Saturday, February 29, 2020

Legislators repeat myths about flu vaccines, get subtly corrected by a colleague who is a doctor; disease remains a threat in Ky.

By Melissa Patrick
Kentucky Health News

With all the people who come through the state Capitol, and all of the handshaking that goes on there, especially when the Kentucky General Assembly is in session, it's no wonder the House opened Monday's session with a call for members to keep in mind the many who were absent due to illness, or that the flu was mentioned several times in the Senate.

But some senators demonstrated how politics and public health don't always match up.

Sen. Dennis Parrett, a Democrat from Elizabethtown, while recording votes that he missed while out with the flu, told his colleagues -- and everyone watching Kentucky Educational Television -- that the last two times he got a flu shot, he soon after got the flu, including this last time.

Parrett insinuated that the vaccine gave him the flu, but medical experts say that doesn't happen.

No one contradicted Parrett, and his remark prompted Senate President Robert Stivers, a Manchester Republican, to say from the dais, "I've never taken the flu shot, and I've never gotten the flu."

Sen. Ralph Alvarado (file photo from LRC Public Information)
Several moments passed before Sen. Ralph Alvarado, R-Winchester, a physician, stood up and said, "I'd like to encourage everyone if they have not gotten their flu vaccination to get one."

He noted that the flu has been particularly virulent this year and stressed that flu is one of the most preventable diseases because of the vaccine. "So people who are watching at home, please go out and get your vaccination," he said.

And to laughter all around, Stivers uttered the line typically used when routine announcements are made: "Members, please take note."

Flu myths and misconceptions

On the surface, what Parrett and Stivers said about the flu is no big deal. But from a public-health perspective, their comments repeated several persistent myths about flu vaccines, which have long been proven to be the best defense against this often serious disease. So far, flu has killed 80 Kentuckians during this season, which runs through May.

The federal Centers for Disease Control and Prevention says that unequivocally that a flu shot cannot give you the disease. The vaccines are produced in two ways, with an "inactivated" or killed flu virus, or by using only part of a flu virus. In other words, there is nothing in a flu vaccine that can infect you.

And while nasal-spray flu vaccines do have live influenza viruses, the CDC says they are weakened, and will not cause a person to get the flu.

One reason for this persistent myth is because the flu virus is constantly changing – which creates confusion and distrust of the vaccine – and some years the vaccine doesn't cover the most prevalent strain of the virus.

Another reason for this persistent myth is because the flu shot does not offer protection immediately, and takes at least two weeks to kick in. So when someone says they got the flu right after having a shot, it means they were exposed to the virus before they developed immunity. Or, someone may have been exposed to a flu virus different from the viruses that the vaccine is designed to protect against.

That said, some people do report a mild reaction to flu vaccinations. The most common reactions are soreness, redness, tenderness or swelling where the shot was given, but some report low-grade fever, headache and muscle aches.

The bottom line: The vaccine is about reducing your risk, not eliminating it. And even if you get the flu after getting a shot, chances are that your symptoms will be less bothersome than if you didn't get it.

And while Stivers has never had the flu, despite never getting a shot, that doesn't mean he isn't at risk of getting it in the future. Also, it's possible to be infected with the flu virus but have no symptoms.

And its not about Stivers or any other individual. Adults need vaccination to provide "herd immunity" for those who can't be vaccinated like babies and those who are immuno-compromised.

The CDC notes that the flu is highly contagious and can spread to people as much as six feet away, largely through the tiny droplets made when coughing, sneezing or even talking.

As Alvarado said, the best way to protect yourself from the flu is to get a yearly vaccine, and it's not too late, since the season usually runs through May. It is recommended that everyone over 6 months old get an annual flu vaccination.

Kentucky has a lot of room to improve its flu vaccination rates, especially among adults. The CDC reports that only 45 percent of Kentucky adults and 65% of the state's children got a flu shot last season.

Besides vaccination, there are other, simpler ways to protect yourself from the flu, a cold, or even the novel coronavirus.

Washing your hands properly is one of the most important ways you can keep from getting sick and spreading germs to others. It is recommended that you scrub your hands with soap and water for at least 20 seconds, or the length of time it takes to sing "Happy Birthday" twice.

Flu in Kentucky

For the last two months, Kentucky has seen about 2,000 new cases of flu a week, and the number of deaths from it continues to rise, with 14 more adults in the state reported to have died from the flu in the week that ended Feb. 22. That brought the state's total to 80 for the season. Four victims were under the age of 18, according to the state Department for Public Health.

The latest weekly report shows that in the week ending Feb. 22, Kentucky counted 1,943 new cases. During the flu season, 21,000 cases have been reported in Kentucky. The actual number of cases is higher, because not all flu cases are counted; flu does not have to be reported, and three counties did not contribute to the latest report. Here are the new cases recorded each week:

1,943 in week ended Feb. 22
1,854 in week ended Feb. 15
2,101 in week ended Feb. 8
1,815 in week ended Feb. 1
1,739 in week ended Jan. 25
1,544 in week ended Jan. 18
1,898 in week ended Jan. 11
2,213 in week ended Dec. 28
1,339 in week ended Dec. 21
814 in week ended Dec. 14
511 in week ended Dec. 7

Hotspots continue around the state, including: Barren County with 94 new cases, for a total of 1,147; Bullitt with 47, for at total of 842; Fayette with 53, for a total of 513; Floyd with 52, for a total of 248; Franklin with 49, for a total of 457; Greenup with 47, for a total of 296; Hardin with 44, for a total of 317; Jefferson with 679, for a total of 7,486; Knott with 52, for a total of 374; Oldham with 55, for a total of 508; Perry with 48, for a total of 1,056; Pike with 61, for a total of 1,111; and Warren with 55, for a total of 761.

MMWR = Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention

Friday, February 28, 2020

House passes bill to loan money to struggling rural hospitals; funding is still in the works, but sponsor appears confident

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Spurred to action when the hospital in his county said it was closing, state Rep. Danny Bentley filed a bill to create a loan program for financially distressed rural hospitals. It went from the House to the Senate without dissent Feb. 28, and Bentley voiced confidence that it will be funded.

Rep. Danny Bentley
House Bill 387 would allow the state Cabinet for Economic Development to provide loans to struggling hospitals for three purposes: to maintain or upgrade their facilities; to maintain or increase staff; or to provide health-care services not currently available.

Loans could run 20 years and would be available to hospitals in counties with fewer than 50,000 people.

Bentley, R-Russell, said more than 60 hospitals would qualify for the loans, and 13 of them are vulnerable to closure. One is already closing: Our Lady of Bellefonte Hospital in his home town, a Greenup County suburb of Ashland.

Most questions about the bill dealt with funding. Bentley told Kentucky Health News that it will be funded. The next day, he said that while funding details are still in the works, "Let's put it this way: It's too important not to be funded."

The bill has a powerful co-sponsor, House Speaker David Osborne, R-Prospect. He told The Associated Press that funding could come from state bonds.

“It's the goal to help turnarounds when turnarounds are possible," Osborne told reporters. “That doesn't mean that we can save every hospital that is failing, just like we can't save every business that's failing. But there are some, when given the opportunity, that can succeed, and that's our goal ... to help those that can."

Osborne told the AP that the idea stems from discussions about the state's proposed $35 million loan to the University of Louisville to help it buy Jewish Hospital and other KentuckyOne Health facilities that were at risk of closing. He said concerns were voiced about how the state could also help struggling rural hospitals. The House has passed HB 99, which would approve the loan.

On the House floor, Bentley pointed to the closing of the only hospital in his county as an example of how devastating the loss of a rural hospital can be. Our Lady of Bellefonte will close on April 30, according to a press release from the Catholic group that owns it.

Bentley said that will kill about 1,000 jobs and about $700,000 in annual tax revenue, and make care less accessible. He added, "If they close a rural hospital on us, they will never re-open them. So we've got to be concerned."

If passed and signed into law, HB 387 would take effect immediately. Many rural hospitals in Kentucky are struggling to keep their doors open.

Kentucky Health News reported in October that a Navigant Consulting Inc. study concluded that 16 of Kentucky's rural hospitals, or about one-fourth of the total, are at high risk of closing unless their finances improve. Another study at the University of North Carolina said eight rural Kentucky hospitals are at high risk of financial distress and 23 more are considered to have mid-high risk. The Kentucky Hospital Association, using 2017-18 data, concluded that 35 of the 70 hospitals it considers to be rural are in poor financial health, with 14 of them "very vulnerable." The numbers vary because the studies measure financial distress differently.

Five rural Kentucky hospitals have closed since 2009, four of them since 2014, according to a UNC report.

Bentley said one reason rural hospitals struggle to make ends meet is because most of their patients are on Medicare or Medicaid, which pay less than the full cost of care.

But that's just part of the problem. The Navigant report pointed to other issues, including: a shift from inpatient to outpatient care, which has left hospitals overstaffed and underused; shrinking populations that tend to be older and poorer, meaning that there are more Medicaid and Medicare patients; and not enough money in their budgets to invest in updated, innovative technology.

The hospital association also says changes in federal reimbursement policies have also hurt Kentucky hospitals. It supports Bentley's bill.

KHA President Nancy Galvagni said in an e-mail. "We do not expect HB 387 to be a panacea for the challenges facing some rural hospitals, but it will be an important support for both the hospitals and for our rural communities." She added, "Kentucky’s hospitals are not just buildings where people seek health care; they are also crucial economic players in our communities across the commonwealth."

Study: Rural women with ovarian cancer are more likely to be diagnosed later, but not because of greater distance to doctors

Rural women who have ovarian cancer are more likely to find out about it when it's already at stage IV than women who live in metropolitan areas, according to a study just published in The Journal of Rural Health.

That matters, because early detection makes survival more likely. From 2000 to 2015, the five-year survival rate of stage IV ovarian cancer was only 29 percent. The American Cancer Society estimates that 23,000 women were diagnosed with ovarian cancer in 2019, and about 14,000 died or will die from it. That includes 280 new cases in Kentucky, and 190 deaths.

Researchers at the University of Iowa and the Centers for Disease Control and Prevention studied about 1,000 women in Iowa, Kansas and Missouri who had been diagnosed with ovarian cancer in 2011-12. At the time they were diagnosed, 111 had stage IV and 889 had stages I-III. Stage IV patients were more likely to be older, rural, and have other health problems.

It is tempting to attribute that difference to poverty, or to difficulty in accessing care, but the study controlled for those factors. Rural women were more likely to be diagnosed with late-stage ovarian cancer regardless of the socioeconomic status of their census tract or the distance to their primary-care provider.

This disparity also isn't likely related to lifestyle factors such as smoking, obesity, or lack of physical activity; though such factors are more prevalent in rural areas, they aren't prominent risk factors for ovarian cancer. And though such lifestyle factors could create a higher incidence of cancer, they aren't likely to create geographic-survival or diagnostic disparities, researchers said.

Rural cancer patients generally have poorer outcomes than non-rural patients, including a lower survival rate. That's true of rural ovarian-cancer patients too, probably because of less access to specialty care and treatment after diagnosis.

The researchers suggest that if rural women had better access to gynecological specialists in urban areas, it could make a difference, since those doctors are highly trained and may be able to recognize the symptoms of ovarian cancer sooner than other health-care providers.

Thursday, February 27, 2020

State House passes 25% tax on electronic cigarettes

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill aimed at reducing teen use of electronic cigarettes by increasing their price passed the state House 75-17 and went to the Senate Feb. 26. The bill would place a 25 percent wholesale tax on the products.

State Rep. Jerry Miller
The bill's sponsor, Rep. Jerry Miler, R-Louisville, told the House that youth use of e-cigarettes is "creating a crisis" and "The most effective way to attack underage use is through raising the price."

The Kentucky Incentives Prevention Survey found that from 2016 to 2018, Kentucky teenagers nearly doubled their e-cigarette use, with more than one in four high-school seniors and one in seven eighth-graders reporting use in 2018.

House Bill 32 would also raise the wholesale tax for "other tobacco products," such as cigars, to 25% from the current 15%, and add e-cigarettes to that list. It would also double the per-unit tax on chewable and non-smokable products, but does not increase the tax on traditional cigarettes.

Gov. Andy Beshear proposed a 10-cent-per-pack hike in the cigarette tax, estimated to raise nearly $40 million for the next two-year state budget.

Miller said his bill is projected to bring in nearly $50 million. He said the amounts were increases "that a large manufacturer" said it could live with without opposing the bill.

The original bill called for a 27.5% wholesale tax on e-cigarettes, which are the only tobacco products in Kentucky that does not have an excise tax. That would be equivalent to the current tax in cigarettes.

Terry Brooks, executive director of Kentucky Youth Advocates, applauded the bill's passage, but asked that the Senate go to 27.5%, "to make a real impact for young people." 

"E-cigarettes put our young people at risk of nicotine addiction, serious lung injury or disease, and other harmful outcomes," Brooks said in a prepared statement. "A tax on e-cigarettes equivalent to that on cigarettes is a proven way to prevent usage among youth and can reduce future healthcare costs and provide additional revenue for the state budget."

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said the 25% tax was close enough to the cigarette tax to reduce youth use of the products. Chandler noted that after the state raised the cigarette tax 50 cents a pack, to $1.10, in 2018, annual sales dropped 36 million packs.

Miller is also the sponsor of House Bill 69, which would add a long list of regulations to e-cigarettes. It passed out of committee on Feb. 12, but has not yet been called up for a House vote.

Representatives from the Kentucky Smoke Free Association, which represents about 400 independent vape shops statewide, told lawmakers at the bill's committee hearing that while they support the added regulations in HB 69 because they address teen-access issues, they did not support the tax because it would hurt their businesses and would discourage adults from using their products as a smoking cessation device.

A recent U.S. Department of Health and Human Services report says more research is needed before it can be concluded that e-cigarettes help people stop smoking.

Bill to help people with addictions get medication-assisted treatments moves; advocates say insurers killed the last one

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to help people with opioid and alcohol addictions to get prescription drugs to treat their substance-use disorders -- the recognized standard of drug treatment -- passed unanimously out of committee Thursday and now heads to the full House.

Kimi Banta, Rep. Kim Moser, Dr. Shawn Ryan in committee
House Bill 389, sponsored by Rep. Kim Moser, R-Taylor Mill, would ban the requirement of "prior authorization" for any prescription drug that is used in the treatment of alcoholism or opioid-use disorder that contains methadone, buprenorphine or naltrexone, which are the recommended first courses of treatment for most patients.

Under prior authorization, insurance companies require health-care providers to get the insurer's approval for certain drugs and procedures before they can be administered.

"Your treatment could be delayed anywhere from several hours to several weeks because of the prior authorization rules that insurance companies have in place," Moser told the House Banking and Insurance Committee. "Ultimately, your health-care provider knows what is best for you . . . but unfortunately, they are not always the ones to make the final decision."

Starting Jan. 1, a law passed during the last legislative session gave insurers five days or less to give or deny approval of a drug, allowing some maintenance drugs used to treat chronic conditions to be approved for up to a year.

Moser, whose main job between 2014 and 2018 was Northern Kentucky director of the state Office of Drug Control Policy, talked about the dangers such delays have for people with addictions, often resulting in relapse or death from overdose.

She also said immediate access to these "life-saving treatments" is imperative because the window for when a person is ready and willing to seek treatment for addiction is often very short.

"The evidence is clear, treatment works," she said. "It helps keep people out of jail, it helps them stay in jobs, it helps them be productive members of society and family members, but most importantly, it saves lives."

This claim is well supported. Most recently, a study published Feb. 5 in JAMA Network Open compared six treatment plans for nearly 41,000 adults with opioid-use disorder between 2015 and 2017 and found that patients who were treated with buprenorphine or methadone were 76 percent less likely to overdose within three months and 59% less likely in 12 months, compared to those who did not get these drugs but participated in other types of treatment.

The same patients were 32% less likely to go to the emergency room or be admitted to the hospital in three months, and 26% less likely in 12 months.

Only 12.5% of the patients in the study were prescribed buprenorphine or methadone, citing a lack of access to doctors who can prescribe those drugs; high co-payments; prior-authorization requirements; "and other restrictions on use," the study said.

Kimi Banta of Louisville told the committee that as an alcoholic and an addict in recovery, "Medically assisted treatment has saved my life."

She said "after years and years of failed attempts to stop my drug use," she was prescribed Suboxone, which is a combination of buprenorphine and naloxone, a drug that reverses an opioid overdose, and that has allowed her to stay sober for two years and rebuild her life.

"I am a changed person and Suboxone bought me the time to do it all," she said. "More Kentuckians deserve this opportunity and should not have to jump through hoops to get medication that can change their life and their families life. This bill will save lives."

Moser, who chairs the House health committee, said the bill is supported by American Medical Association, the Kentucky Medical Association, the American Society of Addiction Medicine, the Kentucky Society of Addiction Medicine and treatment providers everywhere.

KMA President Dr. Brent Wright said in a news release, "This legislation will remove a critical barrier to ending Kentucky’s ongoing overdose and death epidemic. We support this bill because it will save lives."

A similar measure passed the House 97-0 last year, but was not given a hearing in a Senate committee. The joint  KMA and AMA news release says last year's bill "was ultimately defeated by opposition from health-insurance companies."

Kentucky's Medicaid program and some insurance companies have voluntarily lifted prior authorization for some medication-assisted treatments. Moser said her bill would codify this requirement for all three drugs in the Medicaid system and with private insurers.

Moser told Kentucky Health News, "There are patients who when they are ready for treatment for their addiction, they need these medications right away so that they don't go back out and use and overdose and die -- and we are seeing that. That's why [this bill] is so critical."

Wednesday, February 26, 2020

If you're worried about coronavirus, you should be more worried about the flu, and take the same precautions, including a flu shot

Worried about the novel coronavirus spreading in the United States? Take the same precautions that you would against influenza, which is twice as bad as it was in Kentucky last year and is a much bigger threat, having killed 66 Kentuckians.

That's the advice from the Kentucky Medical Association, its foundation and a statewide health foundation, in the wake of the Feb. 25 warning from the federal Centers for Disease Control and Prevention that coronavirus outbreaks are expected in the United States.  

"While novel coronavirus presents a low risk currently to the majority of populations within the U.S., we do know that the virus can spread rapidly and is transmitted primarily through tiny air droplets and close contact with an infected person," said Dr. Brent Wright, president of KMA and board chair of the Foundation for a Healthy Kentucky.

"The good news is we already know how to prevent the spread of such a virus, since protocols for it are nearly identical to those for the flu, which remains a much greater threat to public health currently. . . . While coronavirus is scary, we can be confident that we are doing everything we can to prevent it by treating the threat of the virus the same manner we do the flu."

The flu vaccine won't work against the novel coronavirus, but having the flu weakens the immune system, leaving unvaccinated people more susceptible to contracting other illnesses, including coronavirus. "It isn't too late to get a flu shot, even if you've already had a bout of flu this season," the foundation said in a press release with the KMA and its foundation, the Kentucky Foundation for Medical Care. Flu season usually runs into May.

"Symptoms of coronavirus also closely resemble influenza, so patients are encouraged to consult with their doctor if they are experiencing fever, cough and shortness of breath," the release says. "Health officials have also emphasized that proper hand washing is the most effective way to prevent the spread of both novel coronavirus and influenza."

"Washing your hands with warm soap and water, for at least 20 seconds, as frequently as possible, helps prevent the spread of germs more than anything else," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky. "Covering your mouth when you sneeze or cough and staying away from others when you are sick are also common-sense practices we should be utilizing during all seasons, but particularly to prevent respiratory illnesses like the flu and coronavirus."

Tuesday, February 25, 2020

Bill would let health professionals refuse treatment that violates their conscience; critics say it would put discrimination into law

A bill to allow health-care professionals to refuse to provide treatment that violates their conscience is nearing a floor vote in the state Senate. 

Sen. Stephen Meredith
Senate Bill 90, sponsored by Sen. Stephen Meredith, R-Leitchfield, would also exempt providers from liability for exercising their rights and allow individuals to sue if they have been injured through disciplinary action, such as being fired or demoted over a refusal to provide a health-care service.

"Meredith said it is aimed solely at providing protection for health-care workers under pressure to provide certain treatments or medication they oppose in a rapidly changing climate of medical advances," reports Deborah Yetter of the Louisville Courier Journal..

 "This is not intended to deny health care to anyone," Meredith, a retired hospital CEO, told the Senate Judiciary Committee on Feb. 20.

Opponents, including the Kentucky Mental Health Coalition, the Kentucky Association of Sexual Assault ProgramsPlanned Parenthood and the state Fairness Campaign, argued it could curtail care for health services ranging from abortion and psychological counseling to treatment for rape victims, Yetter reports.

"It's going to put discrimination into the statutes," said Sheila Schuster, a psychologist and executive director of the mental-health coalition.

Several health providers spoke in favor of the bill in committee, including Dr. Steven House, a Glasgow physician who said doctors "should not be forced to participate in treatments that conflict with their morals, religion or their beliefs."

The bill would allow individuals to base their objections on "religious, moral, ethical or philosophical beliefs or principles." It also includes students, such as medical residents or those studying nursing or psychology.

"Critics said the bill is so broadly written that anyone at any health care facility, including the receptionist at the front desk or the janitor cleaning the building, could object to allowing services for someone," Yetter reports.

As approved by the committee, the bill would give insurance companies and self-funded health plans the same rights as health-care providers, but Meredith filed a floor amendment Feb. 24 to take them out of the bill. As of Feb. 25, the bill had still not been posted for a floor vote.

Sunday, February 23, 2020

House passes public-assistance bill with plan for temporary health coverage for people who earn too much to stay on Medicaid

By Melissa Patrick
Kentucky Health News

A bill aimed at moving Kentuckians off public assistance includes several health-related provisions, including a new coverage plan for people who lose their Medicaid benefits if their income rises above the limit for the program.

House Speaker Pro Tem David Meade
presents House Bill 1. (LRC photo)
A heavily revised version of House Bill 1 passed the House Feb. 21 by a vote of 58-32. It was along party lines, except one Democrat who voted for it: Rep. John Sims of Flemingsburg.

Other Democrats said the bill was rushed, but Speaker Pro Tem David Meade, R-Stanford, its lead sponsor, said "We are trying to find a good balance between compassion to help those folks in those situation who truly need care and help in these public assistance programs, but also a balance of accountability."

Most of the bill is aimed at cracking down on fraud, but a major part of it would provide a temporary state health-insurance option for Kentuckians who stop being eligible for Medicaid because their income exceeds 138 percent of the federal poverty level, $17,609 for a single person. It would be available for those earning up to 200% of the poverty line, $25,520 for an individual.

This provision addresses the "benefit cliff," the term for the loss of public benefits by people whose earnings exceed limits for programs but who are unlikely to have jobs with health insurance or the money to afford it. Republicans said they had heard stories of people who ask employers not to give them raises so they can keep their Medicaid benefits.

This health insurance program would require premiums and cost sharing to rise 25% for every 15% in income above 138% of the poverty line. Participants could stay in the program for a year after exiting Medicaid, with a possibility of extension on a case-by-case basis.

The Supplemental Nutrition Assistance Program is a major focus of the bill, as is Temporary Assistance for Needy Families. It would remove from the programs individuals who fraudulently misuse their benefits card, or are completely able-bodied adults with no dependents who choose not to participate in a community engagement program, including work, school or volunteering, if such requirements are implemented. It would expand many benefits, with task groups formed to explore further expansions.

Democratic objections

Some Democrats said they agreed with the goals of the bill, but said it was rushed. They questioned its enforcement costs and said it would lead to lawsuits.

"Although there are good elements in this piece of legislation that I'm glad to see move forward, they are really stamped and trampled on by the bad parts of this legislation," said Rep. Charles Booker, D-Louisville.

Meade said, "What you're hearing today is, we like the expansion of benefits, we want to continue to give people more but we don't want to hold anyone accountable."

The House adopted two amendments from Rep. Kim Moser, R-Taylor Mill, one of which had to do with health. It would require the state to apply for a waiver of the rules to allow Medicaid to pay for substance-use disorder treatment for people who are incarcerated.

The bill would ban from Medicaid and other programs people who violate the rules.

For example, those who are convicted of a drug-related felony who are released from incarceration and fail to sign up for substance-use treatment within 90 days of release would be banned from getting Medicaid, but the bill makes provisions for regaining coverage.

Dustin Pugel, policy analyst for the Kentucky Center for Economic Policy, wrote that "a similar ban in SNAP in Kentucky has led to thousands losing food assistance and likely more who never applied due to a past conviction." Further, he writes that "Medicaid law doesn't allow bans contingent on recovery status or for people with a drug-related felony conviction."

If passed, Gov. Andy Beshear's administration would be required to implement the measures within 120 days. Beshear said Friday, "I want to continue to see where they're going, but I don't believe in a system that pushes people off of benefits." Mark Vanderhoff reports for WLKY-TV.

Beshear added, "I believe in a system that encourages people and gives them the tools to get jobs with higher wages where you naturally move off of them. I believe in providing people opportunity -- not consequences."

Medicaid work requirements?

Reflecting Republicans' concern about the cost of the 2014 Medicaid expansion, the bill says that if the state General Fund appropriation for this population reaches half of General Fund spending on Medicaid overall, those who have been on the expansion for a year would have to participate in at least 80 hours a month of "qualifying activities," presumably work, school or volunteering.

That seems unlikely; the Kentucky Center for Economic Policy reports that it is currently only 10.7% of the budget. Such requirements were an integral part of former Gov. Matt Bevin's plan to overhaul the state's Medicaid program. It and a similar plan in Arkansas were blocked twice by a federal judge, and Beshear rescinded the plan soon after taking office in December.

Several lawmakers predicted that this part of the bill would be challenged in court, noting that a federal appeals court recently upheld the rulings against Arkansas's plan. The Supreme Court may or may not hear an appeal.

Meade said it is "well worth the risk" of a legal challenge to these community engagement requirements for able-bodied workers because they have been shown to move people off public assistance and increase their income in other states.

Concerns about fraud

Much of the debate was around the issue of fraud in public assistance programs, an issue that Rep. Nima Kulkarni, D-Louisville, said likely has to do more with perception than reality.

The U.S. Department of Agriculture reports that public-assistance fraud is 1%, and it was mentioned during the debate that it's reported at 2% in Kentucky.

"My concern here is that we are ignoring actual facts, actual numbers . . . and going with opinions and potential numbers that are not in existence, that we have not heard about in this body," Kulkarni said. "In our zeal to counteract the tiny fraction of fraud that may be occurring in Kentucky, we are potentially impacting millions of lives that are using these programs to simply lift their families out of poverty, to put food on the table at night. I really urge the body to think long and hard about the unintended consequences of this bill to those individuals that are properly using the benefits that they so desperately need."

Early in the two-and-a-half-hour debate, Meade corrected a statement he made Feb. 20 that there were studies showing upwards of 40% of fraud in public assistance programs. He corrected that to say that a group had told him that with its current detection systems, Kentucky was likely only catching 30 to 40% of the fraud in the system. When asked who that group was, he declined to answer. But he said he thinks it is higher than 2% because people are very creative when they commit fraud. "To say that we only have a 2 percent fraud rate, that we feel we are catching it all, is just not imaginable in my mind."

But House Minority Leader Joni Jenkins, D-Louisville, said, "I think what we have here is an attempt to go after a gnat, and when you go after a gnat with a sledgehammer, you tend to destroy the whole darn thing."

Bill to stop 'shenanigans' of Medicaid drug middlemen moves unanimously to House; sponsor says bill is first of its kind in U.S.

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to address payment issues between middlemen known as pharmacy benefit managers and pharmacists who fill drugs for Kentuckians on Medicaid passed the Senate unanimously Feb. 20.

Sen. Max Wise presents Senate Bill 50
Photo by LRC Public Information 
PBMs act as middlemen between insurance and drug companies; they determine what drugs are offered, how much someone pays for the drug, and the payments to pharmacists.

Currently, each of the state's five Medicaid managed-care firms contracts with a PBM to manage the state's $1.7 billion-a-year prescription drug business. A revised version of Senate Bill 50, sponsored by Sen. Max Wise, R-Campbellsville, would require the state to hire a single PBM.

Kentucky lawmakers have been working on the PBMs' "shenanigans," as Wise called them, for years, with little headway.

This bill furthers those efforts with measures to combat billing practices that Kentucky pharmacists have long said are so unfair that they are putting some of the state's pharmacies out of business.

Wise said one such pharmacy was Sacramento Pharmacy in McLean County, noting that Gregg Henry, a pharmacist and the store's owner, had reached out to him many times over the past year about this issue.

Henry told Renee Beasley Jones of the Owensboro Messenger-Inquirer that he was closing his store after seven years because of the low reimbursements paid by the PBMs, which started in 2017. He said he lost $5,000 in January alone because of recent cuts.

"This little bitty pharmacy in this little bitty community stood up," Henry told Jones in reference to at least two years of fighting against the PBMs. "I hope the Sacramento Pharmacy is able to put a face on SB 50. And I hope our martyrdom creates a wake-up call about the absolute necessity for the passage of this legislation."

SB 50 addresses several PBM practices that have hurt Kentucky pharmacies.

For example, it would prohibit the state PBM from requiring Medicaid recipients to get specialty drugs from a pharmacy that is owned or operated by the PBM; require the PBM to pay the managed-care firm the actual discounted pharmacy price negotiated with the pharmacy network, or "pass-through pricing;" prohibit spread pricing, in which a PBM keeps the difference between what it bills Medicaid for medications and what it pays the pharmacy to dispense the drug; and prohibit a whole list of fees.

"This doesn't just fix the problem. This fixes a social injustice that has been cast upon pharmacists throughout the state," Sen. Stephen Meredith, R-Leitchfield, told the Senate.

Wise's original bill called for a complete carve-out of pharmacy from the Medicaid program, which would have gotten rid of the PBMs in Medicaid managed care altogether.

That brought a backlash from the Kentucky Hospital Association, the Kentucky Association of Health Plans and the Kentucky Primary Care Association, which includes federally qualified health centers; all said a carve-out would hurt a federal drug-discount program known as 340B -- the savings from which allows safety-net hospitals and community health centers to expand health programs to the communities they serve.

Sen. Stan Humphries, R-Cadiz, told the Senate that in southwestern Kentucky, "The loss of the 340B drug program would be detrimental to the point of closing doors for some rural hospitals."

After much negotiation and collaboration with stakeholders, including the Cabinet for Health and Family Services, Wise said the bill protects both pharmacies and the 340B program, and is supported by the lobbying groups.

The bill also establishes a single preferred drug list, or formulary, to be used by each managed-care firm, instead of each one having its own separate list; and puts the state Department for Medicaid Services in charge of the reimbursement methodologies, including dispensing fees. An emergency clause would cause it to take effect immediately, so the state PBM will be in place when the new managed-care contracts begin on Jan. 1, 2021.

"We're going to be the first state in the country that is going to do something like this," Wise told Kentucky Health News. "There are going to be a lot of eyes on Kentucky."

Rosemary Smith of the Kentucky Independent Pharmacist Alliance, which represents 500 independent pharmacists, told Kentucky Health News that it supports the bill.

"We are very much in favor of this compromise," she said. "It's not perfect, but it's a step in the right direction and we know we're going to get to where we need to be. . . . This bill will allow us to stay open."

Smith said she and her husband have been forced to close two of their drug stores because of PBMs' low reimbursement rates. They own Jordan Drug pharmacies in Eastern Kentucky.

The Kentucky Pharmacists Association "supports the intent of Senate Bill 50 as amended and is glad the focus can now return to PBMs’ bad actions," it said in a statement. "We thank Sen. Max Wise for his steadfast efforts to hold PBMs accountable and protect community pharmacies and their patients across the commonwealth."

CVS Health, an affiliate of the drugstore chain, which holds most of the state's current PBM business in contracts with manged-care firms, criticized the bill, Deborah Yetter reports for the Louisville Courier-Journal.

"The latest version of SB 50 would be a step backwards for Kentucky’s most vulnerable citizens by fragmenting care coordination and adding additional administrative and financial burden on the commonwealth," a spokesman told Yetter. "Access to high-value, clinically-appropriate care for Kentuckians is a key priority for CVS Health — and we look forward to working with legislators to ensure it’s delivered sustainably.”

Saturday, February 22, 2020

16 more Ky. adults died from flu in the week ended Feb. 15, for a season total of 66; officials say best protection is still a flu shot

Kentucky Health News

The number of new cases of influenza dropped slightly in Kentucky during the second week of February, but 16 more adults in the state were reported to have died from the flu. So far, 66 Kentuckians have died from it this season, four under the age of 18, according to the state Department for Public Health.

The latest weekly report shows that in the week ending Feb. 15, Kentucky counted 1,854 new cases, a slight decrease from the 2,101 new cases reported the previous week. During this flu season, 19,057 cases have been reported in Kentucky. The actual number of cases is higher, because not all flu cases are counted; flu does not have to be reported, and four counties did not contribute to the latest report.

Health officials recommend that everyone over 6 months old get an annual flu vaccination. It is not too late, since the season usually runs through May.

This flu season has been especially bad for children across the nation. In Kentucky, children between 1 and 10 have been hardest hit. That said, a preliminary Centers for Disease Control and Prevention flu-vaccine report shows this year's vaccine has been more than 55 percent effective in preventing flu severe enough to send a child to the doctor's office and 45% effective for all ages, which is similar to the effectiveness of vaccines in previous years.

"Flu vaccination remains the best way to protect children and people of all ages against flu and its potentially serious complications," says the report.

Hotspots continue around the state, with several school districts canceling classes. Counties reporting more than 90 new cases in the week ended Feb. 15 were Barren with 126, for a total of 1,053; Franklin with 91, for a total of 408; Jefferson with 333, for a total of 6,807; Perry with 108, for a total of 1,008; and Pike with 90, for a total of 1,050.

Other hot spots included: Breathitt with 50 new cases, for a total of 209; Bullitt with 41, for a total of 795; Carter with 77, for a total of 169; Fayette with 55 new, for a total of 460; Floyd with 41, for a total of 196; Graves with 64, for a total of 184; Hardin with 52, for a total of 273; Knott with 55, for a total of 322; Oldham with 63, for a total of 453; and Warren with 66, for a total of 706.

MMWR = Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention

Friday, February 21, 2020

Children need 14 doctor visits before age 6, but preschoolers are increasingly not covered by insurance, especially in Kentucky

Kentucky Health News

In 2018, the number of Kentucky pre-schoolers without health insurance was about half again as large as the number had been in 2016, and that was one of the largest increases in the country over that time.

Researchers at Georgetown University in Washington, D.C., found that 4 percent of Kentucky children under 6 lacked insurance in 2018. In 2016, it was 2.7%. In percentage points, Kentucky's increase was the nation's fifth largest.

Chart by Stateline, Pew Research Center
Kentucky's percentage stayed under than the national average, but got much closer to it. The U.S. figure rose to 4.3% from 3.8%.

Ten other states — Alabama, Florida, Georgia, Illinois, Kentucky, Missouri, Ohio, Tennessee, Texas, Washington and West Virginia — also had significant increases, alarming health officials and experts.

Kentucky was one of seven states where the uninsured rate for children under 6 was higher than the rate for those 6 to 18.

"The first years of life play an outsize role in human health. They are foundational to the development of the brain and the cardiovascular, immune and metabolic systems. Early childhood is when medical interventions to correct problems in any of those areas are most likely to succeed," Michael Ollove writes for Stateline, a publication of the Pew Charitable Trusts.

"The American Academy of Pediatrics recommends that children visit the doctor at least 14 times before they turn 6 years old. During those visits, they should receive speech, hearing and vision tests, as well as screenings for genetic disorders and the possible effects of trauma or toxic exposure. The U.S. Centers for Disease Control and Prevention recommends that children under 6 receive numerous vaccinations, including for hepatitis A and B, diphtheria, whooping cough, polio, chicken pox, and measles, mumps and rubella."

Experts say children need 14 medical checkups before age 6.
(Photo by Amber Arnold, Wisconsin State Journal, via Stateline)
Al Race, deputy director at the Center on the Developing Child at Harvard University, told Ollove that a lack of health-insurance coverage often leads to a lack of health care, and can allow health problems to persist into adulthood instead of being corrected: “The earlier you can catch them, the easier it is and the better results you’ll have to put things back on track.”

After Kentucky expanded Medicaid under the Patient Protection and Affordable Care Act in 2014, the percentage of children in the state with health insurance rose to 96.2%, from 93.6%. Children are covered by the Children's Health Insurance Program, a program similar to Medicaid in which the federal government pays most of the cost, but the Medicaid expansion encouraged more enrollment. As the economy improved, adult Medicaid enrollment declined.

Supporters of the ACA said the reduction in the adult uninsured rate stalled because of the Trump administration's attempts to repeal and "sabotage" the law, through a shorter window to sign up for subsidized health insurance, huge cuts to the advertising budget and the number of "navigators" who help people find an insurance plan and the removal of the individual mandate to have insurance. Critics of the ACA blamed the stalled progress on rising premiums in the individual market.

Thursday, February 20, 2020

House passes medical-marijuana bill, 65-30, after specifying illnesses for its use; Senate passage remains much in doubt

Photo illustration from
Kentucky would be the 34th state to make marijuana legal for medicinal purposes, under a bill the state House passed Thursday by a vote of 65 to 30. The long-debated proposal has never gotten this far before, and it probably faces a tougher go in the Senate.

"The bill’s sponsor, Republican Jason Nemes of Louisville, and co-sponsor, Democrat John Sims of Flemingsburg, faced opposition from socially conservative lawmakers who are philosophically opposed to any legislation that could expand the legal use of marijuana and fear that a push to legalize recreational use of the drug would come next," reports Daniel Desrochers of the Lexington Herald-Leader.

“I hope it doesn’t, but you know it’s going to come,” said Rep. Stan Lee, R-Lexington, in a debate that lasted more than an hour. “If you lift the tent up a little and let the nose in, it's not going to stop.”

Nemes tried to address such concerns by having Dr. Jeffery Block, a University of Miami anesthesiologist, "testify in committee that the bill would contain enough regulations to prevent it from being abused," Desrochers points out. "The bill is intended to only allow edibles or pills — it prohibits smoking the marijuana — and forbids colorful packaging that could attract children. It does not allow people to grow marijuana in their homes, but does allow for sale of the marijuana flower, which is often used to smoke."

"The bill would allow doctors to prescribe marijuana for a list of conditions yet to be determined by a panel of 13 people — eight doctors, a pharmacist and four public advocates," Desrochers notes. One of the mostly minor amendments that the House added to the bill "ensured that the list of conditions would include chronic pain, epilepsy, multiple sclerosis and nausea or vomiting. All of those conditions have substantial or conclusive evidence that they are effectively treated by marijuana, according to Block."

Nemes told the House, “House Bill 136, if it is passed, would be the tightest medical marijuana bill in the country.” But Rep. Danny Bentley, R-Russell, a pharmacist, "peppered Nemes with questions about the bill and raised concerns that medical marijuana would not be regulated" by the U.S. Food and Drug Administration," Desrochers reports. "Supporters said the bill would help ease the suffering of many Kentuckians."

The bill would “bring relief to many citizens in this commonwealth,” said Rep. Patti Minter, D-Bowling Green.

"All but two Democratic members of the House voted for the bill, as did a slight majority of the Republican members present," notes Joe Sonka of the Louisville Courier Journal. The bill got more votes from Democrats (34) than from Republicans (31) in a House that has a strong Republican majority; that count could hurt its prospects in the even more strongly Republican Senate.

Senate President Robert Stivers has said more research is needed to prove marijuana's medicinal value, but more recently he said the bill has a "narrow path" to passage in the Senate. “It’s a balancing test of do the goods outweigh the bads,” he said. “And we just haven’t had anything done on that.”

"The renamed Department of Alcoholic Beverage and Cannabis Control would implement and regulate the new state program," Sonka notes. At least 25 medical-marijuana dispensaries would be set up around the state. Federal law prohibits pharmacies from selling marijuana, even in the states that have legalized it for medical use.

Read more here:

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Wednesday, February 19, 2020

House bill that would cap the monthly cost of insulin for many Kentuckians at $100 goes to the Senate without dissent

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to limit cost-sharing requirements for insulin has passed the state House and gone to the Senate.

Rep. Danny Bentley presents his bill to cap
the co-pay for a 30-day supply of insulin at
$100. (KHN photo by Melissa Patrick)
"I'm sure with the bipartisan support over here and the governor's support, we'll have a lot of support over there too," sponsor Danny Bentley, said after the House passed the bill without dissent Feb. 19.

Gov. Andy Beshear endorsed the bill, which has a total of 74 sponsors, at a Capitol news conference the day before.

“Health care is a human right, but tragically right now there are far too many Kentuckians who are at risk of losing their life or permanently damaging their health because they cannot afford their daily supply of insulin,” Beshear said. “This is unacceptable and dangerous, and lawmakers can act by immediately passing legislation to help thousands of fellow Kentuckians. Let’s let Kentucky be one of the first to act. We need to cap insulin costs because it’s the right thing to do.”

While many states are considering legislation to cap monthly insulin costs, so far only two have passed such a law: Colorado and Illinois.

House Bill 12 would require state-regulated health-insurance plans to cap a patient's cost for a 30-day supply of each insulin prescription at $100 "regardless of the amount or type of insulin needed to meet the covered person's insulin needs." It does not include Medicaid, Medicare or self-insured government plans.

The bill passed with a House floor amendment to ensure that an insurer cannot increase its cost-sharing requirements if its current requirement is less than $100 for a 30-day supply of insulin.

Insulin is a hormone that regulates the amount of glucose in the blood, and a lack of it causes diabetes. People with Type I diabetes can't make insulin, so they must inject it to control their blood sugar and stay alive. People with Type II diabetes, which is more common, can produce some insulin, but not enough. Type II is usually treated with diet, exercise and oral medications.

Bentley, a pharmacist from Russell in Greenup County, said more than 500,000 Kentuckians have diabetes, which amounts to about one in eight, and about 50,000 more either have pre-diabetes or have diabetes but haven't been diagnosed. He said diabetes costs the state upwards of $6 billion a year in health-care costs.

He said that in the last 14 years, the cost of insulin has gone up 550 percent, causing some diabetics to ration their supply or skip doses, which can lead to severe health problems or death.

"This is actually needed for survival," said Bentley, who has Type I diabetes.

Democratic Rep. Charles Booker of Louisville, who also has Type I, said with emotion that he was voting yes for his daughters and for his mother, who sometimes didn't even have $100 to buy the insulin he needed to stay alive.

"This bill is an important step forward, making sure that Kentuckians can live a gainful life no matter the ZIP code or how much money they have in their pocket," Booker said. "It's not a partisan thing. It's something that we all should be fighting for."

Rep. Patti Minter, D-Bowling Green, whose son has Type I diabetes, said the bill doesn't go far enough. "This bill does not do everything that many of us want done," she said. "We have work to do to have insulin for all, but this is an excellent start."

Monday, February 17, 2020

KET to air 'Undiagnosed: The Diabetes Epidemic' followed by a panel discussion about the disease on Monday, Feb. 24

Nearly half of Kentucky adults have diabetes or pre-diabetes -- and many of them don't know they have it.

To shine a light on this issue, Kentucky Educational Television is airing "Undiagnosed: The Diabetes Epidemic," a documentary that looks at the rising rates of diabetes and pre-diabetes in Kentucky, with a focus on what Kentuckians across the state are doing to reduce those rates.

More than one in eight Kentucky adults have been diagnosed with diabetes, according to the 2017 Kentucky Behavioral Risk Factor Survey. And 1.2 million, or 35.5 percent of the adult population, has pre-diabetes, a condition where blood glucose levels are higher than normal, but not yet high enough to be diagnosed as diabetes, according to the American Diabetes Association.

The 30-minute documentary will air Monday, Feb. 24 at 9 p.m., followed by a town-hall discussion with a panel of health and community officials, hosted by Dr. Wayne Tuckson of KET's "Kentucky Health."

Panelist include Dr. Connie White, deputy commissioner for clinical services with the state Department for Public Health; Dr. Fred Williams, a Louisville endocrinologist and a past president of the Kentucky Medical Association; Rev. Donald K. Gillett II, senior pastor at East Second Street Christian Church and the executive director of the Kentucky Council of Churches; and Richard Heine, co-facilitator with the Kentucky County Diabetes Coalition. 

The panel hits on a wide range of topics, including the importance of early screenings and interventions, the rise in diabetes rates among young people, the importance of communities to address this issue, and stigma about diabetes.

New federal policy means fewer life-saving liver transplants in Ky., say top medical officials at major universities, who are fighting it

By Mark Newman, Tom Miller and Kelly McMasters

A rushed proposal that became federal policy across the country this month will increase the cost and decrease access to life-saving care for patients in dire need of a liver transplant across much of the South and Midwest.

The result: People in Kentucky and largely rural areas of the country will be more likely to die because they won’t receive the care they need or would have had access to before this month.

As health care professionals and leaders of the state’s two academic medical centers, we are doing everything we can to delay or reverse this detrimental policy. Here’s what is happening and what is at stake for Kentucky:

On Feb. 4, the Organ Procurement and Transplantation Network, based on a recommendation from the United Network for Organ Sharing, implemented a new policy for how livers are allocated around the country for potential transplant. The OPTN sets transplantation policy at the direction of the U.S. Department of Health and Human Services.

The basic framework of this policy would mean more organs in rural states, like Kentucky, would be sent to larger inner-city medical centers that have higher populations. The idea was to create a policy that ensured more critically ill patients (within 500 nautical miles) received access to livers, rather than the patients in closer proximity.

While the transplant policy is well-intentioned, the fact is the governing board creating and directing the policy is dominated by officials from large urban, coastal areas. The resulting policy benefits those areas.

The process creating this program was rushed and the policy is deeply flawed.Even the framers of it concede there will be nearly a 30 percent drop in liver transplant volume in Kentucky as a result of this policy. We believe the drop will be even more significant, on the order of 40%.

Kentucky, as so many of us know, has a higher mortality rate for chronic liver disease such as cirrhosis than the national average. In rural areas of our state, the rate is even higher as access to care is more limited.

Several things -- all negative -- will occur in Kentucky and other rural areas of the country:
•This new policy will decrease access to livers for transplant even further.
•It will increase costs, the result of a more inefficient system because of rising costs for flights, fuel and transportation for Kentuckians and others who will have to travel farther to receive transplantation services.
•It will result in longer waiting periods and poorer health outcomes for Kentuckians and others who have to wait longer for donated livers.
•Others, who have to wait and who don’t have time, will be more likely to die.

We stand with a network of academic medical centers throughout the South and Midwest, including Emory University, the University of Michigan, Vanderbilt University and the University of Virginia, that have filed a lawsuit, asking to prohibit the federal government from implementing the policy. Although the federal court in Atlanta declined to stop the government from implementing the policy on Feb. 4, the fight is far from over.

We are continuing to ask the court to order the federal government to seek additional input. Ultimately, the federal government must craft something more equitable for everyone in America, not just those in larger cities or on the coasts.

We have received support from many federal policymakers, led by Senate Majority Leader Mitch McConnell. However, we continue to appeal to others to do what they can, with the voices and power they have, to prevent or reverse implementation of this ill-advised and biased approach to transplantation care.

We need, and respectfully ask, those in power to listen and act. For so many people, time is running out.

Mark Newman is chief executive of UK HealthCare; Tom Miller is chief executive officer of UofL Health; Kelly McMasters is chair of UofL's surgery department.

Saturday, February 15, 2020

Bills to help health departments with pensions pass House; some counties will have to increase their public-health taxes

By Melissa Patrick
Kentucky Health News

Two bills that were presented as part of a "three-phase approach" to create a sustainable solution to local health departments' pension crisis passed the state House Feb. 13. The third part of the plan involves the state budget.

The budget committee chair, Republican Rep. Steven Rudy of Paducah, cautioned House members that passage of the bills and the House's version of the budget, which will include funding for the bills, didn't mean the pension woes were over, because all of it must also be approved in the Senate.

"Our friends down the hallway will have a bite of this apple," he said. "So to put everybody's mind at ease, it's still a serious issue. We still don't have the permanent fix. But without Phase 1 and Phase 2, we can't get to phase three."

The first bill that passed would completely change the way health departments, regional universities and quasi-governmental agencies pay for their pension liabilities. It passed without dissent.

Rep. DuPlessis explains HB 171. (LRC Public Information photo) 
House Bill 171, sponsored by Rep. Jim DuPlessis, R-Elizabethtown, would move these entities away from the current "percentage of pay" formula, to a model that requires them to pay only what they owe the pension system, divided evenly over the next 27 years. This is often called "level dollar funding."

"This bill assigns their actual liability where they pay no more and no less that what they already owe," DuPlessis told Kentucky Health News in an interview.

The plan is also designed to keep employees in the system; many health departments have shifted to contract labor to reduce their pension payments. It would require all new employees to have a pension obligation of 10.35%, which is dubbed the "normal cost." So, in essence, the departments would get two pension bills to cover their pension costs, one for the unfunded liability for current and past employees and the other for new employees.

DuPlessis said these structural changes to the program will stabilize it. "If we don't take the bull by the horns and fix this, it's going to get to a point where nobody can make their payments," he said.

This proposal stems from a law that was passed during a special legislative session last summer, giving health departments, regional universities and quasi-governmental agencies the choice of staying in the Kentucky Retirement System and paying the full obligations or leaving the system, either by paying a lump sum or buying their way out over time. Those that choose to leave would need to move employees to a 401(k)-type plan.

The departments have said none of these choices are viable, and none have left KRS. The state Department for Public Health has said that without some relief from their pension obligations, dozens of health departments are at risk of closing.

Action is needed. The legislature has frozen health departments' pension contributions at 49.47 percent for the past two years, but on July 1, the day the next two-year budget starts, this is set to jump to 93%, a level many say would force them to close. Gov. Andy Beshear has proposed funding to make the effective rate 67%.

Rep. Joe Graviss, D-Versailles, one of the legislation's three sponsors, told House members that he was "extremely grateful" for the funding, "and I hope that we can keep and add to the money that the governor has allocated to help these organizations -- because they are going to need it. Let's not mince words, it is true, they will need some support."

An actuarial report shows that 14 of the 60 district and county health departments in KRS will owe more money under the 27-year schedule; the rest will owe less.

Randy Gooch, director of the Jessamine County Public Health Department, told Kentucky Health News Feb. 9 that about six departments would need state assistance to help pay pension obligations. He cautioned that this analysis has many moving parts.

DuPlessis told House members that while the original bill had language in it for a subsidy pool to help the entities that needed it, that language has been removed and that help will now be managed in the budget. "There will be a line item for every one of those entities and how much money they will receive," he said.

DuPlessis confirmed that the current plan is to help health departments that aren't able to meet their pension obligations, but in order for them to get that help, their counties must have a health tax of at least 8 cents per $100 assessed property value.

"So if you are below the 8 cents, you're going to have to raise your local taxes if you can't make your payments," he said. "That's fair because the local taxes will pay for the local service -- health departments are a local service."

The state has established a minimum health tax of 1.8 cents per $100 worth of property, with a cap of 10 cents per $100. Several public-health directors have said they have been told that only one county in a district health department would need to levy the 8-cent tax to qualify the district for state help.

A floor amendment was added to the bill that says any health department leaving its district would be responsible for its portion of the pension liability.

A spreadsheet of health departments and taxes that support each of them is at

The second bill would overhaul the state's public-health system, including how health departments are funded and how they would prioritize their resources.

Rep. Moser presents HB 129.
(Photo by LRC Public Information)
House Bill 129, sponsored by Rep. Kim Moser, R-Taylor Mill, passed with a committee substitute on an 88-1 vote, with Rep. Chad McCoy, R-Bardstown, voting against the measure. It is meant to work concurrently with HB 171 and is called the Public Health Transformation Plan.

"Primarily, this creates sustainability of our health departments," Moser said. "It controls the cost and it relieves the instability that we are seeing now in the current system."

The current system funds each health department with the same formula, regardless of its ability to generate local funds. The new formula would take that into account, making it more equitable. In other words, departments that have more resources would get less state funding under this model.

The bill also identifies "core public health" services, which every health department would be required to provide and requires departments to perform community health assessments, which many of them already do, to determine their local public health priorities beyond the core requirements. These local priorities would have to meet certain criteria for the department to address them, and would need to be funded separately.

"This public health transformation initiative will result in a more simplified and a very focused public health model," Moser said. "It will prevent duplication of services. It encourages shared resources and it creates an expertise to really create that economy of scale or that fair and equitable system that we need across the state. This proposal will also increase accountability and transparency at both the state and the local levels within the system."

The bill codifies the existing 1.8 cents per $100 property tax as the floor, with a cap of 10 cents per $100. It also gives health departments one year to increase their environmental fees by up to 25% before the current 5% yearly cap is put back in place. This would allow health departments to bring those fees in line with what the service actually costs.

spreadsheet prepared by the Kentucky Health Department Association estimates that 14 of the 61 health departments would get less state funding, and the rest would get more, using a formula based on a county's population, its ability to support its health department with its current taxing authority, how many employees the county would need to provide only the health services required by law, and an estimated increase in environmental fees.

Moser said it is estimated that health departments' pension-liability contribution deficit could be as high as $38.5 million, and that "18 of our local health departments, which represent 41 counties, will face fiscal insolvency during the fiscal year 2020 without significant financial and operational changes."

Ky. flu cases creep up for the third week in a row; nine more Kentuckians have died from flu; it's not too late to get a flu shot

CDCP poster; for a larger version, click on it.
Kentucky Health News

Amid all the headlines about the novel coronavirus, health experts warn that there is a much more prevalent and potentially deadly virus killing people in Kentucky: influenza. Through the week ended Feb. 8, Kentucky had reported 17,203 cases of flu this season, with 50 deaths from it, four of them people under 18, according to the state Department for Public Health.

In an op-ed for the Lexington Herald-Leader, Dr. Brent Wright, president of the Kentucky Medical Association, and Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, reminded Kentuckians that it's not too late to get a flu shot to protect themselves from the virus.

They also noted that even if you get the flu, the vaccine helps decrease your symptoms. The annual shot is recommended for all over 6 months of age. They offered some practical advice to protect yourself and others:

"If you think you have the flu, consult with your physician as soon as possible, as there are antiviral medications available that can help. The flu is spread mainly through tiny air droplets, so be sure to wash your hands thoroughly, cover your mouth and nose when you sneeze and cough and avoid contact with others while you are sick."

The week ended Feb. 8 was the third in a row that flu cases have inched up in Kentucky, after dropping for three weeks in January.

The latest weekly report shows that Kentucky counted 2,101 new cases, a slight increase from the 1,815 reported the previous week and the 1,739 the week before that. The actual number of cases is higher because not all flu cases are counted; flu does not have to be reported, and five counties did not contribute to the latest report.

The state saw nine more deaths from the flu in the week ended Feb. 8; one victim was under 18. That brought the season total to 50.

Last year at this time, there were 9,263 cases of the flu reported in Kentucky and 25 deaths from it, including one under the age of 18.

Hotspots continue around the state, and while Perry County saw a bit of a reprieve in the Feb. 1 report, its numbers jumped up again during the week ended Feb. 8. It saw 76 new cases, for a total of 900. Pike and Barren counties continue to be hit hard; Pike added 152 new cases, for a total of 960; Barren added 188, for a total of 927. Bullitt County has added more than 100 cases at least two weeks in a row; most recently it added 105, for a total of 754.

Other hotspots: Allen added 39, for a total of 301; Garrard added 41, for a total of 120; Greenup added 59, for a total of 211; Hardin added 67, for a total of 221; Hart added 30, for a total of 179; Knott added 35, for a total of 267; Knox added 38, for a total of 85; Leslie added 39, for a total of 330; and Warren added 56, for a total of 640.
MMWR = Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention