Only two health-insurance companies offer 2018 individual plans on exchange; asking for rate increases averaging 27.5 percent

Update 8/11/17: The Centers for Medicare and Medicaid Services has extended the rate filing deadline for 2018 Obamacare marketplace plans until Sept. 5. 

By Melissa Patrick
Kentucky Health News

The only health insurer offering government-subsidized health plans everywhere in Kentucky for 2018 is asking for rate increases averaging 34 percent, and the only other insurer offering subsidized plans in the individual market wants a hike of almost 21 percent.

The rate requests reflect a base rate that will fluctuate with individual consumers based on their age, whether they smoke and where they live.

Table from Kentucky Department of Insurance website

Kentucky is down to two participating insurers in the individual marketplace for 2018: Anthem Health Plans of Kentucky Inc. and CareSource Kentucky Co., based in Dayton, Ohio.  Humana Inc., which offered individual plans in nine Kentucky counties this year, announced in February that it was leaving the individual market nationwide.

Anthem, which recently announced that it would no longer offer subsidized plan in Ohio, requested an increase of 34.1 percent for its individual policies in 2018.

"Anthem has changed its cost structure in part by making changes to the networks in which people can access doctors under their insurance plan," Boris Ladwig reports for Insider Louisville. "The Kentucky Department of Insurance will analyze the rate requests and decide by Aug. 16 whether they’re warranted. The department can approve, lower or raise the rates."

CareSource requested an increase of 20.8 percent. Overall, the average was 27.5 percent. Insurers offering small-group plans are asking for average hikes of almost 10 percent.

Once again, CareSource will offer exchange plans in 61 counties and Anthem will be the only insurer offering individual plans statewide -- leaving 54 of the state's 120 counties with only one insurer.

The Insurance Department attributes the rate increases to "market forces, an aging population, and systemic instability and uncertainty injected by the failure of Obamacare," the common name it uses for the Patient Protection and Affordable Care Act.

Anthem told Insider Louisville that its proposed rate hike reflects “increases in the cost of delivering medical services coupled with pharmacy expenses and overall increased use of health care services by Anthem members in ACA plans.” The company "warned that it might adjust its request — and its participation in the Kentucky market — in response to legislative changes, especially if the U.S. Congress eliminates or significantly lowers subsidies that help people buy health insurance," Ladwig reports.

The increases have also been attributed to the uncertainties about whether the federal government will continue to pay for cost-sharing subsidies that make coverage more affordable and whether it will enforce the individual mandate that requires everyone to have health insurance or pay a fine.

These uncertainties led Kentucky to extend its filing deadline twice, and has prompted some states to allow insurers to file two sets of premiums for different circumstances: continuation or repeal of the Obamacare cost-sharing subsidies, and the enforcement of the individual mandate.

Insurance Commissioner Nancy Atkins said in the news release that the rate increases are "commonplace for most states."

“DOI has emphasized to carriers that the best possible outcomes for Kentucky consumers must be achieved,” said Atkins. “Obamacare’s failure at the federal level combined with the collapse of the Kentucky Health Cooperative under the Beshear administration placed a substantial strain on the state’s entire healthcare matrix, which continues to impact the current stability of the marketplace.”

The cooperative was a non-profit insurer created under Obamacare to provide more competition in the marketplace, but then was not fully funded by Congress and had to liquidate. It covered 51,000 Kentuckians, many of them the state's unhealthiest people, and those clients have had to find new insurers who must assume their risk.

Both Anthem and CareSource increased their individual exchange policy rates this year by double digits, Anthem by 22.9 percent and CareSource by 29.3 percent.

Kentucky had 81,155 people enroll in coverage through its exchange during the 2017 open enrollment period. Open enrollment in HealthCare.gov for plan year 2018 begins Nov. 1. The release notes that all rates are subject to change and will be finalized by Aug. 16.

CareSource will offer individual exchange plans in these counties: Anderson, Bath, Boone, Bourbon, Boyd, Boyle, Bracken, Bullitt, Campbell, Carroll, Carter, Casey, Clark, Clay, Elliott, Estill, Fayette, Fleming, Floyd, Franklin, Gallatin, Garrard, Grant, Greenup, Harrison, Henry, Jackson, Jefferson, Jessamine, Kenton, Knox, LaRue, Laurel, Lincoln, Madison, Marion, Mason, Menifee, Mercer, Montgomery, Morgan, Nelson, Nicholas, Oldham, Owen, Pendleton, Perry, Powell, Pulaski, Robertson, Rockcastle, Rowan, Scott, Shelby, Spencer, Taylor, Trimble, Washington, Whitley, Wolfe and Woodford.

Three Kentucky journalists among 12 chosen in six-state region for Health Journalism Fellowship program

Three Kentucky journalists have been chosen by the Association of Health Care Journalists to participate in the 2017-18 Regional Health Journalism Fellowship program, including Melissa Patrick of Kentucky Health News, Deborah Yetter of The Courier-Journal and Lisa Gillespie of WFPL in Louisville.

They are three of 12 journalists in the mid-Atlantic region, defined as Maryland, Virginia, North Carolina, Delaware, Kentucky and West Virginia.

AHCJ Executive Director Len Bruzzese called the fellowship one of the most important programs the association offers.

“It’s wonderful to see so many reporters and editors – with such a wide range of experience – show their passion for continuing to build their health coverage expertise,” Bruzzese said in a news release. “This is certainly a topic area in which you can never be satisfied with what you already know.”

The year-long program, supported this year by the W.K. Kellogg Foundation, will provide established journalists with tools to improve the depth and amount of their local health coverage. Among other things, fellows in the program will attend a health journalism conference and a rural health journalism workshop, have access to an exclusive news webinar and attend several on-site trainings, including a customized briefing at the Centers for Disease Control and Prevention in Atlanta.

July 11: This story was updated to reflect that a total of 12 journalist have been chosen for this fellowship. 

Baptist Health Paducah opens nationally accredited cancer center

Grand opening of the Ray and Kay Eckstein Regional Cancer
Care Center. (Photo by Ryan Hermens, The Paducah Sun)

Baptist Health Paducah's new cancer center offers everything in one place to care for cancer patients and is one of 60 cancer centers out of 5,000 that has earned the highest level of accreditation, John Pfeifer reports for The Paducah Sun.

"Our patients are just going to love this," Mike Tutor, executive director for heart, oncology and radiology services, said at its June 27 grand opening ceremony. "Everything is in one place. Treatment will be more convenient and faster since they don't have to go from department to department. Dietary, lab, pharmacy, social work - everything is there, and there is room for a friend or family member to be with their loved ones."

Dr. Peter Locken, a radiation oncologist and member of the Baptist Health Foundation board, added, "We are in the upper 3 to 5 percent of accredited cancer programs in the nation. This is the jewel in our crown."

Bill Brown, president of Baptist Health Paducah, recognized the Eckstein family and members of the Ray and Kay Eckstein Charitable Trust for providing the "lead gift for the cancer center." Brown also offered condolences to the Eckstein family for the loss of Kay Eckstein, who died last week, Pfeifer reports.

"The purpose of this facility," Brown said, "is to make life easier for people fighting this disease."

"The second phase of the project -- renovation of the adjoining 12,000-square-foot radiation therapy suites -- is scheduled for completion later this year,"Pfeifer writes. The 44,000-square-foot Ray and Kay Eckstein Regional Cancer Care Center cost $19.1 million.

Danville paper looks at how the proposed health law would affect the local community

Danville's newspaper, The Advocate-Messenger, broke down and localized the potential impacts of the latest health bill in Congress.

Reporter Bobbie Curd first walked her readers through the Senate bill, noting how it compares to the House-passed health bill and the Patient Protection and Affordable Care Act, then showed how the proposed changes to Medicaid could affect Boyle County.

About 1.4 million people are covered by Medicaid in Kentucky, 470,000 of them through the expansion of the program to people who earn up to 138 percent of the federal poverty line. As of May 2017, Medicaid covers 8,517 people in Boyle County, Curd reports.

Under the repeal-and-replace bill passed by the House, the extra money for Medicaid expansion would end in 2020. Under the Senate bill, current funding would remain the same until 2021, but would be cut back to the traditional Medicaid level over the following three years.

In Kentucky, the federal government pays about 70 percent of costs for traditional Medicaid recipients and 90 to 95 percent for expansion members.

Both bills would cut federal support for traditional Medicaid, through spending limits that wouldn't keep pace with health-care costs. Experts say these cuts will cause states to either raise taxes, cut eligibility or cut benefits in order to maintain their programs.

Local health professionals and lawmakers in Boyle County told Curd what these changes to Medicaid would mean for their community.

County Public Health Director Brent Blevins said people who lose health coverage would have to resume using the emergency room and the health department. “You’re going to see people showing up needing primary care or specialized care that we don’t have,” he said. “Most of ours is preventative care, so where are those people going to go?”

Sarah Hempel is the office manager for her husband Dr. Rick Hempel, a geriatrician in Danville. She told Curd that the need for primary care is so great that they have had to “drastically change their practice” -- seeing 30 to 40 patients a day, making it hard to give quality care.

New doctors “won’t even go into primary care anymore,” she said. “There’s a huge primary-care shortage in this area — it almost has to be a calling,” she said.

Dr. Jeremy Stich of Access Med, a direct-care system where insured patients pay a flat monthly fee with no co-payments, voiced concern that the Senate bill was drafted without input from providers.

“It concerned me when it was done by non-clinicians,” he told Curd. “Too many politicians and too many lobbyists involved. It was the same with Obamacare. That hasn’t changed.”

Danville attorney Mark Morgan, who represents disabled people, told Curd, “I was going to three, maybe four funerals a year for clients who had passed away,” he says — direct results of not getting medical care or medicines. “When Medicaid expanded in Kentucky, that stopped happening. It was a day-and-night transformation. Most of the bad outcomes disappeared.”

He added, “I’m fearful that we’re going to return to the situation we were in before, sitting across the desk from people who can’t get diagnostic testing, can’t get meds and scripts, and I’m going to be going back to funerals again.”

Curd points out that affording health care is not just a challenge for the poor, but for the middle class because of the "surging bite of higher premiums and ridiculously large deductibles."

Blevins said the health department sees many middle-class people looking to afford their care: “I think more middle-class people are really struggling these days. These are families who are going to work every day, trying to pay their bills, not living outside of their means, giving to charity when they can, but are still struggling trying to pay medical bills. I think there’s a lot out there like that we don’t realize it.”

Stich added that working families are struggling to afford health care and are "literally faced with losing their home or their kids dropping out of college because they can’t afford it."

Morgan said, “The people we represent say frequently, ‘OK, I won’t get the medicines or go to the doctor,’ and I end up seeing them in the funeral home. And I’m tired of it, and I don’t want to see it any longer. Certainly not so that taxes can be cut for the wealthy.”

Number of drug overdose deaths in Kentucky continues to rise: 1,404 in 2016, a 7.4 percent increase from 2015

By Melissa Patrick
Kentucky Health News

Kentucky saw a 7.4 percent increase in drug-overdose deaths in 2016, largely driven by heroin and a synthetic opioid called fentanyl that is 30 to 50 times more potent than heroin and is often mixed with other drugs, according to a state report.

Lexington Herald-Leader maps

Of the 1,404 overdose deaths that occurred in Kentucky in 2016, almost half (623) involved fentanyl and one-third (456) of them involved heroin, according to the Kentucky Office of Drug Control Policy report.

“Fentanyl’s impact is really unprecedented,” Van Ingram, executive director of the ODCP, said in a news release. “Users have no way of knowing what drugs they are taking, and even the smallest amounts can trigger a lethal reaction. We’ve seen cases where a bad batch of drugs has led to dozens of overdoses in a single community overnight.”

Ingram added that while a drug that can reverse an opioid overdose called Naloxone is now widely available in Kentucky, he said it is not always effective against fentanyl and often requires several doses to revive the victim.

Three of the top five counties for the highest number of overdose deaths per person were in Eastern Kentucky -- Leslie, Bell and Powell -- along with Gallatin and Campbell counties in Northern Kentucky.

The top five counties for heroin related overdose deaths, fentanyl-related deaths and deaths involving both heroin and fentanyl were all in the state's most densely populated areas: Jefferson, Fayette, Kenton, Campbell and Boone.

Jefferson County had the most overdose deaths at 364, up from 268 in 2015;  followed by Fayette County at 162, up from 141 in 2015. Kenton County saw the largest decrease in overdose deaths, dropping to 90 deaths in 2016 from 112 in 2015. Bell and Knox counties also saw significant declines in overdose deaths, both by half. Click here for county-by-county data.

“Nearly every community in Kentucky experienced a fatal drug overdose last year— if that’s not a wake-up call, I don’t know what is,” Gov. Matt Bevin said in the release. “We don't have the luxury of pretending there isn't a massive problem."

2016 Kentucky overdose
deaths by age group 

The report found that Kentuckians between the ages of 35 and 44 died most frequently of a drug overdose, followed by those aged 45 to 54. More than 400 Kentuckians in the 35 to 44 age group died in 2016 from a drug overdose and more than 300 died in the 45 to 54 age group.

The report also showed that the number of deaths involving prescription painkillers decreased. Oxycodone was detected in 19 percent of deaths, down 4 percent since 2015, and hydrocodone was detected in 16 percent of deaths, down 5 percent. Alprazolam, or Xanax, a benzodiazepine, was detected in 26 percent of the deaths.

Ingram said Kentucky is taking a multi-faceted approach to battle the opioid epidemic: "Government, healthcare, law enforcement -- we are all working furiously to save lives," he said.

Most recently, a law just went into effect that gives the state the ability to schedule new fentanyl derivatives as they arrive on the street, increase penalties for drug dealers and limit the number of painkillers that can be prescribed for acute pain to three days, with some exceptions.  The state has also increased funding toward anti-drug efforts -- $14.7 million in 2016, $15.7 million in 2017 and rising to $16.3 million for fiscal year 2018.

"The consequences of the opioid crisis are far-reaching, affecting every corner of our communities. We must stand united against the opioid scourge and work together to find solutions. Failure is not an option," Bevin said.

In a June 27 Facebook Live video, the governor announced a public service campaign to raise awareness about the dangers of opioids. The campaign website ,DontLetThemDie.com, says Kentucky has the third highest drug overdose rate in the U.S.

Data for the report was compiled from the Kentucky Medical Examiner’s Office, the Kentucky Injury Prevention & Research Center and the Kentucky Office of Vital Statistics.

Form for religious exemption from vaccination can now be obtained online, with no role for any health-care provider

By Melissa Patrick
Kentucky Health News

Kentucky parents who don't want their children vaccinated for religious reasons can now get the religious exemption form online, have it notarized and submit it to their school upon enrollment -- instead of having to obtain it from their health-care provider along with their signature.

Laura Begin (pronounced buh-GEEN), health coordinator for the Cabinet for Health and Family Services Office of Policy and Budget, told the legislature's interim joint health committee that the changes had been in the works for several years, in response to complaints that a medical entity should not have authority over a religious exemption; that a co-payment was often required to get a provider's signature; and that parents and guardians were having trouble finding providers to sign the forms.

"It's still not a perfect form. I feel like it still exceeds the law's requirement. The law simply requires a signed, sworn statement to exempt yourself religiously from vaccines -- that's it," said Erika Calihan of Lexington, who said she was a representative for a "whole lot of moms" who believed in religious liberty. "This is like a thousand times more, but it's better and it's improved and that is because of voices in the community speaking out and standing up for religious beliefs."

Begin said that fewer than 2 percent of Kentucky's children have a religious exemption for vaccinations. In 2016, of the 99,805 students enrolled in Kentucky's schools, there were 202 medical exemptions and 521 religious exemptions.

The new form also includes educational information about the symptoms and effects of the communicable diseases that are prevented by immunization.

In response to public comments on the proposal, the cabinet changed the wording on the form to say "according to the CDC and KDPH," when describing the symptoms and effects of each disease, instead of "I acknowledge that there are increased risks associated if exposed to this disease." Those are acronyms for the federal Centers for Disease Control and Prevention and the Kentucky Department of Public Health. 

After the meeting, Eric Clark, legislative director for the cabinet, said the health department  is "compelled under the law" to share this educational information.

"The decision whether or not to immunize a child is a medical decision, with a vested public-health interest at stake. If an individual can make that decision on a form available online, rather than through the consultation and discussion of a health-care provider, it is the role of the Kentucky Department of Public Health to share information with the public on the risk and symptoms associated with diseases," Clark said.

Dr. Patty Swiney, former president of the Kentucky Academy of Family Physicians, told the committee that the religious decision to not immunize a child should be an informed decision based on "good information and evidence" and not on "fears and misinformation."

Research has disproven any relationship between vaccines and autism, a common concern among those who choose not to vaccinate. The 1998 study that claimed there was a link between the measles, mumps and rubella vaccine and autism has been declared fraudulent and been retracted.

"The best way to treat disease is to prevent it and that is what immunizations do," Swiney said. She added that we no longer have smallpox or polio, and that cases of chicken pox, measles and mumps are rare because of immunizations. But she also said, "We do have epidemic of these preventable illnesses because of children and patients that are not vaccinated."

In 2016, there were 70 confirmed cases of measles across the U.S., and most of those who contracted the disease were not vaccinated, according to the CDC. As of June 17, that number is already up to 108, with 78 of the cases in Minnesota, mostly in children who were not vaccinated, according to the Minnesota Department of Health.

Swiney also spoke to the dangers of meningitis, noting that 10 to 15 percent of people who get meningitis will die and of those who do survive, 20 percent will have a permanent disability.

"Your individual right only goes so far as it affects the public rights to health, and that is why I'm here standing up for this immunization policy," she said.

People who aren't eligible for certain vaccines, like infants, pregnant women and immuno-compromised individuals, depend on others to be vaccinated for protection, a concept called "herd immunity."

Calihan told the committee that the amendment wasn't about immunizations, but instead about religious liberty. "If a parent decides that it is against their religious beliefs to vaccinate  their child under state law we have a right and that is all there is to it," she said. "So it doesn't really matter what physicians say at this point because you are going to find physicians on both sides of the issue."

Calihan said many vaccines have "aborted fetal tissue, among other things that I find objectionable morally." However, the Children's Hospital of Philadelphia says: "Fetal cells are used to make five vaccines: rubella, chickenpox, hepatitis A, shingles and rabies. Fetal cells used to grow the vaccine viruses were isolated from two elective abortions performed in Sweden and England in the early 1960s. Further abortions are not necessary as the cells isolated in the 1960s continue to be maintained in laboratory cultures."

The updated immunization regulation requires a meningitis booster before 11th grade and a hepatitis A vaccine; consolidates the immunization certificate and medical exemption form; and requires home-schooled children who participate in school-sponsored activities to attend in-school classes to provide proof of immunization or an exemption.

It also adds meningitis B to the list of recommended, but not required, immunizations. Meningitis B is responsible for nearly 50 percent of all cases of bacterial meningitis.

The cabinet removed a requirement in the proposal that would require health-care providers to use the Kentucky Immunization Registry by July 1, 2018 in response to comments received.

The Interim Joint Committee on Health and Welfare and Family Services approved the religious exemption form as part of the updated immunization regulation June 21. It will go into effect July 1, 2018 for the 2018-2019 school year. The religious exemption form can be downloaded on the Kentucky Department of Education website and the CHFS and DPH websites.

McConnell pulls health bill for redrafting to get votes, warns Republicans that they might have to compromise with Democrats

McConnell and Sen. John Thune, R-S.D., leave a meeting with
President Trump. (Washington Post photo by Jabin Botsford)

Kentucky Health News

Senate Majority Leader Mitch McConnell delayed a vote on Republican senators' health bill Tuesday, saying it needed redrafting to get the votes it needs to pass. Republicans have 52 of the 100 Senate seats, so McConnell can afford only two defections, and six GOP senators had rejected the bill when he pulled it. Three more did later.

After Senate Republicans met with President Trump, McConnell said the Senate will not take up the bill until “a couple of weeks after this week.” He disputed the fear of some that taking more time will make it harder to pass a bill. “We’re not quite there, but I think we’ve got a really good chance of getting there,” he said. “It’ll just take us a little bit longer,” he said.

But McConnell also went public with a private warning he had issued to Trump and other Republicans: If they can't pass a bill, they will have to work on a bipartisan compromise with Senate Democrats, led by Charles Schumer of New York.

“Either Republicans will agree and change the status quo; or markets will continue to collapse and we’ll have to sit down with Senator Schumer,” McConnell said. “And my suspicion is in any negotiation with Democrats will include none of the reforms that we would like to make on the market side and the Medicaid side. “So for all of those reasons, we need to come up with a solution. The American people elected us to do that, and we’re working hard to get there.”

After releasing the bill last Thursday, McConnell was willing to change it to get votes, even with amendments on the floor, "but the timetable proved to be too ambitious, perhaps too highhanded," writes Dan Balz, chief political reporter for The Washington Post. "The resisters wanted changes — and several demanded more time. That was a toxic combination that McConnell could not overcome. . . . The road ahead will test him as perhaps never before."

The bill's chances dimmed after the Congressional Budget Office said Monday that it would lead to an estimated 22 million more Americans to be uninsured by the end of the coming decade while reducing federal spending by $321 billion.

"Under the Senate bill, CBO warned bluntly, higher premiums and deductibles would mean 'few low-income people would purchase any plan.' That’s why, after the CBO report, more Republicans began whispering that it might be better for McConnell to let the bill die," writes Los Angeles Times columnist Doyle McManus.

“The CBO changed the narrative in a bad way,” an unnamed Republican lobbyist told McManus. “It looks as if we will be sliding Obamacare back to the Democrats -- which is what Trump wanted from Day One.” McManus translates: "What he meant was: If Republicans give up and leave Obamacare in place, they can try to blame Democrats for any problems that ensue."

McManus says this week's developments have increased speculation that McConnell "secretly wants his health-care bill to fail. . . . In a normal political universe, McConnell would want his bill to pass – and my guess is that he still does. But he may be reconsidering."

McConnell remained firm that he wants a bill to pass. He told reporters, “The one thing that I would say is that everybody around the table is interested in getting to yes, interested in getting an outcome. Because we know the status quo is simply unacceptable, unsustainable, and no action is just not an option.”

But if the GOP passes a bill on it own, McManus writes, "Republicans will own every problem in the American health-care system. . . . McConnell hates to fail. But his chances of winning are eroding. According to some Republicans, he’s warming to the idea of taking a dive. It may be the only way he has to show Trump how difficult governing really is."

However, the CBO estimate that McConnell's bill would reduce the deficit more than the House bill gives him room to negotiate. Mike Allen of Axios reports, "An administration source insists there's a path to passage in the Senate, just as there was in the House despite the naysayers. The path as this source sees it: Some sort of deal that gives money in the short-term to the moderates in exchange for long-term reforms for the conservatives. The source said the short-term money would bolster Medicaid and the response to the opioid crisis. The conservative sweeteners would include spending-growth-rate assurances and regulation changes."

James Hohmann, who supervises the "Daily 202" roundup for The Washington Post, analyzes McConnell's performance: "The Senate majority leader believed that the blowback for keeping his health-care bill secret would be less than the blowback for negotiating it in public. On optics, he was correct. Polls show that most voters don’t really care about process. They weren’t particularly angry that he sought to forge consensus behind closed doors – or that he was being hypocritical by doing exactly what he used to attack Democrats for. But the Kentuckian misread the degree to which members of his own conference wanted a seat at the table. . . . There was technically a working group of senators that came up with the bill, but McConnell was in the driver’s seat. Republican senators who were invited to closed-door 'listening sessions' say they were sounded out about what they could and couldn’t support. But several grumbled that they couldn’t get any information out of leadership about what was and wasn’t on the table. Others said privately that the meetings felt less substantive and more like a box-checking exercise."

"Postponing the vote is not necessarily fatal," Hohmann concludes. "Never underestimate McConnell. Despite this miscalculation, he’s proven over 32 years in the Senate that he is a brilliant tactician. If he sincerely wants to get this done, he probably can find a way. But it will be the biggest legislative test of his tenure as majority leader."

Study finds women aged 25 to 44 are driving the increase in opioid-related emergency room and hospital stays in Kentucky

By Melissa Patrick
Kentucky Health News

Kentucky is a national leader in yet another measurement of the painkiller epidemic: the number of opioid-related emergency-room visits and inpatient hospital stays. That was established by a study which found that the numbers are largely driven by women between 25 and 44.

Kentucky ranks eighth in the rate of opioid-related emergency room visits for both men and women. For opioid-related inpatient stays, it is 10th among women and 16th among men.

The study, released by the federal Agency for Healthcare Research and Quality, analyzed inpatient data for 44 states and the District of Columbia and emergency room data for 30 states, both for 2014, the latest year for which full data are available for all states.

Among all the states studied, there was a 64 percent increase for opioid-related inpatient care and a 99 percent increase for emergency-room treatment since 2005.

The study placed Kentucky women in the top quarter of states for both opioid-related emergency room visits and opioid-related inpatient stays. The rates were 304 women per 100,000 people for hospital stays and 209 per 100,000 for emergency-room visits.

The study found that nationally, women are now as likely as men to be admitted to a hospital for opioid-related inpatient care. In 2005, men were more likely, but since then there has been a steady increase in the rate of inpatient stays for both men and women and they are now hospitalized at about the same rate. In Kentucky, women's inpatient hospital stays have been higher than men's since 2008.

(Click on the image to view larger versions of these charts)

Men are still more likely to be treated in the emergency room for opioid abuse than women, both nationally and in Kentucky, but both sexes have shown steady increases and are rising faster than inpatient stays, the study found.

Nationally, patients aged 25 to 44 had the highest rates for both opioid-related inpatient stays and opioid-related emergency-room visits, though patients aged 45 to 64 numbers had nearly identical rates as the 25 to 44 age group for inpatient stays. The report notes that both opioid-related hospital stays and emergency room visits have increased in all age groups since 2005.

In Kentucky, the 25-44 age group also led for both opioid-related inpatient stays (768 per 100,000 in the first three quarters of 2016) and opioid-related emergency-room visits (642 in per 100,000 in 2015).

(Click on the image to view larger versions of these charts)

These rankings should come as no surprise, since Kentucky has some of the highest rates of prescription drug use in the nation, which is one of the main contributors to opioid addiction. It also has one of the highest overdose death rates in the nation.

In 2015, the rate of drug-overdose deaths in Kentucky was just over 30 per 100,000, compared to 16 per 100,000 nationally, according to the Centers for Disease Control and Prevention. Put another way, 1,297 Kentuckians died from an overdose in 2015.

State Rep. Kim Moser told Kentucky Health News in March that there were 3.5 billion doses of opioids prescribed in Kentucky last year which, "enough for 79 pills per man, woman and child." She was describing a new state law that increases drug penalties and limits the prescribing of pain killers to three days for acute pain.

While speaking at a Kentucky Health News health-journalism workshop in November, Van Ingram, executive director of the Kentucky Office of Drug Control Policy, said 56 percent of people who died from an overdose in 2015 had an opioid prescription written in the prior 6 months to their death, 33 percent had a current opioid prescription, and 21 percent had an overlapping opioid or benzodiazepine prescription at the time of their death.

Legal battle over Kentucky's only abortion clinic widens; state imposes emergency rules, Planned Parenthood joins suit

State officials have filed emergency regulations "that some abortion providers say are designed to shut them down," The Associated Press reports. The emergency designation means the rules took effect as soon as the Cabinet for Health and Family Services filed them June 15.

"State law requires abortion clinics to have agreements with hospitals and ambulance services to transfer patients in case of a medical emergency," AP notes. "The new regulations say those agreements have to be a legal contract with a hospital within a 20-minute drive of the clinic."

The administration of Gov. Matt Bevin said the regulations are needed to minimize risks in an emergency. But an attorney for Kentucky's only abortion clinic, EMW Women's Surgical Center in Louisville, said the rules are intended to shut it down.

The state and EMW are already in a legal battle over the clinic's status. On Friday, a federal judge allowed Planned Parenthood of Indiana and Kentucky to join the case EMW filed against the state. Planned Parenthood claimed  the state will use its rules "to prevent any abortion facility from operating in the Commonwealth of Kentucky. No medical facility could ever keep up with the ever-shifting and undisclosed terms of the requirements."

Deborah Yetter of The Courier-Journal  reports,"Kentucky officials last year denied a license to Planned Parenthood to provide abortions at the clinic it opened in December 2015 in downtown Louisville, citing alleged deficiencies in its agreements with a hospital and ambulance service."

McConnell would phase out Medicaid expansion funds by 2024, cut old Medicaid after that; bill short of votes; Paul not on board

By Melissa Patrick and Al Cross
Kentucky Health News

Senate Republicans' bill to repeal and replace the Patient Protection and Affordable Care Act delivered few surprises but drew deadly opposition, putting Kentucky's senators on opposite sides.

Journalists mobbed McConnell. (Photo: Doug Mills, New York Times)

“I’m pleased that we were able to arrive at a draft that incorporates input from so many different members, who represent so many different constituents, who are facing so many different challenges," Majority Leader Mitch McConnell, who directed drafting of the bill by Republicans in secret, said in a floor speech.

Republicans hold 52 of the 100 Senate seats, so McConnell can afford to lose only two votes in his own party, and four Republicans -- including Rand Paul of Kentucky -- announced that they are opposed to the current version.

“Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation," the senators said in a statement. "There are provisions in this draft that represent an improvement to our current health-care system, but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs.”

Senators joining Paul were Ted Cruz of Texas, Ron Johnson of Wisconsin and Mike Lee of Utah. There was some doubt about the strength of the opposition from Cruz and Johnson, but then Sen. Dean Heller, R-Nev., said he couldn't be for the bill as written because of what it would do to Medicaid. President Trump said the bill "is going to be negotiated."

Sen. Rand Paul

Paul told Kelsey Snell of The Washington Post, "The bill looks like we are going to keep all of the Obamacare subsidies — in fact, we may well exceed the Obamacare subsidies. That’s a problem. The bill establishes new money — about $130 billion — for what they call a 'stabilization fund.' That money is going to go to insurance companies that make a $15 billion profit. I find it unconscionable that we’re going to give money to insurance companies that make a $15 billion profit. Those two things don’t look like repeal to me."

If the bill passes the Senate and House and is signed by Trump, two of the biggest impacts in Kentucky would be a phasing out of special funding for the state's 2014 Medicaid expansion by 2024, followed by cuts to traditional Medicaid in 2025.

Kentucky is one of 31 states that expanded Medicaid to anyone with household income up to 138 percent of the federal poverty line, $12,060 for an individual and about $33,000 for a family of four. Medicaid covers 1.4 million Kentuckians, 470,000 of them through the expansion.

Under a repeal-and-replace bill passed by the House, the extra money for Medicaid expansion would end in 2020. Under the Senate bill, it would remain the same until 2021, but would be cut back to the traditional Medicaid level over the following three years.

Then, federal support for traditional Medicaid would decrease, because it would have spending limits based on population rather than reimbursing a state a percentage of whatever it spends, based on a formula that gives poorer states more money. In Kentucky, the federal government pays about 70 percent of costs for traditional Medicaid recipients and 90 to 95 percent for expansion members.

"The cap imposed by the House would grow more slowly than Medicaid spending has, but the Senate’s cap would grow even more slowly than the House’s," Julie Rovner reports for Kaiser Health News. "That would leave states with few options, other than raising taxes, cutting eligibility, or cutting benefits in order to maintain their programs."

Kentuckians who buy private, subsidized health insurance on the federal exchange would also be affected by the Senate bill. During the 2017 open enrollment period, 81,155 Kentuckians enrolled for coverage through the exchange and four out of five of them received a subsidy to help pay for their premiums, according to the Kentucky Center for Economic Policy.

The 142-page bill would lower the qualifying level for people to get subsidies, starting in 2020, to 350 percent of the poverty line from 400 percent (about $94,000 for a family of four).

The bill also eliminates billions of dollars in taxes, mostly for the wealthy and the health-care industry, that are being used to pay the subsidies and the cost of the Medicaid expansion. The proposed tax cuts drew fire from Democrats.

Rep. John Yarmuth

“As the Senate proved again today, Trumpcare’s core mission is not to provide health care to Americans, but to give millionaires tax breaks and fundamentally end Medicaid as we know it," Democratic U.S. Rep. John Yarmuth of Louisville, said in a statement. "The results would be devastating for families: millions of Americans would lose coverage, key health-care protections would be taken away, and crucial services for seniors needing long-term care, children with disabilities, people struggling with addiction, and low-income families would be eliminated."

Jason Bailey, executive director of the Kentucky Center for Economic Policy, said in a statement: "No state has more to lose from this bill than Kentucky because no state has achieved more health and coverage gains in the last few years thanks to the Affordable Care Act. The bill would reduce Kentuckians’ health, harm the state’s most vulnerable and set us further back on fighting Kentucky’s opioid crisis. It will result in less coverage at higher cost, especially for poorer, older and sicker people. It will also lead to substantial job loss at hospitals and doctors’ offices and weaken Kentucky’s rural economies in particular."

In his floor speech, McConnell cited increases in premiums for Obamacare policies and said the 2010 law isn't working. "More Americans are going to get hurt unless we do something," he said. "American families deserve better than its failing status quo — they deserve better care."

The Senate bill would keep the Obamacare provision allowing children to stay on their parents' insurance policies until they turn 26. It would also keep the requirement for insurers to cover those with pre-existing conditions and charge them the same regardless of health history. However, it would allow states to waive some consumer protections such as the 10 essential health benefits, like maternity care and mental health treatment, that Obamacare requires in all insurance plans.

"This would allow insurers to offer less comprehensive policies, so those with pre-existing conditions may not have all of their treatments covered," CNN reports. It could "completely reshape the private insurance market," Danny Vinik of Politico reports. The bill also allows states to apply for federal waivers to eliminate the Obamacare mandate that barred insurers from setting a lifetime limit on an individual's benefits, The New York Times reports.

The bill would repeal the individual and employee mandates for buying health insurance. It would allow insurers to charge older people five times as much as younger ones; the current limit is three times. It would de-fund Planned Parenthood for one year.

UPDATE, June 26: McConnell released a slightly revised version of the bill Monday. "The newest plan would bar people from getting insurance for six months if they had a lapse in coverage for 63 days or more in the previous year," CNN reports. "The provision wasn't included in the original version of the bill, but health care experts have warned that without some kind of continuous coverage incentive, the health care market could become unstable. The point is to make sure healthy people have insurance, which helps keep premium costs down."

For an update from The Washington Post, with a side-by-side comparison of the House and Senate bills and the 2010 law, click here.

Grant County coalition wins passage of 'complete street' policies to improve the health of its citizens

Grant County High School student Brookynn Scudder urged
the Crittenden City Council to adopt a complete-streets policy.

A Grant County coalition has embraced a policy to make future streets in the county safer for all potential users, and one city's effort to enact such policies involved the county's youth.

The Fitness for Life Around Grant County coalition partnered with the Foundation for a Healthy Kentucky to adopt "complete streets" policies that ensures future projects are planned and designed around not only automobiles, but also pedestrians, bikers, motorists and transit riders of all ages and abilities.

Grant County is the first in Kentucky to enact a county-wide complete street policy, and such policies have also been enacted in its four towns: Corinth, Crittenden, Dry Ridge and the county seat of Williamstown.

Ben Chandler, president and CEO of the foundation, called complete-street rules "pro-health policies" that make it easier for community members to make healthier choices.

"People are more likely to forgo their cars when they have convenient, well-lit and well-maintained sidewalks, walking paths and bicycling lanes," he said in a news release. "And one of the best arguments for complete streets laws is they don't require a large up-front appropriation, because they guide future planning efforts and maintenance priorities."

Grant County's coalition is part of the foundation's "Investing in Kentucky's Future" initiative, a five-year, $3 million program, that provided matching grants and training to seven multi-sector community health coalitions across the state to address children's health issues. FFLAG selected childhood obesity as one of its issues to address under the foundation grant.

"The Foundation grant requirements, training and other support for changing systems and policy really spurred us to look at how we could improve walkability in our communities," Elizabeth Steffer, a health educator with the Northern Kentucky Health Department, which is a member of the FFLAG coalition, said in the release. "These new policies will lead to behavior changes that will long outlive the grant."

Example of the Grant County High School students' walkability assessment
presented to the Crittenden City Council to promote complete-street policies

Grant County youth played an active role in getting the policy passed in Crittenden, the most recent city in Grant County to pass the policy. Under Steffer's leadership, youth from Grant County High School worked with the coalition and the Step It Up Kentucky! campaign to get the policy passed.

The effort involved eight students who did a walkability assessment of Crittenden and then compiled their observations and photographs into a presentation to the Crittenden City Council in May, asking members to adopt the complete street policy, which they did on June 6.

"The students told council members that they had the power to make Crittenden healthier, and their presentation made all the difference in getting the ordinance passed," Steffer said.

Student Blake White said in the release that his work on the project was meaningful because it would help ensure the safety of his younger brother, who loves to ride his bike around the community.

The 2016 Kentucky Health Issues Poll found that one in four Kentucky adults rated their neighborhoods only a fair or poor as a place to walk, jog or bike. Two in 10 said their neighborhood was either somewhat unsafe or not at all safe for exercise.

"In addition to encouraging physical activity, enhancing community walkability attracts business investment and increases small business revenue," Chandler said.

Taylor Mill and Independence in Northern Kentucky have also passed complete-street policies.

Attorney General Beshear joins multi-state effort to investigate role of drug manufacturers in opioid crisis

By Melissa Patrick
Kentucky Health News

Attorney General Andy Beshear announced June 21 that he is working with attorneys general from across the nation to investigate whether drug manufacturers contributed to the opioid epidemic by illegally marketing and selling opioids, according to a news release.

Through May 2016, 1,248 Kentuckians had died from a drug overdose, according to the Kentucky Office of Drug Control Policy. This five-month death toll was almost as many as all of the overdose deaths in Kentucky in 2015: 1,297.

"We know that we had 3.5 billion doses of opioids prescribed in Kentucky last year and that is enough for 79 pills per man, woman and child. That's huge," Rep. Kim Moser, R-Taylor Mill, told Kentucky Health News in March.

Moser was explaining House Bill 333, which imposed harsher drug penalties and limited painkiller prescriptions to a three-day supply if prescribed for acute pain. Moser, sponsor of the bill, is the director of the Northern Kentucky Office of Drug Control Policy.

“The single greatest threat to Kentucky is our drug epidemic,” Beshear said in a news release. “The crisis is killing our family and friends – it is the main source of crime in our communities and it is preventing job and economic growth. This is the crisis of our times, and finding a solution requires everyone working together.”

The announcement was made following a lawsuit filed in Ohio earlier this year against Purdue Pharma, Endo Health Solutions, Janssen Pharmaceuticals, Cephalon and Allergan. The suit accuses the drug manufacturers of "misrepresenting the risks of prescription opioids and helping to fuel an addiction epidemic," NPR reports in an interview with Ohio's attorney general.

Beshear's office previously settled a lawsuit, filed by predecessor Greg Stumbo, against Purdue Pharma over OxyContin. The $8 million settlement was given directly to 15 substance-abuse treatment centers throughout Kentucky.

From a different drug-company settlement, Beshear's office allocated $2 million to expand and enhance Rocket Docket programs that expedite drug cases and allow select defendants rapid access to substance abuse treatment.

Beshear has also joined a multi-state lawsuit alleging the maker of Suboxone, a drug used for treating opioid addiction, tried to monopolize the market.

Bevin declines to join bipartisan group of governors' call for continuation of formula used to fund state Medicaid programs

By Al Cross and Melissa Patrick
Kentucky Health News

A bipartisan group of governors, including Kentucky Gov. Matt Bevin, is asking Congress not to shift health-care costs to the states, a real prospect as the Senate prepares to vote on a bill to repeal and replace the Patient Protection and Affordable Care Act.

However, Bevin declined to join the group's request to maintain federal funding rates for Medicaid, the program that covers 1.4 million Kentuckians and is in for big changes if Senate Republicans' health bill becomes law.

Bevin and Kentucky are part of the Governors' Bipartisan Health Reform Learning Network, organized by the National Governors Association Center for Best Practices. It has six Republican and seven Democratic governors from California, Delaware, Kentucky, Minnesota, Montana, Pennsylvania, South Dakota, Tennessee, Utah, Vermont, Virginia, Washington and Wyoming.

The governors summarized their priorities Wednesday, as details of the Senate bill were leaking out. It would end the Medicaid expansion later than a bill passed by the House, but would use a less generous formula for funding state Medicaid programs, beginning in 2025.

A statement of "shared priorities" from the 13 governors in the network says, "It is critical that Congress . . . not shift costs to states. Significant cuts to Medicaid will impact coverage for millions of low-income individuals and could impede state efforts to address the underlying factors driving health care costs."

It also said, "For the majority of the network states that expanded Medicaid, maintaining coverage for those populations at the federal matching rate under current law is of critical importance. (With the exception of Kentucky which does not agree with this statement)."

Bevin's predecessor, Democrat Steve Beshear, expanded Medicaid to people in households with annual incomes up to 138 percent of the federal poverty level. The federal government paid the full cost of the expansion until this year. It is now paying 95 percent, which will drop in annual steps to the current law's floor of 90 percent in 2020.

For traditional Medicaid patients, the federal government pays about 70 percent of the costs, based on a formula that gives poorer states higher reimbursement rates.

The governor's office didn't immediately respond to a request for comment on why Bevin declined to support this part of the statement. During his 2015 campaign, Bevin initially said he would abolish the expansion, and even after dropping that idea, said federal money shouldn't be accepted just because it is available, because it is taxpayer money.

Under the bill to be revealed Thursday, Medicaid funding would use "an even slower growth index than the one used in the House bill," reports Paige Winfield Cunningham of The Washington Post. "That move could prompt states to reduce the size of their Medicaid programs."

Senate GOP health bill would dramatically roll back Medicaid

Kentucky Health News

The health bill that Senate Republicans will unveil Thursday "would reshape a big piece of the U.S. health-care system by dramatically rolling back Medicaid while providing a softer landing to Americans who stand to lose coverage gained under the Affordable Care Act," Paige Winfield Cunningham reports for The Washington Post.

As Kentucky Health News indicated Tuesday, the bill would "cut off Medicaid expansion more gradually than the House bill, but would enact deeper long-term cuts to the health-care program for low-income Americans," Cunningham reports. It also would keep Obamacare's income-based subsidies for private insurance, but scale them back.

"Subsidies are currently available to Americans earning up to 400 percent of the federal poverty level," Cunningham writes. "Starting in 2020, that threshold would be lowered to 350 percent under the Senate bill -- but anyone below that line could get the subsidies if they’re not eligible for Medicaid."

The House bill would end the Medicaid expansion, which serves 470,000 Kentuckians, in 2020. The Senate bill is expected to phase out the expansion over a longer period, but it would cut scale back the overall Medicaid program farther in the long run. "In 2025, the measure would tie federal spending on the program to an even slower growth index than the one used in the House bill," Cunningham writes. "That move could prompt states to reduce the size of their Medicaid programs."

That would be the biggest change in Medicaid since a heavily Democratic Congress created it in 1965, and would perhaps reflect the different attitude that Republicans have toward the program. "Republicans view Medicaid as a form of welfare, and pretty much everyone else views it as a government insurance program," Drew Altman of the Kaiser Family Foundation writes for Axios.

"Perceptions of Medicaid as welfare don't seem bothered much by facts, such as, for example, that two thirds of Medicaid spending goes for the low-income elderly and disabled who don't fit the Ronald Reagan era image of the welfare king or queen. But it's not the majority view in any case. A little less than a third of voters identify as Republicans today, and about half of them see Medicaid as welfare," Altman writes. "It's this group and their perceptions of the program, and elected officials who share their views, that seem to be driving debate about Medicaid today." About 1.3 million Kentuckians are on Medicaid.

Louisville senator hopes third time is charm for his bill to allow marijuana to be used to alleviate suffering of the terminally ill

Kentucky should join the states that have authorized marijuana for medical use, and allow it to be used to relieve suffering of the terminally ill, a Democratic legislator from Louisville told a House-Senate committee Wednesday.

McGarvey after the meeting (C-J photo by Deborah Yetter)

"It's 2017," Sen. Morgan McGarvey told the Health and Welfare Committee. "I think it's time we had a conversation about medical marijuana without snickering."

"Members of the committee took no action on legislation McGarvey is proposing for the 2018 legislative session, but no one spoke against the proposal and some committee members spoke in favor of the measure that went nowhere in the past two legislative sessions," Deborah Yetter reports for The Courier-Journal, quoting Sen. Tom Buford, R-Nicholasville: "This is an issue that's got to be dealt with some way."

McGarvey, who has "sponsored similar, unsuccessful measures in the last two sessions of the General Assembly," said public attitudes are moving toward medical marijuana "in some circumstances," Yetter reports. "And he said he doesn't believe support breaks down on partisan lines."

"Everyone has someone in their life who has suffered from cancer or a debilitating illness," McGarvey said. "What we're hearing from Democrats and Republicans is that we need to provide some relief."

McGarvey told the panel that 26 states already allow medical use of marijuana "and said he sees no reason Kentucky should wait any longer," Yetter reports. McGarvey said,"If you're last, you're last and Kentucky shouldn't be the last state to do this." He said it would not be a "back door" to recreational use of marijuana, as some states have done. "That's an argument made out of fear and not out of fact," he said. "It's not a back door to anything."

Yetter writes, "Several supporters of medical marijuana who attended the hearing said they don't think McGarvey's bill goes far enough, that it should allow broader medical use than just for those who are terminally ill. Among them was Dr. Don Stacy, a Louisville cancer doctor who said he has seen dramatic improvements in patients who acknowledge using marijuana 'behind closed doors' to ease pain and nausea from treatments including chemotherapy and radiation."

Ky. leads nation in opioid-addiction diagnoses for privately insured people, and in the rate of doctors prescribing medication for it

By Melissa Patrick
Kentucky Health News

Kentucky doctors diagnosed more cases of opioid addiction for privately insured people than in any other state in the nation last year, and the state had the nation's highest rate of medication-assisted treatment for addiction.

The findings are in a study, "America's Opioid Epidemic: Data on the Privately Insured Population," by Amino, a health-care transparency company that uses large sets of data to help people find low-cost care.

Looking only at privately insured patients "shows how pervasive this crisis has become" and that opioid use isn't just a problem for people on Medicaid, the report says.

Nationwide, the researchers found a six-fold increase in the number of patients diagnosed with opioid-use disorder between 2012 and 2016, rising from 241,000 to 1.4 million.

The American Society of Addiction Medicine estimated that in 2015, "about 2 million people in the U.S. had a substance use disorder with prescription painkillers and about 591,000 had a heroin-use disorder," Terry DeMio reports for The Cincinnati Enquirer.

The Amino report said its estimates were probably low, especially among the privately insured, because people are hesitant to get treated for addiction and physicians are hesitant to make the diagnosis because of the stigma attached to it, especially for those who get insurance through their employer.

Dr. Will Lopez, a senior medical director in Cigna's behavioral-health business, told DeMio that opioid-use disorders increased after doctors started prescribing more painkillers in the 1990s, when pain level started being considered a fifth vital sign.

"From the start of this problem, it went across all economical statuses," Lopez said.

Treatment with buprenorphine is highest in Kentucky

Addiction is often treated with substitute drugs, and Kentucky has the highest share of physicians prescribing medication-assisted treatment.

MAT medications include buprenorphine, methadone and naltrexone, which are prescribed along with counseling and behavioral therapies to treat opioid-use disorders and to prevent overdoses.

Click on table to view a larger version

Kentucky has nine of the top 10 counties in the nation for doctors using MAT to treat opioid-use disorder. They include Breathitt, Lee, Wolfe, Perry, Boyle, Floyd, Menifee, Bourbon and Rowan counties. All but Boyle and Bourbon counties are in Eastern Kentucky.

DeMio notes that the Northern Kentucky counties of Boone, Campbell and Kenton were not among the counties with high rates of physicians prescribing MATs, though these counties have been "hit hard by the heroin epidemic."

That could indicate illicit trade in MAT drugs in Eastern Kentucky, but there are other possible causes. Dr. Mina "Mike" Kalfas, a certified addiction expert at Christ Hospital's outpatient clinic in Fort Wright, told DeMio that this was because the region has too few MAT providers, leaving many who need the medication unable to get it here. This is a problem nationwide.

The federal Substance Abuse and Mental Health Services Administration reported in 2016 that "Half the people who could use treatment are not able to get it, in large part because they can't afford it or can't find providers." SAMHSA offers a burprenorphine physician-finder online.

The report adds that opioid-use disorders are linked to many serious health conditions. It found that patients with opioid addictions were nine times more likely to have hepatitis C and almost six times more likely to have chronic pain. They were also eight times more likely than people without addiction to have alcoholism, almost seven times as likely to have contemplated suicide, and were more than twice as likely to have anxiety and depression.

Kalfas told DeMio that many of these dual diagnoses make sense because of what heroin and synthetic opiates do to a user's brain. "The depression, suicidal thoughts, loss of joy, are consequences of chronic opioid use, because they experience a decrease in endorphins over time," Kalfas said. Endorphins are natural hormones that activate the body's opiate receptors.

Hepatitis C is linked to intravenous drug use because it is spread through the sharing of syringes. Kentucky has passed legislation for syringe-exchange programs that allow IV drug users to swap their dirty needles for clean ones to decrease the spread of diseases like hepatitis and HIV. As of June 16, the state had 24 operating syringe exchanges and nine that are approved, but not yet operational, according to the Cabinet for Health and Family Services website.

As for chronic pain, DeMio writes, "When states cracked down on the prescription of addictive painkillers, or opioids, used in an attempt to conquer chronic pain, drug cartels moved heroin into the market, and people who'd been cut off prescriptions along with others who'd been using the drugs sold on the streets started using heroin."

Senate health bill expected Thur., McConnell says; could stretch Medicaid expansion but then cut program more than House bill

By Al Cross and Melissa Patrick
Kentucky Health News

Senate Republicans plan to make their repeal-and-replace-Obamacare bill public on Thursday, Majority Leader Mitch McConnell of Kentucky told reporters Tuesday.

The bill is likely to continue the Medicaid expansion, which serves 470,000 Kentuckians, longer than the bill passed by the House, but could make deeper cuts to Medicaid in the long run.

McConnell talked and gestured as Republican Policy Committee

Chair John Barrasso of Wyoming, left, and Conference Chair

John Thune of South Dakota listened, while Republican Whip John

Cornyn of Texas looked away. (Associated Press photo : J. Scott Applewhite)

McConnell's announcement indicated that the bill is being analyzed by the Congressional Budget Office, which would clear it for debate, votes and perhaps passage on the Senate floor next week, meeting McConnell's goal of action before the July 4 week recess that begins Friday, June 30.

"I expect to have a discussion draft on Thursday, and we will go to the bill once we get a CBO score, probably next week," McConnell told reporters. Asked how long the Senate will have to review the bill, McConnell said "plenty of time."

On the floor Monday, Minority Leader Chuck Schumer of New York asked McConnell if the Senate would have more than 10 hours to debate the bill and McConnell wouldn't answer the question, saying only, "We'll have ample opportunity to read and amend the bill."

Schumer and other Democrats have been shut out of negotiations in the bill, which Republicans can pass with no Democratic votes because they are invoking budget rules that preclude a filibuster and bypass the 60-vote requirement to pass legislation.

McConnell said of Democrats, "They've made it clear they are not interested in helping" repeal Obamacare. Republicans plan no committee hearings on the bill, and note that Democrats passed Obamacare with only their own votes.

"No transparency would have been added by having hearings in which Democrats would have offered endless single-payer-system amendments," McConnell said. "That is not what this Senate was sent here to do."

McConnell's office is writing the bill, Republican Sen. Bob Corker of Tennessee told The Washington Times Monday: “The leader is really writing this bill. You can say the Finance Committee is, you could say the Budget Committee is, you could say the Health Committee is — but the leader’s office is writing the bill. And what they’re trying to do is sort of try to attempt hit the sweet spot between those differences that exist, which are natural when you have people from different states. I haven’t seen what that is yet, and to my knowledge no one has seen that yet.”

The Times reports, "Republican negotiators are still fine-tuning how make tax credits in their plan generous enough for certain cohorts, including the needy and older Americans who aren’t yet eligible for Medicare. Yet Sen. Rand Paul, Kentucky Republican, suggested his colleagues want to dole out more taxpayer assistance than the 2010 law they’re trying to scrap."

“One of the key things when it comes out, when we get a copy, is: Are there more subsidies in our bill than Obamacare?” Paul said. “That, to me, really is a non-starter.”

That could depend on what Paul calls a "subsidy." The word generally refers to tax credits and cost sharing for private insurance policies, but could also be applied to the heavy financial support that the 2010 health-reform law gives to states' expansion of the Medicaid program.

McConnell has suggested phasing out the Medicaid expansion through 2023, instead of ending it in 2020, but The Hill reports that the Senate bill could make deeper cuts to Medicaid in the long run: "According to lobbyists and aides, the proposal would start out the growth rate for a new cap on Medicaid spending at the same levels as the House bill, but then drop to a lower growth rate that would cut spending more."

That risks losing the votes of Republican senators such as Rob Portman of Ohio and Dean Heller of Nevada, and McConnell has only two votes to spare. If the vote is 50 to 50, Vice President Mike Pence can break the tie in favor of the Republicans.

"It may be too late to rally support . . . if reports coming out of a meeting of Republican senators are accurate, Rob Garver and Eric Pianin of The Fiscal Times report. "Sen.John Thune of South Dakota and Majority Whip John Cornyn [of Texas] exited a meeting of the Senate GOP caucus Tuesday afternoon and told reporters that there is currently no consensus among members on what the final version of the bill ought to look like." The writers add, "McConnell is the shrewdest politician on Capitol Hill and it would be a serious mistake to underestimate his ability to pull victory from the jaws of defeat."

McConnell "stopped short of guaranteeing that the bill would get the 50 Republican votes it would need to pass it when he brings it to the floor," notes Tierney Sneed of Talking Points Memo. McConnell replied, “We are going to make every effort to pass the bill that dramatically changes the current health-care law.”

The House Freedom Caucus, an ardently conservative group generally aligned with Paul, sent McConnell a letter warning him not to make bill too moderate. McConnell told reporters that the bill will be "a profound, positive improvement over the status quo."

Meanwhile, some lobbying groups expressed frustration at the inability to meet with McConnell. “It is deeply disturbing,” Erika Sward, assistant vice president of the American Lung Association, told the Los Angeles Times. “Patients groups like ours need to make sure that our patients’ needs for healthcare will be met. … We can’t do that if we can’t see what is being proposed.”

"Major physician groups, hospitals, consumer advocates and organizations representing millions of patients with cancer, diabetes, heart disease and other serious illnesses have been pleading with Republican leaders for months to open up the process and listen to their concerns," report Noam Levey and Lisa Mascaro of the Times. "This week, a group of more than 15 patients' groups . . . asked McConnell’s office to meet with them next week, proposing any time between Friday and June 22.

"A representative from McConnell’s office told them staff schedules were too busy, according to representatives of several of the organizations. McConnell spokesman Don Stewart said the majority leader’s schedule is full. 'Numerous meetings are already booked well in advance,' he said."

A group of 120 lobbies for consumer and health-care providers wrote McConnell a letter asking for the preservation of Medicaid, and the American Hospital Association said the Medicaid cuts being considered would have "serious negative consequences for communities across America."

Mike Rust, president and CEO of the Kentucky Hospital Association, told Kentucky Health News that the group has long taken two consistent positions: "Keep the expansion and if they repeal it, restore the cuts to Medicare" reimbursements, which were made when Medicaid was expanded.

Don Ritchie, historian emeritus of the Senate, told the Times that the Senate had not taken such a partisan, secretive approach to major legislation since said not since the years before World War I. That's when "Senate Democrats, at the urging of President Woodrow Wilson, drew up major tariff reforms while shutting out Republicans. But when Democratic leaders tried that again when they had large majorities during the Great Depression, rank-and-file senators revolted. It hasn’t happened since, he said."

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

Post's chief fact-checker gives McConnell an upside-down Pinocchio for a flip-flop the senator won't acknowledge

"It has become a regular feature of the U.S. political system that the politicians in the minority accuse the politicians in power of cutting deals behind closed doors to advance controversial legislation — only to engage in similar tactics once they regain power," writes Glenn Kessler, who runs The Fact Checker column for The Washington Post.

And so it goes with Senate Majority Leader Mitch McConnell and Senate Republicans' health bill, says Kessler as he compares McConnell's recent remarks with those he made in 2009 and 2010 as Democrats were passing the Patient Protection and Affordable Care Act, better known as Obamacare. Kessler, a Cincinnati native, normally gives politicians one to four Pinocchios, depending on how far they stray from the truth; in this case, he gives the Kentuckian one upside-down Pinocchio "for statements that represent a clear but unacknowledged 'flip-flop' from a previously-held position." Here's a video version: