Thursday, August 31, 2023

Baptist Health warns Humana Medicare Advantage policyholders that they could be out of network if negotiations don't work out

Humana Inc. and Baptist Health are negotiating a new contract for patients with Medicare Advantage policies from the Louisville health insurer, and the hospital chain is warning policyholders that Baptist Health providers will be out of Humana's network unless an agreement is reached by Sept. 22.

The issue would not affect hospital services, just doctors and other clinicians at Baptist Health facilities, the company says, adding, "Because insurance coverage varies based on the specific plan you have, we recommend you call Humana at the number on the back of your insurance card to understand if your plan and provider are affected. . . . Only Humana can confirm if the potential out-of-network situation will affect your particular plan’s network."

Humana Medicare Advantage policyholders undergoing treatment for certain medical conditions from a Baptist Health provider will continue to be covered at in-network rates under a program called “Continuity of Care.” These include pregnancy, chronic medical conditions, and treatment such as chemotherapy or dialysis, or home health services. "It's important to note that only Humana can determine if you qualify," Baptist Health says. "To learn more, call the number on the back of your insurance card."

5 things to know about new Medicare negotiations on drug prices

By Arthur AllenRachana Pradhan and David Hilzenrath
KFF Health News

The Biden administration has picked the first 10 high-priced prescription drugs subject to federal price negotiations, taking a swipe at the powerful pharmaceutical industry. It marks a major turning point in a long-fought battle to control ever-rising drug prices for seniors and, eventually, other Americans.

Under the 2022 Inflation Reduction Act, Congress gave the federal government the power to negotiate prices for certain high-cost drugs under Medicare. The list of drugs selected by the Centers for Medicare and Medicaid Services will grow over time.

The first eligible drugs treat diabetes, blood clots, blood cancers, arthritis, and heart disease — and accounted for about $50 billion in spending from June 2022 to May 2023.

The United States is clearly an outlier on drug costs, with drugmakers charging Americans many times more than residents of other countries “simply because they could,” Biden said Aug. 29. “I think it’s outrageous. That’s why these negotiations matter.”

Democratic lawmakers cheered the announcement, and the pharmaceutical industry, which has filed a raft of lawsuits against the law, condemned it.

The companies have until Oct. 2 to present data about their drugs to CMS, which will make initial price offers in February, starting negotiations set to end next August. The prices would take effect in January 2026.

Here are five things to know about the impact:

1. How important is this step? Medicare has long been in control of the prices for its services, setting physician payments and hospital payments for about 65 million Medicare beneficiaries. But it was previously prohibited from involvement in pricing prescription drugs, which it started covering in 2006.

Until now the drug industry has successfully fought off price negotiations with Washington, although in most of the rest of the world governments set prices for medicines. While the first 10 drugs selected for negotiations are used by a minority of patients — 9 million — CMS plans by 2029 to have negotiated prices for 50 drugs on the market.

“There’s a symbolic impact, but also Medicare spent $50 billion on these 10 drugs in a 12-month period. That’s a lot of money,” said Juliette Cubanski, deputy director of the Kaiser Family Foundation’s analysis of Medicare policy.

The long-term consequences of the new policy are unknown, said Alice Chen, vice dean for research at University of Southern California’s Sol Price School of Public Policy. The drug industry says the negotiations are essentially price controls that will stifle drug development, but the Congressional Budget Office estimated only a few drugs would not be developed each year as a result of the policy.

Biden administration officials say reining in drug prices is key to slowing the skyrocketing costs of U.S. health care.

2. How will the negotiations affect Medicare patients? In some cases, patients may save a lot of money, but the main thrust of Medicare price negotiation policy is to provide savings to the Medicare program — and taxpayers — by lowering its overall costs.

The drugs selected by CMS range from specialized, hyper-expensive drugs like the cancer pill Imbruvica (used by about 26,000 patients in 2021 at an annual price of $121,000 per patient) to extremely common medications such as Eliquis (a blood thinner for which Medicare paid about $4,000 each for 3.1 million patients).

While the negotiations could help patients whose Medicare drug plans require them to make large copayments for drugs, the relief for patients will come from another segment of the Inflation Reduction Act that caps drug spending by Medicare recipients at $2,000 per year starting in 2025.

3. What do the Medicare price negotiations mean for those not on Medicare? One theory is that reducing the prices drug companies can charge in Medicare will lead them to increase prices for the privately insured.

But that would be true only if companies aren’t already pricing their drugs as high as the private market will bear, said Tricia Neuman, executive director of KFF’s program on Medicare policy.

Another theory is that Medicare price negotiations will equip private health plans to drive a harder bargain. David Mitchell, president of the advocacy group Patients for Affordable Drugs, predicted that disclosure of negotiated Medicare prices “will embolden and arm private sector negotiators to seek that lower price for those they cover.”

Stacie B. Dusetzina, a professor of health policy at Vanderbilt University, said the effect on pricing outside Medicare isn’t clear: “I’d hedge my bet that it doesn’t change.”

Dusetzina described one way it could: Because the government will be selecting drugs for Medicare negotiations based partly on the listed gross prices for the drugs — distinct from the net cost after rebates are taken into account — the process could give drug companies an incentive to lower the list prices and narrow the gap between gross and net. That could benefit people outside Medicare whose out-of-pocket payments are pegged to the list prices, she said.

4. What are drug companies doing to stop this? Even though negotiated prices won’t take effect until 2026, drug companies haven’t wasted time turning to the courts to try to stop the new program in its tracks.

At least six drug companies have filed lawsuits to halt the Medicare drug negotiation program, as have the U.S. Chamber of Commerce and the Pharmaceutical Research and Manufacturers of America, known as PhRMA.

The lawsuits include a variety of legal arguments. Merck & Co., Johnson & Johnson and Bristol Myers Squibb are among the companies arguing their First Amendment rights are being violated because the program would force them to make statements on negotiated prices they believe are untrue. Lawsuits also say the program unconstitutionally coerces drugmakers into selling their products at inadequate prices.

“It is akin to the government taking your car on terms that you would never voluntarily accept and threatening to also take your house if you do not ‘agree’ that the taking was ‘fair’,” Janssen, part of Johnson & Johnson, wrote in its lawsuit.

Nicholas Bagley, a law professor at the University of Michigan, predicted the lawsuits would fail because Medicare is a voluntary program for drug companies, and those wishing to participate must abide by its rules.

5. What if a drug suddenly gets cheaper by 2026? In theory, it could happen. Under guidelines CMS issued this year, the agency will cancel or adjourn negotiations on any drug on its list if a cheaper copycat version enters the market and finds substantial buyers.

According to company statements this year, two biosimilar versions of Stelara, a Johnson & Johnson drug on the list, are prepared to launch in early 2025. If they succeed, it would presumably scotch CMS’ plan to demand a lower price for Stelara.

Other drugs on the list have managed to maintain exclusive rights for decades. For example, Enbrel, which the FDA first approved in 1998 and cost Medicare $1.5 billion in 2021, will not face competition until 2029 at the earliest.

Feds call for first nursing-home staffing minimums, weaker than industry feared, but homes say it would force some to close

Federal officials' proposed minimum standards for nursing-home staffing are weaker than expected, Bridget Early reports for Inside Health Policy.

The nursing-home industry had anticipated a proposal for about 4.1 hours of employee work time per resident day, meaning that a home with 25 residents would require 18 staffers (times 4.1 hours per resident day = 175 hours per week, divided by 40 hours per week = 17.9 employees).

Instead, the Centers for Medicare and Medicaid Services proposed "minimum nurse staffing standards of 0.55 hours per resident for registered nurses and 2.45 HPRD for nurse aides," as well as a requirement to have a registered nurse at the nursing home around the clock.

"The combined three hours falls short of what a government analysis two decades ago said was the optimal level for quality care: 4.1 hours per day. It also falls short of the 3.76 total hours that a government study said nursing homes currently provide on average," reports Christopher Rowland of The Washington Post.

The proposal is "a long-anticipated response to decades of complaints about neglect and abuse in an industry that critics say is unprepared for the tsunami of seniors heading its way from the Baby Boom," Rowland writes. "Much of the rule would kick in within three years for urban facilities and five years for rural facilities."

The regulation would have major implications for Kentucky, which is farther behind on its nursing-home inspections than any other state but Maryland.

"To address concerns in rural areas where workers are scarce, the Biden administration has provided a series of exemptions in the rule for facilities that can prove they can’t find staff even if they made good faith efforts to recruit and retain workers," Rowland reports. "It plans to pump $75 million into programs intended to bolster the nursing home workforce, such as scholarships and tuition reimbursement."

CMS estimates that the rules would make about three-fourths of nursing homes increase staffing, USA Today reports: "Having enough nurses and aides is the strongest predictor of whether nursing home residents will thrive, researchers have found. But a USA Today investigation last year documented how rarely the federal government enforces decades-old staffing guidelines and rules for nursing homes that participate in Medicare and Medicaid."

The regulation "cleared the White House Office of Management and Budget on Tuesday, Aug. 29, the same day a CMS study underpinning the rule was leaked and created a firestorm among stakeholders," Early reports. "The White House budget office also canceled its two remaining stakeholder meetings on the issue in the wake of the leak. The proposed rule had been pending at OMB since May 30. The two meetings were scheduled for the first and second weeks of September. The meetings were requested by the Organization of Nurse Leaders and the Association of Jewish Aging Services."

Early notes, "The nursing-home industry has lobbied hard against staffing minimums and has called for a White House event to explore alternatives, but patient advocates have backed staffing minimums."

LeadingAge, the largest association for nonprofit nursing homes, told USA Today that the propsoed regulation would be impossible for many nursing homes to meet. “There are simply no people to hire—especially nurses,” said Katie Smith Sloan, the group's president and CEO. “America’s under-funded, long-ignored long-term care sector is in a workforce crisis.” Sloan said nursing homes would have to “reduce admissions or even close” if the rule takes effect.

Wednesday, August 30, 2023

Clinic that serves 33 Ky. counties is first in state to get a grant from program for comprehensive drug treatment and recovery

Owensboro Hope House is one of MCCC's facilities.
Kentucky Health News

A behavioral-health clinic that serves 33 Kentucky counties is the first in the state to receive a grant from a national program that fosters comprehensive drug treatment and recovery centers with a full spectrum of treatment, harm reduction, and recovery support services, especially for people without commercial health insurance.

Mountain Comprehensive Care Center, based in Prestonsburg, is getting the $850,000 grant from the Substance Abuse and Mental Health Services Administration of the U.S. Department of Health and Human Services.

"This grant will allow us to provide treatment for substance-use disorder to persons whose insurance coverage is not sufficient for the treatment required," Promod Bishnoi, CEO of MCCC, said in a press release issued by Eastern Kentucky's congressman, Rep. Hal Rogers.

Rogers said, “This is a life-saving grant program that is needed now, more than ever before. Last year, more than 100,000 Americans died from drug overdoses, so every investment that we make into recovery programs, workforce training, counseling and other resources could mean the difference between life and death for someone.”

Rogers, a Republican from Somerset, announced the grant with Senate Republican Leader Mitch McConnell and Rep. Brett Guthrie of Bowling Green, the ranking Republican on the health subcommittee of the House Energy and Commerce Committee. The release said he recently re-introduced the Comprehensive Opioid Recovery Centers Reauthorization Act of 2023, which would extend the grant program through 2028. It was enacted in 2018.

Guthrie said, “This is welcomed news that Kentucky received its first Comprehensive Opioid Recovery Centers grant. I was proud to lead legislation establishing the Comprehensive Opioid Recovery Center program five years ago. These centers provide targeted resources to communities most impacted by the overdose crisis, including workforce training, medication assisted treatment services, recovery housing, and peer to peer counseling.”

McConnell said, “Kentucky tragically remains one of the states hardest hit by the opioid epidemic. The good news is care centers across the commonwealth are constantly stepping up and finding new ways to combat this crisis. I’m happy to see Kentucky receive its first Comprehensive Opioid Recovery Center grant, which funds crucial services to communities devastated by the opioid epidemic.”

In the eastern third of the state, MCCC has facilities in Bath, Boyd, Carter, Clay, Floyd, Greneup, Johnson, Knott, Lawrence, Lee, Leslie, Letcher, Magoffin, Martin, Mason, Morgan, Pike, Perry, Rowan and Wolfe counties. In Central Kentucky, it is in Bourbon, Clark, Fayette, Garrard, Harrison, Madison and Powell counties. In Western Kentucky, it is in Caldwell, Christian, Daviess, Hopkins, Marshall and McCracken counties.

Tuesday, August 29, 2023

One-fourth of Kentuckians say they have ever been diagnosed with depression; only W.Va. was higher in national CDC survey

Centers for Disease Conrol and Prevention map, adapted by Kentucky Health News
By Al Cross
Kentucky Health News

One in four Kentucky adults in a poll taken in 2020 said they had ever been diagnosed with depression, a higher share than in any state but West Virginia.

Kentucky's age-adusted percentage was 25%; West Virginia's was 27.5%. The national figure in the poll, taken by the Centers for Disease Control and Prevention, was 18.4%.

The poll was taken by the Behavioral Risk Factor Surveillance System, an ongoing CDC-state project in which state employees do random-digit–dialed landline and cell phone calls to adults. The question was, “Has a doctor, nurse, or other health professional ever told you that you had a depressive disorder, including depression, major depression, dysthymia, or minor depression?”

In Kentucky, the county with the highest age-adjusted percentage of people answering "yes" was Wolfe County, at an estimated 30.7%. (That was the most likely percentage in a range of 28.8% to 32.5%, at a confidence level of 95%, or 19 out of 20 cases.)

The rest of the top 10 were Harlan, 29.7% (27.9-31.6); Jackson, 28.9% (27.1-30.9); Casey, 28.9% (27.1-30.7); Clay and Magoffin, 28.8% (27.1-30.6); Bell and Knox, 28.7% (27-30.5); Letcher, 28.6% (26.9-30.5); and Lewis, 28.6% (26.9-30.4). Figures for all counties can be downloaded here.

The 29 counties with the highest estimated shares of reported depression, and 38 of the top 40, were in Appalachia as defined by the Appalachian Regional Commission, which includes 54 Kentucky counties. The highest estimated rate, 31.9%, was in Logan County, West Virginia.

Phil Galewitz of KFF Health News went to Logan and reports that stigma around the topic of mental health is a major obstacle to addressing the problem. Psychiatrist David Lewis of Coalfield Health Center, who grew up in the and taught high-school math there, told Galewitz that people in the region often view seeking mental-health help as being “weak in faith.”

Most states with the highest levels of reported depression were in Appalachia, the southern Mississippi Valley, Missouri, Oklahoma, and Washington, the CDC said in reporting the data. It noted, "Depression is a major contributor to death, illness, disability, and economic costs."

In Kentucky, the counties with the lowest rates of reported depression were Oldham, 21.9%; Boone, 22%; Lyon, 23.6%; Shelby, 23.8%; Fayette, Hardin and Woodford, 24%; Jefferson, 24.2%; Christian, 24.3%; Nelson, 24.4%; Jessamine, 24.5%; Scott and Spencer, 24.6%; Bullitt, 24.7%; and Boyle, 24.8%.

Generally, high-income counties had lower rates of reported depression, and low-income counties had higher rates. Reported depression was "higher in women, younger adults, and adults with lower education levels," the CDC said.

Having been diagnosed with depression is not the same thing as having had depression. Another CDC survey in 2020 asked people if they had suffered symnptoms of depression, and at one point 31% of Kentuckians in the poll said they had.

Study expands access to naloxone, which blocks drug overdose

The study includes distribution of naloxoone (brand name
Narcan) at public events. (University of Kentucky photo)
By Elizabeth Chapin
University of Kentucky

Thursday, Aug. 31, marks International Overdose Awareness Day, a time when attention is directed toward raising awareness about opioid overdose and ways to reverse the deadly effects.

One such way is naloxone, a medication that has become more available throughout Kentucky in recent years with the University of Kentucky’s HEALing Communities Study playing a significant role.

Naloxone, also known by its brand name Narcan, is a medication that when given in time can quickly reverse the effects of opioids and help restore breathing in someone who is experiencing an overdose.

Increasing access to naloxone is one of the evidence-based strategies implemented by the HEALing Communities Study to reduce opioid deaths in Kentucky. Launched in 2019, the $87 million study is focused on 16 counties hardest hit by the opioid epidemic. The goal is to develop sustainable solutions that can be scaled across the commonwealth.

So far, the study has helped thousands of Kentuckians get access to the lifesaving medication. Since the first unit of naloxone was distributed in April 2020, more than 86,000 units of naloxone have been distributed across the 16 counties participating in HEAL.

To put it into perspective: In 2019, the year before the HEAL intervention was launched, that number was just about 7,000, says Trish Freeman, a professor in the UK College of Pharmacy who leads the HEAL Prevention Team and coordinates HEAL’s naloxone education and distribution efforts.

In 2022, 2,127 Kentuckians died from a drug overdose, with 90% involving opioids. While Kentucky’s overdose death rate decreased by 5% last year, it’s still among the highest in the nation.

“No one should die from an overdose and naloxone is one of the most effective ways to intervene and save a life,” said Freeman. “By getting naloxone into the hands of more Kentuckians, we are saving lives today while informing the blueprint for the most effective way for communities to do so going forward.”

Most of the naloxone distributed by HEAL is delivered through partnerships with various community organizations and agencies including treatment, criminal legal system, social service and public health programs.

The study, which is broken down into two waves of eight counties each, has partnered with 245 agencies across all 16 counties. The HEAL Implementation Team, led by Hannah Knudsen, a professor in the UK College of Medicine, works hand in hand with partner agencies to provide the support needed to implement overdose education and naloxone distribution with their clients.

Knudsen’s team of implementation facilitators meet with a wide range of agencies to share information about HEAL’s overdose education and naloxone distribution program and then work with agencies to establish a workflow and provide technical assistance to ensure effective implementation.

The HEAL Prevention team operates a naloxone distribution hub in the Center on Drug and Alcohol Research for partner agencies that also includes training materials, because education about overdose and how to use the medication is required. Under a standing order agreement, HEAL co-investigator Michelle Lofwall, physician and professor in the College of Medicine, signs the order as the physician of record for all naloxone distributed.

The agency partnerships reach those at highest risk for overdose, especially within the criminal legal system, where HEAL has partnered with jails and prisons, drug court, pretrial services, police departments, and probation/parole programs.

The risk of overdose is increased when people are released from a correctional facility because tolerance for the drug can decrease significantly during a period of abstinence. After release, an attempt to use the same amount of opioid may lead to overdose or death, says Carrie Oser, professor in the UK College of Arts and Sciences and co-lead of the HEAL Criminal Legal System Team.

Most jails partnering with HEAL offer naloxone as part of the discharge process. Some, including the Madison County and Jefferson County detention centers, have opted to install “vending machines” in lobbies or discharge areas. The digital kiosks streamline tracking and mandatory training.

“The agencies we work with choose what works best for them given their unique staffing and organization needs. The most important thing is that people who are discharged are getting access to naloxone during this critical time,” said Oser.

Beyond agency distribution, naloxone is dispensed through the HEALing Communities Study comes from its own outreach team. HEAL prevention specialists reach people directly at venues like community events, social service agencies, businesses, schools and addiction treatment and recovery facilities.

In addition to educating people on how to recognize an overdose and properly administer naloxone, the team addresses a lot of myths and misperceptions people have.

“People need to know it’s safe to use on anyone and won’t hurt someone who isn’t overdosing,” said Gabi Deaton, a HEAL prevention-specialist coordinator. “We also talk about the Good Samaritan law, which protects people from prosecution when they report a drug overdose. Our goal is to make sure they’re confident, equipped and ready to intervene in the case of an opioid emergency if they ever need to.”

Deaton serves as the prevention specialist for Campbell County and organizes the outreach efforts of her colleagues assigned to the seven other counties in the HEAL’s second wave.

While the team generally visits locations with people at higher risk of overdose, they reach a larger cross section of the public compared to the agencies. Their visibility helps reduce the stigma surrounding opioid use disorder and ensure that more family members, friends and bystanders are carrying naloxone.

Deaton says people sometimes reach out to thank her after the naloxone she gave them is used to save a life. There are too many to remember them all, but she still keeps in touch with some who are now in recovery.

Soon, it will be easier to access naloxone nasal spray products, including brand name Narcan and its generic counterparts. These products were recently approved by the U.S. Food and Drug Administration for sale over the counter and should be available in pharmacies and other retail stores that sell OTC products by mid-October.

Overdose education and naloxone distribution by a wide range of agencies will likely still be needed to ensure that cost is not a barrier and that people learn now to effectively use naloxone to respond to an overdose.

Monday, August 28, 2023

Attacking respiratory syncytial virus (RSV) on 3 fronts: Monoclonal antibodies for infants, vaccines for pregnant women and elderly

By Dr. Ilhem Messaoudi
University of Kentucky

After an intense season of respiratory syncytial virus in the commonwealth, we have a new tool to protect children from RSV.

In July 2023, the U.S. Food and Drug Administration approved AstraZeneca’s Beyfortus (nirsevimab-alip) for the prevention of RSV lower respiratory tract disease in neonates and infants born during or entering their first RSV season. It’s also for children up to 24 months of age who remain vulnerable to severe RSV disease through their second RSV season.

RSV is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but the virus can be serious, especially for infants and older adults.

Dr. Ilhem Messaoudi on KET's "Kentucky Tonight"
This is not a vaccine for children, but a monoclonal antibody treatment, much like what we saw developed to fight Covid-19 in the early days of the pandemic. The treatment is giving these young immune systems a bunch of antibodies against RSV and helping them fight it off.

The science behind this development is exciting. These types of viruses have been very challenging to make vaccines against, and now we have a great therapy.

To me, as a parent, virologist and immunologist, I see very few downsides of giving Beyfortus to young infants who atre at risk from severe RSV. Anything we can do to protect the smallest, most vulnerable Kentuckians is a step we should take. Because if a child is hospitalized with RSV the only thing we can offer them is supportive care.

RSV protections for pregnant women, elderly adults

Also exciting are the protections we now have for other vulnerable populations: pregnant women and the elderly.

Recently, federal health advisers have shown support of Pfizer’s first-of-its-kind RSV vaccine for pregnant women to protect infants in the first few months of life through the passive transfer of maternal antibodies. This strategy is already used to protect neonates and young infants against pertussis, flu and covid passed using antibodies passed from mom to baby during pregnancy through the placenta and after birth via breastfeeding.

And, back in May, the FDA approved the first-ever vaccine against RSV for older adults from GSK called Arexvy.

It’s amazing that in one year we have a monoclonal antibody treatment for infants and not only one but two different vaccines for pregnant women and older adults.

We now have more tools at our disposal to prevent people of all ages from ending up in the ICU and dying, and it all starts with getting your vaccines and staying up to date on them.

Anyone with questions about treatments for themselves or their children should talk to their primary health-care provider.

Sunday, August 27, 2023

28% of Kentucky students were chronically absent last year, up from 18% before the pandemic; national increase was even more

By Al Cross
Kentucky Health News

Twenty-eight percent of students in Kentucky schools were chronically absent from classes during the last academic year, compared to 18 percent in the 2018-19 school year, according to a national study done at Stanford University with the help of The Associated Press.

But Kentucky's increase was less than the national increase, so much that its figure is now about the national average instead of above it.

Kentucky's rise of 10 percentage points was an increase of 56 percent. Nationally in 2018-19, 14.8 percent of students were chronically absent from school; in 2021-22, it was 28.3 percent. That increase of 13.5 percentage points was a rise of 91 percent from the last year before the pandemic.

"The large and broad increases in chronic absenteeism suggest many students are failing to re-engage in schooling as in-person instruction returned," wrote Thomas Dee, the Stanford education professor who conducted the study.

"The data from 40 states and Washington, D.C., provides the most comprehensive accounting of absenteeism nationwide," AP reports. However, Dee's statistical analyses of the data were unable to find a pattern that explained the wide differences among the states.

Dee said he tested found little if any correlation between chronic-absenteeism growth and a state's infection rate, its classroom masking policies, enrollment losses or differences in how "chronic absemteeism" is defined. Kentucky defines it as missing 10% or more of the year for any reason.

Kentucky's chronic-absentee rate in 2018-19 was higher than the national average. Last year, it was about the same as the national average. (The report gave rates in whole percentage points, not tenths of points.)

The Economist reports possible reasons for increased truancy: "Having experienced remote learning, some students — and perhaps their parents — no longer think it essential or even worthwhile to sit in a classroom. 'It’s the same thing as in the workplace,' says a teacher in New Orleans. 'Once you’ve gone down to only being there two or three days a week, coming back all five is hard.' His classrooms are especially empty on Fridays, he says, so he avoids scheduling the most important lessons then. After the pandemic, people 'started catering to their mental-health needs,' says Tieshia Robinson, a principal at Chicago Collegiate, a public charter school in the city. For parents, that might mean allowing children who are unhappy at school to skip days. Pupils have also grown used to staying at home at the slightest sign of physical illness, says Greg Frostad of New Mexico’s education department."

The highest 2021-22 chronic-absentee rates, 49% and 48%, were found in Alaska and the District of Columbia, which also had the highest rates in 2018-19, 30% and 29%, respectively. The third-highest rate, 40%, was in New Mexico; that was more than double its 2018-19 rate of 18%. Arizona's rate also more than doubled, from 13% to 34%, the eighth highest in 2021-22.

Most of those leaders have high shares of miniority populations. "The pandemic growth in chronic absenteeism exacerbated pre-existing inequalities," Dee writes, noting that the increases were larger "among economically disadvantaged students as well as Black students and Hispanic students."

Other states where the rate doubled or more than doubled were Washington, 15% to 33%; California, 12% to 30%; Mississippi, 13% to 28%; Massachusetts, 13% to 28%; Texas, 11% to 26%; Iowa, 13% to 26%; and Connecticut, 10% to 24%. Dee reports that early figures for 2022-23 from Massachusetts and Connecticut show continued high absenteeism, and The Economist reports a like pattern in England and Australia.
Graph adapted by Kentucky Health News from "Higher Chronic Absenteeism Threatens Academic Recovery from the Covid-19 Pandemic," paper published by OSF Preprints, Center for Open Science

Community professionals who work with Kynect have a new online resource to connect them with resources and each other

By Melissa Patrick
Kentucky Health News

A new website called KyLoop has launched to provide an online connection space for community professionals who work in outreach and enrollment through Kynect, the state's health insurance website that also provides help with food, cash and childcare assistance and employee child care assistance partnerships.

The aim is to help more consumers enroll in health coverage and other public benefits that are offered on Kynect. It was developed by Kentucky Voices for Health, which advocates for health benefits.

The site not only provides a centralized hub of  resources, but also offers an interactive space for its members to ask questions and share experiences. 

KVH Outreach and Enrollment Director Priscilla Easterling said their ongoing "ThriveKY Roadshows" across the state, which provide updates on state and federal policies that impact health, have revealed just how diffiicult it can be for some people to find resources.

Easterling said the website's two main features have been designed to help combat this. 

One is a resource repository that has a curated list of resources and an option for its members to suggest and share resources that have worked for them. 

"We want this to be as reciprocal as possible . . . so we also have an option for people to suggest resources," Easterling said. "If there's something like a resource in their community that they use, that's really helpful in their work, they can suggest that to us and then we will also post that as well, so that everyone is sort of sharing their collective knowledge and also learning from each other." 

The other feature is a forum that allows the members to "share information, ask questions, report problems, report best practices and just share . . . personal experiences," Easterling said. 

The forum will be searchable, and connected to team of subject-matter experts from KVH's partner organizations who can answer questions that come up on the forum, she said: "If you ask a question and you get an answer, that post stays active for other people to search and find later." 

Easterling also noted that the website can help policy advocacy organizations track and report the problems that people report. 

Membership in the program is limited and the siteg will, not be open to journalists or state officials, so "everyone feels safe and comfortable sharing their experiences and asking questions,"  Easterling said.

"But also, we want to be able to offer that sort of follow-up, so if . . . people report technical barriers, or enrollment barriers, or just things that we're not necessarily aware of, we can still follow up with people and take that information directly to the state, and let them know what's going on and hopefully we can address those issues."

Easterling said the federal site had a similar program to deal with technical issues when the Patient Protection and Affordable Care Act rolled out. It has been disbanded, but Massachusetts and Illinois have similar programs and have helped with the Kentucky project, she said. 

KVH has three more ThriveKY Roadshows this year. The next one will be held Tuesday, Sept. 19, at the Foundation for a Healthy Kentucky offices at 1640 Lyndon Farm Ct. in Louisville. Meetings will also be held Oct. 17 in Lexington and Nov. 28 in Paducah. You can register for the meetings online

State and advocates try to keep eligible Kentuckians on Medicaid

State employees staffed a booth at the Kentucky State Fair to help people understand Medicaid changes and how to apply for the program or other coverage. (Ky. Lantern photo by Deborah Yetter)
By Deborah Yetter
Kentucky Lantern

Some patients find out they’ve been dropped from Medicaid when they come in to pick up a prescription. Others, when they arrive for a doctor’s appointment.

And some are struggling to cope with paperwork or documentation required to prove eligibility for Medicaid under new rules that require such information for the first time in three years.

Ashley Shoemaker, director of outreach for the Family Health Centers in Louisville, recalls the relief one man expressed when he was contacted as part of an effort to alert patients about the Medicaid changes.

“He said, ‘I’ve been trying to do this on my own and I don’t know where to start,’” Shoemaker said. “He’s eligible; he just didn’t know where to begin.” Staff helped him complete his application.

But around 70,000 people in Kentucky have been terminated from the health plan for low-income and disabled individuals through June, the latest numbers available from the state.

Mosyt lost coverage for not responding to paperwork, or not properly completing it.

How to renew your Medicaid

What’s going on with the program? If you get health coverage through Medicaid, you may have to resume the annual process of proving you are still eligible for the federal-state health plan for low income and disabled individuals. The requirement was suspended for three years during the Covid-19 pandemic but in Kentucky, resumed in May.

What do I need to do? Watch for a notice in the mail from state Medicaid officials, and be sure to read it and return it with any information requested. If your address has changed in the past three years, make sure the state has your current address either by notifying the state Department for Community Based Services in your county or by calling 1-855-306-8959.

If you have an account through kynect, the state’s online health insurance site, you can log in and update your information and check to see whether you have any messages requiring action. The kynect phone number is 1-855-4kynect (459-6328).

Where can I get help? If you don’t apply by mail or online, you can visit any Department for Community Based Services office; there’s one in every county.

You also can call the kynect hotline listed above to ask help finding a kynector — workers trained to help people get health coverage. They are located at agencies, clinics and other sites.

What if I no longer qualify for Medicaid? Visit the kynect site or meet with a kynector or local insurance agent to look for other options. A number of low-cost health plans are available with federal subsidies that make them affordable.

Health advocates in Kentucky — as well as nationwide — are watching and working to ensure people who are eligible remain insured as states transition back to yearly recertification for Medicaid. The state began sending the first round of notices in May, based on a member's renewal month.

“For three years, people didn’t need to respond to notices they received because their coverage was going to continue,” said Emily Beauregard, executive director of Kentucky Voices for Health, which is closely monitoring the situation.

During the pandemic that began in 2020, the federal government suspended the annual requirement that people prove they are eligible for the coverage which is based largely on income.

Kentucky’s $15 billion-a-year Medicaid program covers 1.6 million people, including adults, children and individuals in nursing homes, with the federal government covering 70% to 80% of the costs.

With the recent decision to lift the federal public health emergency, the states must again begin requiring annual renewal by members.

And that’s proving difficult among people who aren’t used to the annual requirement, may not understand the process or don’t have access to technology required to complete online applications and upload documents, such as income verification, advocates said.

“It’s hard to know if people understand what they need to do and are taking those steps,” Beauregard said.

70,000 Kentuckians terminated through June

Molly Lewis, CEO of the Kentucky Primary Care Association, said she worries that people who have benefited from expanded mental-health and addiction treatment in recent years could suffer if they inadvertently lose Medicaid coverage.

“I am most concerned about all those who have benefited from behavioral-health services,” said Lewis, who represents a network of clinics that see about one million patients a year.

Through June, 70,000 of the around 900,000 Kentucky adults covered by Medicaid have been dropped from the health plan, most losing coverage for “procedural reasons,” such as failing to respond to a renewal notice sent by the state.

Other states are posting similar numbers, with 75% of disenrollments nationwide due to procedural reasons, according to the Kaiser Family Foundation, a non-partisan health policy organization which offers a Medicaid enrollment tracker on its website.

That doesn’t mean all Kentuckians who lose Medicaid lack health coverage.

Eric Friedlander, secretary of the state Cabinet for Health and Family Services, which administers Medicaid, said Kentucky structured its 12-month recertification plan to first target those who are most likely to have obtained other health coverage. That includes up who people 65 and qualify for Medicare, the government plan for older Americans, or who have obtained coverage through employment.

Advocates agree with the approach but still worry that too many people who are eligible are losing coverage for failing to receive or respond to notifications from the state. With only a few months of data available, it’s hard to tell, said Beauregard.

“At this point, it’s too soon to know how many people are walking around uninsured and either don’t know it or think they are not eligible,” she said.

Preliminary numbers show as many as 40% of those losing Medicaid coverage may have obtained other health insurance. And about 3,000 people who lost coverage have been reinstated once they provided applications or documentation, such as proof of income or address, Friedlander said.

Meanwhile, about half of those targeted each month for Medicaid recertification don’t have to do anything at all. They are deemed eligible through “passive” renewal, in which the state is able to validate information such as income and household size by checking state and federal databases.

And those whose income has increased, making them no longer eligible for Medicaid, may be eligible for low-cost, federally-subsidized private plans through kynect, Kentucky’s online health insurance exchange, Medicaid Commissioner Lisa Lee said: “There really is something for everyone.”

Stakes high for kids

Kentucky's approach means thatg it has avoided cutting children from Medicaid. Advocates have sounded sound the alarm about other states where high numbers of children are losing coverage — most often for procedural reasons.

The tens of thousands of children losing coverage in some states prompted one group that monitors Medicaid to suggest states suspend terminating kids to determine what’s going wrong.

In Idaho, for example, around 23,000 children have been removed for failing to return recertification forms, according to the Idaho Capital Sun. Arkansas also has moved aggressively to cut people, including children, from Medicaid.

“The stakes are high,” said a blog post on the Georgetown University’s Health Policy Institute Center for Children and Families. “Gaps in coverage are problems for anyone — but especially for children, who, while not expensive, are regular users (or should be) of health care.”

Children and adults in rural states including Kentucky are especially dependent on Medicaid for health care, the center reported.

Nationwide, seven rural counties have half or more of their adults covered by Medicaid and six of those counties are in Kentucky, it said.

Around 600,000 Kentucky children have health coverage through Medicaid or the Children’s Health Insurance Program, known as CHIP, a Medicaid program for children whose parents earn too much to qualify but are still considered low-income.

That’s more than half the state’s children.

They will be among the last to be recertified under the 12-month process Kentucky began in May, Friedlander said.

‘Health care is expensive’

Meanwhile, state officials, advocacy groups, community clinics and others are working to alert Medicaid patients to the changes through notices, fliers, mail, phone calls, text messages and other means.

State officials set up an exhibit at the Kentucky State Fair to inform the public about changes, with private booths where state workers helped people apply for or renew coverage.

Advocates are especially concerned about those who might unknowingly lose coverage by not receiving or responding to a notice.

“It is important that individuals have insurance coverage because health care is expensive,” Lewis said. “A medical bill for something that’s not covered can be really debilitating.”

It could also affect community clinics that serve a high percentage of Medicaid patients and operate on tight budgets.

“It definitely can affect us from the bottom-line standpoint,” said Kirstie Matzek, CEO of the Shawnee Christian HealthCare Center, a federally authorized community health service in Louisville.

Matzek said her clinic staff has been attending events such as festivals and church picnics to hand out information. Staff also has been notifying patients about the Medicaid changes, she said.

“I know there’s a level of responsibility for the patient,” Matzek said. “But I think we have a responsibility as well.”

Saturday, August 26, 2023

Small 'summer spike' in Covid-19 cases in Kentucky attributable to a slightly more contagious strain; new shot recommended

People who last got a Covid vaccine last fall are starting to
see waning protection. (Getty Images photo via Kentucky Lantern)

By Sarah Ladd
Kentucky Lantern

The “vast majority” of Kentucky’s Covid-19 cases are now the variant EG.5 – also known as “Eris” – according to Louisville infectious disease expert Dr. Mark Burns.

This variant is “slightly more contagious … but overall not very different from the original Omicron” strain, Burns told journalists Wednesday.

EG.5 is an Omicron descendant, according to Yale Medicine. Its symptoms are “essentially the same” as those of other strands: fever, chills and other flu-like symptoms, according to Burns, who is also an associate professor of medicine at the University of Louisville.

The strain accounted for a fifth of cases around the United States, according to Centers for Disease Control and Prevention surveillance as of Aug. 19.

Kentucky data shows an increase in cases over the last few weeks, particularly among young children up to age 4.

That’s partly attributable to a small “summer spike,” Burns said. More folks have traveled recently, he said, and also congregated indoors during extreme heat.

Additionally, Burns said, people who last got a Covid-19 vaccine in the fall of 2022 are seeing waning protection. He said they should plan to get the new shot expected mid-September, which was designed to target omicron and its mutations.

“Overall, we’re still in a good place,” Burns said. “It’s much better now than it would have been in previous years.”

Still, folks should take their own risk factors into consideration when in a crowded, indoor space, Burns said.

“People who are elderly, people who are immunocompromised: If you’re going to be in a situation where there’s not good ventilation, then it might be wise for them to mask up,” he said.

Covid ‘here to stay’

More than 19,000 Kentuckians have died from Covid-19 since it hit Kentucky in March 2020. As of Aug. 21, only 58% of Kentuckians were fully vaccinated against the virus.

UofL Health had seven patients hospitalized with – not necessarily because of – Covid-19 as of Wednesday, a spokeswoman said. The system had no patients in intensive care and none on ventilators.

“The Covid virus, unfortunately, is one that we’re going to have to live with, but is no longer in the pandemic stage,” Burns said. “It looks like it’s going to be here to stay for a while and we will attack it just like we would influenza.”

There will “hopefully” be yearly vaccine updates, too, he said. That way, “just like you get your flu vaccine, you get your Covid vaccine as well.”

Friday, August 25, 2023

Free-market economist says certificates of need shouldn't be required for health facilities; hospitals, nursing homes disagree

John Garen (Lantern screenshot of KET legislative video)
By Sarah Ladd
Kentucky Lantern

Kentucky would be “well served by the improved access to health care” if it were to repeal its certificate-of-need laws, a retired economics professor told a legislative task force charged with examining the state’s CON structure.

University of Kentucky Professor Emeritus John Garen, who said he was speaking as an independent researcher, told legislators Aug. 21 that “the arguments made to justify certificate of need do not stand up to careful examination.”

“We should not have certificate of need on health-care services in general,” said Garen, who made his reputation as a free-market economist.

The certificate-of-need requirement mandates regulatory mechanisms for approving major capital expenditures and projects for certain health-care facilities, according to the National Conference of State Legislatures.

Sometimes called the “competitor’s veto,” 35 states and Washington, D.C., had such laws as of December 2021.

CON laws were passed with the notion that demonstrating a need for a health-care facility or service would prevent overbuilding and hold down costs, but Garen said the laws do not reduce health-care costs in general or improve quality care to underserved populations.

The Kentucky Association of Health Care Facilities, the Kentucky Home Care Association and the Kentucky Hospital Association previously testified before the task force that removing the CON review process would neither lower the cost of care nor improve its quality.

Proponents of keeping Kentucky’s CON rules in place argue that should they be repealed, competitors popping up would take away revenue-producing patients from hospitals, forcing closures or discontinuation of some services.

Sen. Stephen Meredith, R-Leitchfield, a former hospital adimistrator, said Kentucky can’t easily be compared to other places and must also be examined outside of the “average.”

“If we relied on ‘average,’ no one would ever drown in the Rio Grande,” Meredith said. “In the summertime, the average depth is three foot. Kentucky is not average. We get a lot of outlying situations, particularly for the poverty that we have in rural Kentucky, and even some of our urban areas have suffered the same problems.”

Representatives from Northern Kentucky’s St. Elizabeth Healthcare also testified, saying they support modernization of CON laws but not an outright repeal.

Mark Guilfoyle, an attorney with the Louisville firm DBL Law, who spoke alongside St. Elizabeth executive Sarah Giolando, said “certificate of need provides significant benefits,” such as access to care in rural areas.

Guilfoyle said the certificate-of-need law also reduces the need for more tax revenue for emergency medical services and incentivizes providers to serve disadvantaged patients and areas.

The next task force meeting is Sept. 18.

Thursday, August 24, 2023

Schools in Lee, Magoffin close due to Covid-19, other illnesses

Magoffin County Schools were empty Thursday, and were to be closed again Friday. (WKYT image)

The predicted "summer surge" of Covid-19 has been relatively small, but large enough in some Kentucky school districts to make them suspend classes.

Magoffin County schools closed Thursday and Friday, and Lee County schools also closed Tueday through Friday due to illness, WKYT reports. Thursday and Friday were nontraditional instruction days.

Magoffin County Health Department Director Pete Shepherd told the Lexington TV station that the outbreak therevstarted as a combination of illnesses, but is now mainly Covid-19: “We were seeing an uptick of absentees. They were saying Covid, but they were also putting strep throat in there, and there was a virus going around, a stomach virus.”

Shepherd added, “The last month before school, we hardly gave out any home tests. We started giving them out again, and we can’t get them fast enough to give them out.”

WKYT reports, "Shepherd says the district confirmed at least 40 cases on Monday and Tuesday alone, with many others testing at home and keeping their kids out of school. The uptick comes in advance of a new vaccine being rolled out to combat the latest Covid strain. It’s one which Shepherd doesn’t see his county taking much interest in."

He told the station, “Most parents are just -- their kids are going to get sick with it, we’ll hold them home and won’t send them to school. They’re not worried about vaccinations,” Shepherd said. “We can’t hardly give a vaccine away now for Covid.”

Shepherd said that is partly due to the mildness of cases reported so far, but he wants people who are at risk from the diseases to be careful as they spread. And students, too: “They are resilient, and they’re not getting us sick, so that’s the good thing, but we can always take precautions.”

State Health Commissioner Steven Stack "says everyone should consider the new vaccine as well once it’s available," WKYT notes.

"Baptist Health and UK Healthcare say they have nine and 22 Covid-19 patients, respectively. Laurel County is also tracking a rise in cases from school-aged kids. Dozens of people have recently reported having the virus in Laurel County. County health officials say more than 100 cases were reported last week, and about a third of those were in the local school system. The Woodford County Health Department is tracking an increase in Covid cases as well."

UK doctors of pharmacy answer questions about Covid vaccines

A UK vaccine clinic (UK photo by Mark Cornelison)
By Amy Picirilli

University of Kentucky

The Covid-19 public-health emergency may be officially over, but Covid has not completely disappeared from concern. Lexington hospitals are seeing an increase in Covid patients.

With a new Covid vaccine coming this fall, two doctors of pharmacy at the University of Kentucky's Pharmacist Care Clinic, Jim Hallahan and Ryan Babb, answer some questions you may have.

When will a new booster be available? The new booster is currently being developed. The Food and Drug Administration is expected to approve it by the end of August, with shots becoming available in late September or October.

Who should get the new Covid vaccine? The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices will provide guidance about who should get the vaccine when they approve it.

How will the new vaccine be different from what’s available now? Like the annual influenza vaccine, the new Covid vaccine will be targeted toward the strains of the virus that are most common in the community. In hopes of creating the broadest possible immunity for those who take the vaccine, this fall’s Covid vaccine is expected to be a monovalent formulation targeted toward the XBB.1.5 variant."

I am over 65 and/or have serious health issues. Should I get another booster now, before the new vaccine is available? It is advised that patients continue receiving boosters as they are eligible. For additional help regarding the timing of your vaccine series, you can call the UK Pharmacist Care Team at 859-562-2018.

When will the new vaccine be available? New booster vaccines are expected to be available shortly after FDA and CDC approval, which is expected to be in September or October.

If I am fully vaccinated and previously received required boosters, do I need to get the new vaccine? We expect the CDC to recommend this new booster to all eligible individuals this fall, regardless of previous vaccine history. The new vaccine’s formulation was created to target virus strains that are currently most prevalent in the community, helping to boost your immunity and fight severe infection.

Will there be a combined flu-Covid shot this year? No. Although researchers are working on this, a combined vaccine won’t be available this year.

Can I get the Covid and flu vaccines at the same time? Yes, receiving both at the same time has been shown to be both safe and effective.

I’ve had Covid; do I still need to get boosters? Getting a Covid-19 vaccine after you recover from Covid-19 infection provides added protection against getting the disease again. You may consider delaying your vaccine by three months from when your symptoms started or, if you had no symptoms, when you received a positive test. If you are currently infected with COVID, you should not get vaccinated until your quarantine period has ended to avoid potentially exposing health care personnel and others during the vaccination visit.

What should I do if I have never been vaccinated? Please call your local pharmacist; they can provide you with information on how to get started.

Wednesday, August 23, 2023

Kentucky is next to last in currency of nursing-home inspections, and it may not have hit bottom yet, health officials tell legislators

Kentucky is farther behind on nursing-home inspections than only one other state, and the huge backlog might last a long time, Beshear administration officials state officials warned a legislative committee Tuesday. That could leave health and safety problems undiscovered, reports John Cheves of the Lexington Herald-Leader.

“We’re waaay behind,” Health and Family Services Secretary Eric Friedlander told the Health and Human Services Delivery Task Force. “It’s gonna take us, if we’re lucky, a year to dig out of this.”

There are many reasons, he said, including the pandemic, but the main one is a lack of registered nurses, who "form the backbone of the health cabinet’s inspection teams," Cheves reports. Adam Mather, the cabinet's inspector general, said only 30 of the 83 nurse inspector positions are filled.

Adam Mather (KET image
via Lexington Herald-Leader)
“As a nurse myself, I’ve never seen a more challenging environment for the profession,” Mather said. “We’re just unfortunately, nationally, we’re not educating enough nurses to provide the care that’s needed in the country.”

The task force co-chair, Sen. Stephen Meredith, R-Leitchfield, said “We’ve got a very serious issue that kind of caught us by surprise.”

Cheves notes, "The Herald-Leader reported in July that 73 percent of Kentucky’s 277 nursing homes were listed as going more than two years without a so-called 'annual' inspection. According to federal data, only Maryland had a larger backlog, at 75 percent. The national backlog average is 11 percent." The figures come from the federal Centers for Medicare and Medicaid Services, which requires states to inspect nursing homes each year.

"Gov. Andy Beshear’s administration is trying a variety of possible solutions, including pay raises that have bumped the nurse positions from about $50,000 a year in 2020 to a salary range of $72,328 to $95,834," Cheves reports. "It’s also using private contractors to recruit nurses to the health cabinet and even to perform some facility inspections. And it’s creating a new career ladder at the health cabinet to allow licensed practical nurses, with less formal education than registered nurses, to be hired and advance while on the job, the officials said. In the meantime, as it works to reduce the inspection backlog, the cabinet will prioritize nursing homes that have a history of more serious citations or complaints, Mather said."

But Friedlander still isn't sure what they're doing will work. “I’m hoping we are at the nadir,” he said. “I’m hoping we’re at the bottom. But I cannot swear it to you all. It has been a tremendous challenge retaining and hiring nurses, and that’s exactly where we are.”

Tuesday, August 22, 2023

Cancer survivors in Appalachian Kentucky have greater risk of 2nd cancer than those in non-Appalachian counties, study finds

Cancer ribbons (Photo by Panuway Dansungnoen,
iStock/Getty Images Plus)
By Elizabeth Chapin
University of Kentucky

While cancer survivors have an increased risk of developing cancer in the future, that risk is notably higher in Kentucky and Appalachian Kentucky, according to a new UK Markey Cancer Center study.

Published in Frontiers in Oncology, the study shows that cancer survivors in Kentcky's 54 Appalachian counties had a significantly increased risk of developing cancer again (either the same cancer or a new type of cancer) compared to those in non-Appalachian Kentucky.

Survivors of smoking-related cancers in both Appalachian and non-Appalachian Kentucky were more likely to get cancer again, with no ststistical difference between the two regions.

SOAR map, adapted by Kentucky Health News
Kentucky has the nation’s highest rates of cancer incidence and death from cancer, with Appalachian Kentucky bearing the greatest burden, driven by health behaviors such as smoking and lack of screening.

The study's findings highlight the necessity for, and will help to inform, ongoing prevention interventions among cancer survivors in Kentucky.

"The higher risk of subsequent cancers, especially in Appalachia, emphasizes the importance of targeted interventions to address the specific challenges faced by survivors in this region,” said the study’s lead author Jill Kolesar, a professor in UK’s College of Pharmacy, director of the Markey Cancer Center’s Precision Medicine Center and co-director of Markey’s Molecular Tumor Board.

The research team examined data from more than 148,000 adult-onset cancer survivors who were diagnosed with first primary cancers between 2000 and 2014 and followed them for at least five years post-diagnosis. More than 12% of the survivors developed cancer again.

Among both men and women, larynx and lung cancers had the highest risk of redeveloping. While survivors from Kentucky's Appalachian counties have an increased likelihood of subsequent cancers, compared to those in non-Appalachian counties, that was not the case for smoking-related primary cancers, the study found.

Amid misinformation, few adults put significant trust in any health institution or media to be accurate about health topics, poll finds

Many falsely believe that a dewormer can treat Covid-19.
(Photo by Dimas Ardian, Bloomberg, via Getty Images)
By Darius Tahir
KFF Health News

Around 3 in 10 Americans still believe ivermectin, a dewormer for animals, is an effective treatment for Covid-19. And few of them place significant trust in any form of news media or official institution to accurately convey information about health topics, from covid treatments and vaccines to reproductive health issues. So says a new poll from the Kaiser Family Foundation, an independent source of health-policy research, polling and journalism.

The confusion about what’s true — and who’s telling the truth — is of critical importance to public health, experts in political science said. “Misinformation leads to lives being lost and health problems not being resolved,” Bob Blendon, a professor emeritus of public health at Harvard University, said in an interview. Blendon was not associated with the survey.

The KFF poll of 2,007 U.S. adults found that nearly a third said ivermectin was definitely or probably an effective treatment for Covid-19. It’s not. Numerous randomized controlled trials have found otherwise. But only 22% in the poll thought ivermectin was definitely ineffective.

A fifth of those polled thought it was definitely or probably true that the Covid-19 vaccine had killed more people than the virus itself. Under half, 47%, thought that claim was definitely false, which it is. And 30% of respondents thought parents should not be required to vaccinate their children against measles, mumps and rubella, which all states do.

The prevalence of vaccine misinformation is “alarming,” said Brendan Nyhan, a professor of government at Dartmouth College who has spent years studying the transmission of false information.

Lunna Lopes, a senior survey analyst at KFF and one of the poll’s authors, said the results show wide exposure to, but limited uptake of, false claims. “Just because they’re exposed to it doesn’t mean they’re buying into it,” she said. Still, the din of misinformation might leave the populace unsure what to believe. “You might be less trusting, and less likely to outright reject false information.”

The poll also found only grudging trust, at best, for media sources of all kinds and the federal government. The limited trust the survey recorded is colored by wide partisan gaps, noted Nyhan.

KFF Health News graph; for a larger version, click on it.
Respondents did not have “a lot” of trust in the information relayed by any news media institution. Just over a quarter had this high level of trust for local TV news, and that was the highest mark of the news media tested, which ran the ideological and stylistic gamut from MSNBC to The New York Times to Fox News and Newsmax. More people had just “a little” trust in each of these institutions.

For Blendon, the mildness of the trust is a problem. It suggests that “we are short” of trusted sources of news about health.

He said journalists and editors should consider that there’s “something about the way you’re presenting information that’s not seen as credible by viewers.” Seventy percent of those in the poll said news media don't do enough to limit the spread of health misinformation, and 69% said social-media companies weren't doing enough.

Blendon said the public conversation about these topics tends to focus on the often-extreme declarations and wild claims featured on social media and on corporate and government attempts to regulate the medium. 

While the poll shows Americans use social media quite frequently, they have very little faith in the health information they see there. No social media outlet enjoyed a double-digit percentage of respondents saying they had “a lot” of trust in it.

Even so, said Lopes, a significant slice of the public — about a quarter — turn to these platforms for health information and advice. “That stood out to us,” she said. Latinos and the young are especially likely to use the forums.

KFF Health News graph; for a larger version, click on it.
The picture is similarly bleak for official institutions. Around a quarter of respondents said they had “a great deal” of trust in the Centers for Disease Control and Prevention’s recommendations. That dropped to a fifth when it came to the Food and Drug Administration. The Biden administration and Donald Trump lagged behind.

Asked about state and local public-health officials, 13% said they trusted them "a great deal" and 51% said "a fair amount, ranking their overall trust just behind the FDA and the CDC.

Those numbers, combined with the partisan gaps in trust, were especially discouraging for Nyhan. “They will be essential sources of information in future pandemics despite their errors and misjudgments during the pandemic,” he said of public-health institutions.

By far the most highly trusted source of health information? One’s own doctor. Forty-eight percent of respondents had a great deal of trust in their recommendations.

The survey, the KFF Health Misinformation Tracking Poll Pilot, was conducted May 23 through June 12, online and by telephone among a nationally representative sample of U.S. adults in English and Spanish.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF.

More than 1/3 of U.S. heart-attack and stroke survivors don't take aspirin to prevent a second one, 40 years after it was first advised

People who have experienced a heart attack or stroke have prevented another one from happening by taking a daily aspirin. But fewer than half of heart attack or stroke victims worldwide take the inexpensive medication, according to a study in the Journal of the American Medical Association.

“Survivors of heart attacks and stroke often face a high risk of having subsequent events,” said lead researcher Dr. Sang Gune Yoo,  a cardiovascular disease fellow at the Washington University School of Medicine in St. Louis. “In fact, many people die from having recurring attacks. Aspirin offers one effective and relatively low-cost option for reducing the likelihood of additional events in individuals with established cardiovascular disease, and yet most people who could benefit from a daily aspirin don’t take it.”

Graphic by Mike Worful, Washington University, adapted by Ky. Health News
For more than 40 years, research has established that aspirin can reduce the risk of a second heart attack or stroke, by about 25 percent. But more than a third of survivors in the United States and other high-income countries do not take it, according to the study, which looked at a wide range of countries. Generally, the lower a country's average per-capita income, the less likely survivors were to take aspirin; in low-income nations, only 17% do.

The study didn't explain those figures, but Yoo said likely reasons include varying access to health care, inconsistent messaging surrounding use of the drug, and the fact that aspirin is a prescription drug in some countries.

Aspirin is a blood thinner, preventing small blood cells called platelets from forming clots. These clots can block arteries and contribute to a reduction in the amount of oxygen-rich blood being delivered to vital organs. Such blockage also can cause other complications, including a heart attack or stroke.

The study notes that cardiovascular disease, including heart attack and stroke, is the world's leading cause of death. Contributing factors include smoking, diabetes, unhealthy diet, genetics, lack of exercise, obesity and air pollution. 

The researchers analyzed data from nationally representative health surveys in 51 countries. The surveys included questions about people’s medical history of cardiovascular disease and on aspirin use. The study included 125,505 people, with 10,590 self-reporting a history of cardiovascular disease.

Sunday, August 20, 2023

New vaccines being released next month for Covid-19, the flu and RSV are expected to curb ever-mutating respiratory viruses

Johns Hopkins Bloomberg School of Public Health photo
Kentucky Health News

Americans will have access to several vaccines this fall to protect them against respiratory viruses, including Covid-19, influenza and respiratory syncytial virus (RSV), but effectively deploying them is expected to be challenging and confusing.

With the latest major mutation of the Covid-19 virus, "We have to have a lot of humility . . . There are a lot of things we don’t understand," Dr. Scott Gottlieb, a former Food and Drug Administration commissioner who is on the board of vaccine maker Pfizer, said on CBS's "Face the Nation" Sunday.

Gottlieb said studies are underway "to look at whether the new vaccine also covers this BA.2.86 variant . . . and we'll have that data by the time the new vaccines become available. So by the time these are out in September, consumers will know how well it covers that new variant. We'll also probably know whether or not it's spreading."

Confusion about respitratory virus is “absolutely overwhelming, especially for our patients,” Sterling Ransone, a doctor in rural Virginia and board chair of the American Academy of Family Physicians, told Fenit Nirappil and Lena H. Sun of The Washington Post

They report, "An updated Covid booster should be available by late September. Flu shots are arriving at doctors’ offices. And for the first time, infants and seniors could be immunized against respiratory syncytial virus, a persistent foe that public health officials had few ways to prevent." 

The upcoming vaccine campaign comes at a higher cost to insurers and health practices, because the federal government is no longer footing the bill for Covid vaccines. And, providers need more guidance on how to sequence the shots and the risks of giving them together. And there are other issues that can't be addressed until all of the vaccines are formally approved. 

"Doctors have to figure out how to explain the nuances and unknowns of new vaccines at a time of rampant misinformation," the Post reporters write. "Patients perplexed by changing coronavirus vaccine guidance now have more shots to consider. Public health officials worry a messy rollout could further erode confidence in routine vaccination and risk overwhelming the health-care system with preventable cases of RSV, flu and Covid."

The updated Covid booster, designed to work on the XBB strain of the virus,which became dominant this year, marks the shift to an annual vaccination for all age groups, similar to the fall flu vaccine. 

"The FDA is expected to sign off on the updated covid boosters by mid-September, according to officials familiar with the plan. The CDC’s vaccine advisory panel is expected to meet shortly thereafter to recommend who should get the shots — probably everyone 6 months and older. Babies under 6 months are assumed to have antibodies passed along from their mothers. CDC Director Mandy Cohen has said the vaccines should be available for most people by the third or fourth week of September," Nirappil and Sun report.

And as for concerns about getting the three shots at once, the authors write, "The CDC says it has not seen data suggesting safety concerns co-administering covid and flu shots, which could improve uptake of both vaccines. But clinical trials for the RSV vaccines found rare instances of severe side effects in people who received an influenza vaccine at the same time. It’s unclear if it was a statistical fluke or a consequence of co-administering the vaccines. Still, providers must weigh the potential for rare side effects against the potential harm of seniors contracting a severe case of a virus they are not vaccinated against." 

Gottlieb said he expects Covid-19 to follows "a flu-like pattern, with new variants each year." He said this year’s flu vaccine appears to be effective, based on results in South America, where the southern part of the continent is in winter.