Even if Obamacare automatically re-enrolls you, check out your options; open enrollment ends earlier this year: Dec. 15

By Melissa Patrick
Kentucky Health News

This is the first year that more than 80,000 Kentuckians with a 2017 health insurance plan on the federal exchange will be automatically re-enrolled in a 2018 marketplace plan. But that doesn't mean they shouldn't check out other options before open enrollment ends Dec. 15.

"People should not automatically assume that they are going to get re-enrolled in something that is going to work for them," said Emily Beauregard, executive director of Kentucky Voices for Health. "I think it's important that people still log in, see what their plan options are, make sure that if they have been auto-assigned to a plan that it is going to work for them, and not wait until it is too late."

So far, 27,979 Kentuckians have actively selected a 2018 health plan on Healthcare.gov during the first month of open enrollment, according to the Centers for Medicare and Medicaid Services.

This number includes both new enrollees and returning members who have actively selected a health insurance plan on Healthcare.gov. It does not include those who have been been automatically re-enrolled, nor does it indicate how many re-enrollees have compared plans and decided to stick with their old one.

During the same time frame last year, when there was no automatic enrollment, CMS reported 20,276 Kentuckians had signed up for a 2017 health plan on healthcare.gov.

The Kaiser Family Foundation also has warned people to make sure they are happy with their re-enrollment plan because they won't be able to change it in January, as they have in the past.

Whitney Allen, the outreach and enrollment coordinator for the Kentucky Primary Care Association, encouraged people to make an appointment with their local application assister.

Allen said assisters can help ensure that Kentuckians who have been auto-enrolled have been placed in the best plan for them in 2018, and can help people understand that even though their premiums have gone up, so have the tax credits that help them pay for their health insurance -- which she said has caused a lot of "sticker shock" and confusion.

"So a lot of folks are getting plans that are cheaper and with better coverage than their 2017 plan," she said. "But it's actually taking those folks to come in and to schedule an appointment to meet with an application assister to understand that."

Allen added that many people in southeastern Kentucky, where she works, still don't know it's time to sign up for their 2018 Obamacare plan or that open enrollment ends much earlier thus year, which she said is largely because of the "drastic" cuts to advertising and marketing budgets this year.

"If folks aren't reading the notices that they are getting in the mail, then basically they wouldn't know that it is open enrollment," Allen said.

The state's health agency has said it is using direct mail, text messages, phone calls and emails to communicate with current policyholders and potential new enrollees about open enrollment because they no longer get any federal funds for outreach.

Adding to the confusion, some Kentuckians who are enrolled in a plan that will not be available next year will qualify for a special enrollment period that gives them until March 1, 2018 to enroll in a new plan.

John Watkins, the acting executive director of the state's Kentucky Health Benefit Exchange, said in an e-mail that enrollees who have plans that will not be continued next year should have received notice of this in October, and may have received another notification from Healthcare.gov telling them what plan they were placed in.

In other words, it's important that you don't assume that you will qualify for a special enrollment period unless you have been notified by your insurer or healthcare.gov that your plan will no longer continue or was cancelled.

Beauregard encouraged Kentuckians to err on the side of caution when it comes to this year's special enrollment period and to go ahead and sign up before Dec. 15 if they can, and to seek the help of an application assister to help with the special enrollment paperwork if they can't.

Assisters are available in every Kentucky county to help people sign up for coverage, and their services are free. There are also sign-up events throughout the state.

To find an event in your county or an assister, go to healthbenefitexchange.gov. The site also includes net payment examples for all regions of the state and 2018 sample scenarios for individuals and families.

Help is also available through the state call center at 855-459-6328 and the Healthcare.gov customer center at 800-318-2596, which is available 24 hours a day, seven days a week.

Study: Combination of a low-salt and heart-healthy diet is as good as drug therapy for many adults with high blood pressure

A new study finds that cutting back on salt and following the heart-healthy DASH diet can lower blood pressure, a disease that affects almost two out of every five Kentuckians.

“Our results add to the evidence that dietary interventions are as effective as—or more effective than—anti-hypertensive drugs in those at highest risk for high blood pressure, and should be a routine first-line treatment option for such individuals,” Dr. Stephen Juraschek, a study co-author, said in a news release. Juraschek is an instructor of medicine at Harvard Medical School and an adjunct assistant professor at Johns Hopkins University School of Medicine.

Previous guidelines defined high blood pressure as 140/90 milligrams of mercury (mm/Hg) or higher, but guidelines released this year have re-defined it as 130/80 mm/Hg or higher. High blood pressure increases the risk of stroke, kidney disease, heart attacks and heart failure.

The four-week study, published in the Journal of the American College of Cardiology, included 412 adults between the ages of 23 and 76 who had high blood pressure or were at risk of having it. They were asked to either stay on a "regular" diet or to switch to the Dietary Approaches to Stop Hypertension, or DASH, diet. DASH limits foods high in saturated fat and sugar, and is high in fruits, vegetables, whole grains, low or fat-free dairy, fish, poultry, beans, seeds and nuts.

They were also divided into three groups that received varying amounts of salt. One was allowed about a half a teaspoon per day, another was allowed about a teaspoon per day and the third group was allowed about 1.5 teaspoons a day. To reduce the risk of heart disease and stroke, the U.S. Food and Drug Administration recommends a maximum of about 2,300 mg of sodium per day, which is nearly one teaspoon of salt.

None of the study participants took blood-pressure medicines. Their baseline systolic blood pressures (the top number) ranged from 120 to 159 and their diastolic blood pressure (the bottom number) was between 80 and 95.

The participants were sorted into four groups: 120–129 mm Hg, 130–139 mm Hg, 140–149 mm Hg, and 150 mm Hg or greater.

The results varied based on which regimen the participants followed.

Those who followed the DASH diet with high sodium and had a systolic pressure of 150 or greater, had an 11-point average drop in systolic pressure. The effect was much less, a 4-point drop, among those whose beginning systolic pressure was less than 130.

The effect was even greater for those who were on the low-sodium DASH diet. Those who started with a systolic pressure of less than 130 had a 5-point drop in pressure; those who started between 130 and 139 had a 7-point drop; and those who began between 140 and 149 had a 10-point reduction.

The biggest impact was among those who followed the low-sodium DASH diet and started out with a systolic blood pressure of 150 or greater. They had an average drop of 21 points.

Juraschek called the findings "huge" and said they suggest that those at highest risk for serious hypertension achieve the greatest benefit from the combination diet.

The researchers said further research is needed to determine how the combination diet affects people with systolic blood pressure of 160 or greater or in persons with prior heart disease or diabetes.

Here are some holiday dining tips for people who have diabetes, a disease that affects almost 460,000 Kentuckians

Diabetes UK photo

The food and festivities that are part of the holiday season can make it hard to eat healthy, especially if you are one of the almost 460,000 Kentuckians who have diabetes.

But it doesn't have to be if you make a plan and stick to it, says the American Association of Diabetes Educators. To help make this plan, the association created a collection of "Holiday Season Eating Tips" with strategies to help people with diabetes enjoy the holiday season and maintain their blood sugar levels.

When it comes to eating big meals, the association's tip-sheet suggests: not skipping meals; limiting the number of starchy foods on your plate; choosing fruits and vegetables served raw, grilled or steamed; and sticking to calorie-free drinks. And if you choose to drink alcohol, which can lower blood sugar and interact with diabetes medicines, limit the amount and drink it with food.

If you are the one preparing the food, make sure you include healthy food choices like fruits, vegetables and lean meat; avoid frying or adding extra fat during cooking; and avoid sampling the foods more than necessary while you are cooking.

Another way to control your holiday portions is by using the "diabetes plate method," and foregoing seconds, says an article on The Diabetes Council website that also offers tips on managing diabetes during the holidays.

This method involves filling up half of your 9-inch plate with non-starchy, low carbohydrate vegetables, one fourth of the plate with a lean meat or protein and the other fourth of your plate with a carbohydrate of your choice. This method also allows for two more carbohydrate servings, which could be milk, fruit or a higher carbohydrate dessert.

As for all of those holiday treats, the association's tip-sheet recommends taking small portions, eating slowly and savoring every bite.

Holiday parties provide their own set of challenges when it comes to making healthy food choices, including the opportunity to graze, which can lead to poor food choices and overeating.

The tip sheet emphasizes the importance of not skipping meals, which can lead to overindulgence because you will arrive at the party hungry. It also recommends that you study all of the food options before deciding what to put on your plate, adding that if you choose something you don't enjoy, don't eat it.

And as always choose raw vegetables first, with only a small amount of dip (or skip it entirely); eat chips and crackers in moderation; sip on water or mineral water; and don't hang out near the food table.

The association also reminds people with diabetes to check their blood sugar regularly throughout the holidays, possibly adding a few extra checks in on party days to help guide your choices.

The federal Centers for Disease Control and Prevention offers some additional tips for people with diabetes to "holiday proof" their meal plans.

One of them reminds people with diabetes to make sure they eat close to their usual mealtime to keep their blood sugar steady, and if the holiday meal is to be served later than normal, eat a small diabetes-friendly snack at their usual mealtime and eat a little less when the meal is served.

Others include cutting back on carbohydrates during the main meal to allow for a sweet treat; making sure you are sleeping seven to eight hours per night because sleep loss can make it harder to control your blood sugar and tends to make people eat more and prefer high-fat, high-sugar foods; finding ways to fit in your favorite holiday dishes; and to make sure you keep moving, even if your physical activity is broken up into smaller chunks to fit your busy schedule.

And if you need further help with your diabetes management during the holidays, talk to your diabetes educator.

Many Kentuckians with Obamacare plans got premium notices that over-estimated costs for 2018; see HealthCare.gov for facts

By Melissa Patrick
Kentucky Health News

With a shortened enrollment period, huge cuts in advertising and in-person assistance, and ongoing efforts to repeal and replace the federal health law, it's no wonder many Americans are confused about whether they can or should sign up for health coverage on government marketplaces this year.

Perhaps the most basic facts are these: The Patient Protection and Affordable Care Act, also known as Obamacare, is still the law of the land; it still requires everyone to have health insurance or pay a penalty; and the Dec. 15 deadline to sign up for a plan is fast approaching.

The requirement to have health insurance is designed to spread the risk and hold down costs. The penalty for not having it in 2018 will be $695 per adult and $347 per child, with a maximum of $2,085 per family or 2.5 percent of the household's income, whichever is larger.

Another possible source of confusion is that many returning Obamacare customers received renewal notices from their insurer that underestimated their 2018 monthly premium estimate. The notices used the customers' 2017 tax credit for the estimate instead of the larger 2018 tax credit, which could be causing "significant -- and misleading -- sticker shock," says the Kaiser Family Foundation.

Tax credits are available to people who earn between 100 and 400 percent of the federal poverty line to help reduce Obamacare premiums. The smaller your income, the larger your tax credit.

The practice of using the previous year's tax credit amount to determine the upcoming year's estimate wasn't as much a problem in the past because there wasn't much change from year to year in premium costs.

Tax credits will be larger in 2018 because they are based on the cost of benchmark "silver" marketplace plans, which have increased significantly in most markets for 2018 as a result of the federal government no longer paying a cost-sharing payment to insurers to keep these costs down. Generally, people who have had little or no changes in income and qualify for a tax credit will get a bigger one in 2018, and that will keep their monthly premium about the same.

Kaiser offered an example of the differences in estimated and actual costs of a 2018 silver plan for a 40-year-old in Louisville with income of twice the poverty level.

Such a person would pay the same $127 per month for a benchmark silver plan after using the appropriate tax credit. But if the 2017 tax credit is applied to the 2018 premium, as some renewal notices did, that calls for a monthly cost of $277, more than double this year's.

Elizabeth Kuhn, a spokeswoman for the Kentucky Public Protection Cabinet, said in an e-mail that between Nov. 1 and Nov. 22, about 9 percent of the calls to the state's Department of Insurance Consumer Protection Division were related to the federal marketplace, HealthCare.gov, including calls about this issue.

"The department representatives have explained that premiums could potentially be lower," she said. "Also, the premium notices sent to policyholders by insurers referenced that the 2018 premiums were estimates."

In Kentucky, Anthem Inc. is offering plans in 59 counties and CareSource, a Humana Inc. plan, is handling the other 61. Fran Robinson, a spokeswoman for CareSource, said its premium-estimate notices used the 2017 tax credit instead of the higher 2018 tax credit.

Robinson said the notices stated that the premium estimate was only an estimate, and encouraged recipients to update their information on Healthcare.gov to get their actual 2018 premium amount. She said they have explained this to any consumers who have called about this issue and encouraged them to update their accounts to get an accurate premium amount.

Anthem did not respond to the same inquiry from Kentucky Health News.

Suzanne Craig, program manager of the Community Access Project for the Green River District Health Department, told WKMS in Murray that "substantial numbers" of people are signing up for their ACA plans and many are fearful that they will lose their coverage.

"We are seeing more than we expected. These enrollments are taking longer because people have more questions," Craig told Rhonda Miller of WKMS, the Murray State University station.

WHAT CONSUMERS NEED TO KNOW, from Kentucky Health News:

Don't assume you can't afford a health insurance plan this year, especially if you got a notice that says your premium will be higher in 2018 than it was in 2017. Instead, to get the most accurate estimate go directly to Healthcare.gov, update your information and view the cost of all the plan options after the 2018 credit is applied.

Remember that help is available in person, by phone and online.

Every county in Kentucky has an application assister, formerly called Kynectors, to help consumers sign up for health coverage. They are offering sign-up events throughout the state.

To find an event in your county or an assister, go to healthbenefitexchange.ky.gov. The site also includes net payment examples for regions of the state and 2018 sample scenarios for individuals and families. It also provides answers to a list of frequently asked questions.

Kaiser Family Foundation offers a health insurance marketplace calculator to help consumers estimate their 2018 marketplace costs.

Help is also available through the state call center at 858 855-459-6328 and the Healthcare.gov customer center at 800-318-2596, which is available 24 hours a day, seven days a week.

Progression of Alzheimer's disease can be slowed, even though its cause isn't known and there is yet no cure for it

People with Alzheimer's disease can do something about it.

That statement may surprise you, because no cure has been developed for the disease, and we aren't even sure what causes it. But that doesn't mean its progress can't be slowed.

"Medications and management strategies may temporarily improve symptoms, and can often slow progression," Dr. Graham Garrison of KentuckyOne Health Neurology Associates wrote for the Lexington Herald-Leader.

Garrison's column touched on many basic facts about Alzheimer's, including:

"As Alzheimer’s disease progresses, it destroys the memory and other important mental functions. Those suffering from the disease may first notice an increase in forgetfulness or mild confusion, but over time, will begin to forget recent memories. Someone with Alzheimer’s disease may find themselves repeating questions, forgetting conversations or appointments, getting lost in familiar places, forgetting the names of objects or family members, misplacing possessions, or having trouble taking part in conversations. Early on, patients may not be aware of the presence or degree of their impairment, which is typically more evident to others. When a loved one is suffering from Alzheimer’s disease, family members may notice changes in their personality and behavior, including depression, social withdrawal, mood swings, lack of trust in others, wandering, change in sleeping habits, loss of inhibitions, irritability and delusions."

Garrison concludes, "If you or someone you know are exhibiting early signs of Alzheimer’s disease, speak to a physician about your condition. A physician can check you for other, treatable causes of these symptoms, or other forms of dementia."

Central Ky. newspapers endorse $1-a-pack hike in cigarette tax; more legislators talking about need to raise more revenue

The Lexington Herald-Leader's editorial was accompanied by an
an X-ray from the American Lung Association showing lung cancer.

Two Central Kentucky newspapers recently endorsed a $1-a-pack increase in the state cigarette tax as a good way to raise needed revenue while discouraging smoking, the leading cause of the state's many health problems.

"How does Kentucky overcome a challenge that seems insurmountable? How can we eliminate a cultural touchstone that seems so ingrained into who we are as a state that some feel it is impossible to remove?" The Winchester Sun asked at the start of its editorial. "Simple," it answered. "We take a stand and implement strong measures that are essentially proven to save lives."

The editorial adopted the arguments of the Coalition for a Smoke-Free Tomorrow, a broad and diverse group that is pushing for the tax increase as a way to discourage smoking, especially among young people, for whom price increases would be more significant.

"This proposal makes sense financially as well," the editorial said. "The $1 increase is projected to generate more than $266 million in new revenue, which would address the state’s budget shortfall and provide much-needed funding to save the state’s pension systems without breaking past promises.. . . . The time for talking has passed. We need firm action. Kentuckians deserve it. The health of our state depends on it."

The Lexington Herald-Leader's editorial noted that the state raised its cigarette tax "by 27 cents in 2005 and by 30 cents in 2009 to reach the current 60 cents a pack, one of the nation’s lowest. . . . Unless the per-pack increase is $1 or more, it would just be a tax on poor people, doing nothing to protect Kentuckians’ health."

It added, "A significant increase in the price of cigarettes, on the other hand, is the most effective way to combat the addiction that has cursed Kentucky with the nation’s highest rates of cancer and cancer deaths and overall ill health. In only West Virginia does such a high percentage of adults smoke."

Read more here: http://www.kentucky.com/opinion/editorials/article185110303.html#storylink=cpy

The prospect of major budget cuts and the need for pension financing are making more legislators consider raising taxes in the regular session that begins in January, Ronnie Ellis, Frankfort correspondent for Community Newspaper Holdings Inc., said on KET's "Comment on Kentucky" Friday night.

"The public may finally rise up and say enough's enough," when it comes to cuts, Ellis said. "I am somewhat surprised by the number of lawmakers who will ... privately talk about 'We're gonna have to do something in the session to bring in more revenue, or we'll bring up tax reform'," unlike a few weeks ago.

State health department declares outbreak of hepatitis A, a liver disease that is often transmitted due to poor sanitary practices

State and local health officials are working to contain an outbreak of hepatitis, comprising 31 cases in 13 counties, largely in the Louisville area but also from Paducah to Hyden.

The state Department for Public Health has declared an outbreak of acute hepatitis A, it said in a Nov. 21 news release. The number of cases is "a 50 percent increase above the average of 20 cases per year reported over the past 10 years," the release said. "Jefferson County has had 19 confirmed cases, most of which have occurred since August. Cases have been reported in Jefferson, Shelby, Bullitt, Hardin, Henry, Anderson, Mason, Christian, Madison, Fayette, McCracken, Hopkins, and Leslie counties."

  

The release added, "Common risk factors of homelessness or drug use have been identified among 12 of the cases in Jefferson County."

No deaths have been attributed to the outbreak, but “Acute hepatitis A is a serious and potentially life-threatening infectious disease,” said Dr. Jonathan Ballard, the state epidemiologist. “We are working to identify anyone who has been exposed to cases associated with this outbreak and urging those experiencing symptoms of the illness to contact their healthcare provider for appropriate evaluation and medical treatment, if necessary.”

Testing has suggested that the strain of hepatitis involved is one associated with outbreaks in California.

Hepatitis A, a liver disease, can be prevented by vaccinations. Children, ages 1 through 18 are recommended to get the vaccine, “as well as adults with increased risk factors or certain medical conditions,” Ballard said. Those factors include homelessness; all forms of substance-use disorder; people with direct contact with someone who has Hepatitis A; travelers to countries where hepatitis A is common; men who have sexual contact with men; household members or caregivers of a recent adoptee from countries where hepatitis A is common; and people with clotting factor disorders, such as hemophilia.

"Other than age-appropriate vaccinations, the best way to keep from getting Hepatitis A is to wash your hands using warm water and soap, to handle uncooked food appropriately and to fully cook food," the release says. "Always wash your hands before touching or eating food, after using the toilet and after changing a diaper. When soap and water are not available, use alcohol-based disposable hand wipes or gel sanitizers."

The signs and symptoms of Hepatitis A include yellowing of the skin or eyes (jaundice), dark urine, fatigue, abdominal pain, loss of appetite, nausea, vomiting, diarrhea, gray stools and fever. Not everyone with the virus has symptoms.

"The virus is found in the stool of infected people is usually spread from person to person by putting something in the mouth (even though it might look clean) that has been contaminated with the stool of a person infected with Hepatitis A," the release says. "It is often transmitted when people do not wash their hands properly or by eating uncooked or undercooked food."

Information about Hepatitis A is available from the federal Centers for Disease Control and Prevention at https://www.cdc.gov/hepatitis/hav/index.htm.

Secretary of State Grimes forms group to push for legalization of medical marijuana in Kentucky in 2018 legislative session

Kentucky Health News

A task force to get medical marijuana legalized in Kentucky held its first meeting Nov. 21 and plans to meet again in December to review legislation to be presented to the General Assembly when it convenes in January.

"The group includes members of Kentucky's medical community, including doctors, nurses and medical administrators, as well as representatives from law enforcement and state agencies with regulatory oversight, medical marijuana advocates, and military veterans," said a news release from Secretary of State Alison Lundergan Grimes, who created the group and chairs it.

The group's co-chair, Rep. John Sims, D- Flemingsburg, is having a bill drafted, Lexington's WKYT-TV reports. "The outpouring of support we've seen so far on this issue is very encouraging. There is no doubt in my mind medical marijuana would change the lives of so many Kentuckians for the better," Sims said in the news release. "I am convinced that together this group will produce a piece of legislation that everyone can endorse and eventually vote for. This is about improving the health of Kentuckians who are suffering every day. It's a no-brainer to me." 

The task force continues the lobbying efforts of member Jaime Montalvo, founder of Kentuckians for Medicinal Marijuana and a multiple sclerosis patient. "This issue is about compassion for patients, for the people who live in pain every single day," Montalvo said in the release. "My life depends on it, and so many more. We have to get this done."

WKYT reported that some Republicans have questioned the role of Grimes, a leading Democrat who cannot run for re-election to her current job in 2019. Grimes told the station that she wants to be an advocate for "the hundreds of thousands of folks who are suffering across this state," and "It's something people are looking to leaders like myself to help solve."

The Grimes news release said "Significant evidence exists showing marijuana counters side effects of a large number of illnesses and diseases, including cancer, multiple sclerosis, Alzheimer's disease, Crohn's disease, hepatitis C, and post-traumatic stress disorder." While those effects have been widely reported for many years, they have not been explained by scientific research. However, medical marijuana is legal in 29 states and the District of Columbia, according to the release.

The Kentucky Health Issues Poll in fall 2012 found that 78 percent of adults favored allowing people to buy marijuana for medical purposes if their doctor recommended it.

A February 2014 poll for Kentucky news outlets found that 52 percent of adults supported the legalization of marijuana for medicinal purposes, while 37 percent were opposed, with an error margin of plus or minus 3 percentage points.

Later that month, the state House Health and Welfare Committee voted 9-5 to approve a medical-marijuana bill, which never came to a vote in the full House -- then controlled by Democrats, now by Republicans. The 2014 legislature did pass a law allowing cannabidiol, a marijuana extract, to be used in clinical trials or at the University of Kentucky or University of Louisville.

Sen. Morgan McGarvey, a Louisville Democrat who has proposed allowing marijuana to be prescribed to terminally ill patients, says the issue cuts across partisan lines.

Dan Seum Jr., the son of Republican Sen. Dan Seum of Louisville, is among plaintiffs in a lawsuit in Franklin Circuit Court seeking a judgment allowing medical marijuana in the state. The suit argues that to do otherwise "violates Kentucky residents’ right to privacy in their own homes, and that the state constitution does not allow Kentucky to create laws that are without reason," Lisa Gillespie reports for Louisville's WFPL. "Seum’s father . . . voted in favor of a bill in 2014 allowing the state to study a form of medical marijuana."

Kentucky School Boards Association says it will support any legislation to make all schools in state tobacco-free

By Melissa Patrick
Kentucky Health News

Usually opposed to statewide mandates on schools, the Kentucky School Boards Association says it will support any legislation that proposes a statewide tobacco-free school law in the 2018 legislative session, because the majority of its members support such a law.

"We really try to protect local decision-making on these things," Eric Kennedy, director of governmental relations for the association, said in a telephone interview. "But on this, where so many districts have already adopted these policies locally, and I think the health issue for students and staff also being tied into it, this is one of those rare instances where KSBA will support the General Assembly putting in a statewide policy like this."

An August survey of more than 1,000 KSBA members on various legislative issues asked, "Should the General Assembly ban all tobacco products and electronic cigarettes/vapor products on school property?" Among the nearly 300 respondents, 81 percent said yes, Kennedy said, adding that members at 12 regional meetings across the state also voiced their support.

"Because our membership has said they are in such support of it, we will be supportive of any kind of smoke-free school legislation this year," Kennedy said.

Sen. Ralph Alvarado, a physician from Winchester, introduced a bill to require all Kentucky schools to be 100 percent tobacco-free in the 2016 legislative session. It passed easily out of the Republican-run Senate but couldn't garner enough support to be called up for a vote in the House, which was then controlled by Democrats but now has a Republican majority.

Alvarado, a Republican, told Kentucky Health News in September that he plans to sponsor the bill again in the upcoming session, and anticipates a similar one to be introduced in the House. Kennedy indicated he had been told likewise.

Kennedy said that as of August, 74 of Kentucky's 173 school districts had some form of a tobacco-free policy in place, and KSBA knew of at least two more considering one.

Map from 100 Percent Tobacco Free Schools website

The "100 Percent Tobacco Free Schools" website reports only 68 districts with such policies, because its requirements for inclusion are more stringent than KSBA's. While that number is only 39 percent of districts, those districts have 55 percent of the state's students.

To be listed on the site, schools must ban use of all tobacco products, including vapor products, by staff, students and visitors at any time on school-owned property and during school-sponsored events. The site notes that some schools need to update their policies to meet new vapor-product standards.

“Passing a 100 percent tobacco-free school policy sends a strong message to young people that tobacco use is not normal and not accepted," Elizabeth Anderson-Hoagland, youth tobacco specialist for the state Department for Public Health, said in an e-mail. "We know that students in districts with tobacco-free policies that are strongly enforced are less likely to start using tobacco."

Six school districts have passed 100 percent smoke-free policies in Kentucky this year, compared to 12 in 2016. This year's additions are the West Point and Covington independent school districts and the Nelson, Hopkins, Monroe and Owen county districts.

KSBA recently became a member of the new Coalition for a Smoke-Free Tomorrow, spearheaded by the Foundation for a Healthy Kentucky. The coalition has three goals: to help localities enact comprehensive smoking bans; to educate the public and providers about a new law that requires health insurers to cover all federally approved tobacco-cessation medications and programs; and to raise the state's cigarette tax by $1 or more per pack.

The coalition has said raising the cigarette tax would initially generate $266 million a year for the state, decrease healthcare costs, improve employer productivity, improve the overall health of Kentuckians and would prevent Kentucky's youth from ever starting the habit.

Kennedy said KSBA supports both the health and revenue missions of the coalition.

"We at KSBA for many years have advocated strongly for comprehensive state tax-reform to bring in additional revenue to support our schools, and so it fits perfectly in line with that," he said.

New data from the Youth Risk Behavioral Surveillance System survey shows the number of high school students who are smokers has dropped again, from 16.9 percent to 14.3 percent. The numbers also dropped for electronic cigarettes, dropping from 23 percent to 14.1 percent. The national rate for smoking is 8 percent and 11.3 percent for electronic cigarettes, according to the federal Centers for Disease Control and Prevention.

Ky. teen suicides more than double in 2 years; one in 12 high-school sophomores say they have tried to kill themselves

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – A recent survey found that one in 12 of Kentucky's high-school sophomores said they had attempted suicide, prompting experts on the topic to discuss what is being done about it. The main solution offered was more family support for teenagers, even those who may be only temporarily troubled.

In a tone of incredulity, Dr. Allen Brenzel, medical director of the state Department of Behavioral Health, Development and Intellectual Disabilities, told the legislature's joint health committee Nov. 15, "Almost 7,000 students in this survey said on a piece of paper that they actually attempted suicide within the previous 12 months."

Brenzel, the last speaker on the topic, noted that there has been an upward trend in teen suicide deaths, both nationally and in Kentucky -- where the total suicides among teenagers more than doubled between 2014 and 2016,  jumping from 19 to 44.

"From 2014 to 2015 we saw an almost doubling in the adolescent suicide completion rate," Brenzel said. "This is very disturbing, very concerning. It led us to re-double our efforts to collect and partner with many agencies to determine what is the nature of this increase, why are we seeing it , what's happening with our youth and what can we do around prevention."

The 2016 Kentucky Incentives for Prevention survey, given at participating Kentucky schools to even-numbered grades from 6 to 12, found that 15.4 percent of Kentucky sophomores said they had "seriously considered" attempting suicide in the 12 months prior to the survey. The national average is 18.3 percent.

The suicide-consideration rate ranged from 12.2 percent in Eastern Kentucky to 18.2 percent in the Communicare mental-health region (the Lincoln Trail Area Development District) and 17.6 percent in the Pennyroyal region (the Pennyrile Area Development District).

"We're not exactly sure we understand why, but we know there is heavy military family presence in those areas, and we do have some concerns about the cumulative effect of multiple deployments, which is a stressor in military families," Brenzel said. He added that the state has allocated extra money toward suicide prevention efforts in those regions to help military families, and such targeting has been proven to work. Fort Campbell, the Army post with the most deployments, is in the Pennyrile district; Fort Knox is in the Lincoln Trail district.

The Pennyroyal and the other two Western Kentucky regions (and the Comprehend/Buffalo Trace region in northeastern Kentucky) had the highest percentages of sophomores saying they had attempted suicide. Statewide, 12.5 percent of 10th graders said they had made a plan about how to attempt suicide, which is called suicidal ideation; 8.2 percent, or one in 12, said they had actually attempted suicide in the previous year.

"A significant number who have ideation progress to an actual attempt," Brenzel said, "so that is why identifying those students earlier and preventing that progression on that continuum is important."

Dr. Hatim Omar, chief of the Division of Adolescent Medicine at the University of Kentucky, said it's time to stop thinking about suicide as a mental-health issue and make it a public-health issue.

He said one-third of teen suicides have nothing to do with mental health, but are the result of a same-day crisis, and that with the proper prevention efforts and supports -- and a lack of access to a lethal method -- these suicides are often preventable.

For example, he said parents shouldn't just dismiss a teen's broken heart or concerns about a failing grade, but take time to commiserate with the child and not simply brush off such events as part of growing up.

"We want parents to wake up and pay attention to their kids, and listen to them and not ignore them," he said. "But we fail in this very basic thing."

Omar emphasized that research shows that a teen will "do fine if they have one adult who cares about them, if they have a safe place to interact with this adult ,and if we actually give them something useful to do. So why don't we do that? It sounds really simple."

He said the lack of adult support is illustrated by youth in his practice who tell him they no longer have family dinners, while 10 years ago they ate with their families about 15 times a month. He added that even when families eat together, it is often with their noses in a smartphone.

"That's our biggest problem. We are losing our families," Omar said "Kids are not feeling supported."

Risk factors and prevention strategies

Risk factors for teen suicide include a prior attempt, substance abuse, being discharged from a mental hospital, having a firearm in the home, and a bipolar disorder or schizophrenia, Omar said. He added that "major depression" is only responsible for 2 percent to 4 percent of teen suicides.

Omar noted the importance of storing guns and bullets in different places. He told the story of a 16-year-old patient who had decided to kill himself: He found a gun in his house, but couldn't find bullets, so he gave up after 30 minutes.

"That's the difference between life and death," Omar said.

All middle- and high-school students in Kentucky are required to receive some form of suicide-prevention education by Sept. 1, and teachers are required to receive at least two hours of self-guided training. The state has also implemented several peer-led "Sources of Strength" programs that promote resiliency and overall health, with plans to broaden this program to all school districts.

Some districts are doing even more to prevent teen suicide.

Lincoln, Boyle, Harrison, Nicholas and Scott counties use the "Stop Youth Suicide" program, which Omar founded in 2000. This program screens every student starting in sixth grade to determine their suicide risk and "most importantly" let them know help is available, Omar said.

Showing data from Lincoln County, Omar noted that when it started the program in 2007, the school district was seeing an average of two suicides per year, but since then there has only been one, last year. He added that the high school has seen higher attendance and graduation rates, and lower dropout and teen-pregnancy rates.

Dusty Phelps, a psychologist in Pulaski County, said its suicide-prevention and mental-health program, called "Kentucky Aware," is a grant-funded pilot program that could become a statewide model.

Among other things, the program integrates school-based mental-health services into the education system; teaches staff how to recognize signs of trauma and how to respond; creates partnerships with mental-health agencies to support students; and teaches students how to be active participants in their own mental-health care.

Lori Price, a psychologist and coordinator of student and family support Services in Pulaski County, said the district has nurses in every school who are "very tied" to the district's family resource and youth service centers.

"We have trained our nurses in youth mental-health first aid and intervention. And many times our youth service centers and our nurses are the ones that recognize what is going on with our youth," she said. "Our family resource centers and our nurses are a very strong component to our mental health services in our school district."

Price said parents need to be aware that there is a "very dark world on social media," which offers suicide as an option.

Sen. David Givens, R-Greensburg, and Rep. Robert Benvenuti, R-Lexington, both said social media promote the fallacy that everyone else has a perfect life and encourages a constant comparison that is not real.

"That is a burden for a young person with low self-esteem to have to carry," Givens said. "So there has got to be a component of technology usage, digital literacy, understanding that these things lie."

Study finds 1/3 of Americans haven't heard about open enrollment for subsidized health plans, which ends Dec. 15; here's a primer

By Melissa Patrick
Kentucky Health News

About a third of Americans haven't heard anything about open enrollment for federally subsidized health insurance, and nearly half of them say they are hearing less about it this year than last year, according to a recent poll by the Kaiser Family Foundation.

That's a problem, especially in Kentucky, where about 265,000 people had no health coverage in 2016. Of those, 114,000 were eligible for Medicaid and the other 151,000 could have bought a plan on Healthcare.gov -- many with a subsidy to help pay for it, according to Kaiser.

Despite huge national cuts to programs that fund in-person helpers, Kentucky still has application assisters, formerly called Kynectors, in every county who can offer in-person help for free. Here's a short primer of what people need to know to sign up for insurance under the Patient Protection and Affordable Care Act.

What is open enrollment and when is the deadline to enroll?

Open enrollment is a set period of time when people can buy health insurance through the federal marketplace. Open enrollment on Healthcare.gov for 2018 ends Dec. 15. After Dec. 15, you can only sign up for a plan under special circumstances. Coverage for these plans takes effect on Jan. 1, 2018.

But don't plan on shopping on Sunday mornings. Healthcare.gov is shut down for maintenance from midnight to noon Eastern Time  on every Sunday, except for Dec. 10.

Am I required to have health insurance? The Affordable Care Act requires everyone to have health insurance or pay a penalty. And despite all the talk about whether this requirement, called the individual mandate, will remain the law, it still is.

What is the penalty to not have health insurance? The penalty in 2018 is $695 per adult and $347.50 per child, with a maximum of $2,085 per family or 2.5 percent of the household's income.

The Kaiser Family Foundation has encouraged those who are uninsured to look into the cost of a plan because they could pay less in premiums than they would owe as an individual tax penalty for lacking coverage.

How do I enroll? Enrollment is through Healthcare.gov. This website will walk you through your options, including whether you will qualify for a subsidy or not. New users will have to create a user account and complete an online application. Current policyholders will have immediate access to the site's shopping tool. Before you get started, make sure you have all of your tax records and personal information with you. There is also a place on Healthcare.gov to preview 2018 plans and get estimated prices before you log in. Click here.

But can't I just automatically be re-enrolled? If you are one of the 80,000 Kentuckians who already have a plan through the federal exchange, you will be automatically re-enrolled into the most similar plan available. But health experts say make sure you are happy with your plan, because you won't be able to change it in January, as in the past. They also advise that you compare plans and costs, since they have changed since last year.

What is a tax credit? People earning between 100 percent and 400 percent of the federal poverty line will qualify for federal tax credits to help them pay their monthly premiums on plans purchased through Healthcare.gov. The smaller your income, the larger your tax credit. Most people who qualify for a tax credit will find that the cost of insurance in 2018 will be about the same, according to the state's health agency.

What is a cost-sharing reduction? And didn't President Trump end them? Cost sharing reductions are payments that reimbursed insurers for making plans more affordable for people who earn between 100 percent and 250 percent of the federal poverty level.

President Trump did stop these payments, but the two companies offering plans in Kentucky had prepared for this circumstance by increasing their premiums. And because the tax credit that helps pay premiums is based on the average cost of "silver" plans, those who qualify for assistance will get a larger subsidy.

In fact, some people's subsidy will be large enough for them to qualify for a no-cost or low-cost bronze plan, but health experts warn that many of these bronze plans come with very high deductibles or large yearly out-of-pocket costs.

Still, not everyone will benefit from this change. For example, those who make too much money to qualify for a subsidy will likely have to pay more for their plans than in previous years.

What should I do if I make too much money to qualify for any help? Health advocates are encouraging the 20 percent of Kentuckians who don't qualify for any help to look at plans off the exchange, as they could be less expensive.

Kentucky Department of Insurance map shows Anthem
counties in blue, CareSource in pink

Who is offering plans in my area? In Kentucky, Anthem Inc. is offering plans in 59 counties and CareSource is in the other 61.

Where can I get help? Assisters are avialable in every Kentucky county to help people sign up for coverage, and their services are free. There are also sign-up events throughout the state.

To find an event in your county or an assister, go to healthbenefitexchange.gov. The site also includes net payment examples for all regions of the state and 2018 sample scenarios for individuals and families.

Help is also available through the state call center at 858 855-459-6328 and the Healthcare.gov customer center at 800-318-2596, which is available 24 hours a day, seven days a week.

What's the takeaway? Advocates say: Sign up early, make sure you compare costs and plans and make an early appointment with your application assister. State officials remind Kentuckians to pay attention to their mail, text messages, phone calls and email about open enrollment, because that is how the state is spreading the word about open enrollment this year.

Kentucky Primary Care Alliance says its accountable care organization saved Medicare nearly $2 million in its first year

By Melissa Patrick
Kentucky Health News

The Kentucky Primary Care Alliance says its Medicare accountable care organization, in its first year, saved Medicare nearly $2 million.

Accountable care organizations were created under the Patient Protection and Affordable Care Act to encourage doctors, hospitals and other providers to work together to provide coordinated patient care as a way to cut back on unnecessary spending. Participants are provided bonuses as a reward for increased efficiency.

"It is really an excellent way of doctors engaging with their patients and making sure they are getting the care they need, all while making sure they aren't getting a bunch of services that they don't need," Barbara Newton, executive director of the ACO, said in a telephone interview.

For example, Newton said, ACOs focus on well-check-ups, prevention and screening, and chronic disease management in hopes of keeping their patients healthy and out of the hospital and emergency rooms.

"What you are really trying to do overall is to improve the health of your patients," she said. "You get patients used to coming in when they aren't near death's door and seeing the doctor and making sure they get the preventive screenings that they need, the vaccines that they need and that they stay healthy."

She added, "We are just trying to make sure that they get taken care of in the right setting at the right time and that they all have preventive healthcare."

Newton said the $2 million in "shared savings" would normally be split between Medicare and the participating providers and clinics, but instead they will use their share to help pay down the Centers for Medicare and Medicaid Services innovation grant that allowed them to create the ACO. She added that the hope is that their portion of the savings is large enough next year to pay off the balance of the grant, with some to spare.

The Kentucky Primary Care Alliance opened in 2016 with 10 clinics that cared for approximately 4,400 Medicare patients. CMS estimated that their annual cost would average around $10,450, but the clinics were able to save $450 per patient, resulting in $2 million of shared savings for Medicare. Eight more clinics joined the alliance in 2017.

Critics of ACOs say such programs could encourage providers to skimp on care to earn bonuses, but Newton said the program is set up to require ACOs to meet 33 quality benchmarks that range from patient satisfaction with shared decision making to cancer screenings and preventive vaccines.

"They have very strict quality measures that you have to meet and report on in order to qualify for shared savings," Newton said. "So you can't get away with not seeing patients or not providing care. You have to really engage the patients."

Out of 432 ACOs that qualified for shared savings in 2016, only 134 of them, 31 percent, generated a shared savings, the Primary Care Alliance said in its release.

"These are all rural health clinics and federally qualified health centers, providing services in rural and under-served areas of the state," David Bolt, COO of the Kentucky Primary Care Association, said in an e-mail. "Their story tells that good quality care at reasonable costs is available in the communities and to the patients they serve."

In 2016, the Kentucky Primary Care Alliance comprised these clinics: Bluegrass Clinic Stanford in Lincoln County; Bluegrass Clinic Liberty in Casey County; Fairview Community Health Center in Warren County; Health First of the Bluegrass in Fayette County; Lewis County Primary Care Center with clinics in Bracken, Fleming, Mason, Lewis, Greenup and Boyd counties; Sterling Health Solutions, with clinics in Montgomery, Bath and Nicholas counties; Pennyroyal Community Clinics in Caldwell and Christian counties; Triad Health Systems in Owen, Carroll and Gallatin counties; Tri-Rivers Healthcare in Crittenden and Livingston counties; and White House Clinics in Madison, Rockcastle, Estill, Jackson and Garrard counties.

Casey County High School students win award for their smoke-free efforts; 17 percent of Kentucky's youth are smokers

The Casey Youth Coalition won the health foundation's first
Healthy Policy Champion Award for its smoke-free efforts.

A group of 19 Casey County High School students are the first recipients of the Foundation for a Healthy Kentucky's Healthy Kentucky Policy Champion award for their work to change the smoking culture at their school.

"The Casey Youth Coalition has been working for two years to boost adherence to the district's 2015 tobacco-free campus policy, and this award recognizes their unrelenting efforts to change social norms about tobacco use," Ben Chandler, president and CEO of the foundation, said in a news release.

The students' campaign has contributed to a 10 percent decrease in 30-day tobacco use among its 10th graders in 2016, the release said.

"All of us are extremely proud of all we have accomplished because the school's environment has changed," Delaney Sowders, vice president of the coalition, said in the release. "There's no tobacco smell when you enter our school. That has been a long-time problem. It took a lot of our time, commitment, ideas from a diverse group of students, support from our champions and funding, to accomplish this. We still need to work on the community's tobacco use on our campus."

Below is a video created by the Casey County Youth Coalition to instruct other school districts about passing and implementing a 100 percent smoke-free policy in their schools.

Casey County is one of the state's 68 (out of 173) school districts with a 100 percent tobacco-free school policy. As of November 2017, 39 percent of districts have such policies and 55 percent of the state's students are protected from second-hand smoke.

Schools get this distinction if they don't allow tobacco products, including vapor products and alternative nicotine products, by staff, students and visitors at any time on school owned property and during school sponsored events. The 100 percent tobacco-free school website notes that some of the schools need to update their policies to meet the new vapor product standards.

A bill in the 2016 legislative session would have required all Kentucky schools to be 100 percent tobacco-free. It passed quickly out of the Senate, but couldn't garner enough support in the House to bring it to a floor vote. Sen. Ralph Alvarado of Winchester told Kentucky Health News in September that he plans to sponsor the bill again in the upcoming session, and anticipates a similar one to be introduced in the House, where his fellow Republicans gained control this year.

Elizabeth Anderson-Hoagland, a youth tobacco specialist with the state Department for Public Health, said she encourages local school districts to pass 100 percent tobacco-free school policies, despite what happens at the state level.

"It is really beneficial for local communities to take the steps to pass a local tobacco-free district policy," she said in an e-mail. "The process engages students, parents, personnel and community in a discussion about tobacco use and how the community can best protect their young people."

Most Kentuckians support such policies. According to the foundation's 2015 Kentucky Health Issues Poll, 85 percent of Kentucky adults favor tobacco-free schools.

Almost 17 percent of Kentucky's high-school students are smokers and 23 percent of them report using electronic cigarettes, according to the 2015 Youth Risk Behavior Survey. The 2016 national rate for smoking is 8 percent and 11.3 percent for electronic cigarettes, according to the federal Centers for Disease Control and Prevention.

The Casey Youth Coalition is now eligible for the Healthy Kentucky Policy Champion of the Year award, which comes with a $5,000 grant from the foundation given to a Kentucky-based nonprofit of the winner's choice. The winner of that award will be announced next fall. Nominations for the Healthy Kentucky Policy Champion award are accepted at any time. Click here for details.

McConnell says he asked nominee for Health and Human Services secretary to make fighting opioid epidemic a top priority

McConnell and Azar (McConnell office photo)

Senate Majority Leader Mitch McConnell met Wednesday with Alex Azar, whom President Trump has nominated to succeed Tom Price, who resigned, as secretary of the Department of Health and Human Services. Azar is a former deputy secretary of HHS and a pharmaceutical manufactiring executive.

“Alex and I had a productive meeting,” McConnell said in a news release. “We discussed his outlook and vision for a department that oversees some of the nation’s most important programs, including Medicare and Medicaid, the Centers for Disease Control, and the National Institutes of Health. I also asked him to make combating the opioid epidemic, which has devastated families across Kentucky and the nation, a top priority.”

Republicans in Congress say tax bill will include repeal of law requiring individuals to have health insurance; critics object

Senate Republicans' tax bill will include a repeal of the requirement that almost all Americans obtain health insurance, "a major change as they now try to accomplish two of their top domestic priorities in a single piece of legislation," The Washington Post reports. The House is expected to agree.

Lisa Des Jardins of PBS reports that the repeal "helps them with (conservative) critics demanding some kind of Obamacare repeal and, according to the Congressional Budget Office, the repeal would bring an additional $338 billion in savings, mainly because fewer people would sign up for Medicaid." The government exchanges for tax-subsidized Obamacare policies are also used to enroll in Medicaid.

The mandate in the 2010 Patient Protection and Affordable Care Act is tax-related, because failure to have coverage incurs a penalty on tax returns. The Supreme Court decision upholding the law turned largely on that point.

“We’re optimistic that inserting the individual mandate repeal would be helpful” to the effort to pass the tax bill, something Republicans badly want, Senate Majority Leader Mitch McConnell said. President Trump had promoted the idea, but "Republicans had resisted making the change, worried that injecting health care politics would imperil the tax bill," the Post reports.

Sens. McConnell and Paul (USA Today photo)

McConnell announced the change a few hours after his Kentucky seatmate, Republican Rand Paul, said he would offer an amendment to the tax bill to repeal the mandate and give a greater tax cut to middle-class families. Paul "suggested earlier in the day that Republicans should use the money to help taxpayers who would be impacted by the loss of the state and local tax deduction, which the Senate bill currently eliminates," NBC News reports.

As part of the deal, Republicans will allow a vote on the bipartisan Senate legislation aimed at stabilizing individual markets, Des Jardins reports. "It would fund the subsidies that President Donald Trump said he would end and Congress needed to resolve. Democrats love that bill and it could pass overwhelmingly. It also helps with a certain senator from Maine, Susan Collins, who was a key 'no' vote on the original health-care bill."

"The bills cannot be combined due to strictures imposed by the budget process Republicans are using to avoid a Democratic filibuster," the Post reports. Sen. John Thune of South Dakota, chair of the Senate Republican conference, "said he’s confident the votes are there," Des Jardins reports.

"Repealing the mandate would undermine other key parts of the Affordable Care Act," the Post reports. "The health-care law banned insurance companies from discriminating against people with pre-existing health conditions. But in order to prevent people from waiting to buy insurance until they got sick, the law also imposed financial penalties for individuals who did not maintain health insurance coverage. Health experts say eliminating the mandate would destabilize the individual insurances markets set up by the Affordable Care Act, as they would be full of people with high health care costs but have far fewer of the healthy people that insurance companies bank on. In response, insurance companies would likely either massively raise premiums or pull out of the marketplaces entirely. A powerful group of stakeholders, including the major health insurance and hospital insurance lobbies and two influential doctors’ groups, wrote a letter to leaders from both parties arguing that they should retain the individual mandate."

UPDATE, Nov. 19: After criticism of the idea, White House Budget Director Mick Mulvaney said, “If it becomes an impediment to getting the best tax bill we can, then we are okay with taking it out.” He said on CNN’s “State of the Union” that it was not an impediment now.

Kentucky's children improved on several health measures in last year but still lag behind nation; many counties are far behind

By Melissa Patrick
Kentucky Health News

More Kentucky children than ever have health insurance, fewer Kentucky teens are getting pregnant, fewer mothers are smoking during pregnancy, and the state has fewer low-birthweight babies – but that's not the case in every county, according to the annual Kentucky Kids Count report.

The report, released Tuesday by Kentucky Youth Advocates, is part of the 27th annual release of the County Data Book, which provides data on overall child well-being through 17 measures in four areas: economic security, education, community strengths, and health and family.

Instead of ranking counties from top to bottom for each of these measures, as in the past, this year's report shows whether the outcomes have improved or worsened in the last five years.

"Looking at data change over time illuminates areas of progress and areas of needed policy change and investment," KYA Executive Director Terry Brooks said in a news release. “If all of our kids—no matter their families’ income, skin color, or ZIP code—are to grow up to be healthy and productive citizens, their needs must be prioritized.”

Part of Russell County's profile, one of 120 from 
Kentucky available at the Kids Count Data Center

The report also shows how many Kentucky children would be affected if the state or county were able to improve each measurement by 10 percent. KYA's hope is that this will help the state and individual counties see what areas need attention the most.

For example, the report shows Kentucky has seen a 13 percent decrease in the rate of births to mothers who smoked during pregnancy, dropping to 20.6 percent in 2013-15 from 23.8 percent in 2008-10. The national rate is 8.4 percent, according to the 2017 State Health Assessment.

If 10 percent fewer women smoked during pregnancy, 3,533 fewer babies would be exposed to cigarette smoke before birth, which would result in fewer babies with low birthweights. Such babies  (less than 5½ pounds) account for 8.7 percent of Kentucky births.  

Being born too early or with low birthweight increases a baby's risk of health complications, including a 25 percent increased risk of dying in the first year of life.

For example, Lee County has the highest rate of smoking during pregnancy (47.7 percent) and one of the highest rates of low-birthweight babies (12.2 percent). A 10 percent improvement of these measures would result in 11 fewer Lee County babies being exposed to smoke before birth each year, and three fewer babies being born with a low birthweight.

On the other end of the spectrum, only 10.2 percent of mothers smoke during pregnancy in Oldham County, and only 7.4 percent of the babies born there have a low birthweight.

The Foundation for a Healthy Kentucky, which is leading the state's newly formed Coalition for a Smokefree Tomorrow, says it's ready and willing to help counties decrease their smoking rates.

“The foundation is committed to working with advocates and local communities to promote smoke-free ordinances, ensure that expectant mothers have easy access to effective tobacco treatment, and raise the state tax on cigarettes to reduce youth smoking," Ben Chandler, president and CEO of the foundation, said in the news release.

Related encouraging news is that the number of teen births in the state continues to drop, to 34.6 per 1,000 in this year's report, down from 37.9 in last year's report and 48.9 five years ago. The national teen-pregnancy rate is 22.3 per 1,000.

The report says 16 Kentucky counties had teen-birth rates of 60 or more per 1,000 (6 percent), with Wolfe County leading the way at 80.9 per 1,000. Its rate five years ago was 68.2 per 1,000.

Only five Kentucky counties had rates of less than 20 teen births per 1,000 (2 percent). Oldham County had the lowest rate, 8.2 per 1,000.

Other encouraging news is that almost all Kentucky's children (96 percent) have health insurance. The report says at least one in 10 Kentucky children are covered by Medicaid or the Children's Health Insurance Program, called K-CHIP in Kentucky.

The report stresses the importance of making sure Medicaid and CHIP program are sustainable – including the expansion of Medicaid under the Patient Protection and Affordable Care Act to those who earn up to 138 percent of the federal poverty line. It notes, "Children are more likely to have health insurance when their parents do."

The report also says coverage for children "boosts family financial stability due to reduced out-of-pocket costs for health care and increased participation in other supports for which they are eligible, such as Supplemental Nutrition Assistance Program," or food stamps.

The U.S. House of Representatives has passed a bill to fund CHIP for the next five years, but it includes funding provisions that likely won't pass the Senate. A Senate committee has passed a CHIP bill, but without provisions for funding. The deadline for reauthorization was Sept. 30. 

Kentucky will run out of KCHIP money in about five months if CHIP is not renewed. A Kaiser Family Foundation report shows that the federal budget for CHIP was about $14 billion in 2016 and Kentucky's federal share was around $243 million. (For a county-by-county list of KCHIP and Medicaid enrollment, click here.)

The report also called for more outreach and enrollment efforts, and said the state should stop dis-enrolling children for incorrect or missing addresses.

The number of young adults with health insurance in Kentucky is around 77 percent. Robertson County, at 91 percent, has the highest rate; Lee County, at 41 percent, has the lowest.

Other key findings about Kentucky's children in the report:

• Grandparents and other relatives raise 7 percent, the highest rate in the nation.
• Almost half live with families that are considered low-income (annual income of $48,072 or less for a family of four).
• One-fourth live in poverty (annual income of $24,036 or less for a family of four).
• 12 percent live in deep poverty (annual income of $12,018 or less for a family of four).
• 20 percent live in food-insecure households, and food insecurity is widespread; only five counties have fewer than 15 percent of children in food-insecure households.
• In 24 counties, at least a fourth of the children living in a food-insecure home.
• Only half of Kentucky's children are ready for kindergarten or are proficient readers in the fourth grade, and fewer than half of them are proficient in mathematics in eighth grade.
• Almost 90 percent graduate from high school on time.
• 41 per 1,000 are in "out-of-home" care, and the rate increased in 88 counties.
• 26 per 1,000 are incarcerated in the juvenile-justice system, a 57 percent decrease.

Brooks concluded: “Kentucky kids rely on their state leaders to make decisions and investments that prioritize them. As state agencies, the legislature and governor craft the next biennial budget and prepare for the 2018 session, we are calling on leaders to build a budget that invests in kids’ education, health, economic security, and safety. Our communities and economy can only win when Kentucky kids and their families succeed."

Overall Kids Count chart for Kentucky shows previous and current scores in four major areas

The Kids Count Data Center is also available for a deeper dive into the data. It offers a profile sheet for every county, and allows you to create maps, graphs, and make comparisons.

The 2017 County Data Book was made possible with support from the Annie E. Casey Foundation and local sponsors Passport Health Plan, Delta Dental of Kentucky and Kosair Charities.

Feds change Medicaid rules to allow work requirements for some, paving way for Bevin's revamping of program, including premiums

By Melissa Patrick
Kentucky Health News

The Trump administration has announced rules changes for the Medicaid program that allow states to require some enrollees to work or volunteer – changes that likely pave the way for Kentucky's new Medicaid plan to be approved.

Seema Verma (US News photo)

"Let me be clear to everyone in this room, we will approve proposals that promote community engagement activities, " Seema Verma, director of the Centers for Medicare and Medicaid Services, said in a speech to state Medicaid directors Nov. 7.

Gov. Matt Bevin proposed changes to Kentucky Medicaid by requesting a waiver from federal rules more than a year ago. The proposal largely targets "able-bodied" adults who qualify for Medicaid under the expansion of the program under the Patient Protection and Affordable Care Act – those with household incomes up to 138 percent of the federal poverty level.

If approved, the plan would require such beneficiaries who are not "medically frail" or primary caregivers to work or volunteer 20 hours a week to keep their coverage. Work requirements for Medicaid recipients have historically not been approved because they didn't line up with the program's mission to provide medical assistance to low-income people; now the rules are different.

Kentucky Medicaid Commissioner Stephen Miller said at the directors' meeting that Kentucky hopes to implement the state's work requirements by July, Lisa Gillespie reported for Louisville's WFPL.

At the Nov. 6 meeting of Kentucky's Friedell Committee for Health System Transformation, Dr. Gil Liu, the state's medical director for Medicaid, said the state will initially implement work requirements in regions that have the most jobs available, and will then figure out how to implement them in other parts of the state where fewer jobs are available.

The plan would also require most Kentuckians on Medicaid to pay small monthly premiums, initially $1 per person to $15 per family, depending on income. People with disabilities, pregnant women, children and caregivers would not have to pay.

"Miller said the administrative costs of collecting those premiums would be higher than the actual amount of premium collected. But he said the point of the change isn’t to make money — it’s to encourage enrollees to transition out of Medicaid and into private coverage," Gillespie reports.

Critics of the plan, called Kentucky HEALTH, say that won't work because employers don't offer health insurance as a benefit nearly as much as they used to, and the state has many working poor who can't afford private insurance. Most covered by the Medicaid expansion work.

Miller said he expects about 200,000 Medicaid enrollees will be affected by the changes, Gillespie reports. The expansion covers about 478,000 Kentuckians; Medicaid as a whole covers about 1.4 million. For a spreadsheet of enrollment by county in June 2017, click here.

If federal officials approve the waiver, as expected, the state estimates that 95,000 fewer Kentuckians will be on Medicaid in five years than if the proposal is not accepted. The state estimates that will save the state and federal government $2.4 billion over the next five years.

The state pays 30 percent of traditional Medicaid costs. The federal government paid all the expansion costs for the first three years, but this year the state is paying 5 percent, and that will rise in annual steps to the law's limit of 10 percent in 2020.

Bevin has said the state cost is "unsustainable," and rejects arguments that the multi-billion-dollar expansion has generated state tax revenue by boosting employment in health care.

Commissioner
Stephen Miller

The governor's lieutenants also make the argument that the expansion hasn't improved Kentucky's health. Miller did that at the Medicaid directors' meeting.

"He said that even though the state’s Medicaid rolls have soared to cover 33 percent of residents, Kentucky still has high rates of cancer, smoking and obesity," Phil Galewitz of Kaiser Health News reports, quoting Miller directly: “We have to try something else. We need to do more than just help people access health care.”

Officials of then-Gov. Steve Beshear's administration said when they expanded Medicaid that it would take several years to change the state's health status, and that it might even decline temporarily as people who hadn't received care for many years were diagnosed with health problems.

Tens of thousands of Kentuckians have used their new Medicaid benefits to get screened for cancer and other health problems, or get treatment for substance abuse or other issues. A three-year study of the expansion in Kentucky and Arkansas found a 23 percent increase in the share of people in federal surveys who reported that their health is excellent.

Emily Beauregard, executive director of Kentucky Voices for Health, an umbrella group of pro-Obamacare organizations, wrote in an op-ed that Bevin's changes are designed to "remove people from the rolls, rather than to promote health and access to affordable care."

Verma, who played an active role in designing Kentucky's waiver request, told the Medicaid directors that the new rules are "ushering in a new day for Medicaid" that will increase states' flexibility while improving accountability and integrity.

"We owe our fellow citizens more than just giving them a Medicaid card. We owe a card with care, and more importantly a card with hope," Verma said. "Hope that they can achieve a better future for themselves and their families. Hope that they can one day break the chains of generational poverty and no longer need public assistance, and the hope that every American, no matter their race, creed, or origin, can reach their highest potential. We will approve proposals that accomplish this goal."

Verma also said, "Believing that community engagement requirements do not support or promote the objectives of Medicaid is a tragic example of the soft bigotry of low expectations consistently espoused by the prior administration."

Seven other states — Arizona, Arkansas, Indiana, Maine, New Hampshire, Utah and Wisconsin — have submitted varying requests to CMS that would require non-disabled Medicaid enrollees to either work or provide community service.