the committee heard this similar bill,” Wise said.

Opponents of abortion have stepped up efforts to defund Planned Parenthood, which performs abortions but not in Kentucky, since undercover videos released in 2015 purported to show that it sells unborn baby parts for profit.

Wise cited the videos as a reason to support the bill, but they have been found to be heavily edited and misleading. FactCheck.org, a nonpartisan service of The Annenberg Center at the University of Pennsylvania, says, "The full, unedited video they cite as evidence shows a Planned Parenthood executive repeatedly saying its clinics want to cover their costs, not make money, when donating fetal tissue from abortions for scientific research." Experts also said the amount of money mentioned in the videos was not enough to create a profit.

Tamarra Wieder, director of external affairs at Planned Parenthood Advocates of Indianan and Kentucky, said in an interview after the meeting. "The ultimate agenda here is not women's health, it's about outlawing abortion and restricting people's ability to choose what's right for them."

Wise said another reason to withhold funding from Planned Parenthood is because it has a "vested, financial interest" in directing women toward abortion, noting that in 2013-14 the organization had provided 323,653 abortions and made 1,880 adoption referrals.

Federal and state law does not allow tax dollars to be used to pay for abortions, but Wise suggested that it is difficult to ensure that this money isn't crossing over for abortion services: "Under Title X grants, abortion providers can pro-rate expenses such as staff and waiting rooms, carving a portion of the fixed cost of the abortion related staff and facilities."

Opponents of SB 8 (L-R) Dr. Mary Sterrett, Sage Martin and
Tamarra Wieder speak to committee (Photo by Melissa Patrick)

The committee chair, Sen. Albert Robinson, R-London, chairman of the committee, had six opponents of the bill to speak for a little over 15 minutes before Wise presented it.

Wieder told the committee that as a military wife, she was referred to Planned Parenthood because the base was unable to care for her gynecological needs.

"As one of the state's leading and most trusted providers of comprehensive reproductive health care, Planned Parenthood in Kentucky serves more than 7,000 patients a year, a vast majority being low-income women of childbearing age," she said.

Sen. Denise Harper Angel, D-Louisville, the only woman on the committee, voted no and said, "With all the serious issues facing Kentucky, I don’t understand why we spend our time just taking away services for the women of Kentucky."

Wise said that if women need family-planning services, they could go to their local health department or federally qualified health center. But Wieder said, "They say you can go to the health department for this care ... and that's not true. Louisville and Lexington, there is no family planning services from the health department, they contract out. . . and that's not unique to just Louisville and Lexington."

The Louisville Metro Health Department confirmed that, and said it contracted with Planned Parenthood until it stopped taking Title X money. It now sends patients to Family Health Centers, which is a federally qualified health center.

Wieder said the FQHCs in Louisville often refers patients to Planned Parenthood for reproductive health services because "they are inundated with patients seeking other services and they don't have experts in the field that can manage that care, so we do get a lot of referrals from the FQHCs throughout the state, and specifically in Louisville and Lexington."

Tobacco ban for public-school properties and activities heads to the House on 25-8 Senate vote

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The state Senate passed a bill Feb. 15 to ban the use of tobacco products and electronic cigarettes on public-school properties and during school activities, but not without debate about local control and overreach.

Senate Bill 78 would prohibit use of tobacco products by students, faculty, staff and visitors in schools, school vehicles, properties, and activities, and give one year to adopt, implement and enforce the policy. It passed 25-8, with two pass votes and now heads to the House for consideration.

Sen. Ralph Alvarado

The sponsor, Sen. Ralph Alvarado, R-Winchester, told the committee that the bill "is a beginning attempt to help reduce our youth smoking rates in Kentucky," which at 17 percent ranks third in the nation. "A strongly enforced tobacco free school policy can prevent or delay students from using tobacco. Some studies have shown up to a 30 percent reduction in student smoking."

Despite earlier comments by Alvarado that he didn't think others would "dare" oppose a bill to decrease Kentucky's youth smoking rates, several legislators voiced concerns about local control, overreach, unintended consequences and enforcement.

Sen. Paul Hornback, R-Shelbyville, acknowledged the bill's good intent and noted that Shelby County school district was smoke-free, but he also pointed out that the ban doesn't just concern students, "but also concerns the school bus drivers at the school bus garages and places where there aren't even any students around."

"So, I'd urge the members to think about this," Hornback said. "You know, we are in favor of local control until we are not, and this is one of those things where we want to come down and mandate to the local school boards what they need to do, rather than letting them decide like they are doing right now."

Hornback, who was a prominent tobacco farmer before becoming a senator, also wanted to know if a person would be in violation of the law if they had tobacco in their personal vehicle while on school property.

Alvarado replied, "If you would be on school property, you would be in violation, according to this. Again, the enforcement on the policy would be up to the local school boards."

Alvarado, a physician, said he changed the bill at the behest of the Kentucky School Boards Association and superintendents to allow school districts to develop their own enforcement policies.

Just over half of Kentucky's public-school students are in school districts with tobacco-free policies: 62 of the state's 173 districts, covering 654 schools.

Sen. Robin Webb, D-Grayson, said she also appreciated the intent of the bill, but had concerns about its overreach and enforcement, noting that as written, the bill would not allow volunteers or chaperones to use tobacco products in the privacy of their own hotel room on a school-sponsored trip.

"I just think it is a little far-reaching. I don't think it's enforceable," Webb said. "I don't know what the enforcement would be unless it would go back to that local control. I think there are some portions of this bill that are a little vague, undefined and extends beyond the scope of the intention of the bill."

Webb passed on the vote. So did Sen. Johnny Ray Turner, D-Prestonsburg, a basketball coach at a smoke-free school. He voiced concerns about the financial impact of the bill on schools if attendance decreases at outdoor sporting events because people can't smoke. He said tobacco policy should be a local decision.

Besides Hornback, senators who voted against the bill were Republicans Joe Bowen of Owensboro, Tom Buford of Nicholasville, Stan Humphries of Cadiz, John Schickel of Union and Wil Schroder of Wilder, and Democrats Julian Carroll of Frankfort and Perry Clark of Louisville.

Mark Pyle, Christian County health director, is named state's deputy commissioner of public health

Mark Pyle

The director of the Christian County Health Department in Hopkinsville will be the new deputy commissioner of the state Department for Public Health.

Mark Pyle will serve as the state's chief liaison with Kentucky's 63 district, county and independent health departments. The job was briefly held by Randy Gooch, who returned to his old job as health director in Jessamine County, saying it suited him better.

Pyle has headed the Christian County department for nine years, and led it to national accreditation. "Although national accreditation was a crowning achievement, it was not the most important," he told the Kentucky New Era. "The most important achievements were the development of community partnerships, implementing evidence based/population based health programs and forming a culture of above-the-line performance."

Legislature moving bills targeting fentanyl sales, shortening length of most opioid prescriptions to three days

The General Assembly is moving bills to increase penalties for the sale of fentanyl and put a three-day limit on prescriptions of other high-potency painkillers, in an effort to stem the state's opioid epidemic.

Kim P. Moser

"This is a public-health crisis," freshman Rep. Kimberly Poore Moser, R-Taylor Mill, a former nurse who reminded the House Judiciary Committee that Kentucky has the nation's third highest rate of deaths from opioid overdoses.

Her legislation would raise the penalty for selling any amount of fentanyl, "a powerful synthetic opioid," reports Bruce Schreiner of The Associated Press. "Current law allows lesser felony charges, with lighter penalties, for people convicted of trafficking less than 2 grams."

"The bill would create a new crime of trafficking in a misrepresented controlled substance, a felony punishable by one to five years in prison," Schreiner writes. "It's aimed at drug dealers who sell fentanyl to buyers who think they're getting less-potent painkillers, with sometimes deadly results."

Read more here: http://www.kentucky.com/living/health-and-medicine/article133010659.html#storylink=cpy

Rep. Robert Benvenuti, R-Lexington, said at the House Judiciary Committee's Feb. 15 meeting, "We have people in this commonwealth who are actively marketing something that is the equivalent to shooting somebody. And we've got to have strict penalties for that. . . . And if it means longer terms of incarceration, there's one way not to get into that situation – don't traffic in this stuff."

The bill would also "direct licensure boards overseeing doctors and others with prescriptive authority to write regulations setting guidelines to generally limit a patient's supply of painkillers to three days," Schreiner reports. "There would be exemptions in cases of chronic pain, end-of-life and cancer care and if a provider believes there's a medical necessity for a longer prescription."

Gov. Matt Bevin told the committee, "We've got to make it harder to get addicted." Schreiner reports, "Bevin said no amount of government money or rehabilitation programs will fix Kentucky's drug woes until action is taken to reduce the state's acute drug addiction rate."

The committee approved the bill on a bipartisan vote. The day before, the state Senate passed and sent to the House a bill to toughen penalties for people caught trafficking smaller amounts of heroin or fentanyl.

About 3/4 of the Kentuckians getting free exams and screenings via Medicaid are covered by its expansion, study finds

More than three-fourths of the Kentuckians who got free medical screenings through Medicaid last summer were covered by the expansion of the program under the Patient Protection and Affordable Care Act, according to a study done for the Foundation for a Healthy Kentucky.

Likewise, almost three-fourths of Medicaid substance-abuse treatments were for people included in the expansion of the program to people with incomes up to 138 percent of the federal poverty level, $16,394 for an individual or $33,534 for a family of four.

Medicaid covered more than 44,000 dental exams, 10,143 screenings for breast cancer, 6,319 colorectal cancer screenings, 6,153 hepatitis C screenings and 4,495 diabetes screenings for non-elderly Kentucky adults during July, August and September 2016. It also covered 7,039 births, 22 percent of which were for for expansion patients.

"The dramatic growth in preventive health screenings for low-income Kentucky adults is one of the most meaningful benefits of Medicaid expansion in Kentucky," said Ben Chandler, CEO of the foundation. "Getting recommended tests such as colorectal cancer screenings, mammograms or dental exams gives Kentuckians the chance to either prevent chronic disease or get earlier treatment. These screenings can quite literally save lives. They can also lead to significant savings for Medicaid and other programs that pay the cost of caring for Kentuckians who otherwise would put off medical visits and just get sicker."

Since the Medicaid expansion began in January 2014, people covered by it have had 224,720 dental exams, 15,692 screenings for diabetes, 59,529 breast cancer screenings, 38,190 colorectal cancer screenings, 24,157 hepatitis C screenings and 53,465 substance-abuse treatments, according to the study by the Health Access Data Assistance Center at the University of Minnesota.

State Senate committee approves bill to remove insurance-company barriers to smoking-cessation treatments

Feb. 22 Update: SB89 passed 35-2 out of the full Senate and now heads to the House for consideration. March 14: SB89 passed 90-1 out of the full House. March 21: SB 89 was signed by Gov. Matt Bevin. 

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Kentuckians could get treatments to help them quit smoking without facing obstacles from their insurance companies, under a bill that a state Senate committee approved unanimously Feb. 15.

Sen. Julie Raque Adams

Senate Bill 89 would require all insurance policies sold in Kentucky to cover all smoking-cessation medications and counseling approved by the U.S. Food and Drug Administration "with no barriers to access," said Sen. Julie Raque Adams, the bill's sponsor. "The choice is simple: If Kentuckians want to quit smoking, they will have true access to the necessary tools. If they don't, no money or effort is expended."

The Patient Protection and Affordable Care Act requires all insurance policies to cover smoking-cessation treatment, but Adams said that doesn't mean they are readily available. The Louisville Republican said many insurers have barriers to treatment such as co-payments, prior authorization, limits on length of treatment, annual and lifetime limits on attempts to quit, and step-therapy requirements that dictate the order in which physicians can prescribe treatments. SB 89 would provide barrier-free access to all U.S. Preventive Services Task Force-recommended smoking cessation treatments in all Kentucky health plans, including Medicaid.

Dr. Shawn Jones, senior physician in the Ear, Nose and Throat Group at Baptist Health Paducah and past-president of the Kentucky Medical Association, said in a telephone interview that he runs into these barriers "all the time."

"A lot of times we will want to try certain medications, whether it is a medication that has been out for a long time, like Wellbutrin or [a newer one like] Chantix, and a lot of insurers won't pay for that, even though the studies say they are much more effective than the nicotine-replacement-therapy that the patient may have already tried over-the-counter, and that doesn't count because it wasn't from a prescription from the physician," he said.

Asked if he ran into annual limits on quit attempt barriers, Jones laughed and said, "I haven't been able to get a whole lot of people covered the first time, so I haven't had the trouble of getting them covered the second time. My experience has been more with the Medicaid population and it's very difficult to get them the treatment they need."

Dr. Shawn Jones

Jones, who spoke in favor of the bill at the Senate Health and Welfare Committee meeting, said smoking costs the state $1.92 billion in annual health-care costs, of which $590 million goes to Medicaid (most of which is federally funded), and kills almost 9,000 Kentuckians a year. The state leads the nation in smoking; 26 percent of Kentucky adults smoke.

"If we are going to use the word crisis with respect to the opioid epidemic in Kentucky, and I think we should, then we must do the same with regard to smoking," he said, noting that smoking kills many more people. "Smoking in Kentucky is nothing short of a catastrophic pandemic of gargantuan proportions, and that does not do it justice."

Jones said 70 percent of U.S. smokers say they want to quit, and 34 percent of those try to quit, but only about 10 percent are successful. "It's not easy to quit smoking," he said. "Many smokers simply cannot quit without true, barrier-free access to the treatments prescribed by their doctors, and physicians play a critical role in helping people quit."

Jones wrote in an op-ed in the Lexington Herald-Leader that the insurance companies' set of obstacles "makes it extremely difficult for smokers to stay motivated to quit."

Erica Palmer Smith, speaking on behalf of the American Cancer Society Cancer Action Network and other patient advocacy groups, told the committee that insurance companies' barriers to access "cause confusion among providers and patients about the availability of treatment, meaning fewer Kentuckians don't attempt to quit smoking."

Adams said after the meeting that the bill has the support of the state Cabinet for Health and Family Services, and noted that the state Department of Insurance estimated the financial impact of SB 89 to be minimal, $1.10 a year for the average policyholder. She said it will save insurance companies and Medicaid money in the long run.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, applauded the committee's vote. "If anyone wants to quit smoking, we ought to help them do it, instead of throwing up roadblocks," he said in a news release. "Senate Bill 89 will improve health in Kentucky and save taxpayer money."

Ky. uninsured rate has dropped significantly under Obamacare, but many struggle with maintaining stable coverage

By Melissa Patrick
Kentucky Health News

Many more Kentuckians have health insurance because of the Patient Protection and Affordable Care Act, but more than one in five Kentucky adults under 65 say they still don't have stable coverage, according to the latest Kentucky Health Issues Poll.

The Sept. 11-Oct. 19 survey found that 12 percent of Kentuckians aged 18 to 64 were uninsured. Another 9 percent reported they had health insurance, but had been uninsured at some point in the past 12 months.

"Health insurance is still an iffy proposition for more than one in five Kentucky adults who are 18 to 64," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll. "While the ACA has ensured coverage for over 355,000 Kentuckians from 2014 through 2015, there's still a significant number of Kentucky adults who can't rely on getting routine preventive and wellness care, let alone effective treatment for chronic conditions, because they can't rely on insurance to cover the cost."

The poll also found that the number of Kentuckians 18 to 64 on public insurance has dropped, while the number with employer-sponsored health insurance was about the same as last year.

Public insurance, such as Medicaid or military benefits, was reported by 29 percent of Kentucky adults under 65, down from 35 percent in 2015. Forty-five percent of Kentucky adults said they had employer-sponsored coverage in 2016, compared to 41 percent in 2015. The latter difference is not statistically significant, because the poll's error margin is plus or minus 2.5 percentage points, but chances are that fewer Kentuckians had such coverage.

The uninsured rate for Kentuckians 18 to 64 has dropped by more than half since the 2014 implementation of the ACA. The report notes that 97 percent of all Kentuckians 65 and older have health insurance.

Among Kentuckians aged 18 to 26 who reported having health insurance, 24 percent said they were covered on a parental plan, made possible by the ACA.

Chandler said, "As the Commonwealth moves forward to transform Medicaid, the foundation is working to help policymakers understand who has health insurance coverage and who doesn't. KHIP is one piece of the foundation's ongoing work to help sustain the gains Kentucky has made while identifying gaps we still need to fill."

The poll was conducted for the foundation and Interact for Health, a Cincinnati-area foundation, by the Institute for Policy Research at the University of Cincinnati. It interviewed a random sample of 1,580 adults on both landlines and cell phones.

Humana says it will pull out of government health-insurance exchanges next year

Humana Inc. announced Feb. 14 that it would stop selling health insurance through the government marketplaces created by federal health reform. That made the Louisville-based company "the first major insurer to cast a no-confidence vote over selling individual plans on the public exchanges for 2018," The New York Times noted.

The company said its early analysis of Obamacare enrollment for this year showed “further signs of an unbalanced risk pool,” meaning too many "customers with expensive medical conditions continued to enroll as compared with healthy people," Reed Abelson explains for the Times.

The change will mean relatively little to Kentucky, since Humana was selling on the federal exchange in only nine counties (Bourbon, Bullitt, Clark, Fayette, Jefferson, Jessamine, Oldham, Scott and Woodford) and off the exchange in nine (Boone, Bullitt, Campbell, Gallatin, Grant, Jefferson, Kenton, Oldham and Pendleton).

"Humana is not a major player in the individual exchanges and is among the national insurers, like Aetna and UnitedHealth Group, that have struggled to make money in the market," Abelson notes. Humana and Aetna abandoned their planned merger after a federal judge ruled it would violate antitrust laws.

On the Obamacare exchanges, "The company has steadily scaled back its presence, selling policies for 2017 in just 11 states," Abelson notes. "The company’s main focus has been selling private insurance under Medicare," under the brand Medicare Advantage.

Study analysis by Ky. critic of hospital safety estimates more than 200,000 preventable hospital-associated deaths each year

An analysis of two well-controlled studies estimates that the number of preventable hospital-associated deaths are over 200,000 each year, argues a commentary in the Journal of Patient Safety.

In an online review, Dr. Kevin Kavanagh, the lead analyst, acknowledges that critics of such studies will say the data is flawed because they often include older and sicker patients.

However, he adds they also don't include diagnostic errors, deaths that occur after the patient goes home from the hospital, or don't include data about patients whose deaths are imminent. Thus, he concludes, the number of deaths in these studies are more often underestimated, not overestimated.

"The onus is on the facilities to provide better data," he said, adding that his analysis looked at the two studies with the most rigorous data sets.

"We calculated an annual rate of 163,156 preventable deaths and when combined with diagnostic errors, non-captured events and deaths after hospitalization can be projected to approximate 200,000 preventable deaths annually," Kavanagh, a retired physician and chairman of HealthWatch USA, said in an e-mail.

The report says that despite having the knowledge to prevent many adverse events, "many health systems do not adequately invest in patient safety to put well-known safety improvement strategies in place." The report offers as an example resistance to mandatory nurse-to-patient ratios, which have been proven to decrease falls, pressure sores, urinary tract infections and decrease medication errors.

"Advocates are not calling to prevent problems for which solutions are not known, but calling to implement known solutions to prevent all too common problems," the report says. "What ties the occurrence of preventable adverse events and mortality together is the willingness and determination of facilities to adopt a culture of safety and to invest in patient safety."

It also points out that data from countries with nationalized health care systems and "well-defined and near-uniform implementation standards" cannot be compared to the United States' combination of non-profit, for-profit and government-systems.

Kavanagh said that even if the preventable hospital mortality rate from medical errors "is not the 163,156 that we have projected, but is as low as the 25,000 per year based on the United Kingdom's NHS data, that equates to approximately 5 potentially preventable deaths per year, per hospital in the United States, or one every two to three months.

"In addition, one could argue that this figure should be doubled by accounting for deaths from diagnostic errors," Kavanagh writes. "In what other industry would such a record be tolerated, let alone defended? Would the airline industry and public ever tolerate even a single preventable airline crash? We can and must do better."

KET examines successful recoveries from opioid addiction, airs a forum to discuss Kentucky's opioid crisis

Kentucky Educational Television is airing "Journey to Recovery," a documentary that looks at Kentucky's opioid epidemic and explores the state's available treatment options through personal stories of recovery.

The program, narrated by Grammy-winning recording artist and Kentucky native Sturgill Simpson, first aired Monday, Feb. 13. It will be air again Wednesday, Feb. 15 at 2 a.m. ET. KETKY will show it Feb. 16 at 3 p.m.; Feb. 18 at 2 a.m.; Feb. 27 at 11 a.m.; and March 8 at 10 a.m. (all ET). Go to http://www.ket.org/health/opioids for archived KET and national programs addressing the growing opioid epidemic.

Opioids, including heroin and many prescription painkillers, killed more than 33,000 people in the United states in 2015, according to the Centers for Disease Control and Prevention. In Kentucky, 1,248 died from drug overdose in 2015, up from 1,071 in 2014, according to a report from the Kentucky Office of Drug Control Policy. 

The documentary examines both abstinence-only programs as well as medication-assisted treatment programs. In addition to interviews with recovered addicts, the program also has interviews with several of the nation’s top addiction experts, including Dr. Nora Volkow, director of the National Institute on Drug Abuse and Dr. Robert DuPont, a former NIDA director and founding director of the Institute for Behavior and Health.

After the documentary's initial airing, Renee Shaw hosted an "Inside Opioid Addiction Forum" to discuss ways to battle the opioid crisis. Panelists included Justice Secretary John Tilley and Health Secretary Vickie Yates Brown Glisson.

The forum is available online and will air on KETKY Feb. 14 at 6 p.m., and on KET Feb. 15 at 3 a.m. It will also air on KETKY Feb. 15 at 5 a.m. and 11 a.m.; Feb. 16 at 4 p.m.; Feb. 18 at 3 a.m.; Feb. 27 at noon; and March 8 at 11 a.m. (all ET).

Republicans will not only keep the Medicaid expansion, they will broaden it, says Lamar Alexander, Senate health panel chair

Sen. Lamar Alexander (Photo by M. Scott Mahaskey, Politico)

Republicans in Congress will not only keep the expansion of Medicaid, but will broaden it, says U.S. Sen. Lamar Alexander of Tennessee, a former governor who is a familiar figure to many Kentuckians and is close to Senate Majority Leader Mitch McConnell of Kentucky.

That's what Alexander told reporters Burgess Everett and Jennifer Haberkorn of Politico, which headlines their story by saying that he could be "the stealth Republican force behind Obamacare repeal" and replacement. But other senators may disagree and have more leverage.

The Patient Protection and Affordable Care Act allows states to expand Medicaid to people earning up to 138 percent of the federal poverty level, $16,394 for an individual or $33,534 for a family of four. Democrat Steve Beshear did that as governor in 2014, adding 440,000 people to the rolls; Republican Gov. Matt Bevin is trying to reduce the cost, now that the state has to pay a small part of it: 5 percent this year, which would rise to the current law's limit of 10 percent in 2020.

Alexander told Politico that Republicans need to first fix the subsidized insurance markets the ACA created, "which are suffering from high premiums and low competition, even if they represent just 4 percent of those insured in the United States," the reporters write. "From there, he wants Republicans to turn to Medicaid expansion — which Republicans will keep and potentially even broaden, he says — before eventually addressing problems with the country’s patchwork of employer-sponsored health care plans. In essence, Alexander is trying to triangulate an approach that can become law."

President Donald Trump campaigned on a promise to repeal the law soon after taking office, but said recently it might be next year before that happens. "Daily Senate Republican lunches regularly erupt in disagreement over strategy," Politico reports. "It’s now mid-February without a clear path forward, after years of Republican show votes to repeal the law. . . . Conservatives inside and outside Congress have already grown frustrated with the GOP’s plodding pace."

Alexander is not as conservative as other Republicans. but he is chairman of the Senate Health, Education, Labor and Pensions Committee, which makes him a major player in the discussions. He "was one of the first lawmakers to call on Republicans not to scrap Obamacare until a replacement is ready to go," the reporters note. "That’s now the GOP’s mantra."

"If there’s a softer side to Republicans’ plans to gut the law, it’s best represented by Alexander, a lawmaker who so loves cutting a deal that he voluntarily left the top ranks of Republican leadership to better work with Democrats," Everett and Haberkorn write. "The folksy Tennessee senator is quietly prevailing upon Republican lawmakers to take a deep breath. . . . His goal, in a nutshell: to reassure millions of Americans that Republicans aren’t trying to snatch away their health insurance."

Alexander "repeatedly stressed" in the Politico interview that he is on the same page as Trump and House Speaker Paul Ryan, the reporters note. "Those relationships have given other Republicans confidence in Alexander’s role." Sen. John McCain (R-Ariz.), told them: “That’s the key guy.”

But Finance Committee Chair Orrin Hatch of Utah, whose panel has jurisdiction over taxes, insurance subsidies and Medicaid, told Politico that Alexander “doesn't have much to do with it. He takes a great interest in it, and I’m glad he does, and I want to get his best ideas.” The two disagree, for example, on taxes that fund the subsidies; Hatch wants to repeal them quickly, but "Alexander urges caution: If Republicans repeal taxes now, how can they be sure they’ll have the revenue needed to pay for their replacement plan?"

Newspapers big and small tackle Kentucky's opioid epidemic

The opioid epidemic, and the growing concern about stronger and more lethal painkillers, is getting plenty of coverage by major news outlets in Kentucky, one of the states most troubled by it. But smaller news outlets are also tackling the issue.

Click on image for larger version

The Courier-Journal's latest effort, by Beth Warren and Matthew Glowicki, explored the spread of fentanyl, which they write "is blamed for causing or contributing to nearly 43 percent of [Jefferson] County's 325 fatal drug overdoses last year — and taking more lives than homicides." The pressed-pill form resembles oxycodone and other weaker painkillers, but "A dose as small as two milligrams — about the size of Abraham Lincoln's cheek on a penny — can be lethal. . . . It's cheaper than heroin and delivers a more powerful high, appealing to manufacturers and traffickers. It's often made in China and shipped to Canada or Mexico and then hauled into the United States, but it also has been sent directly from China."

Van Ingram, director of the the state Office of Drug Control Policy, told the Louisville newspaper that he expects fentanyl to be the biggest factor in fatal overdoses in 2016, once the data are compiled. "Last year, fentanyl surpassed the known number of heroin-related deaths in Kentucky — with 28 percent of all fatal overdoses linked to heroin, compared to 34 percent to fentanyl," the reporters write. The latest threat is from carfentanil, "an elephant tranquilizer up to 100 times more potent than fentanyl."

Two weeks earlier, The C-J published a story by Warren about how overdose sites have become crime scenes, leading to prosecutions against drug dealers. The story began with an online exchange between an accused dealer and a victim, in which they discussed the possibility of a fatal overdose. The exchange, captured from her cell phone, provided not only a compelling start to the story but a compelling illustration that dominated the newspaper's front page: an example of translating digital media into print media.

The stories of addiction can be told from the viewpoints of police and of survivors of overdose victims, but also from the view of those who have survived addiction and are in recovery. The weekly Adair County Community Voice is doing that with a series titled "Journey to Recovery," the latest installment of which tells the story of Misty May, a mother whose would-be nursing career was destroyed when she became addicted to crack cocaine after just one dose.

"We've all heard the phrase 'all it takes is one time' when it comes to drug addiction, but you never truly understand this phrase until you have been through it yourself," Adam Capps begins his story about May, who has been sober for 11 years with the help of drug court, which requires treatment. It was accompanied by a sidebar about Kentucky's high rate of overdoses, a phone number to get help, and a note from the newspaper saying in part that "There must be open conversation in developing new tactics and ideas to combat drug dependency issues in our community. Locking the issues behind bars is not addressing or helping to fix our problems." In an editorial the next week, Capps wrote, "I've had to rearrange the way I think about drug addicts, and I hope the stigmas associated with addicts can become a thing of the past."

As Republicans wait to address Obamacare, Democrats and supporters of the law appear to gain new footing

This story has been updated.

"Republican efforts to repeal Obamacare could help Democrats do what they have been unable to for seven years: sell the American people on the benefits of the health law," James Hohmann writes for The Washington Post's "Daily 202" news briefing.

"Poll numbers are moving in their direction. Grassroots organizing – from protests to town halls – is en fuego [on fire]. For years, the national and local media focused on the problems with the rollout of the law. But reporters have begun writing much more, instead, about the people who stand to lose benefits they’ve obtained. . . . The tenor of press coverage has shifted dramatically since the election toward emphasizing plusses, rather than minuses, of the law."

Hohmann lists several news stories, some driven by activities of groups that favor the Patient Protection and Affordable Care Act, such as the "Save My Care Bus Tour" that stopped in Lexington. Meanwhile, Democrats say Republicans' lack of action has given supporters of the law time to mobilize.

The top Democrat on the tax-writing House Ways and Means Committee, Rep. Richard E. Neal of Massachusetts, told Hohmann that he expects that hospitals and health-care companies who benefit from the reform law will give public warnings about the dangers of repealing it: “Medicaid expansion has now become a middle-class benefit.”

The law allowed states to expand the program to people with household incomes up to 138 percent of the federal poverty level, $16,394 for an individual or $33,534 for a family of four. That added half a million Kentucky adults to the program. Republican Gov. Matt Bevin asked the federal government to approve changes that his administration forecasts would reduce Medicaid enrollment by 85,000, and the Trump administration is expected to approve.

But in Congress, "Many Republican politicians are speaking pretty openly about the political danger of scaling back coverage," Hohmann writes. "Lawmakers are getting nervous about facing the kind of contentious town halls that their Democratic counterparts faced in 2009," when the law was being debated, and several "have already faced big crowds of angry activists back home." Republican Gov. Paul LePage of Maine said at a town hall meeting, “I’m not sure you’re going to have anyone in Washington with the courage to repeal the ACA.”

That sort of talk may change now that former Rep. Tom Price of Georgia, a strong opponent of the law, has been confirmed as secretary of the Department of Health and Human Services. He and his fellow Republicans have had little to say about their plans for replacing the law since they gained almost full control of the federal government, and Sen. Bob Corker (R-Tenn.) told reporters Feb. 6 that he has “no idea” when Republicans might start drafting: “I don’t see any congealing around ideas yet.”

President Donald Trump said things would begin to happen once Price was sworn in, but he told Bill O’Reilly of Fox News last weekend, “Maybe it’ll take ’til sometime into next year” to develop a replacement plan, a process that will be “very complicated.” A week later, on CBS's "Face the Nation," Trump adviser Stephen Miller said, "We're a lot farther along than most people realize" and "We look forward to presenting details ... very soon."