State refuses to release correspondence with feds on Medicaid waiver; Beshear rules against cabinet; appeal seems likely

By Melissa Patrick
Kentucky Health News

The Cabinet for Health and Family Services has refused to provide the Kentucky Equal Justice Center correspondence between the state and federal government about Kentucky's proposed changes to Medicaid, saying the documents are exempt from the state Open Records Act because they include "preliminary recommendations and opinions on policy developments."

Attorney General Andy Beshear disagreed in a Sept. 25 opinion, and said the cabinet had failed to satisfy its burden of proof to withhold the documents.

The KEJC asked May 18 for all correspondence on or after Jan. 1, 2016 between the governor's office and/or CHFS and the U.S. Department of Health and Human Services, including the Centers for Medicare and Medicaid Services, related to the state's request for a waiver of some Medicaid rules.

Republican Gov. Matt Bevin's request was filed about a year ago and is expected to be approved soon. State officials have said they are making plans to implement the program in January.

"Obviously, we have a strong interest in looking at these records because we are very concerned about the Medicaid waiver and what the effect of that waiver is going to be," Anne Marie Regan, KEJC's senior staff attorney, said in a telephone interview. "And we have a right to know what those documents look like. We have a right to some transparency in the process."

The Cabinet's first letter to Regan, dated May 23, said the documents were "not readily available," and that they needed until May 30 to compile, review and redact them. Beshear's opinion says the agency didn't provide a sufficiently "detailed explanation" to invoke an exemption, and said that its explanation did not "constitute a reason for additional delay."

The cabinet's second letter to Regan, Aug. 31, said that after searching all of its databases, "the search revealed no releasable documentation," and all of the documents were exempt because they include "preliminary recommendations and opinions on policy developments." It added that if HHS approves the waiver, "those communications that become part of the final agency action will then become releasable."

When KEJC appealed to Beshear, his office asked the Cabinet for copies of all existing responsive documents for a private or in camera review.

The Cabinet provided only five documents for review, and told the Attorney General it was "reluctant to release the documents withheld . . . even solely for in camera review"

The opinion, signed by Assistant Attorney General Michelle D. Harrison, said that since the cabinet didn't provide all of the records in the dispute for review, it had "failed to satisfy its burden that all of the requested records were properly withheld," adding that "the sampling provided was largely nonexempt."

The opinion said, "Our in camera review of the five pages that CHFS provided, which are purportedly representative of the remaining e-mails withheld, refutes the agency's position that any recommendations or opinions are contained therin with a single exception. . . . With the exception of a sentence, none of the information summarized in either document could be properly characterized as recommendations nor were any opinions expressed or policies formulated therein."

Under state law, the cabinet must hand over the requested documents to the justice center or appeal the decision in court within 30 days of the opinion.

Cabinet spokesman Doug Hogan said in an e-mail, "The Cabinet is confident in its determination that the records are exempt because they are preliminary recommendations or opinions on policy developments."

An appeal also seems likely because Beshear, a Democrat who might run against Bevin in 2019, is already at odds with the governor on several issues.

The justice center has been a vocal opponent of the waiver proposal, which mainly targets able-bodied adults who qualify for Medicaid under the expansion of the program to those who earn up to 138 percent of the federal poverty line, under the Patient Protection and Affordable Care Act.

In addition to saving the state money, the new plan is designed to encourage participants to have a higher level of involvement in their health care through things like premiums and work requirements -- both of which the justice center adamantly opposes. It also says there will be 95,000 fewer Kentuckians on Medicaid in five years than if the plan isn't implemented.

Regan pointed out that it's important to know that the Cabinet is accurately reporting what thousands of Kentuckians said during the two open-comment periods (most of which were in opposition to the plan) and what the federal government is requiring the state to do to get it approved.

"The process has not been transparent. We don't really know what the state is saying to the government. We don't know what the federal government is saying back. This has been going on now since last year," Regan said. "We think we are entitled to that information to evaluate whether what the state is saying is accurate."

The cabinet asserted that the waiver is a "draft" and should be exempt because if released it would "'potentially disrupt the negotiation process,' and 'could also create confusion among individual consumers' in addition to program staff," the opinion said.

Louisville sees a spike in whooping cough cases in Sept.; health official urges parents to make sure children are immunized

The Louisville Department of Public Health and Wellness reports that it is seeing a dramatic spike in whooping cough in infants one year of age and younger.  From Sept. 1 to 26, there were six cases.

“It is vitally important for infants to get their immunizations against whooping cough on schedule,” Public Health and Wellness director Dr. Sarah Moyer said in a news release. “In children this age, the disease can be very serious and even deadly.”

Whooping cough — known medically as pertussis — is a highly contagious respiratory infection. Although it initially resembles an ordinary cold, whooping cough may eventually turn more serious, particularly in infants and young children.

In infants, the cough can be minimal or non-existent. Infants may also display sleep apnea, a pause in their breathing pattern, and may even turn blue. About half of infants younger than 1 who get the disease need hospital care.

The best way to prevent whooping cough is through vaccinations. The childhood vaccine is called DTaP. The whooping cough booster vaccine for adolescents and adults is called Tdap. Both DTaP and Tdap protect against whooping cough, tetanus and diphtheria.

The Louisville health department says infants should receive a series of DTaP immunizations at 2, 4, and 6 months, with boosters at 15-18 months and 4-6 years. Children should then get a single dose of Tdap vaccine at 11 to 12.

Pregnant women should receive a single dose of Tdap during every pregnancy, preferably at 27 through 36 weeks.

Parents of infants and all people who live with an infant or who provide care to an infant should also be immunized against whooping cough.

It is recommended that the infant's family members receive a one-time dose of Tdap if they have not already done so.

 “Even if parents and care givers have been immunized against whooping cough as children, vaccines can wear off over a period of time. Parents and care givers can then infect young children,"  Moyer said.

Parents should check with their physicians to see if their child has been immunized against whooping cough. Parents in Louisville who do not have health insurance should contact the Department of Public Health and Wellness at 502-574-6520.

State gets $10 million grant to integrate primary and behavioral health care, in yet another initiative to combat substance abuse

The Cabinet for Health and Family Services has been awarded a $10 million federal grant to integrate primary care and behavioral health care in two regions of the state, as part of an effort to combat the state's opioid epidemic.

Kentucky is one of three states chosen by the Substance Abuse and Mental Health Services Administration to receive the five-year grant, which will be provided to two community health centers -- Centerstone in Louisville and Mountain Comprehensive Care Center in Eastern Kentucky.

The project will integrate primary care and behavioral health, focusing on individuals with physical health conditions who are at risk of developing chronic health conditions, including those with substance use disorders, says the news release.

 “The project presents a unique opportunity to improve health outcomes for Kentuckians with behavioral health and chronic health issues,” said Dr. Allen Brenzel, medical director for the Department of Behavioral Health, Development and Intellectual Disabilities. “Centerstone of Kentucky and Mountain Comprehensive Care Center are ideal partners because of their track record of collaborative community relationships and commitment to integrated treatment services.”

The project will begin next month with the formation of local implementation teams and advisory councils.

'Kick It, Kentucky' spends week encouraging smoking cessation in a state with the nation's highest smoking rate

By Melissa Patrick
Kentucky Health News

Kentuckians who want to stop smoking can take advantage of the many cessation tools offered by the state, including a new law that requires insurance companies to cover smoking-cessation treatments and counseling without imposing barriers.

That was the message at the Sept. 27 announcement of the first ever "Kick It, Kentucky" week, where more than two dozen organizations gathered in Lexington to promote smoking cessation.

"More adults in Kentucky smoke than in any other state in the nation and we also have the second-highest youth smoking rate in the country, but the good news is there has never been a better time to quit," said Erica Palmer Smith, Kentucky government relations director for the American Cancer Society's Cancer Action Network, one of the supporting organizations.

Several of the health advocates noted a long list of health benefits that come to a person who stops smoking: Within 20 minutes of quitting, a person's heart rate and blood pressure drop; within a couple of weeks, their lung function improves; and within a year, their risk of a heart attack drops by half. These benefits are listed on a poster that will be placed in doctors' office waiting rooms and public buildings as part of the Kick It, Kentucky effort.

Sen. Julie Raque Adams

Sen. Julie Raque Adams, R-Louisville, who was the primary sponsor of the smoking-cessation bill, told the group that smoking kills more than 9,000 Kentuckians a year, and stressed that "tobacco continues to be the leading cause of preventable death in the commonwealth."

The new law requires all insurance policies sold in Kentucky, and Medicaid, to cover all smoking-cessation treatments and counseling approved by the U.S. Food and Drug Administration with no barriers to access. For example, the law bans co-payments or deductibles for cessation products.

"There's never been a better time to quit," said Adams, who is also the chairwoman of the Senate Health and Welfare Committee. "Kentuckians who decide to quit will reap immense and immediate health benefits."

The president and CEO of the Foundation for a Healthy Kentucky, Ben Chandler, told the group that in addition to leading the nation in cancer and deaths from it, Kentucky ranks near the bottom of states for heart disease deaths, adult asthma and chronic obstructive pulmonary disease (COPD) -- which are all related to smoking.

"Therefore, I submit to you that the single most effective thing that we can do to improve the health of the people in this commonwealth is to reduce those smoking rates," he said. "Ladies and gentlemen,we've just simply got to do it. We've got to do it. It's a crisis and the need is dire."

He noted that this can be accomplished on a community and statewide level through smoke-free laws and raising the cigarette tax, or on an individual level, as Cheryl Weiss did.

Weiss, 36, said she smoked 20 years before quitting this year. "I got to where smoking was taking my time, my money and my energy," she said.

The Lexington woman credited her decision to quit smoking to an incentive program at her work that directed her to an eight-week smoking cessation program called "Freedom from Smoking" through the American Lung Association.

She said that by not smoking, she will save $26 every two weeks on her health insurance, plus the savings from not buying cigarettes -- and she said, "I feel healthier."

Other resources to help quit smoking can be found at www.quitnowkentucky.org and www.smokefreetomorrow.org. Kentucky's Tobacco Quitline is 1-800-QUIT-NOW (1-800-784-8669). In addition, many local health departments offer smoking cessation classes.

Federal judge strikes down new abortion law that required narrated ultrasound; Bevin administration says it will appeal

A federal judge has struck down a new Kentucky law that required a physician to perform an ultrasound and display and describe the image of the fetus to the patient before providing an abortion, Darcy Costello and Deborah Yetter report for The Courier-Journal.

In a one-page opinion, District Judge David Hale ruled Sept. 27 that House Bill 2, which also required the physician to play an audible heartbeat of the fetus to the patient, violates a physician's First Amendment rights. Supporters of the law, which was enacted in January, say it was meant to better inform women seeking an abortion.

Hale wrote in his 30-page opinion: "HB 2 is intended to dissuade women from choosing abortion by forcing ultrasound images, detailed descriptions of the fetus and the sounds of the fetal heartbeat on them, against their will, at a time when they are most vulnerable."

The Courier-Journal reports that a lawyer for EMW Woman's Surgical Center in Louisville, the state's only abortion clinic, called the ruling a victory for patients, but supporters have promised an appeal to the U.S. Court of Appeals for the 6th Circuit.

"We are disappointed in the court's ruling and will appeal immediately to the 6th Circuit," Amanda Stamper, a spokeswoman for Gov. Matt Bevin, told the newspaper. "We are confident the constitutionality of HB 2 will be upheld."

But Andrew Beck, a lawyer with the American Civil Liberties Union's Reproductive Freedom Project, told the Courier-Journal that he expects Hale's permanent injunction to withstand an appeal. "It's an extremely solid ruling," he said.

Hale said the law is "designed to convey the state's ideological, anti-abortion message" and goes "well beyond" the basic information that a physician should give a patient. He added that the law "appears to inflict psychological harm on abortion patients."

HB 2 permits a woman to look away from the image and cover her ears, but physicians who failed to attempt to show and describe the fetus to the patient could face fines of up to $250,000 and action against their medical license. State law already requires counseling 24 hours in advance of an abortion.

The ultrasound law is one of two abortion bills the legislature passed during its first week this year after Republicans took control of both chambers. The second measure, Senate Bill 5, bans abortions at or after the 20th week of pregnancy. An attorney with the ACLU told The Courier-Journal that they don't plan to challenge that law, but will continue to monitor it.

Meanwhile, the state's only abortion clinic awaits a judges ruling to determine if it can remain open.

The Bevin administration revoked its license in March, claiming it lacked appropriate agreements with a hospital and ambulance service in the event of a patient emergency. After a three-day trial earlier this month, it was granted a temporary restraining order so it can remain open until the judge rules on the case, which is expected later this year.

Building community as a way to combat opioids was a resounding theme at Foundation for a Healthy Kentucky's annual policy forum

By Melissa Patrick
Kentucky Health News

What if ending the opiod epidemic boiled down to re-building local communities, and re-thinking how we raise our children?

That may sound like a pie-in-the-sky ideal, but it resonated with many who attended the Foundation for a Healthy Kentucky's Howard L. Bost Memorial Health Policy Forum in Lexington Sept. 25.

Ben Chandler and Sam Quinones at Bost Forum
(Foundation for a Healthy Kentucky photo)

Keynote speaker Sam Quinones, author of Dreamland: The True Tale of America's Opiate Epidemic, told the sold-out crowd that the opioid epidemic is about so much more than drug trafficking and drug marketing; it is also about the isolation that has resulted from the loss of community.

Quinones talked about how we've moved away from the desire to invest in places that allow us to come together, likely referencing a now-closed community swimming pool called Dreamland that had once been the social epicenter of Portsmouth, Ohio, a town that is now ravaged by the opioid epidemic -- and the namesake of his book.

"Heroin is the perfect symbol for how isolated we have become as Americans, and how much we have killed off or ignored what would bring us together," he said. "I believe therefore more strongly than ever that the antidote to heroin is not Naloxone, it is community."

Ben Chandler, president and CEO of the foundation, passionately agreed with Quinones. He said improving communities would improve the overall health of Kentuckians.

"Every man for himself is unhealthy," Chandler told reporters. "We are social animals. We need each other desperately and when we are isolated from each other, which has become more and more the case in our society, we are less healthy on a number of different fronts."

He added, "But I can tell you we need to get the resources necessary to create community -- and you say the word tax, say it one time and immediately in this country we think it is a nasty word."

Chandler, a former congressman and state attorney general, said that now that he is out of politics he can talk about that "nasty word" and said it's time for a much higher cigarette tax in Kentucky.

"We need more funding for a lot of things and we need more funding for these heath matters," he said. "The cigarette tax is a beautiful tax for a state like Kentucky. We lead the country in smoking. We lead the country in cancer. What's better than to try to cut our health problems with smoking cigarettes and cancer and at the same time provide $260 million annually to the budget. We can do that. The General Assembly can do that in January."

Van Ingram, executive director of the Kentucky Office of Drug Control Policy, noted that while state and federal support is necessary, the real work of fighting this opioid epidemic is often done one community at a time, adding that some towns are more ready than other.

"When the community is behind these efforts, the folks who are elected get behind these efforts," he said.

Harvey Milkman
(Foundation for a Healthy Ky. photo)

Harvey Milkman, a professor of psychology at Metropolitan State College of Denver, told the group about an initiative in Iceland that has dramatically decreased the drinking and smoking rates of its high-school students and suggested that it could be replicated anywhere.

"I'd rather build a child than repair an adult," he said.

In addition to maintaining a regular student survey that pinpoints risky behaviors, the initiative centers around local programs that provide regular, organized, after-school activities for students as well as community efforts that promote family time, positive peer interactions and a sense of general well being.

Since Iceland instigated this initiative, the percentage of high-school students who had been drunk in the previous month dropped from 42 percent in 1998 to 5 percent in 2016; the percentage who had ever used marijuana is down from 17 percent to 7 percent; and the smoking rate fell from 23 percent to 3 percent.

Milkman added that his own research found that people who use drugs are addicted to changes in their brain chemistry and will often choose one that complements how they naturally deal with stress. For example, people who choose heroin want to shut down, and those who choose an amphetamine tend to be more hyper-active.

From this research, he created a program that took kids who had problems with drugs and offered to teach them anything they wanted to learn -- like music, hip-hop or martial arts -- with the idea that these activities could also alter their brain chemistry. At the same time, they were given life-skill training. Milkman said the program, which lasted 10 years, had "significant positive results," which were instrumental in informing the Iceland project.

"So it's really a social engineering project. How do you engineer communities that provide the needs that are really conducive to healthy living," Milkman said, adding that it can be done, but requires a collaboration between research, policy and practice -- along with ongoing dialogue.

Quinones advised parents to stop trying to protect their children from pain, both physical and emotional, noting that our desire to not feel any pain has only fed the opioid epidemic.

"You want to keep your kids off heroin, make sure people in your neighborhood do things together in public often. Make sure you kids ride bikes outside. Let them skin their knees. Don't protect them, let them fail. Don't protect them from the consequences of their failure," he said.

He added: This epidemic "is a powerful force for change in our society. It seems to me to be calling us as Americans to really examine how we've been living -- and we would be foolish to miss the opportunity that it provides."

Author of Dreamland says opioid epidemic is making people talk about addiction, a first step in finding solutions

By Melissa Patrick
Kentucky Health News

Since Dreamland: The True Tale of America's Opiate Epidemic was published in 2015, the author says the nation has seen both positive and negative changes in the epidemic that is sweeping Kentucky and other states.

"The negative changes are pretty dramatic," Sam Quinones said in a telephone interview with Kentucky Health News. "The number of people who are dying from this is every year more, and there doesn't seem to be an end in sight. . . . It's a very scary time."

On the other hand, individuals and families have "come out of the shadows" and are now telling their stories of addiction, which he said will help lead to solutions.

Quinones came to Kentucky to speak at the Foundation for a Healthy Kentucky's annual Howard Bost Memorial Health Policy Forum, Monday, Sept. 25 in Lexington. It sold out.

He said in the interview that it's hard for him to talk about positive reactions to the epidemic, given the torment it has caused so many families. But he's glad there is talk.

"And that's what happened with AIDS. When people came out of the shadows, we found solutions to AIDS," he said. "With more awareness, more people are working together on this . . . and I definitely believe that is a crucial part of this whole response."

He added, "You have a lot more political action, you've got a lot more budgetary action, you've got media paying far, far greater attention to this than even a few years ago -- and so all of that is for the positive."

He also said the epidemic has caused people to question old dogma and re-think how the nation, the state and communities have treated addiction and its victims.

“In Kentucky, I would say one of the most radical ideas that has been tried – I would give it enormous applause – is you have two dozen counties at least that are now transforming part of their jails, pods that are within their jails, to full-time rehabilitation clinics," he said. "I think that is magnificent."

Dreamland, named for a huge, old swimming pool in Portsmouth, Ohio, a town ravaged by the opioid epidemic, is a collection of stories that traces the origins and effects of the epidemic, which started 20 years ago.

It tells the story of  a society that wants to be pain-free, both physically and emotionally; an extremely addictive prescription painkiller and its aggressive marketing campaign; the subsequent shift in how the medical community viewed pain, and how it became the fifth vital sign; and how a heroin trafficking operation out of Mexico, using a customer-service business model, forever changed how illicit drugs are delivered in America.

Sam Quinones

Quinones emphasized that he left his "politics at the door" when he wrote Dreamland and encouraged others to do the same when they read it, and not "cherry-pick" aspects of the book that suit their point of view, which he said sometimes happens.

"It's a big picture," he said. "It's a mosaic of things that went into this and you need to consider them all."

He said it will take a variety of responses to deal with the epidemic, including individual and humane care for patients who are addicted to prescription opioids, instead of just cutting them off; appropriate use of medication-assisted therapies, along with supportive group therapies; and a shift in the way we view pain, both physically and emotionally.

Quinones said the epidemic seems to be calling into question parenting practices that aim to protect children from all pain, such as the practice of giving all kids in an event a participation trophy; to question whether or not possessions actually lead to happiness; and to examine the role of personal responsibility related to diet and exercise as ways to approach issues of physical pain.

"I think there are a lot of ways in which this epidemic is calling us to question how we've been living."

Trump seeks Paul's vote for last-ditch bill to repeal and replace Obamacare, which would cost Kentucky billions in future funds

UPDATE, Sept. 26: Sen. McConnell says the Senate will not vote on the bill.

By Al Cross
Kentucky Health News

Kentucky would be a big financial loser under Senate Republicans' last-ditch plan to repeal and replace the Patient Protection and Affordable Care Act. Sen. Rand Paul says he opposes the bill, but not for that reason; he says that it would "keep Obamacare," which he has vowed to repeal, and that a more limited reform he favors is on the way from President Trump.

It remains to be seen whether Kentucky's senior senator, Majority Leader Mitch McConnell, will bring the Graham-Cassidy bill up for a vote by Saturday, Sept. 30, the deadline to pass it with a simple majority under budget-reconciliation rules. He has said he intends to, but that was before Arizona Sen. John McCain said Friday afternoon that he wouldn't vote for the bill, making its passage unlikely.

Friday morning, Trump had pressured Paul, tweeting “Rand Paul, or whoever votes against Hcare bill, will forever (future political campaigns) be known as ‘the Republican who saved ObamaCare.’”  Paul replied on Twitter, “Calling a bill that KEEPS most of Obamacare ‘repeal’ doesn’t make it true. That’s what the swamp does. I won’t be bribed or bullied.”

The next day, after McCain's announcement, Trump tweeted, “I know Rand Paul and I think he may find a way to get there for the good of the Party!” At a speech in Alabama that night, he said, “I haven't given up on him because I think he may come around.”

On NBC's "Meet the Press" Sunday, Paul said, “I’ve always been a ‘yes’ for repeal,” but said he opposes the bill because it keeps “almost all of the spending, and just re-shuffles it and block grants it to the states. . . . You’re keeping all the money we’ve been spending through Obamacare, most of it, re-shuffling it, taking the money from Democrat states and giving it to Republican states. I think what it sets up is a perpetual food fight over the formula.”

U.S. Senator Rand Paul, R-Ky. (file photo)

Paul had made the money-shuffling argument before, and it sounded weak to editors at National Review. The old-line conservative magazine went after him Wednesday, Sept. 20, implying in an editorial that Paul, a Bowling Green ophthalmologist, secretly doesn't want to change the Obamacare system that has provided free Medicaid for 470,000 Kentuckians and subsidized private insurance for 81,000.

"The senator’s objections to the bill amount to a case for improving it, perhaps in a conference committee after it passes the Senate," the editorial said. "They do not amount to a case for voting it down. The bill goes farther in the right direction than the 'skinny repeal' bill for which Paul voted earlier this summer. That bill abolished only the individual and employer mandates. . . . Graham-Cassidy is still much better than Obamacare. It abolishes the individual and employer mandates, caps per capita spending on Medicaid, blocks federal funds from going to insurance plans that cover abortion, and lets interested states attain freedom from some of Obamacare’s regulations."

The editorial concluded, "There has been widespread speculation that Paul is playing a game on Obamacare: that he does not really wish to see major changes to it and will find libertarian-sounding objections to any Republican bill that has a chance of passage. This speculation may be unfair. But Paul’s arguments for a no vote make so little sense, and are so hard to square with his previous votes, that it is getting harder to dismiss."

"Meet the Press" host Chuck Todd told Paul that the editorial implied "that you don’t really want to change the Kentucky system. There’s a lot of people in Kentucky that like the system. But you can’t get caught ever saying that."

Paul replied, "That is a personal insult to my character," calling the magazine "a bunch of neocons who don't like libertarians." Earlier, he said, "I started my political career campaigning against Obamacare," pledging repeatedly to repeal it. "I can't in good conscience vote to keep it . . . Once we do, the Republican name is on health care, and thsi isn't going to work."

National Review blogger Theodore Kupfer wrote Sept. 22 that Paul's money-shuffling argument is "not quite accurate. Three analyses of the bill, from the [liberal-leaning] Center on Budget and Policy Priorities, [consulting firm] Avalere, and the [federal] Centers for Medicare and Medicaid Services, have found that the change in federal health-care funding would be negative for states that expanded Medicaid under the Affordable Care Act. Among those states are Republican strongholds Arizona, Louisiana, Arkansas, Ohio, and Kentucky."

Other analyses predict Kentucky would be one of the big losers, because it was one of the states that expanded Medicaid in 2014 under then-Gov. Steve Beshear. The Kaiser Family Foundation estimates that Kentucky would get 19 percent less money in 2020-26, $5.4 billion, than current law provides. That would be the 10th largest percentage loss among the states. The New York Times produced a chart showing that in funding per person, Kentucky would be the eighth biggest loser among the 50 states and the 35 expansion states.

The charts show the estimated differences in what states would get under the bill compared to what they are projected to get under current law. In its overall chart, the Times colored orange the states represented by senators that voted against at least one version of Obamacare repeal bills in July, as Paul did.

The bill is being revised to attract votes from holdouts, but Paul remains opposed, The Washington Post reports. If Paul remains opposed, the bill seems unlikely to pass, since Republicans need 50 votes and hold 52 Senate seats. The bill has drawn widespread opposition from lobbying groups. "A bipartisan group of governors and several influential interest groups came out against the proposal," the Post noted. The Post's Elise Viebeck writes that the hurry-up process for the bill is "unusually chaotic," and Rep. John Yarmuth, D-Louisville, said the new version uses "phony numbers."

Paul has sent Trump a list "of what it would take to get him from no to yes," Jonathan Swan of Axios reports. "It's hard to see how they'd stop at least half a dozen moderate Republican senators dropping their support" for the bill. The list includes "a significant reassessment of this trillion-dollar spending machine," making Obamacare rules optional for states, and expanding association health plans, something that can't be done under budget-reconciliation rules -- but maybe by Trump alone.

Paul repeated on NBC what he told Kentucky interviewers last week, that the Trump administration will act "in the next couple of weeks" to start implementing his plan for a national-association health plan, in which anyone could enroll. That could create a group with great bargaining power, but the plan would also be exempt from most Obamacare rules, allowing people to buy thinner, cheaper coverage and taking them out of the Obamacare markets, perhaps weakening them.

Kentucky's other senator was asked Sept. 20 why he would support a bill that would cost the state billions in federal funding. McConnell spokesman Robert Steurer cited Gov. Matt Bevin's support of the bill with 14 other Republican governors, and quoted McConnell as saying:

Mitch McConnell (Reuters photo)

“The men and women we represent have suffered a lot under Obamacare. Skyrocketing costs. Plummeting choices. Collapsing markets. Many of us thought our constituents deserved better. That’s why we did as we promised and voted to repeal this failed law so we could replace it with something better. The forces of the status quo went all out to defeat our every effort to improve health care. Thus far, they have succeeded. Thus far, they have yet to offer truly serious solutions of their own. The Graham/Cassidy bill would repeal the pillars of Obamacare and replace that failed law’s failed approach with a new one: allowing states and governors to actually implement better health-care ideas by taking more decision-making power out of Washington. Governors and state legislators of both parties would have both the opportunity and the responsibility to help make quality and affordable healthcare available to their citizens in a way that works for their own particular states. It’s an intriguing idea and one that has a great deal of support.”

Jennifer Haberkorn of Politico writes, "If successful, Graham and Cassidy would accomplish what McConnell couldn’t: Make good on the GOP’s pledge to undo Obamacare and transform Medicaid from an open-ended entitlement into a capped program. Critics say the result would be draconian cuts that would throw millions off of their health coverage and endanger the most vulnerable Americans."

McConnell is taking a political risk with Graham-Cassidy, after failing to get a repeal bill through the Senate in early August and strongly backing appointed Sen. Luther Strange in an Alabama primary against defrocked judge Roy Moore, who has made McConnell's leadership an issue. Moore is favored to win the Sept. 26 runoff primary.

"McConnell may figure he has nothing left to lose," write Burgess Everett and John Bresnahan of Politico. "He’s already taken a huge political hit for failing to repeal Obamacare. And Republicans say privately that if McConnell didn't take one final stab, he'd be lashed by Trump for giving up. . . . McConnell clearly sees an upside in showing Trump and the GOP base that Republicans haven't abandoned repeal. After weeks of declining to endorse the latest health-care bill, McConnell has embraced Graham and Cassidy’s bill as the Sept. 30 deadline approaches, endorsing it on the floor and playing up the bill on social media."

Public-health nurses from Ky. return after hurricane relief work

“The Kentucky Angels,” a group of public health nurses from Kentucky, returned to the state Friday after helping victims of Hurricane Irma in Florida, Tom Latek reports for Kentucky Today, published by the Kentucky Baptist Convention.

"The team, which consisted of 10 nurses and two administrative staff members, spent more than a week helping displaced residents in the Orlando and Naples areas," Latek reports. "The Florida Department for Public Health and the residents they assisted gave them the nickname of 'Kentucky Angels'."

The nurses work for health departments in Louisville, Franklin County and Northern Kentucky. They "were the first team from Kentucky to respond to a request for help from another state in the wake of a natural disaster," Latek reports. "They were originally expected to be deployed for 15 days, but their deployment ended up lasting eight days.

The Cabinet for Health and Family Services produced a news release and a video story about the Angels, which can be viewed at https://www.youtube.com/watch?v=sZs3HJ4AXrY.

SAVE THE DATE: Friday, Nov. 10 for Covering Health: A News Workshop, in Madisonville; free of charge to all journalists

On Friday, Nov. 10 in Madisonville, the Institute for Rural Journalism and Community Issues and the Foundation for a Healthy Kentucky will present the latest in their series of workshops to help local journalists cover health care and health in Kentucky.

The presenters will include Al Cross, director of the institute and editor-publisher of Kentucky Health News; KHN reporter Melissa Patrick, a former nurse; Dr. Ellen Hahn of the University of Kentucky College of Nursing, who directs the Bridging Research Efforts and Advocacy Toward Health Environments (BREATHE) program; and Wayne Meriwether, CEO of Twin Lakes Regional Medical Center in Leitchfield, a leader of the Population Health Committee in Grayson County.

"Covering Health: A News Workshop" will run from mid-morning to mid-afternoon at the Ballard Convention Center, near the KY 70 interchange with Interstate 69 (formerly the Pennyrile Parkway). Lunch will be served, and the event will be free of charge, thanks to support from the foundation.

"We hope many reporters and editors who cover Western Kentucky will spend a few hours with us to learn how their reporting can help their readers, listeners and viewers live healthier lives and better understand the health-policy debates going on in Frankfort and Washington," Cross said. "We also invite their suggestions for the program."

The program will be announced soon. For a report on last year's workshop, in Eastern Kentucky, click here.

192-bed Prestonsburg hospital will become 12th in ARH system

The hospital will become Highlands ARH Regional Medical Center.

Continuing the trend of hospital consolidation, Prestonsburg-based Highlands Health System will become part of Appalachian Regional Healthcare, the hospital firms announced Friday. They said they hope to complete the merger early next year.

"It has been very important to us to identify a strong organization that can continue to provide the same level of advanced healthcare services our patients have come to expect from Highlands as well as position the hospital for continued growth in the future," Highlands President Harold C. Warman said. "Appalachian Regional Healthcare has been the leading provider of care in Eastern Kentucky for more than 60 years and in that time the health system has been consistently recognized for its quality and commitment to excellent patient care."

The 192-bed Highlands Regional Medical Center "will become the 12th hospital in the ARH system," a news release said. "All other Highlands outpatient services and facilities in Floyd, Johnson, Martin and Magoffin counties are also included in the merger."

Education and updates on substance-use disorders, treatment and policy scheduled at University of Pikeville Tuesday, Oct. 3

Shaping Our Appalachian Region's Healthy Communities program and the University of Pikeville will host a substance-use disorder education event Tuesday, Oct. 3 from 11 a.m. to 5 p.m. at the university's Kentucky College of Optometry (Health Professionals Education Building). The meeting is for "health professionals and stakeholders who share the vision of reducing the scope and impact of substance use disorder and related consequences through education, awareness, prevention, and access to services," SOAR said in a news release. The event is free, but space is limited, so registration is required.

Speakers at the event will provide guidelines based on evidence, "discuss how to integrate prevention and management into practice in a rural setting, and provide resources and tools to help current and future providers in Appalachia turn the tide on the substance use epidemic," the release says. 

The special circumstances of addiction in pregnant women and their children will be discussed by Dr. Connie White, deputy director of the state Department for Public Health; Dr. Allen Brenzel of the Department for Behavioral Health, Development and Intellectual Disabilities; and Jill Martin, of the Hazard Primary Care Centers and Mountain Comprehensive Care Clinic.

The event will include personal stories of addiction and recovery from former basketball star Rex Chapman and others. The audience will hear legislative and regulatory updates from UK HealthCare officials Mark Birdwhistell, Douglas Oyler and Dr. John O’Brien Jr.

“We are facing an opioid crisis in Eastern Kentucky that is threatening our livelihood and way of life,” said Dr. Joshua Crum, associate dean of clinical affairs at the university's Kentucky College of Osteopathic Medicine. “KYCOM is meeting the challenge put forth by Governor Bevin to fight this epidemic through an inter-professional and collaborative approach known as the Kentucky Addiction Prevention Education program. Partners include the University of Kentucky and the University of Louisville Schools of Medicine and Dentistry.”

SOAR was created to advance the economy of Appalachian Kentucky, but it and the federal Centers for Disease Control and Prevention "have partnered for more than two years to build a more connected network of health-focused organizations, institutions, federal partners, and individuals in Appalachia," the release notes.

“Substance-use disorder is a real issue in every community in the SOAR region,” said Jared Arnett, the group's executive director. “This epidemic has touched every single person in our region in some way, shape, or form. A groundswell of meaningful solutions and best practices has evolved from the work of countless individuals and organizations that are passionate about treating those battling substance-use disorder.”

State changes Medicaid reporting procedures to reduce burdens for providers, get better data for comparisons

The state Department for Medicaid Services is trying to "streamline reporting procedures for healthcare providers across the state" and "reduce administrative burdens for physicians and provide more uniform data for comparisons," it said in a news release.

“Quality measures are critical as we become more data-driven in our efforts to address outcomes and improve patient care,” Health Secretary Vickie Yates Brown Glisson said in the release. “This is the first step toward applying a greater level of consistency among reporting so that everyone is collecting the same data, requirements are less burdensome for the health-care community and ultimately we have a clearer picture of what is going on in our state’s health-care landscape.”

Medicaid officials say they have worked closely with health-care interests to create a "quality measure set," unveiled Thursday at the annual Kentucky Medicaid Group Management Association conference in Louisville.

"Every insurer and government program defines quality in their own way," Kentucky Medical Association Executive Director Patrick Padgett said in the release. "They require different information to be submitted by physicians, which increases administrative burdens and costs, while confusing patients about how the healthcare system defines quality,”  

Joe Smith, CEO of the Kentucky Primary Care Association, said in the release, “The partnership between DMS and the provider groups across the state is a positive step in improving the health of the Medicaid members. KPCA member clinics are pleased with the leadership at DMS for providing a Kentucky driven direction on health care quality measurement."

In Ky., four people a day die of drug overdoses; lawmakers learn about prevention, treatment, recovery efforts in day-long meeting

By Melissa Patrick
Kentucky Health News

"Recovery is possible. Treatment works."

That was the one consistent message of hope for those with an opioid addiction Sept. 20, as a stream of experts told Kentucky lawmakers that opioids have become a "public health catastrophe" in the state, as one put it.

"Today, there is not a lot of good news," Van Ingram, executive director of the Office of Drug Control Policy, told the members of the Interim Joint Committee on Health and Welfare and Family Services and Medicaid Oversight and Advisory Committee at a joint, all-day meeting in Frankfort.

"When the clock strikes midnight tonight, four Kentuckians will have died of a drug overdose," Ingram said. "When the clock strikes midnight tonight, 140 Americans will have died from a drug overdose. These are all preventable deaths that don't have to happen."

Kentucky saw a 7.4 percent increase in overdose fatalities in 2016, and more than half of the 1,404 deaths involved fentanyl, a synthetic opioid that is up to 50 times more potent than heroin, according to Ingram's office. One-third of the deaths involved heroin. Ingram noted that this trend continues, with fentanyl being present in 53 percent of overdose deaths in the first half of this year.

Throughout the day, more than 20 experts talked about the impact of opioids in the state, including prevention and treatment strategies.

Kentucky Chamber of Commerce President and CEO Dave Adkisson said the epidemic has taken a toll on the state's economic growth and development, especially participation in the labor force.

“The businesses I’ve talked with throughout the state say drug abuse is a key contributor to the problem,” Adkisson said. “Many people actively looking for work cannot pass the drug tests required for employment and many of those who do have jobs are exiting the workforce due to untreated, or undertreated, addictions.”

Dr. Gil Liu, the medical director of the Department for Medicaid Services, said that over the past two years, Kentucky has doubled its behavioral health spending and quadrupled its substance use treatment spending.

He warned that Kentucky has the nation's highest rate of newly diagnosed hepatitis C, which is largely spread when intravenous drug users share needles.

He said the state is working to relax some of its "stringent" rules around who can or cannot be treated for the disease, but warned that the treatment, which can cure the disease, is costly. His PowerPoint presentation said it would cost the state $2.4 billion if all hepatitis C diagnosed recipients received treatment. Now, the state pays around $70 million.

"Those who have entered into treatment and that we have information on represent the tip of the iceberg," he said. "We have a large caseload that has yet to enter into treatment."

Dr. Allen Brenzel, clinical director of the Department of Behavioral Health, Development and Intellectual Disabilities, said addressing children's adverse childhood experiences must be part of the solution to "break the cycle" of addiction. He said 50 percent of drug use and 78 percent of intravenous drug use in adults may be attributed to ACEs.

ACEs are potentially traumatic events in a child's life, like physical abuse or substance misuse in the home, that can have negative, lasting effects on their health and well-being. Kentucky's children have "significantly higher" ACE scores than the rest of the nation.

"If we want healthy adults, we've got to screen for ACEs. we've got to identify them, we've got to address them," he said.

Brenzel and others talked about the importance of medication-assisted treatment for substance abuse.

“If this is something that the individual requires to lead a healthy lifestyle, to work, to have insurance, to raise their kids, then we have to end this stigma that somehow if you’re not off your medication that you’re not in recovery, and I do think we’re progress in that,” Brenzel said.

 “We’ve had a long battle, in my opinion, over the last 10 to 15 years about abstinence-only versus medication-assisted treatment. It’s not versus. It’s that individual assessment that leads to the individual, most appropriate treatment for that person.”

Dr. Molly Rutherford, vice-president of the Kentucky Academy of Family Physicians, said it's time to move beyond the stigma of addiction and the stigma of treating people with MAT.

"Stop arguing over the right treatment," she said. "The right treatment is different for every individual and is the treatment that prevents his or her death."

Dr. Lana Davenport, medical director of The Infinity Center in Ashland, said medication-assisted treatment is probably the best treatment for rural people with substance-use disorders, because abstinence-only programs require ancillary services, such as Alcoholics Anonymous or Narcotics Anonymous, and they often don't exist in rural areas.

Several groups shared how their programs help pregnant women with substance-use disorders and their infants, who are often born with neonatal abstinence syndrome. In Kentucky, one out of every 50 newborns has NAS.

Jennifer Hancock, president of the Volunteers of America chapter in Louisville, which runs Freedom House, a program that serves pregnant women with an addiction for up to two years after the child's birth, said the average cost of an NAS case is about $100,000. She said every 10 healthy babies represents a $1 million savings to the state, because most of the cost of these babies falls to the Medicaid program. She called the state's opioid problem "a public-health catastrophe."

Brenzel wrapped up the meeting by noting that Kentucky received $10.5 million from the federal 21st Century CURES Act, and will spend this money on a combination of evidence-based projects that focus on prevention, treatment and harm reduction.

One of the projects will create "bridge clinics" at the University of Kentucky, the University of Louisville and the Saint Elizabeth hospitals in Northern Kentucky that will allow them to become the first point of treatment for people with addictions.

The hospitals' emergency rooms will be staffed with a peer-support specialist who, with permission, will connect with the patient in the emergency room and then will regularly follow up with them after discharge. If the patient wants to start treatment immediately, the emergency rooms will have a protocol to assess the patient and do that, if appropriate.

The hope is to increase those getting treatment from 10 percent to upwards of 70 percent, Brenzel said.

Ingram said, "We're going to beat this. It's just going to take time."

Dr. Mark Newman, Owensboro native, taking over at UK HealthCare from Dr. Michael Karpf, who will remain an adviser

Dr. Mark Newman

The University of Kentucky has a new hospital leader. Dr. Mark Newman succeeds Dr. Michael Karpf as executive vice president for health affairs.

Newman, an anesthesiologist, has been president of Private Diagnostic Clinic, the physician practice plan for Duke University’s Medical Center, since 2014. A native of Owensboro, he has been at Duke since 1992.

"Newman grew up in Kentucky as part of a farm family with a strong focus on education," a UK news release said. "He stayed close to home to attend Western Kentucky University to help his family while his father was ill, and began running the family farm after his father passed away." Getting an Air Force scholarship to the University of Louisville medical school, he completed a residency in the Air Force and a fellowship at Duke University Medical Center before returning to active duty. He was deployed for the invasions of Panama, Kuwait and Iraq.

“I will be helping lead one of the nation’s renowned institutions of higher learning, research and clinical care as well as returning to my home state,” Newman said in the release. “The last decade has seen UK HealthCare evolve into a system with the focus and the flexibility to grow and build on its reputation while advancing the health- and patient-care opportunities for people throughout the commonwealth, and I look forward to being part of its continued success.”

Karpf "will continue making his $900,000 salary for the next year as he advises UK President Eli Capilouto on state and federal health care issues," Linda Blackford reports for the Lexington Herald-Leader. "Under Karpf’s 13 years of leadership, UK HealthCare invested almost $2 billion in new facilities, faculty, programs and technology, as well as forging new partnerships with regional health care institutions and expanding the College of Medicine to satellite locations around the state. Capilouto has frequently said Karpf oversaw the greatest success story in academic health center history, a statement he repeated at the UK Board of Trustees meeting Friday," Sept. 15.

"After Karpf’s year of advising concludes, he will make $200,000 a year as a part-time faculty member in the College of Medicine, conducting policy research," Blackford reports. "Karpf’s eventual part-time salary was calculated by taking 50 percent of the salary earned by medical professors who are at the 75th percentile of pay in the Association of American Medical Colleges survey."

Read more here: http://www.kentucky.com/news/local/education/article174155761.html#storylink=cpy"

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Read more here: http://www.kentucky.com/news/local/education/article174155761.html#storylink=cpy

Obamacare boosted Ky. hospitals, but bad debts are rising again due to high-deductible plans, and the law's future is uncertain

Baptist Health Richmond is among hospitals featured in the story.

Kentucky's expansion of Medicaid under the Patient Protection and Affordable Care Act turned out better for the state's hospitals than they expected, but they worry about its future, Josh Shepherd writes for The Lane Report, a Lexington-based business magazine.

While two Kentucky hospitals closed soon after the expansion began in 2014, "Elizabeth Cobb, vice president for health policy at the Kentucky Hospital Association, points out that there have been no hospital closures in the past several years and revenue from Medicaid expansion has stabilized several community hospitals that were considered financially at risk in 2014," Shepherd reports.

Cobb told Shepherd that Kentucky's health-care industry is much more stable now than it was earlier in this decade. "Medicaid expansion is partially responsible because residents who gained insurance coverage sought care and created a revenue surge," Shepherd writes. "More importantly, she said, provider systems have shifted away from over-reliance on inpatient hospitalization to generate income."

When Kentucky expanded Medicaid, "Hospital administrators worried that expanding eligibility to families with incomes up to 138 percent above federal poverty guidelines would negatively affect their payer mix by shifting patients from commercial insurance to Medicaid, which pays less reimbursement for services," Shepherd notes. But KHA found that the 103 percent increase in the Medicaid population was mostly from people who didn't have insurance and would have otherwise been treated as charity cases. Hospitals reported significant decreases in bad debt.

"The increase in Medicaid enrollment has produced a significant net gain in most hospital revenues across the commonwealth," Shepherd writes. "According to the Kentucky Hospital Association, rural hospitals have been helped tremendously by providing a federal payer where there once was just mounting bad debt owed by private payers." However, more individual patients now have high-deductible plans that are putting them in debt to hospitals, Shepherd reports.

The Medicaid expansion is in doubt because of a last-ditch attempt by Republicans in Congress to repeal the reform law. Even if that fails, federal officials are expected to approve Gov. Matt Bevin's request for a waiver of rules allowing changes that would tamp down enrollment and introduce "deductibles for recipients as an incentive to 'avoid unnecessary care'," Shepherd notes.

Kentucky's share of people with health insurance goes up again, giving state most-improved status, but future remains uncertain

By Melissa Patrick
Kentucky Health News

In the third full year since the Patient Protection and Affordable Care Act was implemented, the percentage of Kentuckians without health insurance continued to shrink, giving the Bluegrass State a larger drop in its uninsured rate than any other state.  So says a new report from the U.S. Census Bureau, with data from its year-round American Community Survey.

Census Bureau map; click on it to view a larger version

Kentucky's uninsured rate dropped to 5.1 percent in 2016, down from 6.1 percent in 2015 and 8.1 percent in 2014. In 2013, the year before the ACA was implemented, the rate was 14.3 percent.

Put another way, 95 percent of Kentuckians had health insurance in 2016, compared to 86 percent in 2013.

That gain came mainly because then-Gov. Steve Beshear expanded Medicaid under the ACA to those who earn up to 138 percent of the federal poverty line, adding about 470,000 Kentuckians to the free health-insurance program.

“It’s clear beyond a shadow of a doubt the Affordable Care Act is working. It has helped Kentuckians get the care they need to improve their health, work and take care of their families. It has created jobs in our state and kept many more Kentuckians from being an illness or accident away from financial ruin,” Kenny Colston, communications director for the liberal-leaning Kentucky Center for Economic Policy, said in a news release.

The survey also found that 96.7 percent of Kentucky's children had health insurance in 2016, up from 93.6 percent in 2013. Kentucky Youth Advocates estimates this represented an increase of 37,000 children. Children are covered by the Children's Health Insurance Program, a program similar to Medicaid in which the federal government pays most of the cost. Kentucky calls its part of the program K-CHIP.

Medicaid and K-CHIP funding uncertain 

The recent gains aren't guaranteed to continue, with changes looming on both the state and federal level for both the adult and children's insurance programs.

Gov. Matt Bevin has submitted a proposal to overhaul the state's Medicaid program that largely targets "able-bodied" adults without dependents who qualify for Medicaid under the expansion. Bevin says the state can't afford to pay for this expanded population; the state's share is 5 percent this year, rising in annual steps to the ACA's 10 percent limit in 2020.

Bevin's plan is designed to encourage participants to have a higher level of involvement in their care through premiums and work or volunteer requirements. If approved, the state estimates that 95,000 fewer Kentuckians will be on Medicaid in five years than if the proposal is not accepted by federal officials. They are expected to approve Bevin's request, and perhaps allow other changes.

The Bevin administration has said that the goal is for these able-bodied adults without dependents to move to higher-paying jobs that offer employer-provided health insurance. Opponents of the plan say these higher-paying jobs are scarce in Kentucky, and note that many in this group already work at low-paying jobs that don't offer health insurance -- or if it's offered, it's not affordable.

KYA Executive Director Terry Brooks said some of the recent changes in Bevin's proposal could create "very real barriers to coverage" for adults, which research shows could result in fewer children being covered. "We also know that kids are more likely to have health insurance when their parents do," he said in a prepared statement.

Bevin spokesman Woody Maglinger told The Associated Press, "It may be a fact of life in Terry Brooks' alternate universe, but it is not a fact in Kentucky," Maglinger said. He noted that Bevin's plan would not change Medicaid eligibility requirements for children.

Last-ditch ACA repeal pushed; Bevin favors, Paul opposes

In Congress, Republican Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina are pushing a last-ditch effort to repeal the ACA and redistribute its funding from states that expanded Medicaid to states that did not, Sarah Kliff of Vox reports.

The bill would block-grant Medicaid money but would not allow states to re-enroll people now covered by the Medicaid expansion, reports Ed Kilgore of New York magazine: "They’d have to cover them some other way, presumably via private insurance."

The bill would reduce federal funding of Medicaid in Kentucky by more than $3 billion over the next 10 years, but Graham told Fox News that Bevin has endorsed his bill.

Graham also said Senate Majority Leader Mitch McConnell "needs to be as committed to repealing Obamacare as [Democratic predecessor] Harry Reid was to passing Obamacare, and Harry Reid had us in on Christmas Eve on Obamacare passage. . . . We had a lot of time off in August when we should have been here, repealing and replacing Obamacare."

McConnell told Kentucky Health News that the bill will come to the floor if there are 50 votes for it, which would put Vice President Mike Pence in position to break the 50-50 tie and pass it. "There’s a lot of discussion, but the time is running on that," McConnell said Thursday afternoon. "It could well come up. If we have 50 votes, we’ll go to it." The deadline to pass the bill with 50 votes, under budget-reconciliation rules, is Sept. 30.

Cassidy told The Washington Post that the bill has "48 or 49" votes, but it has not been vetted for passage under reconciliation, and the Congressional Budget Office has not said how the bill would affect the federal budget or the insurance-coverage rate. McConnell has asked the CBO to "quickly score" the bill, the Washington Examiner reports.

The Examiner adds: "Sen. Rand Paul, R-Ky., announced he would not be in favor of the legislation, which he called 'Obamacare lite'." Graham said on Fox that he would tell Paul that he should trust Bevin to provide "state-run health care." Paul was among the 49 votes for McConnell's last repeal-and-replace bill.

Congress also faces a Sept. 30 deadline to extend funding for CHIP, which provides health coverage for roughly 9 million children. The Senate Finance Committee has agreed on a plan to extend the program for five years, but phase out federal funding in 2021.

Two flu cases reported in Kentucky; CDC recommends everyone over 6 months old get a flu vaccination

Two confirmed cases of influenza have been reported in Jefferson County, signaling the coming start of the flu season in Kentucky.

The federal Centers for Disease Control recommends that every American over six months of age get a flu vaccination, and especially encourages people who may be at higher risk for complications or negative consequences:

• Children aged six months through 59 months;
• Women who are or will be pregnant during the influenza season;
• Persons who are 50 years of age or older;
• Extremely obese persons, those with a Body Mass Index of 40 or greater;
• Persons with chronic health problems;
• Residents of nursing homes and other long-term care facilities;
• Household contacts (including children) and caregivers of children younger than 5, particularly contacts of children younger than 6 months and adults 50 or over;
• Household contacts and caregivers or people who live with a person at high-risk for
complications from the flu; and
• Health-care workers, including students who have contact with patients.

Adequate supplies of flu vaccine are expected to be available for this year’s flu season, the state Department for Public Health said in a news release. "Only injectable influenza vaccine formulations will be distributed in the United States," the release said. "Vaccination can be given any time during the flu season."

"Getting the flu can be debilitating and sometimes life-threatening. Vaccination is the best tool we have to prevent the flu," state Health Commissioner Hiram Polk said. “It’s also extremely important to take simple preventive steps to avoid the flu. You should also follow the advice your parents gave you to prevent flu and other illnesses that tend to circulate at this time of year – wash your hands frequently, cover your mouth when you cough or sneeze and stay home when you’re sick.”

The flu can be very contagious, and can cause fever, headache, cough, sore throat, runny nose, sneezing and body aches. For more information on influenza or the availability of flu vaccine, Kentuckians should contact their primary-care provider or local health department. Information is also available online at https://www.cdc.gov/flu/index.htm.

State panels to hold a full-day meeting on heroin, other opioids

By Melissa Patrick
Kentucky Health News

State officials will hold what amounts to a symposium on heroin and other opioids, at an all-day meeting of two committees in Frankfort on Wednesday, Sept. 20.

The Interim Joint Committee on Health and Welfare and Family Services and the Medicaid Oversight and Advisory Committee will meet jointly from 10 a.m. to 3:30 p.m. in Room 154 of the Capitol Annex. The meeting also includes an invitation-only working luncheon that will be televised in rooms 149 and 154 for those who would like to listen to the panel discussion.

Kentucky has the third highest drug-overdose rate in the country. The Kentucky Office of Drug Control Policy reported a 7.4 percent increase in overdose deaths in 2016, and of the 1,404 overdose deaths in the state, more than half involved fentanyl, a synthetic opioid that is up to 50 times more potent than heroin, and one-third involved heroin. The National Institute on Drug Abuse reports that 80 percent of heroin use starts with a prescription opioid.

The number of Kentuckians who know someone who uses heroin or abuses prescription drugs in the state is growing.

The latest Kentucky Health Issues Poll on this topic found that 17 percent of Kentucky adults know someone who is using heroin, up from 9 percent in 2013 and 13 percent in 2015. It also found that 27 percent of Kentucky adults say they know someone who has abused prescription pain medications.

The House Health and Family Services Committee chair, Rep. Addia Wuchner, told Don Weber of Spectrum News that she has been evaluating treatment centers in Kentucky and surrounding states to see which model might best serve the state's growing addiction crisis.

"Some are good, some maybe not so good," said Wuchner, a Republican from Florence. "We’re putting a lot of money into it, you know; families are paying money, Medicaid is paying money, insurance companies are paying money, but what are the best practices?" she asked.

Wuchner, who is also a nurse, told Weber that the Sept. 20 meeting will look for "smart and effective" solutions, adding, "It will be a full day committee committed to just this issue."

The agenda shows a host of experts speaking throughout the day on the status and overall impact of the heroin and opioid crisis in Kentucky, including awareness and prevention programs, harm reduction programs, treatment and recovery options, and programs that affect special populations, like pregnant mothers and their infants and the justice populations. The day-long program will wrap up with a look at the progress that has been made and the work that lies ahead.

The luncheon panel includes Dr. Phillip Chang, chief medical officer at the University of Kentucky, who will discuss hospital-based efforts; Dr. Kelly Conrad, medical science director for Addiction Alkermes, who will discuss neuropsychology and opioid use disorder; and Dr. Michael Sprintz, founder and CEO of Sprintz Center for Pain and Recovery, Cellerian Health, who will discuss a physician's journey from addiction to recovery.

Here is the agenda for the main part of the meeting:

OPIOIDS IN KENTUCKY

Awareness, Prevention, and Treatment of Heroin and Opioid Use, Misuse, and Abuse

I. Overview of the Epidemic and Scope of the Crisis: Introductory Remarks (10 minutes): Reps. Addia Wuchner, R-Florence, and Kimberly Moser, R-Taylor Mill

II. OPIOIDS IN KENTUCKY MORNING PANEL I (30 minutes): Status and Overall Impact of the Heroin and Opioid Crisis
a.  Status of Heroin and Opioid Crisis: Van Ingram, Executive Director, Office of Drug Control Policy
b.  Health-care Impact: Dr. Gil Liu, Medical Director, Department for Medicaid Services
c Employment and Economic Impact: Dave Adkisson, President and CEO, Kentucky Chamber of Commerce

III. OPIOIDS IN KENTUCKY MORNING PANEL II (20 minutes): Awareness and Prevention
a. Children and Youth and the Impact of Adverse Childhood Experiences: Dr. Allen Brenzel, clinical director, state Department for Behavioral Health, Developmental and Intellectual Disabilities
b. Core-Life: Bonnie Hedrick, program manager/liaison, Northern Kentucky Office of Drug Control Policy

IV. OPIOIDS IN KENTUCKY MORNING PANEL III (40 minutes): Special Populations Part I: Pregnant/Parenting Women and Infants
Video: "Katie’s Story"
Jennifer Hancock, president and CEO, Volunteers of America Mid-States Freedom House
Teri Wilde, nurse manager, Baby Steps Program, St. Elizabeth Healthcare
Dr. Henrietta Bada, University of Kentucky

V. Harm Reduction: Safe Drug Disposal (15 minutes)
Sen. Alice Forgy Kerr, R-Lexington

VI OPIOIDS IN KENTUCKY AFTERNOON PANEL I (20 minutes): Treatment and Recovery Options, Part I: Medication Assisted Treatment
Dr. Mark Jorrisch, president, Kentucky Chapter of the American Society of Addiction Medicine
Dr. Molly Rutherford, founder, Bluegrass Family Wellness
Dr. Allen Brenzel, clinical director, Department for Behavioral Health

VII. OPIOIDS IN KENTUCKY AFTERNOON PANEL II (25 minutes): Special Populations, Part II: Justice Population
a. Quick Response Teams: Linny Cloyd, deputy, Quick Response Team Coordinator, Boone County Sheriff’s Office; Independence Fire Chief Scott Breeze
b. Angel Initiatives: Mike Ward, Chief, Alexandria Police Department
c Jail Substance Abuse Program: Jason Merrick, Director of Addiction Services, Kenton County Detention Center

VIII. OPIOIDS IN KENTUCKY AFTERNOON PANEL III (45 minutes): Treatment and Recovery Options, Part II
a. Outpatient Treatment: David Hayden, Vice President of Clinical Operations, SelfRefind; William Carter II, CEO, The Infinity Center
b. Long-Acting Injections: Steve Cummings, Our Lady of Peace; Chris Harlow, St. Matthew’s Pharmacy
c. Residential Treatment: Mike Cox, president, Isaiah House; Tim Robinson, founder and CEO, Addiction Recovery Care
d. Comprehensive Approaches: Nancy Hale, president and CEO, Operation UNITE

IX. The Progress Made and the Work Ahead (15 minutes)
a. Current Initiatives in the Department for Behavioral Health, Developmental and Intellectual Disabilities: Dr. Allen Brenzel, clinical director
b. Closing Remarks: Reps. Addia Wuchner and Kimberly Moser

Study finds SNAP not enough for healthy diet, as budget plans call for cuts in program on which Ky. is more reliant than most

By Melissa Patrick
Kentucky Health News

The Supplemental Nutrition Assistance Program, formerly known as food stamps, only covers 43 to 60 percent of the cost of the federal nutrition guidelines, according to a study by researchers who say policymakers should consider that as they propose deep cuts to the program.

“Even though SNAP is not designed to cover all of the cost of food – it’s meant to be a supplemental food program – this study makes it clear that there would be many low-income households that would not be able to cover the gap needed to eat a diet consistent with federal dietary guidelines,” Lindsey Haynes-Maslow, co-author of the study, said in a news release.

The report notes that the average gross income for all SNAP participants is $786 a month, and the expectation is that "SNAP households are expected to spend about 30 percent of their resources on food," says the U.S. Department of Agriculture.

The study, published in the Journal of Nutrition Education and Behavior, estimated how much it would cost to fulfill the USDA's MyPlate guidelines, which recommend filling half your plate with vegetables and fruits, the other with a lean protein and grains, along with a serving of low-fat dairy. Then it estimated the additional costs needed by SNAP recipients to adhere to it.

The researchers concluded that SNAP benefits are sufficient to meet the needs of children under the age of 8 and women over the age of 51, but are insufficient for older children, younger women, and men of any age.

It found that while the average monthly SNAP benefit is $254 per household, the cost of feeding a family of four according to the MyPlate guidelines is between $1,000 and $1,200 per month, depending on the number and age of children in the home.

The study used average monthly SNAP benefits for 2015 and monthly retail price data from the USDA to determine food costs. The calculations also took into account the time it takes to shop for and prepare the food, citing previous studies that show that in addition to food costs, the time it takes to prepare nutritious foods is a barrier to eating healthy.

“Even without including labor costs, a household of four would need to spend approximately $200 to $300 in addition to their SNAP benefits to follow the dietary guidelines," said Haynes-Maslow, who is also an assistant professor of agricultural and human sciences at North Carolina State University.

SNAP funding based on guidelines that were replaced in 2010

The researchers pointed out that SNAP funding is based on the 2005 Food Pyramid nutrition guidelines, which MyPlate replaced in 2010. They encouraged policy makers to use current information on "the true costs of healthy eating" as they consider cuts to the program. They say proposed cuts to SNAP would "decrease the amount of benefits available for food purchases, and fewer people would have access to the program."

President Trump's 2018 budget proposal calls for $191 billion in cuts to the SNAP program over 10 years, a cut of more than 25 percent. The cuts would largely come from requiring a "state-match" that would shift 25 percent of the cost of the program to states by 2023, while giving them flexibility to cut benefits.

The U.S. House of Representatives' 2018 budget proposal calls for even deeper cuts, which are "$4.87 billion below last year's level and $2.6 million below the president's budget request," the House Appropriations Committee said in a June 27 news release. The Senate has no budget proposal yet.

“This research highlights how modest these benefits really are, which is something a lot of people, including many policymakers, probably don't realize. In Kentucky, it's just $1.36 per person per meal," Ashley Spalding, research and policy associate for the Kentucky Center for Economic Policy, said in a telephone interview. “And so with benefits already this modest, the recently proposed federal cuts would be devastating for our state.”

As of February, 651,889 Kentuckians received SNAP benefits. Of those, 41 percent were children, 25 percent were elderly or disabled, 52 percent lived in a rural county, and about 36 percent were working, Spalding wrote for the Ky Policy Blog, which details the impacts of the proposed SNAP cuts on Kentucky.

Kentucky Center for Economic Policy table 

Spalding notes that Eastern Kentucky would have the most to lose from cuts, because the state's 5th Congressional District has the sixth largest number of households on the program.

She also cites studies that show how SNAP lifts people out of poverty, and that people who receive SNAP when they are children have improved academic achievements, are more likely to graduate from high school, and ultimately have better long-term health outcomes.

Spalding said Kentucky is in no position to take on additional funding responsibilities for SNAP, as proposed in the Trump budget. The state ended the 2017 fiscal year on June 30 with a $138 million shortfall, and is projected to end the 2018 fiscal year with another $200 million shortfall. Gov. Matt Bevin recently ordered a 17 percent budget cut across most state agencies.

The Kentucky Association of Food Banks, representing seven food banks, distributed the equivalent of 58 million meals last year, which doesn't even meet the demand, Tamara Sandberg, the executive director of the Kentucky Association of Food Banks, said in a Lexington Herald-Leader op-ed .

"Despite the large volume of food distributed by our network each year, we struggle to keep pace with the demand because of the high need for food assistance in Kentucky," she wrote.

Sandberg urged the Kentucky congressional delegation to oppose any budget cuts to SNAP and other poverty-reduction programs. She noted that 65 percent of households served by the food banks also receive SNAP benefits.

She said, "Despite our best efforts to meet the need for food assistance among our neighbors, Kentucky’s food banks could never make up the difference if SNAP was cut."