Health Secretary Vickie Yates Brown Glisson resigns to run for Congressional seat held by Louisville Democrat John Yarmuth

Glisson signed candidacy papers. (Kentucky Today photo by Tom Latek)

FRANKFORT, Ky. -- State Health Secretary Vickie Yates Brown Glisson filed to run against Democratic Rep. John Yarmuth in Louisville's 3rd Congressional District just hours before the Jan. 30 filing deadline.

Glisson's entry "could set up an intense debate over health care," the Louisville Courier Journal notes, since she has overseen changes recently approved for the state's Medicaid program, which was expanded under the Patient Protection and Affordable Care Act. Yarmuth voted for the law and has been a vocal opponent of the Medicaid changes, which among other things will require "able-bodied" Kentuckians to work or volunteer in order to get their healthcare -- the first time such requirements have been approved by federal officials.

Glisson, a Louisville Republican, ran the Cabinet for Health and Family Services and was responsible for more than 7,000 employees and an annual budget of more than $12 billion. She told reporters that she had been thinking about the race  "for some time," and that Gov. Matt Bevin was supportive of her decision, Phillip M. Bailey and Morgan Watkins report for the Courier Journal.

"I want Louisville to succeed," Glisson said. " I want Louisville to become a city that is strong and robust and a city where our citizens can succeed, so that's why I'm running. . . . I think I can be a strong voice for Louisville."

Bevin named Scott Brinkman, secretary of the Executive Cabinet, acting secretary to fill Glisson's vacancy temporarily.

Glisson has two opponents in the May 22 Republican primary, Louisville residents Mike Craven and Rhonda Palazzo. Yarmuth is unopposed for the Democratic nomination.

Yarmuth is a six-term congressman who has faced little resistance in previous elections. He has held the seat since upsetting Republican incumbent Anne Northup in 2006 and is the only Democrat in Kentucky's congressional delegation.

"As the top Democrat on the House Budget Committee, Congressman Yarmuth is focused on combating attacks by Washington Republicans on the priorities of Louisville families, but he looks forward to debating whichever candidate emerges from the party of Trump primary later this year," Heather Dearing, a Yarmuth campaign spokeswoman, told the Courier Journal.

Prior to becoming health secretary, Glisson was an attorney with the Louisville law firm Frost Brown Todd. She has also served as president of Nucleus, an economic development arm of the University of Louisville. She also was listed as a special assistant to former U of L President James Ramsey, advising in the areas of health, life science and research.

UPDATE, Feb. 22: Before filing for Congress, Glisson negotiated a return to U of L with Dean Craig Blakely of the School of Public Health and Information Sciences, but Provost Dale Billingsley rejected the $200,000 annual appointment, "citing her lack of teaching and research experience and the university’s current budget crunch," Joe Sonka reports for Insider Louisville. "This move comes one day after every Democrat in the state House signed a letter to U of L interim President Greg Postel asking him to reconsider the proposed hiring of Glisson, citing the 'lack of transparency and curious circumstances” of her hiring and her “excessively high salary.'" Rep. Jim Wayne of Louisivlle told Sonka that J. David Grissom, chair of the Board of Trustees, "had encouraged him to find as many signatures as he could for the letter and told him that his main objective is to get the university’s finances back in order."

Ky. Obamacare enrollment bounces back; increase 2nd in nation

Kentucky had the second greatest percentage increase in the number of residents who signed up for health insurance under the Patient Protection and Affordable Care Act in the 2017 signup period, compared to the year before. The number in Kentucky was 110.4 percent higher than the 2017 sign-up. The rankings may change as numbers come in from remaining states that extended their enrollment deadlines (in blue on chart).

ACAsignups.net chart; SBM means state-based marketplace, or exchange; FF-SBMs are federally facilitated (hosted).

Charles Gaba, an independent analyst and writer of ACASignups.net, found that Kentucky and 12 other states were ahead of their 2017 enrollment numbers and 11 were ahead of their 2016 enrollments. Gaba's analysis compares 2016, 2017 and 2018 enrollment data for states that participate in either a state exchange or the federal exchange.

A big reason for Kentucky's leading position is that its Obamacare enrollments in the state dropped last year, when the state moved from its own exchange to the federal exchange. Gaba, on Twitter, said the change had "confused people greatly."

Enrollment dropped to 81,155 in 2017, from 93,666 in 2016. Between 2017 and 2018, the state saw a 10 percent increase, to 89,569, which brought the number of Kentuckians on subsidized Obamacare plans close to 96 percent of the 2016 enrollment total.

Another reason: Kentuckians who were enrolled in 2017 were automatically re-enrolled for 2018 unless they picked a different health plan. The year before, a full re-enrollment process was required, Dustin Pugel noted in a blog post for the Kentucky Center for Economic Policy.

Pugel, an analyst for the left-leaning center, said the numbers would have been even higher in Kentucky and the rest of the nation if not for efforts by the Trump administration that discouraged enrollment, such as an open-enrollment period that was cut in half and huge budget cuts to the national marketing and navigator budgets.

Reporters dig deep to tell history of opioids and the epidemic

The history of "how painkillers became killers," as the Courier Journal's print-edition headline put it, was told by CJ reporter Laura Ungar and Jerry Mitchell of the Clarion Ledger in Jackson, Miss., in a USA Today Network story Sunday. The CJ's online headline says "Drugs kill more Americans than guns and cars. Kentucky was ground zero from the start."

And it still is, as a county-by-county map opioid prescription rates with the story helps illustrate. Most with high rates are in Appalachia, reflecting the deep roots of the opioid epidemic in the region.

USA Today map adapted by Kentucky Health News

The seedbed of the epidemic was Eastern Kentucky and southern West Virginia, and in 2001 the state of West Virginia sued Purdue Pharma, the maker of OxyContin, the drug that "arguably opened the floodgates," as Caitlin Esch put it last month in a report for Marketplace, based partly on previously unsealed files from McDowell County. She reveals how a misleading sentence in the drug's label, approved by the U.S. Food and Drug Administration, became "the linchpin of the most aggressive marketing campaign ever undertaken by a pharmaceutical company for a narcotic painkiller," The New York Times reported in 2007. 

House committee approves bill to keep doctors' reviews of other doctors from being used in malpractice lawsuits

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to keep doctors' reviews of other doctors from being used in medical-malpractice lawsuits has passed a House committee and moves to the full House, where a similar bill stalled out last year.

Rep. Addia Wuchner, R-Florence, chair of the Health and Family Services Committee, told the panel that Kentucky is one of only two states that don't apply this privilege to medical peer reviews. She said protections in her bill will ultimately improve health care in the state.

"Medical peer review is an industry-wide practice that allows health-care professionals to openly, honestly and candidly discuss their performances with their colleagues and their teammates and learn from their experiences so that we can improve healthcare and outcomes for all patients," she said.

Dr. James Borders, chief medical officer for Baptist Health Lexington, assured the committee that hospital peer reviews are not an attempt to conceal anything.

"When it comes to the routine, day-to -day care of patients, we need to have the openness and flexibility to ask colleagues as to how they would do something better," he said. "I think of what a chilling effect it would have to think that every comment made in those kinds of conversations would be in some way open to legal challenge."

Wes Butler, a health-care lawyer, explained that House Bill 4 was designed to address a state Supreme Court decision in the 1990s that peer-review privilege in Kentucky should not extend to malpractice suits.

Senator Ralph Alvarado, R-Winchester, proposed a similar bill that made it to the House floor last year but didn't get a vote, largely because of a floor amendment by Rep. Chad McCoy, R-Bardstown, to allow statements of fact in peer reviews to be used in court.

McCoy, a member of the health committee, voted for Wuchner's bill, told Kentucky Health News that, "Cheese pizza is better than no pizza." He added that the language in the committee substitute that assures providers who are claiming the privilege are only doing so for safety and quality purposes, in the same way that the federal law requires, allowed him to vote for the bill.

"I am still fearful here," he said, noting that a doctor's testimony and peer review might conflict. "It didn't go where I wanted it to go, but it is an improvement and it's an important bill and like I said, 'cheese pizza'. . . . It's worth it to give up on the privilege if we can get hospitals to participate and try to make themselves better for every body out there."

Rhonda Hatfield-Jeffers, a plaintff's lawyer from Somerset, was the only person who spoke against the bill. She said that while she appreciated the changes, "We want to make sure no factual statements are hidden."

Cigarette-tax advocates say it would reduce smoking by pregnant women, a bad behavior in which Kentucky leads the nation

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- The best way to help pregnant women in Kentucky stop smoking is to increase the cigarette tax by $1, to $1.60. That was the main message at the Coalition for a Smoke-Free Tomorrow's Jan. 23 rally at the state Capitol.

Ben Chandler, chair of the coalition and the president and CEO of the Foundation for a Healthy Kentucky, told the small crowd that such an increase would result in nearly 6,000 fewer smoking-affected pregnancies and births over the next five years in the Commonwealth.

"Think of that: more than 1,000 Kentucky babies every year who are healthier because they were not exposed to the toxins in cigarettes while they grew and developed in the womb," Chandler said.

He added that Kentucky has the highest rate of smoking during pregnancy in the nation, with more than one in five pregnant women in the state smoking cigarettes at some time during their pregnancy. The national rate is 8 percent. That rate is even higher in 35 counties, 30 percent. And in four counties -- Clay, Jackson, Lee and Owsley -- it exceeds 41 percent.

Misti Williams tells how she quit smoking during her pregnancy
at a Coalition for a Smokefree Tomorrow rally. (Coalition photo)

Misti Williams, pregnant with her fifth child, said she smoked during her previous pregnancies, but decided she would quit when she learned of her current pregnancy. Her baby is due in a few weeks and she said she hasn't smoked since July.

"I want something radically different for this child," she said after the rally.

The 31-year-old Lexington woman attributed her success to her participation in a smoking-cessation program, which offered both counseling and an alternative list of activities to do when she had the urge to smoke. She said she uses that list as her screen-saver on her cell phone.

Williams talked about how hard it was to quit, but said every day she didn't smoke was a victory and she wants to encourage other pregnant women to keep trying, even if they relapse.

"I want to help other women who don't think it's possible," she said after the rally.

Smoking during pregnancy can cause miscarriage, premature birth, low birth weight, a variety of birth defects and even infant death, according to the federal Centers for Disease Control and Prevention.

Chandler also pointed out that pregnant smokers are also a budget issue because of the added expense incurred by the state to care for many of these infants, noting that women who smoke during pregnancy are two and a half times more likely to be on Medicaid.

women.smokefree.gov

Amanda Fallin-Bennett, a tobacco-control researcher in the University of Kentucky College of Nursing, said that while access to tobacco-cessation treatment is important for women who want to quit smoking during pregnancy, raising the cigarette tax by at least $1 would be more effective.

"Research shows that the most effective way to reduce smoking is raising the tobacco tax," Fallin-Bennett said. "In fact pregnant women along with kids are particularly likely to quit or reduce their smoking when the price goes up."

The CDC says: "A $1 increase in cigarette taxes increased quit rates among pregnant women by 5 percentage points. Higher cigarette prices also reduced the number of women who start smoking again after delivery."

Angela Brumley-Shelton, a tobacco coordinator with the Lexington-Fayette County Health Department, said that while researchers know that exposure to maternal smoking and second-hand smoke after birth puts an infant at a higher risk of death, they are still working to determine exactly why that is. "But in Kentucky, we know that it is one of the most consistent risk," she said.

Pregnant women who want to quit smoking should talk to their health care provider about quitting. The state tobacco quit line (1-800-QUIT-NOW or 1-800-784-8669) also offers special services and counseling for pregnant women and for those who have recently delivered. Click here to learn more about the state's quit line. The Smokefree Women website also offers tips and tools to help pregnant women quit smoking.

Walter May, leader of Pikeville hospital's growth, ousted as CEO

May spoke at the 2014 opening of the Pam May Clinic Building
and garage, a $130 million project. (News-Express file photo)

Walter May, who led the transformation of Pikeville Medical Center into one of Kentucky's leading hospitals, has left as president and chief executive officer, without official explanation.

"In a statement, Pikeville Medical Center said May’s position as CEO will now be filled by Assistant CEO Donovan Blackburn," the Appalachian News-Express of Pikeville reports. "Blackburn was appointed assistant CEO in May 2017, after serving for 13 years as city manager for the City of Pikeville."

Donovan Blackburn

Blackburn switched jobs the same week that Pamela Todd May, the CEO's wife and the hospital's chief lawyer, died at age 64. Former Gov. Paul Patton of Pikeville told Kentucky Health News that he thought Walter May, who is 80 or 81, brought on Blackburn to groom as a successor.
The hospital's press release, headlined "PMC Announces Changes," gave no hint of the reason for May's departure. Its only mention of him was, “The hospital wants to express its deep appreciation for more than 56 years of service to the hospital by former CEO and board chairman Walter E. May. May has not given any statements about his future plans.”

But there had already been much talk in Pikeville about May and the hospital. In a full-page advertisement in the Oct. 26 News-Express, May responded to "an anonymous group of people in the community have been circulating some financial information about me and my family" and payments they and their businesses had received from the hospital.

"With a hospital the size of PMC in a small community the size of Pike County, it is inevitable that the hospital will hire relatives of a member of the board of the directors or will do business with a company that has some relationship to a member of the board," May wrote. "To guard against impropriety, PMC employs KPMG, a large, nationally-known accounting firm, to evaluate transactions between the hospital and members of the board of directors, key employees, and/or their family members, including some doctors. KPMG has indicated that each transaction evaluated contains reasonable compensation for services being performed for the hospital. In keeping with good corporate governance principles, the hospital does not obtain any other services from that particular accounting firm."

May also defended employment of "members of my extended family," his wife's work for the hospital and his own compensation, which he said was set by the board of directors, and cited the hospital's progress. He said he had taken pay cuts during business downturns, and in the current one, reduced payments to his East Kentucky Broadcasting Co. by 20 percent. "I view advertising as an investment," he wrote.

EKB has several radio stations in East Kentucky and West Virginia and a cable news channel in Pikeville. May has been president of the Kentucky Broadcasters Association and chairman of the National Association of Broadcasters. He "began his medical career at the Appalachian Regional Hospital on Harolds Branch when he was appointed to the board of directors in 1962," the News-Express reports. The hospital was sold to Pikeville Methodist Hospital in 1966 and May was also appointed to the board. He was appointed as chairman in 1990 before being named interim CEO in 1998. By January 2000, he had been named president and CEO and maintained both positions until Tuesday’s announcement."

The Pikeville hospital is in an area with many health issues.

During his tenure, May led the renaming of the hospital to Pikeville Medical Center. Its heritage remains reflected in its motto, “World-Class Quality Health Care in a Christian Environment.” The hospital announced in 2016 that its payroll had reached 3,000. It is one of only two Kentucky hospitals with top ratings for hospital safety since ratings began in 2014, but was on the low end of 2015 ratings of Kentucky hospitals for preventing hospital-acquired infections. In the same year, it received top patient-satisfaction ratings and was one of only three rural hospitals rated in excellent condition by the state auditor's office.

"Under May’s leadership, the medical center saw a major addition to the main structure, the addition of the Leonard Lawson Care Center, the Pam May Clinic Building, a partnership with the Mayo Clinic, an after-hours clinic and more," the thrice-weekly News-Express reports. It also started a weekly newspaper, The Medical Leader.

May told Pete Fernbaugh of Healthcareix in 2012, “I’m getting more satisfaction out of this than I ever did being in broadcasting, because I know that there are people alive today in this region that would not be alive if I hadn’t taken some action that I’ve taken. I know I’ve made a difference and what makes it even more special is that I can pass some of these people walking on the street. They wouldn’t know who I was, and I don’t know who they are, but somehow that makes it more special to me.”

May closed his newspaper ad by writing, "I have said all I plan to say about this situation, other than to extend an invitation to the anonymous group of people who have raised this issue. If they truly have the betterment of our community and the best intentions for PMC in mind, I invite them to come out from behind the curtain of anonymity for a positive and frank discussion. Until then, I leave you with this old saying: The Native Americans said you never shoot an arrow into the chief until he is mortally wounded. Well, folks … I’m not mortally wounded."

Health department says flu is epidemic in Ky.; schedules Facebook Live discussion on it Thursday, Jan. 25 at 6 p.m. ET

The state Department for Public Health says this season's influenza activity is now considered an epidemic.

The health department scheduled a Facebook Live discussion about flu on the Cabinet for Health and Family Services' Facebook page Thursday, Jan. 25 at 6 p.m. ET. Kentuckians can send advance questions to the "Flu and You, How to Protect Yourself" event to chfs.communications@ky.gov or post questions in the comments section during the event at https://www.facebook.com/kychfs/.

Health officials are warning that this season’s strain of the flu virus can be extremely serious, even deadly -- and not just for those in high-risk categories. In general, children, the elderly, extremely obese people, and those with chronic health conditions or weak immune systems are considered at higher risk of getting the flu.

The health department said in a news release that the most common flu type identified in Kentucky and in 78 percent of the 65 flu-associated deaths this season is influenza A; and that of the deaths so far, 7 percent have occurred in previously healthy individuals with no reported risk factors for severe illness.

“Pneumonia, bacterial bloodstream infections, and sepsis are examples of serious influenza-related complications that may require hospitalization and sometimes result in death of healthy people with no known risk factors for serious illness,” State Epidemiologist Dr. Jonathan Ballard said in the release.

This is the sixth consecutive week of widespread flu activity, which is the highest level of flu activity given.

“Widespread influenza activity means that Kentuckians are likely to encounter one or more persons shedding influenza virus at work, at school, while shopping, while traveling, at athletic or entertainment events, and in places of worship,” said acting Health Commissioner Dr. Jeffrey D. Howard. “A person who will develop influenza illness actually can transmit the virus to other persons beginning one day before their illness begins.”

He added, "“Flu vaccination is the most effective protection against flu. We especially recommend that all healthy Kentuckians aged six months and older be vaccinated. The flu season typically runs until late spring so it is not too late to get vaccinated.” It takes about two weeks following the administration of the flu vaccine for the recipient to develop protection from the flu.

Symptoms of the highly contagious flu virus are fever, headache, cough, sore throat, runny nose, sneezing and body aches. Anyone with flu symptoms should seek immediate medical advice to determine if they should be treated with an antiviral drug, which could shorten the course of the illness or reduce its severity.

The federal Centers for Disease Control and Prevention offers these tips to stop flu germs:

• Avoid close contact with sick people.
• While sick, limit contact with others as much as possible to keep from infecting them.
• If you have flu-like symptoms, stay home for at least 24 hours after your fever is gone (without the use of a fever-reducing medication), except to get medical care or for other necessities.
• Cover your nose and mouth with a tissue when you cough or sneeze -- and throw the used tissue away.
• Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
• Avoid touching your eyes, nose and mouth.
• Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

71% of Kentucky adults continue to support smoking ban

Seventy-one percent of Kentucky adults support a comprehensive statewide smoke-free law, the same percentage as the last time the Kentucky Health Issues Poll asked the question, in 2016. Opposition to a smoking ban rose to 27 percent from 25 percent, a change that was within the poll's error margin of plus or minus 2.4 percentage points for each number.

The poll, taken Oct. 24 to Dec. 2, found that a statewide ban still has strong bipartisan support, with 79 percent of Democrats and 68 percent of Republicans saying they favored it. Support among Democrats rose by 3 percentage points from the previous poll, but dropped by 10 points among independents, to 62 percent from 72 percent.

Most adults in every region of the state favor a statewide smoke-free law. Support increased in the Louisville area to 80 percent in the most recent poll, from 74 percent in 2016 and support dropped in the Lexington area to 74 percent, from 82 percent in 2016. Those changes are within the larger error margins for subsamples. Other regions showed even less change.

Kentuckians who say they have never smoked continue to voice the greatest support for a statewide smoking ban, at 83 percent; 74 percent of former smokers favor it. Even among smokers, 44 percent say they favor such a law.

The annual poll, which is co-sponsored by the Foundation for a Healthy Kentucky and Cincinnati foundation Interact for Health, found that nearly a third of Kentucky adults said they were exposed to secondhand smoke at their workplace in the week before they were surveyed.

In a news release about the poll, Ben Chandler, president and CEO of the foundation, listed a few of the many dangers of secondhand smoke, including cancer, heart disease and stroke and called on Kentuckians to pass a comprehensive workplace smoke-free law.

"The single most effective thing we can do to improve Kentucky's health is to reduce our smoking rates," Chandler said. "And one of the most successful tools for doing that is to enact smoke-free laws, which also protect nonsmokers from tobacco smoke."

Chandler is also the chairman of the newly formed Coalition for a Smoke-free Tomorrow which has over 140 members. One of the immediate efforts of the coalition is to help counties pass local smoke-free laws, with a statewide ban part of a longer-term goal.

The Kentucky Center for Smoke-free Policy reports that only 33 percent of Kentuckians are protected from exposure to secondhand smoke by local smoke-free ordinances. Nationally, 27 states and the District of Columbia have enacted smoke-free laws, says the release. Almost 25 percent of Kentucky adults are smokers.

The state House passed a statewide smoking ban in 2015, but it was not called up for a vote in the Senate. Republican Gov. Matt Bevin, who took office in December 2015, has said this should be a local decision so it's not likely such a bill will pass while he is in office.

Medicaid enrollees sue federal agencies and officials, alleging their approval of Kentucky Medicaid changes violated the law

By Al Cross
Kentucky Health News

Sixteen Kentucky Medicaid enrollees filed a class-action lawsuit in Washington on Wednesday, claiming that federal officials violated federal law this month by approving changes to Kentucky Medicaid and declaring their intent to approve similar changes in other states.

The lawsuit alleges that work requirements in the program, to be phased in starting July 1, "sharply deviate from the congressionally established requirements of the Medicaid program and vastly exceed any lawful exercise" of the Department of Health and Human Services' authority to waive Medicaid rules for experiments that advance the goals of the program.

The suit also charges that HHS violated the law by authorizing income-based premiums to be paid by Medicaid enrollees, from $1 a month to 4 percent of their household income; locking people out of the program for failing to meet requirement, including paying premiums and making reports; by requiring cost-sharing for non-emergency use of an emergency room; and eliminating payment for non-emergency medical transportation.

"This case challenges the efforts of the Executive Branch to bypass the legislative process and act unilaterally to 'comprehensively transform' Medicaid, the cornerstone of the social safety net," the suit says. "The Executive Branch has instead effectively rewritten the statute, bypassing congressional restrictions, overturning a half century of administrative practice, and threatening irreparable harm to the health and welfare of the poorest and most vulnerable in our country."

In addition to the work and premium requirements, the suit also says the Kentucky plan violates federal law by eliminating of three months' retroactive coverage for disqualified enrollees who re-enroll. The suit says the plaintiffs will be unable to meet the plan's administrative requirements, and "Continuous and adequate health insurance coverage is fundamental for each plaintiff’s ability to work." It describes each plaintiff's situation in detail, taking up 30 pages of the 79-page complaint.

The first is Ronnie Stewart, 62, of Lexington. The suit said he retired from a job as a hospital assistant because he can't be on his feet all day, and suffers from arthritis, diabetes and high blood pressure. It says his his sole income is $841 monthly Social Security but his estimated expenses are $1,035 per month and he can't afford to pay premiums for Medicaid and still buy food and pay rent.

"He is concerned that he will lose his health coverage if he is unable to work because of his health or if he takes a job with varying work hours," the suit says. "In addition, Mr. Stewart will be at risk of being locked out of Medicaid coverage if he is unable to file or fails to file required reports, including reports within 10 days about changes in his income that would affect eligibility," as the changes will require.

Stewart is the oldest of the 16 plaintiffs, who are as young as 20 and come from several areas of the state (Louisville, Lexington, Bowling Green, Covington, Ludlow, Ashland, Radcliff, Berea, Salyersville, Martin and the nearby Floyd County crossroads of Dwale). They are represented by the National Health Law Program, a public-interest law firm; the Kentucky Equal Justice Center; and the Southern Poverty Law Center. The defendants are HHS, its Centers for Medicare and Medicaid Services and their top officials. There are no Kentucky defendants.

The suit notes that Gov. Matt Bevin's stated goal for the waiver was "to comprehensively reform Medicaid," and argues that "States cannot impose additional eligibility requirements that are not explicitly allowed by the Medicaid Act." It cites the federal law on waivers, which does not contain such an explicit prohibition. Claims made in filing a lawsuit give only one side of a case.

The suit says the state anticipated that with the changes, "more than 95,000 adults would lose Medicaid coverage altogether." Actually, it said that in five years, the Medicaid rolls would have 95,000 fewer people with the changes than without them, partly because of non-compliance. Tens of thousands of people go on and off Medicaid each month. The program covers 1.4 million Kentuckians; a county-by-county list of enrollments as of last June is at http://www.uky.edu/comminfostudies/irjci/MedicaidenrollmentbycountyJune%202017.xlsx.
For an example of how a local newspaper can report on the Medicaid program with the data, from the Todd County Standard, click here.

Children's Health Insurance Program extended for six years

After 114 days without a long-term budget, the Children's Health Insurance Program is getting funding for the next six years as a piece of the bill that reopened the government Monday night. The program, which provides health insurance for 9 million American children, 30,000 in Kentucky, has enjoyed broad bipartisan support since its inception in 1997, but has been increasingly employed as a political carrot by Republicans, one which the Democrats refused until today.

"Last fall, Republicans proposed a plan to extend the CHIP program for an additional five years. But that plan included a series of deeply partisan spending cuts to cover the costs of extending CHIP — such as slashing Obamacare programs and Medicare — and Democrats refused to support the bill," Sarah Kliff reports for Vox. States scrambled for emergency funding over the next few months, but Republicans left the program on the back burner in favor of priorities such as repealing and replacing Obamacare, and pushing through a bill cutting taxes.

In its December bill to keep the government open, Congress gave CHIP emergency funding for mid- to late-January, but the two parties still couldn't agree for how to pay for it in the long-term. Republicans wanted states to eventually start paying a greater share of the cost, and Democrats didn't. A Congressional Budget Office estimate ended that debate, saying the elimination of the ACA's individual mandate made it cheaper for states to have CHIP than not.

Republicans added a six-year funding extension for CHIP onto the latest bill to tempt Democrats, who were holding out for action on the Deferred Action for Child Arrivals program. Democrats agreed after Senate Majority Leader Mitch McConnell said he would schedule a vote on a DACA bill "and related issues" by Feb. 8 if the government remains open. The Democrats are hoping that, when the funding bill runs out that day, they will have more leverage on DACA without CHIP hanging over their heads, Dylan Scott reports for Vox.

Attorney general files suit against national drug distributor for flooding some counties with opioids

Kentucky's attorney general has filed suit against a drug wholesaler, saying the company employed unfair, misleading and deceptive business practices to flood the state with highly addictive opioid painkillers.

Democrat Andy Beshear alleges that San Francisco-based  McKesson Corp. failed to report large volumes of opioid shipments in rural eastern Kentucky to state and federal authorities. The suit seeks an unspecified amount of money and an order to keep McKesson from committing false, deceptive or unfair acts.

Floyd County, Kentucky (Wikipedia map)

"The lawsuit said that in the time at issue, McKesson, which supplies pharmacies, had just under a third of the market share. In Floyd County, that means the lawsuit attributed to McKesson about a third of the 56.3 million doses of painkillers — or more than 1,400 per person — distributed from 2010 through 2016," Bill Estep reports for the Lexington Herald-Leader. "The company knew, or at least should have known, that much of the hydrocodone and oxycodocone it was distributing was being sold illegally and abused, the lawsuit argued."

Read more here: http://www.kentucky.com/news/state/article195929964.html#storylink=cpy

Suing drug manufacturers and distributors is an increasingly popular move among attorneys general, advocates, and Native American tribes. And Kentucky, which has been hit hard by the opioid epidemic, has seen success with suing drugmakers for the opioid epidemic: Purdue Pharma settled a civil suit filed in Pike County by a previous attorney general for misleading doctors, patients and regulators about the addictive nature of OxyContin.

Beshear's lawsuit is similar to a suit filed last year by the U.S. Justice Department, which alleged that McKesson failed to report suspiciously large orders for opioids in Kentucky and other states, which contributed to the rise in opioid abuse. McKesson settled the federal case for $150 million. In 2008 the company agreed to pay $13.25 million for similar violations but didn't fully comply with the restrictions set into place after the settlement.

Read more here: http://www.kentucky.com/news/state/article195929964.html#storylink=cp

Keys to fighting opioids in Appalachia: reducing stigma, educating the public and physicians, getting success stories in news media

The stigma of opioid addiction in Appalachia "not only keeps some from seeking help, but follows those who did — putting them at risk for relapse," the Knoxville News Sentinel's Kristi L. Nelson reports, on a six-month study that interviewed residents and held discussions with them.

“We interviewed people who had been in recovery for 20 years, and they said they were still viewed in their community as a ‘junkie’ and an addict and can’t get a job,” said Jennifer Reynolds of Oak Ridge Associated Universities, which did the study. “They have gone through this incredibly different process to change their life, and in the view of their community, they’re right where they were, at the beginning — and that’s really disheartening.”

Jennifer Reynolds and Kristin Mattson of Oak Ridge Associated
Universities discuss their report on communication about opioids
in Appalachia. (Photo by Brianna Paciorka, Knoxville News Sentinel)

Reynolds and ORAU colleague Kristin Mattson "found grass-roots community organizations — some made up of people in recovery or families who’d lost loved ones to addiction — are having some impact on the stigma," Nelson reports, but the two said, “We still have a long way to go.”

"The researchers noted some cultural attitudes that contribute to the problem," Nelson reports. "They include an expectation of privacy that keeps neighbors or friends from intervening; a willingness to 'share' pills with someone else experiencing pain; a lack of other opportunities, especially for younger people; and a normalization of dealing with pain by taking pills obtained from a doctor. . . . Some people, they found, don’t realize prevention efforts are aimed at them." One said, “I’m not taking opioids, I’m taking hydrocodone.” That's an opioid. “So they dismissed the message,” Mattson said.

Physicians and rural isolation are part of the problem. "Every focus group had members who said physicians provided them or family members, including children, larger-than-necessary quantities of opioids; a few said they’d gotten 'pushback' from doctors when refusing pills, even when patients told doctors they were in recovery for opioid addiction," Nelson writes. "The researchers found few, if any, recommended pain-control alternatives exist in smaller rural communities."

“There’s no physical therapy, there’s no massage, there’s no acupuncture,” Mattson said. “These alternatives are not available, and even if they were, there wouldn’t be insurance coverage to pay for it.”

The residents said physicians need more training — "Out of 47 community members who said they’d been prescribed opioids, two said they’d been given information by a provider," Nelson reports — and communities need more places to dispose of drugs, better education about drugs, how to properly use opioids and what to ask doctors. Some also called for "random drug testing of youth — to link them with services, not punish them; better access to treatment, including medication-assisted therapies such as suboxone and methadone; peer support for those hospitalized after an overdose or jailed after a drug crime; and more nonjudgmental messages framing addiction as a long-term health problem rather than a moral failing."

The discussion groups also "suggested sharing detailed stories that could make a difference: how it feels to have your child removed because of your drug use; why your mother might be relieved you’re in jail because she knows — at least that day — you aren’t dead; how a legally obtained prescription from a doctor can lead to addiction; and how people do find a way back."

News media need to play a role, too, said Reynolds, who is ORAU's section manager for health communication. She said news reporting on crime and overdose deaths “really adds to this feeling of, ‘Well, prevention’s not working in our community,’ and that’s not really true. “We have many people entering recovery all the time, and we do have success stories. If we could start reporting on those, I think that would make such an impact.”

At least one recovering addict in Appalachia is being very proactive in taking his story to the public through local newspapers. Phillip Lee of Albany, Ky., writes a column for the Clinton County News and other area newspapers, free of charge.

Reynolds and Mattson's report, "Communicating About Opioids in Appalachia," was produced with two other federal agencies, the Appalachian Regional Commission and the Centers for Disease Control and Prevention. It is based on interviews with 25 people in 12 of the 13 ARC states and a dozen focus groups in the Central Appalachian towns of London, Ky.; Kingston, Tenn.; Oneida, Tenn.; and Princeton, W. Va.

Bevin's budget boosts efforts against opioid abuse but would cut several health programs, including poison control center

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. — Gov. Matt Bevin's proposed budget would boost programs that fight substance-use disorders and the state's over-burdened social-services system, but calls for cuts to other health-related programs, including the state's only poison control center and one that trains doctors in rural parts of the state.

Bevin's proposal to the General Assembly calls for an additional $34 million to fight the opioid epidemic, with a focus on helping pregnant women addicted to drugs. It also includes $24 million to hire more social workers and give raises to those already employed.

Medicaid, which covers about one-third of the state's population, is the state's largest health expense. The governor's budget recommendation for Medicaid is around $11.5 billion in the first year and $11.8 billion in the second year, mostly from federal funds. The Kentucky Hospital Association told Kentucky Health News that it was pleased with the numbers.

"It looked like there was just a minimal reduction so we were pleased that the budget maintained the funding for Medicaid," said Nancy Galvagni, senior vice president of the association. "We understand from talking with people at the Cabinet [for Health and Family Services] that they consider it funded going forward."

Administration officials told reporters at a Jan. 17 budget briefing that the Medicaid budget had been included in the governor's across-the-board 6.25 percent cuts, but the cut was taken from the projected need of the Medicaid program, not current funding.

The governor also proposed that 70 state programs lose all of their funding, with a projected savings of $85 million a year. At least nine of them related to health. Some haven't received state funding in recent years, but others have depended on it.

One of those is Norton Kosair Children's Hospital Poison Control Center, which is the state's only poison control center, serving all 120 counties. It received $729,000 in each of the past two fiscal years from the state, Joe Sonka reports for Insider Louisville.

Maggie Roetker, a spokeswoman for Norton Healthcare, told Sonka that the funding amounts to 43 percent of the poison center's $1.7 million annual budget. She said the federal government provides $234,000 and Norton makes up the rest.

Sonka reports that according to the center's current service contract with the state, it fields about 70,000 callers a year; saves Kentuckians more than $10 million a year by keeping people out of emergency rooms; and saves Kentuckians $3 to $5 million per year by consulting with patients who are already hospitalized by a poison, which decreases the length of their stay.

Another program set to lose funding is Madisonville's Trover Clinic, for a program that allows medical students from the University of Louisville to complete the last two years of medical school in rural communities. The Kentucky Center for Economic Policy reports that this program is scheduled to receive $910,000 in the fiscal year that ends June 30.

Two other health-related programs on the governor's chopping block include the Lung Cancer Research Grants Program at U of L and the University of Kentucky, which is getting $5,176,100 in the current fiscal year and the Autism Training Center, now getting $119,300, according to KCEP.

The budget would "eliminate state funding for five cancer research or prevention programs, including . . . screening programs for colon, breast, cervical and ovarian cancer," Linda Blackford reports for the Lexington Herald-Leader. But it includes $2.5 million each year in new money for the Pediatric Cancer Research Trust Fund, for brain-cancer research at the two universities, which would have to each provide $1.2 million to match the state appropriation.

The fund was created in 2015 by Sen. Max Wise, R-Campbellsville, whose son Carter, now 10, had cancer when he was six months old. Wise said he and the universities asked for $9.8 million over two years. "It shouldn't be a competition, but unfortunately it is," Wise told Blackford. "We were not trying to play priorities or favorites."

The screening programs for breast and cervical cancer are operated with federal funds, so elimination of any state funds would not impact it, said Doug Hogan, spokesman for the Cabinet for Health and Family Services. Hogan said the colon-cancer screening program had not received state funds for several years.

"Health screenings for preventive services are covered by all insurance plans and there are no deductibles or co-pays," Hogan said. "That applies to various preventive screens including those for colon, breast and cervical cancers."

Jaimie Studts, professor of behavioral science at the UK College of Medicine, said the Kentucky Lung Cancer Education Awareness Detection Survivorship Collaborative, also called the Kentucky LEADS Collaborative, has never received any state funding. He said it was slated to get $10,000 in each year of the current budget, but Bevin "red-lined" the allocation, saying the health secretary would need to determine how best to spend that money.

Including the program among the list of 70 to be cut "doesn't directly affect us in terms of dollars," Studts said. "But indirectly it does send a message that the governor and this administration is not interested in making those kinds of efforts to address Kentucky's burden of lung cancer."

Some other health programs on the list hadn't received any funding from the state for the past several years: ARC of Kentucky, a group that supports people with intellectual and developmental disabilities, and Madison County Early Intervention Services. They were not scheduled to get any funding in the 2018 fiscal year, according to KCEP. It has published a list of programs proposed for elimination and the current appropriation for each.

Bevin says his cuts are necessary to fully fund the state's pension obligations, with his budget setting aside about $3.3 billion, or 15 percent of state spending, for that purpose.

Opponents of the governor's budget cuts are calling for raising new tax revenue through comprehensive tax reform, which the governor said could happen in 2018. However, his office said in his budget news release that "He is calling for genuine tax reform that will make Kentucky more competitive with its neighboring states -- not merely a bump in the sales tax or an increase in the cigarette tax."

Kentucky's new Medicaid program will have administrative hurdles that are likely to cost some their health coverage

Critics of the Trump administration's decision to add work requirements to Kentucky's Medicaid program cite research to support their concerns that this requirement will cause fewer people to enroll in the program.

Margot Sanger-Katz of The New York Times compiled a list of examples, writing that there is "a lot of research available about the Medicaid program, specifically, that shows that sign-ups fall when states make their program more complicated."

One of several examples that she shares is from 2003, when the state of Washington tried to reduce Medicaid spending by requiring beneficiaries to prove eligibility twice a year, instead of just once, and added some paperwork. One result: 40,000 fewer children in the health insurance program in just one year. The policy was reversed two years later.

Conversely, Sanger-Katz writes that in the early 2000s, Louisiana wanted to increase the number of children in the state health insurance program, so it simplified the sign-up process, resulting in a "surge of enrollment" and "the number of administrative cancellations fell by 20 percentage points."

Another example, which Sanger-Katz doesn't mention, comes form Indiana, the model for Kentucky's program. There, when small, income-based premiums were required, 55 percent of the affected enrollees either never made a first payment or missed a payment while enrolled.

Donald Moynihan, a public-affairs professor at the University of Wisconsin, who is writing a book on the effects of administrative burdens, told Sanger-Katz that it is well documented that complex programs make non-compliance more likely, especially for those who aren't well organized.

"Anyone who has ever forgotten to pay a bill on time, or struggled to assemble all the necessary forms of identification before heading to the DMV, is likely to sympathize with how administrative hurdles can stymie someone," Sanger-Katz writes. "But these may be especially daunting for the poor, who tend to have less stable work schedules and less access to resources that can simplify compliance: reliable transportation, a bank account, internet access."

Kentucky's new Medicaid program creates several "administrative hurdles," and nine other states have asked to make similar program changes, Sanger-Katz reports.

The Kentucky plan requires "able-bodied" Kentuckians on the program to work at a job or participate in an approved list of "community engagement" activities at least 80 hours a month, and to document their participation.

It requires enrollees to pay small, income-based premiums monthly; to report any changes in their income within 10 days of the change; and to renew their coverage promptly at the end of the year.
Failure to meet these requirements very quickly results in a six-month lock-out, invoking more rules.

For example, those below the federal poverty level who don't pay premiums will be required to make co-payments. Those above the poverty level will be allowed to re-enroll if they pay their past-due premiums and take a financial- or health- literacy course.

Gov. Matt Bevin and his lieutenants argue that the changes will give beneficiaries more "dignity and respect" and promote personal responsibility. But they also estimate that the changes will leave the program with almost 100,000 fewer enrollees after five years than without the changes, partly because of "non-compliance."

Bevin tells PBS requiring Medicaid enrollees to work will build character; foe says he's lowballed number who will lose coverage

By Melissa Patrick
Kentucky Health News

In a national television interview, Gov. Matt Bevin reiterated his assertion that the work requirements for some in Kentucky's newly approved Medicaid program will provide them with an opportunity to have more "dignity and self-respect" by allowing them to be more engaged in their health care.

"So what is it we’re looking to change is, we simply want, for those that are able to be engaged in their own health outcomes, we want them to be, because there’s dignity and self-respect that is offered to people through the ability for people to do for themselves," he told PBS NewsHour host Judy Woodruff Jan. 15.

The new program, called Kentucky HEALTH (Helping to Engage and Achieve Long-Term Health), requires "able-bodied" Kentuckians on Medicaid to work 80 hours a month and document their participation requirement on a monthly basis. The program will be phased in regionally starting July 1, and Medicaid members will get 90 days notice when it applies to them. Kentucky is the first state to establish such requirements, under a new policy of the Trump administration.

The "community engagement" requirements will be phased in with the first phase starting in July and the full program expected to be rolled out by the end of the year, Beth Kuhn, commissioner of the Department of Workforce Investment, told Kentucky Health News.

The work requirements will mostly affect the 480,000 or so Kentuckians who are on Medicaid through the 2014 expansion of the program under the Patient Protection and Affordable Care Act to those who earn up to 138 percent of the federal poverty level: $16,643 for a single person and about $34,000 for a family of four. Pregnant women, full-time students, and the medically frail will be exempted.

The requirements can be filled by doing a number of things besides working at a job, such as looking for work, volunteering, getting job training, going to school, or caring for an elderly or disabled family member.

Bevin didn't answer Woodruff's question about how the state will determine who is medically frail, or who will qualify as caregivers. Instead, he again explained who would be exempt and how the work requirement could be filled, stressing the value of community engagement on a person's well being.

"The key is to have them engaged in their communities, because it is through that engagement that people have healthier outcomes. They have an interaction with people. They become a part of the fabric of their community. It’s better for them, and their health, and for their children and their families as well," he said. He added that the program isn't designed to find "big savings," but to "create opportunity for people to pursue the American dream."

Woodruff noted that the Kaiser Family Foundation reported that in 2016, 60 percent of "able-bodied adults" on Medicaid were already working. She asked what percentage he thought should be working, and Bevin said 100 percent, adding that there are 200,000 available jobs right now in Kentucky "waiting for somebody to fill them." He added, "Why should somebody have to go to work every day and pay taxes to provide something to someone who could do the same thing, but chooses not to? That’s very un-American."

Woodruff told Bevin it sounded as if his "underlying assumption" is that "many, many" of the able-bodied people on Medicaid are really trying to avoid work, and asked him if that assumption was true. Bevin said, "No, I think, again, this will be a very small subset. . . . This is for those who are not working and maybe want the opportunity. . . . Human beings want to be treated with dignity and respect. They do. And we’re going to give them that opportunity."

Opponents of the program say it is so complicated that it will create "barriers to care" that will result in low-income Kentuckians losing coverage merely for failing to report or pay small, income-based premiums, the other major facet of the program.

The Bevin administration has estimated that the number of people on Medicaid will be 95,000 fewer in five years than without the program, partly because of "non-compliance."

Judith Solomon, vice president for health policy at the left-leaning Center on Budget and Policy Priorities, writes that she expects the number will be much larger than 95,000 because the state doesn't account for those who will experience gaps in coverage "due to the lock-outs for failing to meet work requirements, pay premiums, or report changes or renew coverage in a timely manner."

Solomon says there is a "robust body of research" that shows premium requirements will reduce enrollment. She notes that in Indiana, the model for Kentucky's program, 55 percent of the affected enrollees either never made a first payment or missed a payment while enrolled.

Under Kentucky's new plan, missing payments -- along with failing to meet work requirements, not reporting changes in work status or not renewing coverage appropriately -- would result in a six-month lock-out for those with incomes above the poverty level. Those below that level will be be placed in a different plan that requires co-payments. Those above the poverty level will be allowed to re-enroll if they pay their past-due premiums and take a financial- or health-literacy course.

Recognizing that there are exemptions to the work requirements for those who are medically frail, Solomon says this is not a fail-proof safeguard, because many with disabilities won't meet the strict medically frail definition, creating yet another opportunity for people to lose their coverage.

Senate health committee recommends $1 increase in cigarette tax; doctors say it would increase state revenue and save lives

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – What started as an information-only hearing about the benefits of raising tobacco taxes in tobacco-friendly Kentucky ended with an unexpected vote of recommendation by the Senate health committee to raise the state's cigarette tax by $1 a pack, to $1.60.

Sen. Julie Raque Adams, chair of the Senate Health and Welfare Committee, opened the Jan. 17 meeting by making clear that the hearing on the idea was meant to "open the conversation" about what it would mean for the state, since Gov. Matt Bevin has said tax reform will be considered in 2018 – meaning a special session if not in the current, regular session.

But after compelling testimony and a long list of statistics about how smoking-related illnesses plague the health and economics of the state – which the legislators said they'd heard many times before – Sen. Alice Kerr, a Republican from Lexington, moved  that the committee recommend a $1 "health-care assessment" on cigarettes, the concept proposed by Sen. Stephen Meredith, R-Leitchfield.

Adams, R-Louisville, initially declined to call a vote on the motion, but after several members said they would second it, she allowed the vote for recommendation, and it passed without dissent. The action has no legislative effect but could be an indicator of increasing support for the tax.

Dr. Jason Chesney, the director of the University of Louisville James Graham Brown Cancer Center, told the committee that while he was against raising taxes in general, he considered increasing the cigarette tax by $1 a "health-care policy."

"It's been proven in state after state that if you raise the cigarette tax by $1, then you will reduce youth smoking . . . and in turn that will lead to less adults smoking," he said. The proposal would make similar increases in state taxes on other tobacco products.

Kentucky has some of the highest smoking rates in the nation for both adults and teens, 24.5 percent and 14.3 percent, respectively.

Dr. Mark Evers, director of the University of Kentucky Markey Cancer Center, told the committee that estimates from the American Cancer Society and the Campaign for Tobacco-Free Kids show that raising the cigarette tax by $1 will keep approximately 23,000 of Kentucky's youth now under 18 from becoming adult smokers, and would reduce the current number of youth smokers by 4,800.

Chesney noted that Kentucky leads the nation in the number of people with cancer and the number of deaths from it, and that 34 percent of those cancer deaths are due to smoking.

He said that even though he cares for thousands of cancer patients every year, and has developed anti-cancer drugs, "I can say with confidence that this initiative is more important than anything I'll do in my life."

Evers concurred: "Senators, I'm here to tell you that given this information, raising the tobacco tax by at least $1 may be the single most important, significant policy measure you can take in your lifetime, and certainly as Dr. Chesney said, in my lifetime to improve the health of Kentuckians."

Ashli Watts, senior vice president of public affairs for the Kentucky Chamber of Commerce, told the committee that over 90 percent its members favor the $1 increase, and she noted a recent statewide poll that shows over 70 percent of Kentuckians support it, regardless of political affiliation.

Watts said smoking costs the state nearly $2 billion annually in health-care costs, with almost $600 million of that for Medicaid – which are taxpayer dollars. She added that lost worker productivity caused by smoking in the state totals more than $2.3 billion.

"Kentucky business leaders know that increasing the cigarette tax will improve our companies bottom line, help us attract new businesses and workers, produce a more productive workforce and most importantly save lives," she said.

Meredith said he is looking for a House sponsor for his legislation because revenue-raising measures must originate in the House. A retired hospital CEO, he told the committee that he had worked in health care for more than 40 years and that when it comes to smoking and the poor health of Kentuckians, nothing has changed.

"It's time to stop having this conversation and start action," he forcefully told the committee.

Sen. Max Wise, R-Campbellsville, asked the panel and the committee about the "slippery slope" that this type of tax presents, asking, "What's next? . . . Is it a war on Twinkies?"

Watts responded by saying that the Chamber members have drawn a pretty clear line on this issue because, "When you smoke, everyone in that room also inhales that smoke as well. When you drink a soda, the person sitting next to you is not going to be affected. So that is where we have kind of drawn the line."

Other statistics shared by the panel included:

Health impacts of smoking in Kentucky

• 3,000 Kentucky kids will start smoking this year
• Smoking doesn't just cause lung cancer, it can also cause bladder cancer, heart disease, emphysema, bronchitis, asthma and congenital birth defects
• Smoking kills more people in Kentucky than alcohol, HIV/AIDES, car crashes, illegal drugs, murders and suicides combined
• Smoking related diseases make up six times the number of deaths in Kentucky, compared to deaths from the opioid epidemic

Economic impacts of smoking in Kentucky

• Smoking cost every tax payer in Kentucky about $1,100 each year

Raising the cigarette tax by $1 would:

• Would lead 29,400 current adult smokers to quit
• Prevent 14,800 premature deaths
• Reduce the number of smoking affected pregnancies and births by nearly 6,000 in 5 years

Health-care cost savings from a $1 cigarette tax increase:

• $5.3 million over 5 years in the cost of treating lung cancer
• $14.7 million over 5 years for the cost of treating pregnancies and births affected by smoking
• $11.6 million over 5 years for treating smoking related heart attacks and strokes
• $6 million over 5 years in Medicaid spending for smoking related costs

Analysts think Medicaid work requirements pose little political risk

Bevin and President Trump (AP photo)

"Kentucky is one of the poorest states in America, and its residents are among the sickest. Yet the governor's decision to force Medicaid recipients to meet a work requirement — something that could take health coverage away from 100,000 people — is unlikely to carry any political repercussions for the GOP in this deeply red state." Tony Pugh reports for McClatchy Newspapers' Washington bureau.

Pugh notes that 2017 Kaiser Family Foundation poll found that 70 percent of Americans support work requirements for Medicaid recipients, and that Republican Gov. Matt Bevin is betting Kentucky feels the same way.

Kaiser Family Foundation graphic.
Click on it to enlarge. Click here for more information.  

Read more here: http://www.mcclatchydc.com/news/politics-government/article194990909.html#storylink=cpy

In Kentucky and other states with many low-income residents, people who work but often struggle to pay for health care tend to resent those who get government-subsidized health care, according to Al Cross, director of the University of Kentucky's Institute for Rural Journalism and Community Issues, which publishes Kentucky Health News. "If you can say, 'All we’re doing is requiring people to be more active participants in their health care and require some work-related activities,' I think the general population looks at that and says, 'What’s the matter with that?'" Cross told Pugh.

"Supporters say the Medicaid work policy will cut government dependency, weed out people who don’t really need the assistance and build work ethic among low-income enrollees," Pugh reports. "Critics say the requirement will be expensive to administer, provide an unnecessary barrier to coverage and penalize people who can’t work due to undiagnosed medical problems." Kentucky's new policy estimates nearly 100,000 fewer Kentuckians will have health coverage in five years, than if the policy were not implemented.

Eight other states with Republican governors (Arkansas, Arizona, Indiana, Kansas, Maine, New Hampshire, Utah and Wisconsin) and one state with a Democratic governor (North Carolina) have asked the Trump administration for the green light to enact similar requirements. Several of those states could be battlegrounds in statewide and congressional elections in November. But the Medicaid work requirements aren't likely to be a problem for most Kentucky Republicans, since there are no statewide races this year.

The traditionally lower turnout among low-income voters who would be affected by the measure could also help protect Republicans, Cross said. And it's worth noting that the Kentucky counties with the highest Medicaid rates backed Bevin in 2014, mostly because of social issues such as religion, abortion and anti-Obama sentiment.

But the political dynamics at play in Kentucky may not apply in other states. "It may depend on rival Democrats making a linkage between Medicaid and overall concerns about health care and insurance," Pugh writes. Democrats are likely to emphasize health coverage in elections this year, since 3.2 million Americans lost health coverage in 2017 and it's an issue that most people care about. A poll by Hart Research Associates last week showed that voters cared about health care more than the economy, taxes, immigration, or terrorism in the 2018 congressional elections.

State-UK partnership creates system to track drug overdoses

Illustration by FiveThirtyEight and Getty Images

Kentucky has been hit hard by the opioid epidemic, but the state is trying to fight it with innovative efforts to gather more specific data about overdose deaths. The Kentucky Injury Prevention and Research Center, a partnership between the state Department for Public Health and the University of Kentucky College of Public Health, built a "drug-overdose fatality surveillance system" that combines information sources like death-certificate information, post-mortem toxicology analysis, and victims' prescription history to get a better picture of which drugs are killing people and under what circumstances.

"The efforts that KIPRC and the state have made to improve this data have led to crucial findings, including that Kentucky’s crisis isn’t one crisis, but many," Kathryn Casteel reports for FiveThirtyEight. "Different parts of the state are afflicted with different drugs. Northern Kentucky, for example, has a high prevalence of heroin and fentanyl — a synthetic opioid that is more deadly than heroin and other types of opioids — while in the eastern part of the state, prescription opioids are still the main concern.

KIPRC chart; click on the image to enlarge it.

"We’re not doing this for the sake of research," Svetla Slavova, a biostatistician with KIPRC, told Casteel. "We provide actionable data for policymaking, treatment and prevention. We’re trying to be responsive and provide data that will help make these decisions." Because of KIPRC's research, Van Ingram, the executive director of the Kentucky Office of Drug Control Policy, said he was able to push legislation increasing the availability of the anti-overdose drug naloxone.

One of KIPRC's biggest efforts is to make death-certificate information more uniform across the state, because "even the smallest differences in language can leave overdose deaths uncounted," Casteel reports. Sarah Hargrove, a data management analyst for KIPRC and former autopsy technician for the state, is spearheading the effort. It's tough going, since some coroners in the state's 120 counties, many of them small, have limited resources and funding, and many have little medical experience.

But KIPRC is making headway. "Researchers were able to determine the specific drugs that were involved in 97 percent of drug overdose fatalities in 2016; that’s compared with 82 percent using death certificates alone," Casteel reports. The also used the surveillance system "to find which drugs were most commonly involved in deaths linked to a combination of substances, as well as which drugs were involved in overdose deaths among people of different age groups and genders."

State health plan says online service has saved it $2.5 million

The state says it has saved $2.5 million in the last two and a half years through a health-and-wellness service that allows 300,000 state employees, teachers and others in the state health plan to get doctor consultations and care online.

The “LiveHealth Online Medical + Behavorial Health” initiative, started in June 2015, will continue to expand its services, the state Personnel Cabinet said in a news release. For example, psychiatric “virtual visits” began this month.

“This service is incredibly user-friendly,” Personnel Secretary Tom Stephens said. “It lets you talk face-to-face with a doctor through your mobile device or a computer with a webcam. It’s faster, easier and more convenient than a visit to an urgent care center. . . . There are no appointments, no waiting and no sitting in traffic. It’s quick, easy and connects you to a doctor of your choice in minutes.”

The state plan is Kentucky's largest self-insured health plan, "with benefits designed in partnership with multiple vendors to provide greater access to quality healthcare with increased customer service," the release says. "The Kentucky Executive Branch is the state’s largest employer, with over 30,000 employees."

HIV cases among N.Ky. drug users jump, sparking fear of an outbreak; health officials renew calls for syringe exchanges

Health officials in Northern Kentucky have renewed their cry for syringe exchanges following a huge surge in cases of the human immunodeficiency virus among intravenous drug users in Kenton and Campbell counties.

"HIV cases were up nearly 50 percent to 37 in 2017; the HIV cases among drug users rose 260 percent to 18," reports Terry DeMio, who covers drug abuse for the Cincinnati Enquirer.

The 50 percent increase in the two counties was mirrored across the Ohio River, where Hamilton County, which includes Cincinnati, reported a 50 percent jump in HIV cases.

Local health officials asked the federal Centers for Disease Control and Prevention to determine whether the increase amounted to an outbreak of HIV, like those they and the CDC have predicted. One expert says an outbreak in Appalachian Kentucky is only a matter of time.

Dr. Jeffrey Howard, Kentucky's acting health commissioner, told Terry DeMio of the Cincinnati Enquirer, "We do not want to give the impression of widespread community risk for HIV in Northern Kentucky." However, local officials and advocates were not so sanguine.

Dr. Lynne Saddler, director of the Northern Kentucky Health Department, "cautioned that 2017's rise in reported cases may only be the tip of the iceberg, since many people aren't tested for HIV and injection drug users generally don't the proper health care," the Enquirer reports. "Kimberly Wright, leader of the private Facebook group Kentucky Parents Against Heroin, said the threat isn't just to injection drug users or health and safety workers."

"We're all at risk now," Wright told DeMio. "Here's the thing I think people don't get about users: We have males and females who are prostituting out here. …You know, we have strip clubs where these girls are going to dance to earn their money. We have married men going into these places that are leaving with them."

Advocates and health officials redoubled their calls for syringe exchanges where IV drug users can get clean needles, preventing the spread of infection and providing an opportunities to recruit them into treatment. Local officials, feeling political pressure from both sides, have dithered.

"Kenton County commissioners have approved an exchange there, but Covington has resisted unless a neighboring county gets an exchange, too," DeMio notes. "Campbell County gave a thumbs up, but Newport hasn't acted on the issue."

Approval is required from the county government and the city where an exchange is placed. At a news conference, advocates and heath officials turned up the heat on politicians.

"We must act immediately," Garren Colvin, president and CEO of St. Elizabeth Hospital, said at a news conference with other health officials. "More than ever, Northern Kentucky now needs comprehensive syringe access-exchange programs."

Brent Cooper, president and CEO of the Northern Kentucky Chamber of Commerce, said "It's about lowering our collective health-care costs, improving the health of our community and attracting and retaining workers and business." The chamber "has been at the forefront of fighting the heroin epidemic for more than five years," DeMio notes.

Opponents of syringe exchanges say they enable drug use, but research has debunked that notion.