Wednesday, March 30, 2022

Legislature passes public-assistance reform bill with changes that please advocates, but they and health secretary still see issues

By Melissa Patrick
Kentucky Health News

Legislation aimed at getting able-bodied adults off Medicaid and other public-assistance programs and back into the workforce, and decreasing fraud in the programs, has passed the General Assembly in a watered-down form.

Rep. David  Meade, R-Stanford
"The goal is to make sure that the folks who truly need these benefits are receiving them and that we're cutting down on fraud and cutting down on those who are ineligible," House Speaker Pro Tem David Meade, R-Stanford, said in presenting his House Bill 7 to the Senate Health and Welfare Committee March 28.

The Senate made several changes that made the bill less restrictive and passed it 24-12. The House concurred with the changes and sent the measure to Gov. Andy Beshear on a 70-22 vote.

The Senate adopted an amendment by President Pro Tem David Givens, R-Greensburg, with three changes that further eased some of the restrictions. 

The changes would allow fluctuating income data to be used when determining eligibility, instead of the most recent data available; let Medicaid applicants self-attest their personal information as a last resort to determine their eligibility; and allow the Cabinet for Health and Family Services to apply for a waiver of work requirements in the Supplemental Nutrition Assistance Program under certain circumstances when the legislature is not in session. 

The bill would still require more documentation since self-attestation is to be used as a last resort and that could create a hardship for many Kentuckians, said Emily Beauregard, executive director of Kentucky Voices for Health: "It creates roadblocks; it creates major delays."

Beauregard said in a letter to the many advocates who opposed the bill that the changes go "a long way in mitigating some of the more harmful provisions of the bill." However, she told Kentucky Health News, "We still continue to oppose the bill." 

Asked his biggest concern when it comes to the new Medicaid requirements, Cabinet for Health and Family Services Secretary Eric Friedlander said, "The increased red tape for individuals." 

Senate Minority Leader Morgan McGarvey said in the floor debate that he appreciated Givens' changes, but still opposed the bill because it could keep tens of thousands of Kentuckians from receiving benefits.

"I think this does make this a better bill," said McGarvey, D-Louisville. "I think the overall bill is still lacking. I thinks it is still punishing people, potentially punishing people just for being poor."

Sen. Ralph Alvarado, R-Winchester, who carried the bill in the Senate, said, "The only way you can lose benefits is if you’re doing something illegal or [are] able-bodied with no dependents at home."

The latter part of that became less certain with one Senate change. It would give the cabinet one year to implement a "community engagement" program for able-bodied adults without dependents who have been enrolled in Medicaid for more than a year, but one without the specific requirements of the original bill.

The original would have required the cabinet to seek a federal waiver to let Kentucky Medicaid require able-bodied adults not primarily responsible for a dependent to participate in at least 80 hours a month of "community engagement," including work. Federal courts say federal law doesn't allow that, but the House bill would have required the cabinet to apply annually, subtly hoping for a political change in the federal government that would allow it.

The final version would make the cabinet implement the program "to the extent permitted under federal law" but does not specify a number of hours or a work requirement, leaving the details to the cabinet.

Beauregard told Kentucky Health News that they could support voluntary community-engagement programs because they are great ways to help people get back to work or find better jobs, especially if combined with child-care and transportation support. 

The bill would also make the Education and Workforce Development Cabinet establish a job-placement assistance program for adults on Medicaid who are able-bodied and not primarily responsible for a dependent.  

It would also create a task force to study the "benefits cliff," the great adjustment faced by many people who go off public assistance but still lack the resources to access health care and other needs.

Even though she voted against the bill, Rep. Angie Hatton, D-Whitesburg, told her House colleagues that the Senate changes allayed many concerns of health advocates.   

"I just think it's a matter of what keeps you up at night," she said on the House floor. "For me, it doesn't keep me up at night worrying that there's a tiny percentage of people who might get benefits who didn't deserve them. What keeps me up at night is worrying that there might be people hungry, who couldn't jump through hoops and get their benefits." 

Meade disputed Hatton's assertion, saying a study by the Gatton College of Business and Economics at the University of Kentucky shows that it costs the federal government $1.86 billion and Kentucky taxpayers $186 million per year to pay for all Kentuckians who are enrolled in Medicaid improperly. 

He said Kentucky ranks third in the nation for the biggest increase in improper Medicaid enrollment under the Patient Protection and Affordable Care Act. "You can see that we actually do have a major problem in this state," he said, "and that is what we are going to try to start taking care of."  

Here are some other provisions related in HB 7 related to Medicaid:

  • After the federal government lifts the pandemic-era limit on the state's ability to disenroll people, the health cabinet would have 12 months to do a full audit of the Medicaid rolls.
  • Medicaid coverage for treatment of substance-use disorder for prisoners, included in the 2020 budget, would be put into law.
  • The cabinet could not make approve someone for Medicaid under presumptive eligibility before their qualifying paperwork is completed.
  • The bill would ban the cabinet from developing a state basic health program for low-income people not eligible for Medicaid without first obtaining specific legislative authorization. 
  • The cabinet must must seek a federal waiver to authorize anything it needs to implement the legislation, tell the legislature if it is denied, and reapply "with or without modifications based on instructions from the General Assembly."
  • The task force would investigate and report on the cost of using a single electronic benefits card for Medicaid and the Supplemental Nutrition Assistance Program, formerly food stamps. 
  • The attorney general, currently Republican Daniel Cameron, could bring action against the cabinet if he thinks provisions of the bill are not appropriately implemented.

Wide-ranging abortion measure goes to Beshear's desk; Planned Parenthood says bill would 'eliminate abortion access in Kentucky'

Protest in the Senate (Courier Journal photo by Deborah Yetter)
By Melissa Patrick and Al Cross
Kentucky Health News

FRANKFORT – The legislature has passed a wide-ranging abortion bill that would ban the procedure after 15 weeks of pregnancy and that Planned Parenthood says would "eliminate abortion access in Kentucky."

The Senate passed the bill 29-0. Every Democrat but Sen. Dennis Parrett of Elizabethtown, who voted yes, left the chamber in solidarity with protesters in the gallery overlooking the chamber. Hours later, the House concurred with the Senate's changes and sent the bill to Gov. Andy Beshear on a vote of 74-19.

As senators voted, protesters chanted "Abortion is health care." After security officers escorted them out, they gathered on the landing below the Senate steps and chanted "Hands off our bodies," which was audible as the roll call continued.

House Bill 3 would set higher standards for judges to approve abortion without parental consent, strengthen rules for parental consent and disposal of fetal remains, increase reporting requirements, and ban mailing of medications that have become the means for most abortions in Kentucky.

The bill has an emergency clause, which makes it effective upon becoming law, rather than the usual 90-day hiatus. Senate Democratic Leader Morgan McGarvey said providers can’t necessarily implement it quickly. “We don’t treat other laws like this in this regard,” he said, and shouldn’t “when this is a decision best left to the woman and her physician.”

Planned Parenthood Alliance Advocates issued a statement saying that HB 3 “would completely eliminate abortion access in Kentucky immediately upon becoming law by piling on a laundry list of abortion restrictions so extreme that they would make it impossible for providers to operate in the state.”

“HB 3 is solely and deliberately designed to eliminate all abortion in the state of Kentucky,” said Tamarra Wieder, the group's state director. “This bill ignores our constitutional rights, dismisses science, and contradicts public opinion. We strongly urge Gov. Beshear to veto this cruel, dangerous bill and support what the majority of Kentuckians want – access to safe and legal abortion.”

Even if Beshear vetoes the bill, all it takes to override him is a majority vote in both chambers.

The abortion medication targeted by the bill consist of two drugs: one to block progesterone, a hormone necessary for a pregnancy to develop; and the other to cause contractions to empty the uterus early in a pregnancy.  In mid-December, the U.S. Food and Drug Administration allowed the drugs to be sent by mail.

Republican Sen. Ralph Alvarado, a Winchester physician, spoke at length about the need for women to be properly screened and counseled by a "qualified and competent" provider before a "chemical abortion." He said the bill "Will prevent at-home, pill-by-mail, do-it-yourself abortions that leave women to fend for themselves if medical complications arise." 

He said a peer-reviewed study of Medicaid claims data shows that emergency-room visits following chemical abortions are on the rise, occurring as frequently as 35 ER visits per 100 abortions. As evidence, the bill's sponsor, Rep. Nancy Tate, R-Brandenburg, gave Kentucky Health News a study from the Charlotte Lozier Institute, the research arm of the anti-abortion group Susan B. Anthony List.

The Kaiser Family Foundation reports: "Medication abortion is a safe and highly effective method of pregnancy termination if the pills are administered at nine weeks’ ge­­station or less, the pregnancy is terminated successfully 99.6% of the time, with a 0.4% risk of major complications, and an associated mortality rate of less than 0.001 percent (0.00064%)."

Language from Senate Bill 321 to ban abortions in Kentucky after the 15th week of pregnancy was added to HB 3 in a floor amendment. SB 321's sponsor, Sen. Max Wise, R-Campbellsville, said the bill is "closely modeled" after a Mississippi law that is awaiting a decision from the U.S. Supreme Court.

"In the event that the Supreme Court upholds Mississippi legislation as constitutional," he said, "we will then have a pro-life law in place that would not be subject to a good-faith legal challenge."

An amendment filed by Sen. Denise Harper Angel, D-Louisville, to add exceptions for rape or incest to HB 3 failed to pass. Without it, she said, "This body turns its back on these victims of heinous crimes." 

Alvarado and Tate said current law allows abortion for any reason up to 20 weeks, so such exceptions are not necessary. Alvarado added that the judicial process to bypass lack of parental consent would help a minor with that decision. 

Legislators in both chambers spoke to the difficulties minors already have with the judicial-bypass process, and said the tighter parental-consent rules will make getting abortions more difficult, especially for immigrants, the poor and those living in rural areas.

The bill would require the minor and the consenting parent or legal guardian to have a government-issued identification and show the judge that a reasonable attempt has been made to notify a parent or legal guardian with joint or physical custody within 48 hours prior to the consent being signed. 

Rep. Nima Kulkarni, D-Louisville, said most young people talk to their parents before an abortion, but those who don't typically don't because of fear of harm, including being kicked out of the home. Others, she said, may not live with their parents or be able to locate them.

"Parental consent laws force young people to delay care, travel out of state, incur additional cost to obtain care or forego care altogether," she said.

The bill would establish an online complaint portal with the names of all physicians in Kentucky who provide abortion services. McGarvey said that will put them at risk, because there have been 11 murders, 26 attempted murders, 42 bombings, 189 arsons and thousands of criminal activities directed at people providing legal abortion services since 1977. 

McGarvey said the portal would allow anonymous publication of complaints, and such a portal in Texas has led to "thousands upon thousands" of false complaints from both sides that the law requires state government to investigate, wasting time and money.

The debate was as passionate as it was familiar.

Sen. Karen Berg, D-Louisville and a physician, said medication abortion is safer than pulling a wisdom tooth and 14 times safer than childbirth, but "There are certain legislators who feel that they have a right to regulate their personal religious and their personal moral beliefs over the rest of us under the guise, under the guise of safety for women. . . . Leave your religion and morality out of my health-care decisions."

But Rep. David Hale, R-Wellington, won applause in the House by saying he voted because of the 4,104 "children" who were "murdered" by the 4,104 abortions in Kentucky in 2020: "My purpose in being in this chamber is to see this atrocity stopped."

Tuesday, March 29, 2022

Beshear seeks one more month of pandemic food benefits, after leaving impression that the legislature hadn't left that option open

By Melissa Patrick
Kentucky Health News

On March 21, Republicans in Kentucky's legislature overrode Democratic Gov. Andy Beshear's veto of their resolution ending the Covid-19 state of emergency about a month early, and with it an extra $100 a month in food benefits for 544,000 Kentuckians, who will revert to the standard $243 monthly benefit.

Senate President Pro Tem David Givens of Greensburg said any state could apply for an extra month of the benefits after the end of its emergency, but Beshear said there had to be a state-declared state of emergency.

Technically, they were both right. Now Beshear has requested the extra month of additional Supplemental Nutrition Assistance Program benefits, formerly called food stamps, from the U.S. Department of Agriculture.

State spokesman Brice Mitchell told Kentucky Health News that the state asked for the one-month "phase-out" extension of the benefits on Monday, March 28, a week after the legislature overrode his veto.

"Since the General Assembly voted to end food assistance for nearly 500,000 Kentuckians, the Cabinet for Health and Family Services is notifying the USDA today that a transition period is now needed for April to notify recipients that their benefits are ending May 1," Mitchell said in an e-mail. "If the General Assembly would have not taken this action, the cabinet would have been able to have requested that the benefits continue beyond May 1." The emergency had been scheduled to end April 14.

After the legislature overrode the veto of Senate Joint Resolution 150, Beshear said it would take benefits from Kentuckians, because it had barred him from declaring another emergency.

He said March 24, "We could have continued to provide, at no cost to the Commonwealth, extra dollars to help kids and seniors afford food that costs more than before the pandemic. So what this legislature said is no more help. We're going to go back to giving you the same amount pre-pandemic, even though things cost more."

Beshear didn't respond directly to a question asking him if he had investigated the federal guidance that Givens alluded to, instead saying the state needed an emergency declaration to continue the benefits. He said the resolution was passed for political reasons, and "It's not worth any political point that someone's trying to make to take food off the table of those that need it."

The sponsor of SJR 150 is Sen. Donald Douglas of Nicholasville, who was elected in a special election in December and is opposed in the May 17 Republican primary by Andrew Cooperrider of Lexington, who was a fervent opponent of anti-pandemic measures and has said the bill is designed to boost the candidacy of Douglas, a more mainstream candidate.

Senate President Robert Stivers issued a statement on March 22 criticizing the governor's desire to continue the emergency benefits. 

“Twenty-eight states have already declared the end of the emergency, as well as the U.S. Senate,” Stivers said. “Continuing to operate under a false emergency for the sake of pulling down federal dollars is simply fraudulent and unethical.”

Cameron and 20 other attorneys general, most of them in GOP, sue to overturn CDC mask mandate in public transportation hubs

Attorney General Daniel Cameron has joined 20 of his counterparts in a lawsuit to overturn the Centers for Disease Control and Prevention's rule requiring masks to be worn in public transportation hubs.

The suit "argues that the mandate exceeds the authority of the CDC, noting that the Biden administration continues to use a failed interpretation of a quarantine statute that has been ruled against in court several times," Cameron's office said in a press release.

Cameron said, “With most states now relaxing their Covid-19 requirements, the CDC should follow suit and eliminate the mask mandate for airports, train stations, and other transportation hubs. We believe the current mask mandate exceeds the authority of the agency, and the Biden administration should end it immediately.”

The attorneys general, most of them Republicans like Cameron, argue that the law used to justify the mandate does not authorize such broad measures. only authorizes rules directly related to preventing interstate spread of disease, and does not permit mask requirements for individuals who show no sign of infection, the release says. The suit also argues that the rule is arbitrary and capricious and does not consider preventive actions by states.

The other plaintiff states are Alabama, Alaska, Arizona, Arkansas, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Mississippi, Missouri, Montana, Nebraska, Ohio, Oklahoma, South Carolina, Utah, Virginia and West Virginia. To read the lawsuit, click here.

Most in nationwide poll say they have contracted the coronavirus, but concern about serious Covid-19 illness in their family declines

Most Americans say they have contracted the coronavirus, and the infected are more likely to be Republicans, says a new poll by Monmouth University in New Jersey. "This appears to be the first poll to show a majority of Americans saying they’ve been infected at some point," reports Aaron Blake of The Washington Post. "Other polls from recent months have shown a sharp uptick in those who report testing positive — particularly during the rise of the omicron variant — but Monmouth’s poll brings in those who believe they’ve contracted the virus but lack a diagnosis."

In the March 10-14 telephone survey, 52 percent of respondents said they had contracted the virus, up from 40% in late January, and 57% percent of Republicans said they had been infected, but only 38% of Democrats said they had. In January, the numbers were 50% and 28%. "This tracks with polls that more narrowly surveyed self-reported positive tests. It also suggests the gap has grown since the pandemic began," Blake notes.

Blake casts a skeptical eye: "Is the gap really this big? Polls asking people to self-report things like an infection are prone to response bias. Democrats might be less willing to acknowledge falling ill: Given the emphasis on mitigation on their side of the political aisle, they might view infection as some kind of moral failing. Republicans, by contrast, have long been more likely to argue that mitigation efforts have gone overboard and the virus is overblown. What better way to prove that than to say you personally contracted the virus and lived to tell the tale?

"But if that were a major factor, you might expect the gap between Republicans and Democrats to be greater when it comes to one specific self-reported measure: non-diagnosed cases. This would seem a prime opportunity for Republicans to say they believe they’ve had the virus even if they might not have, and for Democrats to downplay their infection status. On both sides, though, about 1 in 5 who say they’ve had the virus lacked a diagnosis.

"Notably, this gap in self-reporting didn’t always exist. Early in the pandemic, the percentage of Republicans and Democrats reporting positive tests was roughly equal — and for much of 2021, the gaps weren’t nearly as wide as they are now. Of course, this difference may be inflated by self-reporting. But the fact that even that self-reporting gap has grown is important. And it provides even more evidence that, as the pandemic has progressed, the virus has hit Republicans harder."

Despite the greater prevalence of infection, "The number of people who are very concerned about a family member becoming seriously ill from the virus (23%) has dropped to its lowest point since last June (also 23%)," Monmouth reports. "This marks a 15-point decrease over the past two months." The biggest drop was among Democrats: 30% in March, compared with 61% in January,

Monday, March 28, 2022

House-passed bill to expand individuals' vaccine privacy rights fails to make it out of Senate committee as session nears end

By Melissa Patrick
Kentucky Health News

A House-passed bill to keep state and local governments from asking employees and applicants if they have received a Covid-19 vaccination, and to ban colleges and universities from requiring disclosure of immunization status, has failed in a Senate committee with three days left in the legislative session. 

Rep. Savannah Maddox
House Bill 28, sponsored by libertarian Republican Rep. Savannah Maddox of Dry Ridge, passed the House 71-22 on March 10, but Monday the Senate Health and Welfare Committee voted 5-4 against it. 

Sen. Danny Carroll, R-Benton, who has been critical of the restrictions Democratic Gov. Andy Beshear imposed to thwart the Covid-19 pandemic, said he voted no out of concern for what the future may hold.

"It's easy to make policy in retrospect, looking at what has happened," Carroll said. "What is difficult is to make policy and foreseeing the future. There is no way we can know what Covid will bring, what the next variant might be. How important it is that people know someone's vaccination status, that could mean the difference between life and death, depending on the variant and how deadly it is."

Voting yes were Republicans Stephen Meredith of Leitchfield, Michael J. Nemes of Shepherdsville, Max Wise of Campbellsville and Chairman Ralph Alvarado of Winchester, who said he cast his "aye" vote at the end of the roll call for the "sake of the sponsor." Earlier, he questioned her handling of the bill.

Alvarado asked Maddox if she had the votes to pass the bill and if she had reached out to all committee members. Maddox said that when she approached Alvarado last week, it did not have the votes to pass, "but since that time, it has gained a bit of momentum" and that she had spoken to "a great number of them about this bill."

Alvarado said, "I know that you haven't spoken to all of them, at least. And so the question there becomes, why not? I know you had reached out, asked for this bill to be heard and you're right, a brief text message was, you don't have the votes. So I'm curious if you have them. Customarily, if a sponsor asks for a bill to be heard, the presumption is that you have the votes for it to pass. And so typically, it's an important bill, that would be the thing that I would hope to have coming forward."

HB 28 would also ban public entities from mandating or issuing vaccine passports and would allow parents or guardians of children in schools to opt them out of any Covid-19 vaccination requirements on the basis of a conscientiously held belief. Kentucky's public schools do not require Covid-19 vaccinations. The bill defines a public entity as the state, a local government, or any of their agencies or departments.

"This bill is not intended to debate the merit or non-merits of receiving a vaccine," Maddox said, adding later, "It comes down to the fact that Kentuckians are capable of making good decisions for themselves and their families when it comes to their health care without any undue influence force or coercion from the government." 

The Kentucky League of Cities opposed the bill, saying it violates the home-rule powers of local governments.

Brittney Welch of the Kentucky Nurses Association said that if nursing schools could not ask students their vaccination status it would "severely alter the ability of nursing schools" to put them in clinical settings. Maddox said HB 28 would not keep hospitals from following federal vaccine mandates, and nursing students there would have to obey them.

Senate Republican Caucus Chair Julie Raque Adams of Louisville said she voted "no" because the bill would put the University of Louisville Medical Center in direct conflict with federal law.

Also voting no were Republican Jason Howell of Murray and Democrats Karen Berg and Denise Harper Angel of Louisville.

Pandemic numbers nearing levels seen before Omicron variant hit

Kentucky Health News graph from weekly state reports
By Al Cross
Kentucky Health News

The pandemic in Kentucky has declined to levels not seen since early last summer, when numbers bottomed out just before the surge of the Omicron variant of the coronavirus drove them to record levels.

From last Monday through Sunday, the share of Kentuckians testing positive for the virus was 2.29 percent, less than half the 5% level at which public-health officials say poses the risk of widespread outbreaks.

Since March 7, when the state started issuing weekly instead of daily reports, the rate has declined from 6.04%. The rate was below 2% for 12 days in late June last year, just before Omicron hit.

Omicron's BA.2 subvariant is becoming widespread and is at least twice as transmissible as the original, but hasn't been shown to cause worse disease.

The state reported 5,530 new cases during the reporting week, an average of 790 per day, still well above last summer's low average of 163 in the last week of June 2021.

But the state's seven-day infection rate fell to 4.82 daily cases per 100,000 residents, not too far above last summer's low of 3.13 per 100,000.

Hotspots remain. Counties with rates more than double the statewide rate, putting them into double figures, were Cumberland, 21.6 per 100,000; Perry, 16.1; Taylor, 15.5; Trimble, 15.2; Wayne, 14.1; Magoffin, 12.9; Anderson, 12.6; Adair, 11.9; Pike, 11.8; Floyd, 10.8; and Wolfe, 10.

The state's weekly report said 26 percent of the new cases were in Kentuckians 18 and younger. Generally in Kentucky, the younger someone is, then less likely they are to be vaccinated for Covid-19.

The report said 263 hospital patients had Covid-19, with 50 in intensive care and 25 on mechanical ventilation. The total number of Covid-19 patients is less than the number on intensive care five weeks ago.

One of the more encouraging indicators was a decline in the number of deaths. The state attributed 236 more deaths to Covid-19 last week, just over 33 per day, down from the approximately 40 per day recorded the previous three weeks. The state's pandemic death toll stands at 14,895.

Sunday, March 27, 2022

One mother's story helps show how recovery from addiction, difficult anywhere, is even harder in much of rural Kentucky

Megan Simpson works after group class at Living Clean transitional
housing in Manchester. She recently completed peer support training
and passed her certification test. She started as a peer support specialist
in Corbin and is scheduled to go to court in April to regain custody of
her three children. (Photo by Silas Walker, Lexington Herald-Leader)
Kentucky Health News

The continuing struggle of Megan Simpson of Manchester helps show the difficulty that rural and small-town Kentuckians have getting treatment for substance-use disorder.

Simpson's story of addiction, treatment, relapse and recovery has been told in two long installments by Liz Moomey of the Lexington Herald-Leader. The latest appeared Sunday, along with a story by Moomey about the limited access that rural Kentuckians have to treatment.

She reports, "In many rural areas, resources are often few and far between to get treatment and return to life after recovery. Sober living housing is scarce. Transportation is limited. Childcare is sparse. Broadband internet for telehealth appointments or for virtual recovery meetings is unreliable."

“Many people don’t have all those stars aligned and they have a very difficult path ahead of them,” said Matt Brown, Addiction Recovery Care’s senior vice president of administration, who "struggled with substance use disorder for 18 years," Moomey writes. "He considers himself fortunate to have a wife who stayed with him through his addiction, an education and a job."

Rural areas not only lack a choice of providers for counseling and treatment, there is a lack of anonymity in small towns, Moomey notes, quoting Brown: “Everybody knows everything.”

The Kentucky Access to Recovery program of the nonprofit Federation of Appalachian Housing Enterprises, a 37-county program that "connects participants recovering from opioid-use disorder or stimulant use disorder to housing, childcare, dental care, transportation and other services," Moomey writes. 

KATR map via Herald-Leader, adapted by Kentucky Health News; to enlarge, click on it.
Aaron Brown, a Western Carolina University professor who researches the issue, "said KATR wants to address the practical needs of rural Kentuckians that prevent people from accessing recovery," Moomey reports. Brown said the types of jobs available and the benefits provided are more limited in rural areas. From his research on rural areas, good-paying jobs were often more taxing and didn’t always provide the option to take off work to participate in recovery opportunities."

Brown told Moomey that the ideal recovery model has these steps: medical detoxification, inpatient rehabilitation and a sober living facility with intensive outpatient services, such as group and individual treatment. But that's not always realistic in rural areas "because of lack of services and health professional shortages," Moomey writes.

Friday, March 25, 2022

CDC rates fewer Ky. counties at high risk from virus, but levels in some have increased and state's risk level is still relatively high

State version of CDC map, with additional label by Kentucky Health News
Kentucky Health News

Kentucky as a whole is at lower risk from the coronavirus than it was a week ago, according to the Centers for Disease Control and Prevention. But about the same number of counties are rated at low risk, and the risk ratings increased in a few counties.

On Thursday the CDC listed 10 counties as high-risk. In those places, it still advises masks to be worn in indoor public spaces. The number is fewer than half the 24 listed last week, but two counties, Casey and Powell, moved from medium risk to high risk.

The 52 counties rated at medium risk included Ballard, McCracken, Carlisle and Hickman, in far Western Kentucky, which moved up from low risk.

The CDC says residents in medium-risk counties who are immuno-compromised or at high risk for severe illness should talk to a health-care provider about "additional precautions, such as wearing masks or respirators indoors in public. If you live with or have social contact with someone at high risk for severe illness, consider testing yourself for infection before you get together and wearing a mask when indoors with them."

CDC map, adapted by Kentucky Health News
The number of counties rated at low risk declined from 59 to 58. The ratings are based on new coronavirus cases, Covid-19 hospitalizations and the percentage of staffed inpatient beds occupied by Covid patients.

Kentucky remains one of the higher-risk states, according to the CDC's national map.

Legislature moving bills to address health-care worker shortage

Centers for Disease Control and Prevention illustration
By Melissa Patrick
Kentucky Health News

In the final days of the 2022 legislative session, three bills to address Kentucky's healthcare workforce shortages are moving. One addresses the nursing shortage directly, one works toward recruitment and retention more broadly, and one addresses Medicaid payments for community health workers. 

Senate Bill 10 addresses the nursing shortage with both short-term and long-term solutions, Rep. Kim Moser, R-Taylor Mill, said in presenting the bill to the House Wednesday, March 23. 

Moser said the key components of SB 10 would streamline the process for out-of-state and foreign trained nurses to practice in Kentucky without compromising the standards of care; would improve access to nursing education by removing "arbitrary" enrollment limits without compromising the quality of the programs; and add term limits and geographic requirements for the Board of Nursing

The Kentucky Nurses Association says Kentucky will need as many as 16,000 more nurses by 2024.

Rep. Kim Moser
Asked how many new nurses these provisions would produce, Moser said that the effort is just "a piece of the puzzle" to increase the health-care workforce in Kentucky. "While I don't have hard and fast numbers, I do think that this will certainly help," she said. 

SB 10, sponsored by Sen. Robbie Mills, R-Henderson and Senate President Robert Stivers, R-Manchester, passed out the House 93-1. It awaits Senate concurrence with some minor changes related to the nursing board. UPDATE, March 29: The Senate concurred, giving the bill final passage.

Another bill, sponsored by Moser, would impact the health-care workforce more broadly by establishing a Healthcare Worker Loan Relief Program for qualifying health-care workers.

"House Bill 573 establishes a much needed recruitment and retention tool for addressing healthcare worker shortage, especially in rural and underserved areas of Kentucky," Moser said in presenting the bill to the House March 23. "It provides financial incentives to attract and retain health-care providers."

The loan program would be aligned with the Kentucky State Loan Repayment Program and administered by the University of Kentucky's Center of Excellence in Rural Health

The program would be set up as a trust fund in the state treasury that would consist of state general fund appropriations, gifts and grants from public and private sources and federal funds. 

Moser said this program would supplement federal funding, which requires a state match for scholarships and loan forgiveness; would expand the list of  health-care workers eligible to participate; and require recipients to work in under-served areas of Kentucky. 

The bill's House committee substitute calls for the loan relied fund to get $2 million a year, and adds ophthalmologists, optometrists and audiologist to the list of eligible recipients. 

The House passed HB 573 91-3, but at week's end, it had not received any of its three required readings in the Senate or been assigned to a committee. UPDATE, March 30: HB 573 has been placed in the Senate Appropriations & Revenue Committee and has received two readings. 

Moser's HB 525, which would allow Medicaid to pay certified community health workers, passed the Senate on its March 25 consent calendar and is back to the House for concurrence with Senate changes. UPDATE, March 29: The House concurred, giving the bill final passage. 

CHWs aren't trained medically, but are trained as patient advocates who come from the communities they serve. They help their clients coordinate care, provide access to medical, social and environmental services, work to improve health literacy, and deliver education on prevention and disease self-management.

HB 525 would require the state Department for Medicaid Services to seek federal approval for a state plan amendment, waiver or alternative payment model, including public-private partnerships, for services delivered by certified CHWs. It would also streamline their certification process.

Even a mild case of Covid-19 can cause long-term brain damage

Illustration from JAMA Network
Brain changes could be a lingering outcome of even mild Covid-19 cases.

Researchers at Oxford University in England reported that several months after study participants had Covid-19, they had more brain-tissue loss and more brain-size shrinkage than participants who did not have the disease. They used brain scans from the United Kingdom's Biobank—a research resource with data from half a million volunteers—that were collected from 2014 through early March 2020, and they invited hundreds of original volunteers aged 51 to 81 for a second round of scans between February and March 2021.

With nearly 800 volunteers, the new study is the largest set of Covid-19 brain-imaging analyses to date. It’s also the first to focus on patients with mostly non-severe illness and to include pre-infection data from the same people. The study is published in the peer-reviewed journal Nature.

The brain scans and cognitive scores of participants who had Covid-19 showed greater changes between the two time periods than those of the participants who did not have Covid. On average, the participants who had Covid suffered from greater tissue damage and brain shrinkage, and has less ability to do complex tasks.

The study had too few cases of influenza to draw comparisons, but brain differences among 11 volunteers who developed non–Covid-19 pneumonia between imaging sessions did not substantially overlap with brain regions implicated in the Covid-19 analysis. This could indicate that the study’s findings are specific to infection by the novel coronavirus, not respiratory infection in general.

It is unclear how long the cognitive effects of Covid-19 might last. A recent report in JAMA Neurology suggests the changes in some patients might endure, particularly for those with more severe disease. However, in a written FAQ provided to news media, the study's lead author, GwenaĆ«lle Douaud, suggested that the damage observed in her team’s study might improve in due course: “Since the abnormal changes we see in the brain of the infected participants might be related to their loss of smell, it is possible that recovering their smell might lead to these brain abnormalities becoming less marked over time. Similarly, it is likely that the harmful effects of the virus (whether direct, or indirect via inflammation or immune reaction) decrease over time after infection.” 

How best to manage patients’ cognitive symptoms remains an area of robust study, according to Dr. S. Andrew Josephson. The current analysis, he said, “also emphasizes just how important it is to continue to work to understand the mechanisms of these neurological symptoms and whether vaccination or severity of illness modifies them.”

FDA allows several more e-cig products to remain on market; decisions pending on products of several major makers

A newly approved product
The Food and Drug Administration is allowing several more tobacco-flavored electronic cigarette products to remain on the market, it said Thursday. "The agency authorized several tobacco-flavored vape pods and e-cigarette devices made by the e-cigarette brand Logic Technology Development," PoliticoPro reports.

FDA Commissioner Robert Califf said in a statement, "We know that there is a demand among adult smokers to use e-cigarette products to try to switch from more harmful combusted cigarettes, but millions of youth are using these products and getting addicted to nicotine. The balance of these issues was considered by the agency's career scientists when evaluating the potential marketing of e-cigarette products."

"Logic, owned by tobacco giant Japan Tobacco Inc., holds a large share of the e-cigarette market," PolitcoPro reports. "FDA, however, denied the company's applications for flavored products. It is still deciding the fate of Logic's menthol-flavored offerings."

FDA's announcement began "what is expected to be a period of intensified activity on the contentious issue of e-cigarettes," reports Laurie McGinley of The Washington Post. "The FDA decision seems likely to presage rulings on companies with the biggest market shares, including Juul, blu, Vuse and NJoy. Mitch Zeller, director of the FDA’s Center for Tobacco Products, is retiring in early April, and speculation is widespread that he wants to issue decisions on the big companies before he leaves."

Thursday, March 24, 2022

Beshear says Omicron BA.2 subvariant circulating in Kentucky; public-health advice is the same: get vaccinated and boosted

Illustration by the University of California at Los Angeles
By Melissa Patrick
Kentucky Health News

While the pandemic continues to wane in Kentucky, Gov. Andy Beshear cautioned Thursday that the more contagious BA.2 subvariant of the coronavirus is circulating in the state. 

At his weekly press conference, Beshear said Omicron BA.2 had been confirmed in 29 Kentucky residents from 13 counties since the first week of February, and "Molecular sequencing is performed on only a small subset of cases, so there have likely been many more BA.2 infections that haven't been confirmed."

WLKY-TV reports that the new variant has been found in Louisville wastewater, according to Louisville Metro Health and Wellness. "Dr. Joseph Flynn of the Norton Medical Group said Thursday that this variant is 50-80% more infectious," reports Valerie Chinn of WDRB-TV.

Beshear said Kentucky's level of BA.2 is probably close to the national average of 35%, according to sequencing done by the Centers for Disease Control and Prevention for the week ended March 19. 

He said there is still much to learn about this variant and it is too soon to know if it will lead to excess hospitalizations or deaths, more severe disease or more resistance to either natural or vaccine-induced immunity. 

"Based on early studies, it's thought to spread faster, be more infectious and replicate more efficient than the original Omicron, which would make it one of the most contagious viruses at least in our lifetimes, if not what we know of human history," Beshear said. "But we do not necessarily have evidence that is going to harm people any more than Omicron, and we certainly hope less."

Chinn reports for WDRB, "Doctors said BA.2 is technically classified as a part of the omicron family of viruses, but genetically, this strain is very different, with about 40 mutations separating it from its cousin, BA.1. That makes it about as distinct from the original Omicron as Alpha, Beta and Delta were from each other."

Beshear said we also know that the Covid-19 vaccines and booster shots protect against severe illness, hospitalization and death, and Kentuckians can choose to wear a quality mask if they are concerned.

White House chief medical adviser Dr. Anthony Fauci said on ABC’s “This Week” last Sunday, “We’ll likely see an uptick in cases, as we’ve seen in the European countries, particularly the U.K. Hopefully we won’t see a surge. I don’t think we will. The easiest way to prevent that is to continue to get people vaccinated . . . to continue to get them boosted.”

In Kentucky, 56% of the total population is fully vaccinated and only 44% of the eligible vaccinated population has had a booster shot, which experts say is needed for immunity to all forms of Omicron.

Beshear said, "If you haven't gotten your booster yet, please go get it. . . . Again, living with a virus is not the same as ignoring it and living as opposed to dying from a virus means taking the steps that protect you and protect your family."

That message was reiterated in an op-ed for the Lexington Herald-Leader by Dr. Kevin Kavanagh, founder of HealthWatch USA, who continues to encourage Kentuckians to remain cautious. 

"In the two weeks ending on March 19, the national total infection rate had fallen by 37%, but the percentage of BA.2 in newly infected individuals more than doubled with a 177% increase," he wrote. 

In closing, he said, "The BA.2 variant may well cause another surge. At this point, we should not let down our guard and relax mitigation strategies. We must respect others, some of whom [will] wear a mask to protect, but above all, get vaccinated along with obtaining boosters when indicated."

State Senate floor leader says medical marijuana bill is dead

The latest effort to legalize marijuana for medical use in Kentucky is “done for the year,” the majority floor leader of the state Senate told Austin Horn of the Lexington Herald-Leader Thursday.

“I have said all along I wouldn’t stand in its way if we had the votes, but we do not have the votes in the Senate,” Republican Damon Thayer of Georgetown, an opponent of House Bill 136, told the newspaper.

Generally, Republicans who have 30 of the 38 votes in the Senate will not put a bill before the full chamber unless a majority of Republicans support it. Thayer "did not offer comment on the whip count among the GOP caucus or when he came to understand that the bill was dead in the Senate," Horn reports.

In the House, just over half of the Republicans who voted on the bill voted for it, Horn notes. It passed the House 59-35. A similar medical marijuana bill passed the House in 2020 but died in the Senate.

The latest bill's sponsor, Rep. Jason Nemes, R-Louisville, did not immediately respond to a call from Kentucky Health News. He told Horn that he was “still trying to get senators to support HB 136.”

Joe Sonka of the Courier Journal reports, "Nemes was hoping to be invited to a meeting of the caucus to pitch members on his bill, but Senate President Robert Stivers told the Courier Journal that is not going to happen." Stivers also opposes medical marijuana.

After changes to appease county governments, the bill to address ambulance transfer times is raring to go for its final dispatch

Dwayne Oliver and Doug Byers of Lee County's ambulance service
refit one after a run. (Photo by Ryan C. Hermens, Lexington Herald-Leader)
UPDATE: March 29, The Senate passed HB 777 with a committee substitute 34-2. The House concurred in the Senate changes, giving the bill final passage. 

By Melissa Patrick
Kentucky Health News

After yet another round of negotiations, a House bill aimed at improving ambulance transfer times nears a vote on the Senate consent calendar, used to pass bills without further discussion.

"All parties came to the table and I think we all agree," Rep. Ken Fleming, R-Louisville, the bill's sponsor, told Kentucky Health News. "We know it's not perfect. We do have a lot of work ahead of us in the task force, and then we're gonna really peel this whole issue back even further to make sure that we deliver the best quality of care for patients." 

Fleming told the Senate Health and Welfare Committee March 16 about a friend's sister who died while waiting on transport, and of organs that had barely made it to the hospital on time to save a life.

The Kentucky Association of Counties objected to parts of House Bill 777 and Chairman Ralph Alvarado asked them to go back to the negotiating table to work our their differences.

Senate President Pro Tem David Givens, R-Greensburg, was touted as being instrumental in finding consensus. He said KACo still does not support the bill, "but I sense that their opposition has now been moved to a place of neutrality." The bill is being pushed by the Kentucky Hospital Association.

Fleming said one change would require the Cabinet for Health and Family Services to send a notice to all cities and counties that a hospital has proposed to establish an ambulance service. The legislative bodies of the affected cities and counties would have 30 days to respond, and lack of response will be deemed support.

Another change would "sunset" the new rules in 2026, while allowing "all actions taken by cities, counties and hospitals, exemptions from obtaining a certificate of need and any certificate of need" granted under these new rules to remain in effect on and after this date.

A certificate of need is, in effect, a license to operate a health-related service. "Kentucky and Hawaii are the only states that regulate ambulance services under a certificate-of-need provision," notes Alex Acquisto of the Lexington Herald-Leader. And Kentucky does that with an independent Kentucky Board of Emergency Medical Services, comprised of EMS personnel.

The bill would make the board an independent agency of the state government, which would investigate all complaints about ambulance services, while leaving discipline to the board, and create a task force to do a thorough review of "the need, or lack thereof, for the certificate-of-need process for ambulance services."

Fleming said that will be one of the task force's biggest assignments. "There are 48 states that do not have certificate of need when it comes to ambulances," he said, "so we've got to figure out why are we an outlier."

Rep. Ken Fleming
The task force was a way to scale back the original version of the bill by deferring action on some points. "We're going to have to roll up our sleeves," Fleming said. "It's just going to be good, healthy discussions." He said it will be important for the task force to look at EMS workforce issues because that is a challenge that keeps coming up. 

Among other things, the bill would reform the certification requirements to allow cities, counties and hospitals to transport patients under certain conditions; make it easier for patients to register complaints; and exempts organ-procurement organizations from speed limits and traffic-flow patterns while transporting a human tissue in an emergency.

Stories of ambulance delays abound.

Acquisto's story begins with the story of an emergency patient at the St. Claire Regional Medical Center in Morehead with a ruptured blood vessel in his esophagus who waited five and a half hours for an ambulance (helicopters were not available because of rain) and was finally transported to Lexington in an ambulance from Ohio, which hospital CEO Donald Lloyd told her is "not permitted."

Acquisto reports that a survey done by the hospital association found that the average wait time for patients to be transported was seven to eight hours, with 90% of those requests to transfer a patient to a higher level of care, according to Nancy Galvagni, president of the association.

U of L says it will spend $144 million to upgrade hospital

Artists' rendering from University of Louisville Health
The University of Louisville plans to expand and renovate its 40-year-old hospital in Kentucky's largest city.

Officials say the $144 million project will include a seven-story tower with 20 new patient rooms, for a total of 360 private rooms at the hospital; four new operating rooms; a 24-bed observation unit to ease strain on the emergency department and reduce wait times; and a new lobby and waiting area, with renovations to the gift store and coffee shop.

Officials hope the expansion will be done by 2024. They said it will add 325 new jobs – nurses, clinical and nonclinical staff.

U of L Health CEO Tom Miller said Thursday the upgrades are much needed as more people seek specialty care at the region's only Level 1 trauma center. "Level 1 trauma centers provide the most comprehensive care for serious injuries that require a fast response, according to Medical News Today. They often have surgeons on staff 24 hours a day," WFPL reports.

“Every day this past year, 40 patients a day didn’t get a room in our hospitals [and] had to stay overnight in the emergency departments or in our recovery areas,” Miller said. “Today is the day to prioritize the health of this community. And I will tell you as an academic health care facility, we take that responsibility to heart.”

Gov. Andy Beshear, Louisville Mayor Greg Fischer, U.S. Rep. John Yarmuth and acting U of L President Lori Gonzalez also spoke at the news conference. Beshear praised U of L for its Covid-19 response and vaccine rollout.

“This expansion is great news for the commonwealth because you treat patients from all 120 counties,” Beshear said. “Now you’ll be able to serve even more people and hopefully we can put this pandemic behind us and then address so many challenges in health that afflict our people.”

U of L will pay for the project with its own funds, private donations and borrowing through tax-free bonds and revenue bonds, a news release said.

Wednesday, March 23, 2022

Bill near final passage would delay lab results of cancer or genetic markers from going on electronic health records for 72 hours

UPDATE: March 30, The House concurred with the Senate, giving the bill final passage. 
UPDATE: March 29, The Senate passed HB 529 with a committee substitute 36-0. 

By Melissa Patrick
Kentucky Health News

The legislature is nearing final passage of a bill that would give health-care providers a chance to contact patients to go over certain laboratory results before they go on patients' electronic health records.

Rep. Killian Timoney
House Bill 529, sponsored by Killian Timoney, R-Lexington, would require pathology or radiology reports that may show a finding of malignancy, or test results that could reveal genetic markers, to not be disclosed to a patient as part of their electronic health record for 72 hours, unless the health-care provider directs their early release. 

The Senate Health and Welfare Committee approved the bill without dissent and put it on the chamber's consent calendar, which it uses to pass bills without further discussion.

Doctors told the committee that the bill is needed.

"As physicians, we are quite concerned that patients are receiving deadly, life-threatening diagnoses on their phones without any medical care and medical support. We have numerous accounts of patients being harmed because of that, and causing harm to themselves," said Dr. David Danhauer, chief medical information officer at Owensboro Health. "We ask that, with this bill, allow our providers time to review, contemplate a plan, and set up appropriate consultation with those patients."

Dr. Susanne Arnold, a medical oncologist and associate director of the University of Kentucky's Markey Cancer Center, told the committee that they believe 72 hours "is an appropriate length of time" in most situations to be able to have a face-to-face discussion with a patient about such serious diagnoses. 

Sen. Karen Berg, D-Louisville, a physician, praised the bill. "This can be a horrible, horrible situation for patients," she said. "Imagine, honestly, opening up your telephone and seeing the report that says advanced metastatic cancer and it's 5:30 on a Friday night and you don't even have anyone to call. That's unethical."

While presenting the bill March 9 in the House floor, where it passed 84-14, Timoney said it would apply to upwards of 4 percent of all tests, and give patients access to a trained professional instead of "Dr. Google" or WebMD. He referred to the bill as the Compassionate Patient Care Act. 

The bill has an emergency clause that would make it effective immediately upon enactment.

Bill Wagner, who headed group of health clinics for disadvantaged in Louisville, wins Gil Friedell Memorial Health Policy Award

Wagner, left, with Foundation President and CEO Chandler
William Wagner, retired CEO of Family Health Centers of Louisville, is the latest winner of the Foundation for a Healthy Kentucky's Gil Friedell Memorial Health Policy Award, for his work expanding access to care and coverage.

“Bill’s passion for bettering the health of Kentuckians is a perfect reflection of the spirit of the Gil Friedell Memorial Health Policy Award,” said Ben Chandler, the foundation's president and CEO. “Dr. Friedell was a passionate advocate for access to health care. Bill’s 40-year career is a testament to his commitment to serving others by expanding opportunities for health-care coverage and bringing medical care to underserved areas in rural and urban communities. He has made a profound impact on the health and wellness of countless Kentuckians.”

Wagner established primary-care centers focused on people who are low-income, homeless, immigrants and refugees, then expanded them to include dental, behavioral health, pharmacy services, health education, outreach and enrollment services.

He was influential in the evolution of Kentucky’s Medicaid program, helping develop the nonprofit Passport Health Plan for managed care of Medicaid patients and the Children’s Health Insurance Program, providing medical services for hundreds of thousands of children and adults in Kentucky.

He also helped shape the next generation of social workers and public-health professionals through his work with the Kent School of Social Work and the College of Public Health at the University of Louisville.

“It's an honor to receive the award,” Wagner said. “I accept it on behalf of all the health care providers who work so hard to provide medical care access in underserved areas of Kentucky – urban and rural. They’re the real heroes. I have great respect for them and working with them made my job so fulfilling.”

Wagner retired at the end of 2021, something he delayed due to the pandemic. During it, he worked with non-English-speaking communities to provide testing and education. When vaccines rolled out, Wagner was at the forefront, helping with logistics, outreach, and education, most notably with the homeless.

The Memorial Health Policy Award is named for Gil Friedell, first director of the Markey Cancer Center at the University of Kentucky and cofounder of the Kentucky Cancer Registry. He helped launch a nonprofit advocacy education organization in 2005 that later became the Friedell Committee for Health System Transformation. The Foundation created the award when it united with the Friedell Committee in 2018.

Wagner and Friedell worked in the mid-1990s to create a community partnership for breast and cervical cancer screening in Louisville’s West End, which had extremely high death rates from those diseases.

The foundation makes a $5,000 grant to a Kentucky nonprofit working to improve health policy in the commonwealth in honor of the Friedell Award winner. Wagner selected Kentucky Voices for Health, a nonpartisan coalition that amplifies the voices of individuals, families, and communities in the decisions that affect the health and well-being of all Kentuckians.

Wagner said he selected KVH because of his concern that many Kentuckians could lose the Medicaid coverage to which they gained access in the pandemic. “Having health-care coverage is key to having access to medical care and living a healthier life,” he said. “I’m concerned when the emergency measures for expanded Medicaid expire, we will have many folks who aren’t sure how to recertify or apply through Kynect. KVH can help fill those gaps.”

Wagner was selected from the foundation's 2021 Healthy Kentucky Champions, Kentuckians honored for making a difference in the health of their communities or the state. Nominations for the 2022 awards are due by May 20. For more information and to nominate someone, visit Healthy-KY.org.

Almost six months after going into hospital with Covid-19, and a double-lung transplant as a last resort, patient is heading home

Staff members congratulate Victor Gonzales-Villatoro on his discharge at UK. (Photo by Hilary Brown)
By Hilary Brown
University of Kentucky

Staff at UK HealthCare gathered Wednesday to celebrate the discharge of patient Victor Gonzales-Villatoro, who was hospitalized with Covid-19 in October. The disease ravaged his lungs, Victor’s family was told he had almost no chance of survival, and they considered withdrawing life support.

As a last effort, UK doctors considered Victor a candidate for a double lung transplant and placed him on extracorporeal membrane oxygenation (ECMO) to see if his body could recover enough to withstand the transplant surgery.

For several months, while on ECMO, Victor remained unconscious. He awoke, and with a determined spirit, worked hard to gain the strength to receive a transplant — including getting up and walking while still connected to ECMO. On March 1, after five months on ECMO, Victor, 37, got a new set of lungs. Within a week, he was off the ventilator and walking.

Victor’s fighting spirit and unwavering determination endeared him to his care providers. After almost six months in the hospital, Victor was discharged amid a chorus of cheers and applause. He will spend the next few weeks at Cardinal Hill Rehabilitation Hospital in Lexington, where he will work to regain his strength and endurance.

Tuesday, March 22, 2022

McConnell, Va. senator poke FDA about lack of action on rules to enforce two-year-old minimum age of 21 to buy tobacco products

Sens. McConnell and Kaine at the University of Louisville's
McConnell Center in 2019 (Courier-Journal photo by Pat McDonogh) 
Senate Republican Leader Mitch McConnell of Kentucky and Democratic Sen. Tim Kaine of Virginia have complained to the Food and Drug Administration about the agency's delay in implementing the law they got passed more than two years ago to raise the minimum age to buy tobacco products to 21.

They also needled FDA Commissioner Robert Califf, who was confirmed by the Senate on Feb. 15, about "the lack of communication regarding the inaction, and asking the commissioner for plans regarding the future," reports Halfwheel, blog about cigars and tobacco issues.

McConnell and Kaine sent Califf a letter March 11 "to express concern about the delays in finalizing regulations related to the Tobacco 21 legislation and the lack of transparency around the implementation and enforcement of that legislation," as they put it. Without updated regulations, "FDA is limited in its ability to punish retailers for potentially violating the new standard," Halfwheel notes.

The senators noted that the FDA's compliance checks of retailers fell off greatly in 2020, with less than half the number of inspections and a third as many warning letters as in 2019.

"Many states and local governments had already passed legislation increasing the minimum age to purchase tobacco products to 21 prior to December 2019 and many more have followed through since then," Halfwheel reports. "By changing state and local laws, it allows for state and local law enforcement to issue warnings and citations to those caught selling tobacco products to people under the age of 21."

McConnell and Kaine asked Califf to respond by Friday, March 25, with a timeline for issuance of the regulations, "including details on the rule’s current status in the review process and an explanation for why FDA did not meet the statutory deadline for issuing a final rule," which was June 2020.

Monday, March 21, 2022

Republicans end state of emergency by overriding veto, say Beshear can get one more month of extra food benefits from feds

By Melissa Patrick
Kentucky Health News

Kentucky's overwhelmingly Republican legislature has overridden Democratic Gov. Andy Beshear's veto of a resolution ending the Covid-19 state of emergency about one month early, resulting in a $100 monthly food assistance cut for 544,000 people. Legislators say he can get that money back another way. 

"It is my very clear understanding from reading the federal guidance that every governor across the state has the opportunity to extend the access to those additional benefits for a one-month period beyond the state's declaration of the end of emergency," Senate President Pro Tem David Givens of Greensburg, said during the Senate floor debate Monday.

Givens later added, "And if I'm not mistaken, I think 28 other states have ended their state of emergency and successfully received that one-month extension if they have so applied."

Beshear's office did not respond directly to questions about Givens' remarks, instead referring Kentucky Health News to Beshear's veto letter and a letter sent to every legislator Monday by S. Travis Mayo, general counsel to the governor, suggesting that they still disagree with this assertion. 

Beshear wrote in his March 16 veto message that "without the state declaration of emergency related to the Covid-19 global pandemic, the emergency SNAP Allotments will end." SNAP stands for Supplemental Nutrition Assistance Program, formerly called food stamps.

The counsel's letter said the emergency allotment requires "a State declaration of an emergency related to Covid-19." The legislature has barred Beshear from declaring another Covid-19 emergency without its OK.

State Sen. Donald Douglas
Presenting Senate Joint Resolution 150 for the override, sponsor Donald Douglas of Nicholasville said that when the emergency allotments go away, benefits will return to the normal level, and to suggest otherwise is "fearmongering."

"Ask yourself, should SNAP benefits be a way of life?" Douglas asked. "Now we know it is for some; should it be a way of life for adults? Just ask yourself that question.”

The resolution will cut the current monthly benefit of $243 by about $100.

Douglas did not answer Democratic Leader Morgan McGarvey's question about what restrictions are currently in place due to the state of emergency (there are none), but said, "Ending emergency is just as important to the psychological well being of our state as it is to anything else."

Addressing the presiding officer, the normal legislative custom, Douglas said, "This is really not about what restrictions, Mr. President, this is about the commonwealth moving forward." 

McGarvey replied, "Let's not play politics with this bill. Let's not put at risk the federal dollars needed by families and kids across Kentucky in all of our districts to make this point three weeks before the decision we set and made in January of this year," referring to the legislature's decision to end the state of emergency on April 14.

The Senate overrode the veto 25-8, along party lines. Five Republicans did not vote: Sens. Matt Castlen of Owensboro, C.B. Embry of Beaver Dam, Paul Hornback of Shelbyville, Alice Forgy Kerr of Lexington, and Adrienne Southworth of Lawrenceburg.

Several Eastern Kentucky senators said they were able to vote yes on the override because of the assurance that these food benefits could be obtained by other means. The region has some of the highest rates of SNAP participation, according to an interactive map by the Kentucky Center for Economic Policy

"I would normally vote no against this, but based upon the governor having the authority to extend this and nobody losing any benefits I'm going to vote aye," said Sen. Johnnie Turner, R-Harlan.

Sen. Brandon Smith, R-Hazard, said, "I believe wholeheartedly like many other governors that have shown leadership, this governor has the full authority within his wheelhouse to extend this past another 30 days."

Sen. Phillip Wheeler, R-Pikeville, said "This is a very simple fix that our governor could do. Our people deserve to move on from the state of emergency." 

Sen. David Yates, D-Louisville, encouraged his colleagues to vote no, saying passage of the resolution would impact "the weakest among us" and that the rationale for passing it is "purely political." Douglas has a primary-election opponent who has been an outspoken foe of pandemic restrictions, but Yates said the political motive is directed at Beshear.

“It makes me sick to my stomach,” Yates said, that Republicans are hurting people “for no reason whatsoever other than to take a political shot at the governor.”

Sen. John Schickel, R-Union, said, "I would admit that this bill is largely a symbol, but it's a very important symbol; the symbolism is we're ready to move forward." 
 
Sen. Ralph Alvarado, R-Winchester, said, "There is no more state of emergency here. What you have is legislators that are here today, asking us to tell the federal government that we still have one so we can get more money. That amounts to lying by some people's standards. I think that's wrong. . . . I don't think we should be asking for help when we're no longer needing it." 

The House overrode the veto of SJR 150 by a 68-16 vote with no discussion. The state of emergency will end as soon as Secretary of State Michael Adams signs it.