Health-care leaders urge Kentuckians to act now to secure 'life-changing' insurance coverage before it's too late; help available

By Dr. Lori Caloia, Dr. Jason Smith and Dr. James Frazier

Access to health-care services, doctors, vaccines, medications, therapies and guidance can have life-changing consequences. Health-care coverage is not a "nice to have." It’s a must-have. And it’s available for Kentuckians of all ages. And for those enrolled in Medicaid, action is required to stay covered.

During the pandemic, the federal government enacted a Public Health Emergency, which meant that individuals covered by Medicaid were allowed to stay in the program regardless of whether their eligibility had changed. This was to prevent coverage gaps during the health crisis. But renewals have now restarted, and people covered by Medicaid must act to keep coverage or find a new health plan.

Action must be taken to ensure coverage

Medicaid renewals in Kentucky began again last April, and 1.6 million Kentuckians – 37% of our state’s population – are being asked to show their eligibility for Medicaid and the Children’s Health Insurance Program.

Acting now is critical. Many people are unaware that their coverage may be ending, or may have already ended. Data from Kentucky and across the country shows that millions have lost Medicaid coverage but have not transitioned to other health insurance plans through an employer or Kynect, Kentucky’s state Health Benefit Exchange. Of course, going without health insurance is dangerous medically and financially, and it’s unnecessary when Affordable Care Act plans are available for as little as $0.

Take steps now to make sure you have coverage. Even if you’re not enrolled in Medicaid, affordable health insurance for you and your family is available.

What to know about renewing and enrolling in health-care coverage

Many resources have been made available to help Americans understand and take advantage of options to stay covered. In fact, the Commonwealth of Kentucky and Anthem Blue Cross and Blue Shield in Kentucky both offer tools and resources to help people easily understand their options and access the coverage that meets their needs. Anthem offers MyHealthBenefitFinder.com, a self-service tool allowing anyone to answer a few, simple questions, and get information that helps them understand the types of health coverage they may be eligible for. The tool then provides clear steps on how to access that coverage. Anthem also offers a dedicated call center for those who have questions about navigating the Medicaid renewal process. Call 1-855-690-7784 (TTY 711), Monday through Friday, 7 a.m. to 7 p.m.  

The Kentucky Health Benefit Exchange, at khbe.ky.gov, is full of information, resources, agents, and health coverage guides called Kynectors who can answer questions and help you understand your coverage options. HealthCare.gov is another warehouse of information, quick start guides as well as connections to healthcare navigators and brokers in each community.

Affordable, accessible coverage is available for people of all ages and most circumstances. It just takes action to secure that coverage. That’s why Anthem is urging Kentuckians to start the new year by spending time following up on where they, their loved ones, and acquaintances stand with their healthcare coverage. If help is needed, take advantage of the resources that are available. Taking just a few minutes could make a life-changing difference.

Dr. Lori Caloia is the medical director for Anthem Blue Cross and Blue Shield in Kentucky. Dr. James Frazier is chief medical officer at Norton Healthcare. Dr. Jason Smith is chief medical officer at University of Louisville Health and p rofessor at the University of Louisville.

Fewer Kentuckians enrolled in federally subsidized health plans for 2023, likely because many of them could remain on Medicaid

By Melissa Patrick

Kentucky Health News

Fewer Kentuckians signed up for a government-subsidized health plan on Kynect, the state-based marketplace, in 2023 than in the previous two years, likely because more of them qualified for Medicaid during the pandemic and were still covered by it. 

The final Centers for Medicare & Medicaid Services 2023 open enrollment report shows 62,562 Kentuckians signed up for health insurance on Kynect through Jan. 15, which was the last day to enroll.  That's a 15% drop from 73,935 in 2022 and a 19% drop from 77,821 in 2021, according to last year's report. 

"Our best guess is that more Kentuckians are currently covered by Medicaid right now because of the continuous-eligibility provision that's been in place during the pandemic," Emily Beauregard, executive director at Kentucky Voices for Health, said in an email. "When renewals begin this spring, we expect some Kentuckians enrolled in Medicaid to move" to a private but federally subsidized Qualified Health Plan. 

Beauregard referred to the end of a federal program that kept people continuously enrolled on Medicaid during the pandemic without the need to re-enroll and certify their incomes to qualify. This program will end March 31, under an end-of-year omnibus law that requires Medicaid agencies to restart their annual renewal process. This process has been dubbed "Medicaid unwinding." 

At a Jan. 12 state Senate and House Joint Health Services Committee meeting, Veronica Judy-Cecil, senior deputy commissioner of the state Department for Medicaid Services, gave a snapshot of how many Kentuckians this will affect.

She said the state estimates that of the 1.7 million Kentuckians on Medicaid, 243,368, about 14%, will lose eligibility during the unwinding. Slides presented at Beshear's Feb. 2 news conference indicated that the estimated number of people impacted by the unwinding has gone up to 260,000.

Of that group, an estimated 85,400 have incomes over 138% of the federal poverty level, the Medicaid limit, and will qualify for a qualified health plan with federal tax credits through Kynect. 

Private insurance plans purchased on Kynect offer significant tax subsidies to offset insurance costs for people earning between 100% and 400% of the federal poverty level, or between $13,590 and $54,360 for an individual. About 80% of enrollees nationwide qualify for subsidies that reduce their monthly payments to less than $10, according to the federal Department of Health and Human Services.

Special enrollment period for health insurance on healthcare.gov ends Aug. 15; subsidies are bigger, and more people qualify

By Melissa Patrick
Kentucky Health News

Time is running out to sign up for low- or no-cost health insurance through the federal marketplace under the special enrollment created by Congress and President Biden. The deadline to sign up on healthcare.gov is Aug. 15. 

AARP illustration

The president reopened the marketplace in mid-February under the American Rescue Plan Act, for people who needed coverage during the pandemic, and later extended the deadline to Aug. 15. 

The special enrollment is open to both new and existing customers, including the thousands of Kentuckians who got temporary Medicaid coverage during the pandemic through the state's "presumptive eligibility" program. 

About 120,000 Kentuckians lost that temporary Medicaid coverage in July, according to Brice Mitchell, a spokesman for the state Cabinet for Health and Family Services.  

Mitchell said the state has told some of those people they would be losing their coverage and encouraged them to check kynect.ky.gov to see if they qualify for traditional Medicaid, or go healthcare.gov to apply for a federally subsidized plan. He said state Kynectors, who help people enroll, will continue the outreach through August. 

Dustin Pugel, senior policy analyst at the Kentucky Center for Economic Policy, encouraged Kentuckians who recently lost their temporary Medicaid coverage and are not covered by work or traditional Medicaid to "Run, not walk, to the marketplace to find an affordable option." 

Priscilla Easterling, the outreach coordinator for Kentucky Voices for Health and a Kynector, also encouraged Kentuckians without health coverage to explore their options on healthcare.gov, especially those who looked at plans in the past and found them unaffordable at that time.

"With the increased subsidies that the American Rescue Plan included . . . we have seen so many people save a surprising amount of money," Easterling said. "It is 100-percent worth just checking it out. . . . It's a totally different ballgame."

A federal report says 34% of those who got a subsidized plan since April 1 paid $10 or less a month for their coverage, thanks to the American Rescue Plan's premium reductions. In Kentucky, 32% of new customers and 19% of returning customers were able to find a plan for $10 or less per month. 

In the special enrollment period, plans are more affordable due to bigger premium subsidies through tax credits, and no repayments are required if a tax return shows they didn't qualify for the tax credit. Also, more people eligible for the subsidies, and costs are limited to no more than 8.5% of income, down from nearly 10%.

For the first time, the new rules allow those earning more than 400% of the federal poverty level -- about $51,000 for an individual and $104,800 for a family of four in 2021 -- to get a subsidized plan. 

This change is especially helpful to older adults with incomes above 400% of the poverty level, because unlike traditional health plans, which are allowed to charge more based on age, special-enrollment premiums are capped at 8.5% of income.

"Compared to current premium payments, a 60-year-old with a $55,000 income would pay 77% less for a bronze plan ($146 vs. $634 per month), 56% less for a benchmark silver plan ($390 vs. $887 per month), and 52% less for a gold plan ($453 vs. $951 per month), on average," says the Kaiser Family Foundation.

Also benefiting from this expansion to 400% of the poverty line are self-employed people who have not had access to affordable health insurance. "As wonderful as the Affordable Care Act was to open up affordable coverage for so many people," Pugel said. "It really did leave that group of folks out." 

Through the end of June, 13,773 Kentuckians had signed up for health insurance during the special enrollment period, according to a federal report. That's an increase from the special enrollment periods in 2020 and 2019, when 6,747 and 7,041 signed up, respectively. 

But fewer than 10% of eligible Kentuckians have taken advantage of the opportunity. Easterling said about 115,000 Kentuckians who qualify for a subsidy under the special enrollment period have not yet signed up.

Nationwide, more than 2 million have signed up.

Open enrollment is usually in effect only six weeks at the end of a year, except for those who experience a "qualifying life event," like getting married or losing a job. After the special enrollment period closes on Aug. 15, open enrollment will re-open Nov. 1.

Biden's American Families Plan would make some of these measures permanent, including the bigger tax credits, coverage to those who earn 400% and above the federal poverty level, and the premium cap of 8.5% of household income. Those measures will stop at the end of 2022 unless Congress makes them permanent.

Dec. 15 is the deadline to sign up for federally subsidized health insurance; Kentucky enrollment is running behind last year's

By Melissa Patrick

Kentucky Health News

The deadline to enroll in federally subsidized health insurance for 2021 is fast approaching, with the last day Tuesday, Dec. 15 to sign up for coverage that starts Jan. 1.  

And while anyone already enrolled will automatically be re-enrolled in a 2021 marketplace plan, it is highly recommended that you check out other options to make sure your current plan still meets your needs. 

“It’s very important for individuals to update their applications, even if they were covered last year, so they can review the most current information on what savings are available and to find a plan that best meets their needs,” Kentucky Health Benefit Exchange Director Edith Slone said in a news release.  

Some things to consider when choosing coverage are whether the number of people in your household has changed, whether your income or medical needs have changed -- which is especially important this year because of the pandemic -- and whether the plan includes your providers or their formularies include your prescriptions.

Consumers are also encouraged to not only look at premium costs, but to also look at annual deductibles, which must be met before much of the coverage will kick in. 

And don't assume you can't afford coverage. The Cabinet for Health and Family Services says about 80 percent of Kentuckians who sign up on healthcare.gov will qualify for a tax credit or subsidy to reduce their monthly payments. 

Under the 2010 Patient Protection and Affordable Care Act, subsidies to offset premium costs are available on a sliding scale for people who earn between 100% and 400% of the federal poverty level. That range next year is $12,760 to $51,040 for an individual and $26,200 to $104,800 for a family of four, says Kaiser Health News, in an article that addresses how to choose a plan if you've had covid-19 and are worried about possible long-term complications.

Map shows Anthem marketplace plan availability by county.

In addition, many Kentuckians will have more choices this year, probably at a slightly higher cost, since Anthem Health Plans and CareSource both expanded their coverage areas, giving 94 of the state's 120 counties more than one company to choose from. This year, only 56 counties had two insurers on the healthcare.gov marketplace. 

Anthem is offering at least one of its 13 plans in all 120 counties in 2021, up from 93 in 2020. CareSource is offering all 12 of its plans in 94 counties, up from 83 in 2020.

Through the end of November, 2,939 fewer Kentuckians had enrolled on the federal exchange than at the same time last year. That was 12.2% less than at this time last year, but because of calendar procession, this year's tally had two fewer days, or 6.7% fewer. Nationally, more people had signed up compared to last November. 

Map shows CareSource plan counties in blue.

As of Nov. 28, Kentucky's enrollment on the federal exchange was 24,043, compared to 26,982 last year, according to the Centers for Medicaid and Medicare Services. None of these numbers reflect any automatic re-enrollments.

"We expected numbers would be less this year due to the pandemic," Susan Dunlap, spokeswoman for the health cabinet, said in an e-mail. " More are qualifying for presumptive-eligibility Medicaid coverage and traditional Medicaid coverage due to loss of income" in the coronavirus pandemic.

Another challenge may be a lack of awareness about the Affordable Care Act coverage on the marketplace, which is most widely known as Obamacare. The Kaiser Family Foundation reports that its polling found public awareness about the 10-year-old law is falling, compared to a decade ago.

"For example, 59% of the public knows the ACA offers subsidies for marketplace health plans, compared to 75% ten years ago," the foundation reports. "Among uninsured consumers today, understanding of ACA options and enrollment rules is more limited. Less than half (43%) know open enrollment is the time to sign up for marketplace plans; and 14% of uninsured individuals living in states that have expanded Medicaid eligibility under the ACA know about this expansion. KFF also finds many consumers are unsure about the current status of the ACA; as of this spring, just 22% of the uninsured know the law remains in effect. Uncertainty may result in part due to public debate and news coverage about a pending Supreme Court case to overturn the law." 

The health cabinet said it is reaching out to current and potential enrollees via direct mail, emails, phone calls, and community outreach events held by local Kynectors, who help people enroll.  

The foundation says the importance of health coverage is greater than ever because of the surge of new coronavirus infections, which can cost upwards of $10,000 for a mild-infection and tens of thousands of dollars for more severe cases. 

"At the very least, people with ACA-compliant private insurance are protected by out-of-pocket maximums, limiting how much enrollees must pay for a hospitalization. There is currently no guarantee that hospitals waive covid-19 treatment costs for uninsured patients, meaning those without coverage could be on the hook for large medical bills," the foundation reports.

It's important to not miss the Dec. 15 deadline because unless you qualify for a special enrollment period, you won't get another chance until next year. 

Where can I find help?

The state-based call center is available at 855-459-6328 to assist Kentuckians with questions about  where to go for coverage, answer questions and pre-screen for eligibility. The Healthcare.gov customer service center (800-318-2596) is also available 24 hours a day, seven days a week, excluding holidays.

Click here to find a Kynector, who can provide in-person help with applying for health coverage at no cost. Click here for information on how to assign an authorized representative to apply for or manage your benefits, Kynectors, and insurance agents, who can also help you sign up for benefits. 

Healthcare.gov provides a shopping tool to allow you to preview 2021 plans and estimated prices before you log in.

Healthinsurance.org also offers an Open Enrollment 2021 Guide.

The Kaiser Family Foundation also offers a Health Insurance Marketplace Calculator to provide estimates of health insurance premiums and subsidies for people purchasing insurance on their own on Healthcare.gov. It allows you to enter your income, age and family size to estimate your eligibility for subsidies and how much you should spend on health insurance. It will also allow you to see if you qualify for Medicaid.

Broker says Anthem's new short-term plan will undermine Obamacare; Anthem says it's designed to complement ACA plans

Screenshot of Anthem Enhanced Choice website

By Melissa Patrick

Kentucky Health News

This story has been updated to reflect that the Anthem Enhanced Choice plans cover all 10 of the required Essential Benefits that are included in the Affordable Care Act. .

Anthem Blue Cross Blue Shield is offering a new, short-term health plan that one insurance broker says could lead to destruction of the Patient Protection and Affordable Care Act, often called Obamacare.

Joel Thompson, a longtime independent broker at LessSellingMoreHelping.com, says six new Anthem plans called "Enhanced Choice" are being marketed as an alternative to ACA plans for healthy people who make too much money to qualify for financial assistance through a tax credit on an ACA plan. 

"What this could have the effect of doing," Thompson said, "is to draw the healthy people out of the ACA insurance pool and take us a step closer to the dreaded death spiral, as far as only the unhealthy being given coverage through the ACA."

Anthem disagreed, and said its new plan is offered as a complement to its ACA marketplace plans, not as a replacement. 

"Anthem offers 2021 ACA marketplace options in every county in Kentucky and is committed to the individual market," Anthem spokesman Jeff Blunt said in an e-mail. "We also know that one size does not fit all in health care. Marketplace plans are a great option for many, but not all." 

He said the plans "were designed as an option for those who don’t qualify for a federal subsidy or have access to employer-sponsored health plans: the working uninsured, for example. Especially now, in the wake of the pandemic, we must find new ways provide more Kentuckians affordable access to care."

Anthem, the nation's second largest health insurer, is offering Enhanced Choice in Kentucky, Indiana, Ohio, Missouri, Wisconsin and Georgia. 

Open enrollment runs through Dec. 15 on healthcare.gov for ACA plans that will take effect on Jan. 1. Short-term plans like Enhanced Choice are not sold on the marketplace and can be bought at any time. 

On its website, Anthem calls the new plan a budget-friendly option for people without health coverage who do not qualify for ACA subsidies. It notes that "Coverage and cost varies based on where you live, the plan you choose, your age, gender, medical history and tobacco usage." 

Thompson said, "The bottom line -- this is pre-existing conditions being snuck into the system by Anthem. It's like a fly in the oatmeal. It's something they are hoping people don't see, but it has the potential to being the first step toward destroying the ACA marketplace." 

The Anthem website that offers details of the Enhanced Choice plan says it is not required to comply with certain federal market requirements for health insurance, principally those contained in the ACA, and that consumers need to "check your policy carefully to make sure you are aware of any exclusions or limitations regarding coverage of pre-existing conditions or health benefits."

Blunt said the plan covers the 10 essential benefits required by the ACA, including hospitals, prescriptions, office visits to physicians and specialists, urgent and emergency care and 100% payment for preventive care, pregnancy, maternity, and newborns; mental health and substance use disorder treatment;  rehabilitative and habilitative services; laboratory services; and pediatrics. It also covers telehealth visits, which have become increasingly common during the coronavirus pandemic. 

The Anthem website notes that Enhanced Choice may have limits on lifetime and/or annual dollar limits on health benefits. That appears to be $1 million per member, per benefit period, according to the website. Expiration or loss of eligibility for coverage could result in having to wait until the next open enrollment period begins to get other coverage. 

Thompson, who is based in Ceredo, W.Va., near Ashland, said Anthem has made the plan attractive to Kentucky consumers by offering a network of providers for it that is wider than those for its ACA plans. 

And, he said, they have made it more enticing for brokers by paying twice as much commission on sales of the plan than what it pays for selling an ACA plan. Anthem says that this added commission is offered to accommodate a more laborious enrollment process than is required with ACA plans. 

The Enhanced Choice plan also allows a consumer to apply only once for nearly 36 months of continuous coverage.

Blunt said the plan is already generating a lot of interest: "In just the first two weeks of Anthem Enhanced Choice availability in Kentucky, we’ve seen a tremendous response both in terms of consumer interest and enrollment."

Thompson recognized the attractiveness of this new plan for healthy Kentuckians who make more than 400 percent of the federal poverty level, which is the cut-off for a marketplace subsidy. Without a subsidy, Thompson said, ACA plans can be "quite expensive."

In order to get the tax credit for ACA coverage starting in 2021, an enrollee must make between 100% and 400% of the poverty level. "In 2021, the subsidy range in the continental U.S. is from $12,760 to $51,040 for an individual and from $26,200 to $104,800 for a family of four," according to the Kaiser Family Foundation.  

Thompson said, "Frankly, if I'm in the best interest of the consumer, there's no way I would not show them this plan, even though I totally oppose its existence, because my role is to always work in the best interest of the consumer." 

Nevertheless, he added, "It's not something that I think needs to be or should be competing with the ACA."

Thompson said the ACA works because all the underwriting differences have to be uniform across all carriers. "What Anthem is doing here is saying, 'Hey, we're going to be offering something that's off the market,' but it has the severe potential of disrupting the market, especially if it catches on," he said. "This is more of a threat to the ACA than what's in the Supreme Court, by far."

The court heard arguments last week in a challenge to the ACA's constitutionality, but justices' comments indicated that they were unlikely to throw out the law.

Many times, losing your job also means losing health insurance; here's a guide to replacing your employer-paid coverage

By Trudy Lieberman

Community Health News Service

The growing numbers of unemployed Americans – likely to hit 20 million or more due to the coronavirus – bring with them a loss of employer-provided health insurance coverage. The pandemic has laid bare the deficiencies in America’s main vehicle for providing health insurance.

The system, which grew up after World War II as a way to attract workers, had already begun to decline. Over the past 20 years the share of non-elderly Americans covered by job-based insurance dropped from 68 percent to 57 percent, and the drop has occurred in the heart of the middle class: all income groups below $104,800 for a family of four and about $51,000 for a single person.

Those grim statistics raise a crucial question: How will middle-income people who are laid off be able to pay for insurance on their own, let alone the deductibles, coinsurance, and co-payments that come with policies these days? Many cannot.

If you are in this predicament or know someone who is, this column lays out the main options available. A warning: All have drawbacks, but here's a general rule: The best choice is usually the option that gives you the greatest coverage, for the lowest price, for the longest time.

COBRA: The Consolidated Omnibus Budget Act of 1985 gave employees who lose job-based coverage the right to remain on their employers’ policies for at least 18 months, and longer under some circumstances.

COBRA applies to workplaces with 20 or more employees, and those who lose their jobs have to pay the premium plus a small administrative fee. The average annual family premium for employer-provided coverage last year was $20,500, with the employee paying only $6,000 of that amount, so this isn’t likely to be a great option for someone who was just laid off, unless they can tap their savings.

Patient Protection and Affordable Care Act policies are a better option for many laid-off workers, but can be problematic for some. Those with low and middling incomes – below 250 percent of poverty, or a little more than $64,000 for a family of four – should consider an ACA policy. You’ll get government help paying the premium and, most importantly, the deductibles, coinsurance, and co-pays, which are increasingly pinching family budgets, making it hard for them to afford care.

Families with incomes between 250 percent and 400 percent of poverty (nearly $105,000 for the family of four) get less premium-payment help, declining as income rises. The biggest problem for families in this group is that there is no help for deductibles, co-insurance, and co-pays. That makes these policies less attractive, especially when someone gets sick and finds that a deductible of $8,000 means they won’t get any help until they have paid at least that amount out of pocket.

If you don’t qualify for cost-sharing subsidies, you’ll have to make a choice: Go with a cheaper premium but higher cost sharing, and be prepared to pay more if you get sick; or, pay more up front and have more protection when illness strikes.

Since the president has declined to open the ACA marketplaces, you’ll have to apply for a policy through a special provision that lets people enroll if they’ve lost employer coverage in the last 60 days or expect to lose it in the next 60 days. You can also qualify if you’ve lost coverage you had through a family member. Kentucky's site for ACA plans is healthbenefitexchange.ky.gov.

Remember that having a preexisting health condition is not a barrier to obtaining an ACA policy. That is a huge help to anyone who is ill.

Medicaid is a good option for people with low incomes. Administered by states, it is largely free, and provides comprehensive coverage, but only to people in households with annual incomes under 138 percent of the federal poverty line (in most states, which like Kentucky expanded Medicaid under the ACA). The Families First Coronavirus Response Act that Congress passed March 18 bans states from disenrolling anyone who was covered by Medicaid as of that date, making it easier to maintain coverage.

Kentucky has made it easier to apply for Medicaid, reducing its 20-page application to one page and presuming eligibility. Apply by calling 1-855-459-6328 or online at Benefind.ky.gov.

(There has been confusion over whether to sign up for presumptive-eligibility Medicaid or the traditional programEmily Beauregard, says executive director of Kentucky Voices for Health, a nonprofit advocacy group. "Beauregard said people who have lost jobs should apply for presumptive eligibility first," the Lexington Herald-Leader reports. "If someone still needs health insurance after the two months or June 30 deadline is up, then they should apply for traditional Medicaid. Eligibility for that program is based on household income. If people don’t qualify for traditional Medicaid and have lost their jobs, they should try to get insurance on the ACA exchange, Beauregard said.")

Short-term policies are an alternative made available last year by the Trump administration. They offer coverage for up to three years and can cost half as much as more comprehensive policies. But they generally don’t cover preexisting conditions and often don’t cover maternity care, mental-health treatment or prescription drugs. I call them the “buyer-beware” option because some consumers have purchased them only to be left with large bills when they got sick. If you’re offered one of these, proceed with extreme caution.

Navigating this marketplace has never been easy. Send your health policy questions and concerns to Trudy at trudy.lieberman@gmail.com.

Sunday, Dec. 15, is the deadline to sign up for federally subsidized health insurance, better known as Obamacare

By Melissa Patrick
Kentucky Health News

Time is running out to sign up for federally subsidized health insurance for 2020. The deadline for enrollment on Healthcare.gov is Sunday, Dec. 15, and fewer Kentuckians have enrolled than at this time last year.

Five weeks into to the six-week enrollment period, Kentucky enrollment on the federal exchange was

26,982. That was 3,190 fewer than the 30,172 who had enrolled by that time last year. Nationally, 321,165 fewer people had signed up.

The numbers for both years only reflect people who had signed up for a new plan or who had actively chosen a plan. Those who already have plans on Healthcare.gov and don't choose a new one will be automatically re-enrolled, and those numbers haven't yet been included in the enrollment reports.

Even if you have a plan on Healthcare.gov, experts say it's a good idea to look at all of your options each year to make sure you have the plan that best suits your needs or offers the best cost.

Josh Peck, the founder of Get America Covered, told Inside Health Policy that while it's concerning that the numbers are down, new enrollees are up nationally compared to last year, which "could bode well for final sign-up totals." Further, he noted that there is usually a surge of enrollment during the last weeks of sign-ups.

Don't assume you can't afford coverage, because most people using the marketplace qualify for financial help to lower their costs. In 2019, 79 percent of Kentuckians enrolled through the federal exchange qualified for tax credits and subsidies that reduced their premiums.

Update 12/10/19: A Kaiser Family Foundation report published Dec. 10 found that 31% of uninsured Kentuckians who could be shopping on the marketplace were eligible for premium subsidies large enough to cover the entire cost of a bronze plan, which is the minimum level of coverage available on Healthcare.gov.

"Rather than continuing to go without insurance, the 4.7 million uninsured people eligible for no-premium bronze plans would benefit from the financial protection health insurance offers. While bronze plans have high deductibles, they all cover preventive care with no out-of-pocket costs, and a number of bronze plans cover additional services, such as a few physician visits, before the deductible. If a low-income enrollee in a bronze plan needs a hospitalization, they will likely have difficulty affording the deductible, but the deductible will also likely be much less than the cost of a hospitalization without insurance," says the report. 

A person should qualify for a federal subsidy, or a tax credit, with an income between 100% and  400% of the federal poverty level. The federal government has an online calculator that indicates whether you fall into this bracket.

Consumers should also be wary of plans that appear to meet the Patient Protection and Affordable Care Act standards, but actually don't. That's because President Trump's administration, which has tried to weaken "Obamacare" after failing to repeal it, has loosened restrictions on plans that aren't compliant with the ACA, called "short-term plans," which are less expensive but offer less coverage.

The best way to make sure your plan is ACA-compliant is to shop on Healthcare.gov; if you are working through an insurance broker, say you want an ACA-compliant plan.

Where can I find help? 

The state-based call center is available at 855-459-6328 to help assist Kentuckians with where to go for coverage, answer questions and pre-screen for eligibility. The Healthcare.gov customer service center (800-318-2596) is also available 24 hours a day, seven days a week. Click here to find an application assister or an insurance agent near you.

Carol Adkins, coordinator of community engagement and outreach for the Kentucky Primary Association, encouraged Kentuckians who are signing up for health insurance on Healthcare.gov to talk to an application assister each year before they sign up because plans often change and premiums and options fluctuate.

"Always make plans to meet with a free, certified application assister to help you apply or re-certify," she said in an e-mail. "They are trained to help with the initial application, answer questions, explain options, assist with enrollments and more."

She stressed that  assisters are not agents and do not benefit in any way from your enrollment, but are simply there to help you with your application at no cost to you. She also noted that KPCA has assisters that specifically work on connecting children with coverage all over the state.

If you miss the deadline, the only way you'll be eligible to enroll in or change your health plan for 2020 is if you qualify for a special enrollment period. To qualify for special enrollment, you must have a qualifying life event such as a change in family status (for example, marriage, divorce, birth, or adoption of a child), change in residence, or loss of other health coverage (such as loss of employer-based coverage, or loss of eligibility for Medicare or Medicaid).

House health-care draft suggests a plan that could leave rural areas short of coverage

A 100-page draft of a House Republican plan to repeal the Patient Protection and Affordable Care Act suggests that rural, middle-class Americans may soon struggle to afford health insurance.

The document, which was leaked to Politico last week, specifies that Medicaid expansion for low-income, able-bodied adults won’t be completely eliminated, but eligibility and funding will be rolled back after 2020, Vann R. Newkirk II reports for The Atlantic.

"The draft also contains a provision changing federal funding for Medicaid in 2020 onward from an open-ended obligation to a system where the per-person spending every year is capped based on spending levels in 2019 and increased annually to correspond with medical inflation," he writes.

Then-Gov. Steve Beshear expanded Medicaid under the law, to people with household income up to 138 percent of the federal poverty level, now $16,394 for an individual or $33,534 for a family of four. Now the state is having to pay 5 to 10 percent of the cost, and Gov. Matt Bevin says the state can't afford it. He has asked for permission to change the program, but what Congress does with the program nationally would likely override action in Kentucky.

Rural residents, who rely more heavily on public insurance than do city-dwellers, are particularly vulnerable to Medicaid cuts. The health issues that are prevalent in rural areas are serious and contribute greatly to the climbing mortality among middle and lower class white Americans, he notes. "People like coal miners in Trump country in Kentucky and West Virginia are on the frontiers of several developing health crises, and per-capita spending caps on Medicaid would only further limit their states’ ability to respond," Newkirk writes.

The draft plan by House Republicans repeals the tax-based individual mandate to have health insurance and replaces it with an incentive to maintain continuous coverage. This proposal would allow insurers to charge up to 30 percent more in premiums to people who go without coverage at any point for more than two months and who purchase insurance on individual, small group, or exchange markets, Newkirk says. The fee would also apply to young adults who don't enroll in coverage as soon as they age out of their parents' plans. In addition, the added surcharge would be paid as profits to insurers rather than being remitted as taxes to sustain the system, he writes.

Another reform set forth in the draft is a measure to replace the cost-sharing reductions and premium tax credit subsidies of the ACA's exchanges with a refundable tax credit. The existing tax credit is adjusted by income, age, and the average price of insurance in a person's market. The draft version of the tax credit would only take into account age, starting with $2,000 per year up to age 30 and capping at $4,000 for people over 60, Newkirk notes.

While older people who are likely to have more health problems would get more subsidy than "young invincibles," Newkirk writes, the worry is that adequate medical care will be out of reach for lower-income people who are also more likely to have health problems. Geographical factors are also likely to become an issue for a tax credit based solely on age, since medical costs vary substantially from place to place.

A tax-credit plan that doesn’t account for the actual cost of a person’s health insurance might reasonably be expected to create areas where coverage is simply unaffordable, Newkirk notes. Research suggests that health-insurance premiums are higher for rural counties and states.

Newkirk writes, "Those costs increase even as rural residents have less access to basic health care and worse overall health status than their metropolitan peers. . . . The result of all these provisions would almost certainly be a system that benefits people who already have wealth and health and penalizes others, but there would also be very strong geographic effects. For one, pegging Medicaid spending to a base year would reduce states’ ability to ramp up health-care spending because of disasters or emerging health problems, and these problems already exert the most pressures on states and areas with infrastructure that is ill-equipped to combat them," Newkirk writes.

Newkirk says that disparity between costs and access for rural Americans creates a conundrum for Republicans. "By reducing state Medicaid financial flexibility, reducing oversight over minimum insurance requirements, instilling continuous coverage requirements, and removing regional costs offsets, their Obamacare replacement would in essence put health insurance even further out of reach for sicker, rural patients who need it more and then penalize them for being left out," he writes.

Many rural Americans already suffer the effects of “health care deserts” because of collapsing rural hospital systems and waning access to basic specialty services. In addition to those health care and service deserts in rural areas, Newkirk writes, Republicans would be contributing to newfound “coverage deserts.”

Bevin gives much lower estimate for ending Kynect, says Medicaid expansion depends on agreement with federal officials

Gov. Matt Bevin
(Photo via www.bizjournals.com)

Gov. Matt Bevin said it will only cost the state "one to two million dollars at the most" to dismantle Kynect, the state's online health insurance marketplace, instead of $23 million, which he said is a "made up" number.

Bevin made his comments in an interview with Terry Meiners on WHAS Radio on the afternoon of Jan. 13.

The $23 million estimate came from an Aug. 27 meeting of the legislature's Budget Review Subcommittee on Human Resources, where Kynect Executive Director Carrie Banahan said in a presentation, "Vendor projections indicate the IT work alone would take 9 months to complete at a cost of $23 million."

The information-technology vendor is Deloitte Consulting LLC, but Bevin told Meiners, "It will cost us one to two million dollars at the most. That's the conversations I've had with people at Deloitte."

Bevin said the $23 million estimate "is just a made up number that someone made up and people continue to run with."

Bevin notified federal officials Dec. 30 that Kentucky plans to shut down Kynect, which he says is redundant because there is a federal exchange and that isn't fair because all Kentuckians are paying for something that relatively few use. The federal exchange charges a 3.5 percent fee on policies it sells; Kynect is funded by a 1 percent assessment on all health-insurance policies in the state.

"It will cost for those individuals a little more for their policy in terms of the premium they pay, but frankly it's a few tens of thousands of people out of 4.4 million," Bevin said. "Why should 100 percent of us pay for something that less than 2 percent of us are using? We are going to stop doing it. It is redundant."

Advocates say using the federal exchange will be more inconvenient for Kentuckians and insurance companies, and leave Kentucky short of the people needed to help people use the system.

Kynect was initially funded by $283 million in federal funding. Bevin said Kentuckians will enroll for health coverage through the federal exchange during the November 2016 open enrollment and "then it will be done."

Kynect has not released its 2016 enrollment numbers, but last year about 500,000 Kentuckians had coverage through it, about 400,000 on Medicaid. Enrollment for subsidized private insurance ends Jan. 31.

When Meiners noted that Bevin wasn't as adverse to Medicaid expansion as he was near the beginning of his campaign, Bevin said, "I am very adverse to us doing it under the current structure because we can't afford it," he said. "We were left with a $128 million shortfall in 2016 alone."

He noted that the shortfall was for traditional Medicaid, not expanded Medicaid, and asked how the state can afford to pay for expanded Medicaid when it is over budget on traditional Medicaid, "unless it's changed dramatically for both."

The Medicaid expansion includes those who have incomes up to 138 percent of the federal poverty level. The federal government is paying the entire cost of it through this year; in 2017 states will pay 5 percent, rising in annual steps to the law's limit of 10 percent in 2020.

Bevin has appointed Mark Birdwhistell, a University of Kentucky health executive and former state health secretary, to help him design a new Medicaid program for the state. He noted that he will be working with the federal Centers for Medicare and Medicaid Services over the next six months to determine if they can "work something out."

"If we do not, we will have no choice but to un-expand," he said. "And that is what we have the ability to do; it's what we may be forced to do; it's what I would rather not do; and it's what we are going to work toward not doing if at all possible."

Deadline to buy health insurance and avoid penalty is Sunday, Jan. 31; a relative few people may qualify for exemptions

By Melissa Patrick
Kentucky Health News

Kentuckians have until Jan. 31 to sign up for subsidized health insurance through Kynect, the state's online insurance marketplace, or face a penalty when they file their tax returns.

The penalty for not having health insurance this year is 2.5 percent of your income, or $695 per adult and $347 per child, with a maximum of $2,085 per family, whichever is higher. The penalty will either be taken from a future tax refund or imposed when individuals file their taxes, according to the Kynect website.

The 2010 federal health-reform law requires most people to have health insurance, either through Medicaid, Medicare, veterans' coverage, the Kentucky Children's Health Insurance Program, job-based coverage or private insurance.

A few circumstances allow for exemptions, including: certain hardships, membership in some groups, some life-changing events, incarceration, if health coverage is considered unaffordable, or if household income is below the threshold for filing a tax return, according to Healthcare.gov. For more information on exemptions, go to www.IRS.gov/aca or www.healthcare.gov/exemptions-tool.

For help getting coverage, either call 1-855-459-6328, visit Kynect's website at kynect.ky.gov or visit one of its two locations at Mall St. Mathews in Louisville or Fayette Mall in Lexington. Kynectors, trained assisters who help people choose and sign up for plans, are also available in every county.

The federal government has said the deadline will not be extended this year, unlike last year. Enrollments or changes made on existing plans between Jan. 16 and 31 will take effect March 1.

After Jan. 31, the only way to purchase health insurance on Kynect will be if there's a major life event, like marriage or a change of employment. Those who qualify for Medicaid can apply year round.

Gov. Matt Bevin notified federal officials Dec. 30 that Kentucky plans to shut down Kynect, which he says is redundant because there is a federal exchange. This does not immediately affect Kynect, which will remain open and will keep accepting enrollments until Jan. 31.

This follows the shutdown of all advertising for Kynect, which was cancelled during the middle of open enrollment, although Anthem is still running ads that remind people of the requirement to have coverage. A few Kynect ads are still running because the contracts involved, such as those for certain sports broadcasts, did not allow cancellation.

One group that might need reminders about the requirement and this year's higher penalty are Kentucky's so-called "young invincibles," many of whom choose to forgo health insurance and pay the penalty because they are young and healthy.

For Obamacare insurance plans to be viable, they need young, healthy people to enroll and pool the risk with older, sicker policyholders whose health care cost will likely exceed their premiums. Humana Inc. said recently that it will pay more in claims by Obamacare policyholders than it will get from them in premiums.

Get health coverage by Jan. 31 or pay penalty of up to 2.5% of income

The deadline to get health insurance for 2016 and avoid a penalty for not being insured is Jan. 31 and this year, unlike last, there will be no extension, Baylee Pulliam notes for Louisville Business First.

More than 3,000 Kentuckians missed the initial deadline this year but then gained coverage because of the extension, Jill Midkiff, executive director for communications for the Kentucky Cabinet for Health and Family Services, told Pulliam. This extension was meant to help those who weren't aware of the penalty for not having health insurance util they started to file their income-tax returns and saw it.

"A special enrollment period around the April 15 tax filing deadline will not be offered this year," Kevin Counihan, CEO of HealthCare.gov, the federal government health insurance exchange, wrote on The CMS Blog. "If you don’t enroll by then, you could have to wait another year to get coverage and may have to pay the fee when you file your 2016 income taxes.”

The penalty for not having health coverage in 2015 is $325 per adult and $162.50 per child (up to $975 for a family), or 2 percent of their annual household income, whichever is higher.

The penalty for next year is $695 per adult and $347.50 for each child (up to $2,085 per family), or 2.5 percent of annual household income, whichever is higher.

If you're not sure what your penalty could be, there's a calculator tool on the HealthCare.gov website.

Counihan said that for many the fee is greater than the yearly cost of a plan and that generally, "the higher your income, the higher the fee you will have to pay."

So far, 60,277 Kentuckians have enrolled in subsidized 2016 coverage through Kentucky's exchange, Kynect, and about 30,000 haven't renewed their plans, Midkiff told Pulliam in early December.

For coverage that takes effect Jan. 1, the deadline is Dec. 15.

Obamacare still divides Kentuckians, but opinion has firmed up; view of its personal impact on them is now even

By Melissa Patrick and Al Cross
Kentucky Health News

Kentuckians still have a marginally unfavorable opinion of the federal health-reform law, and their views about it have firmed up, according to the latest Kentucky Health Issues Poll.

However, the opinion of those who say the law has had an effect on their family has improved to the point that they are evenly divided on the controversial topic.

"Although many still report they do not have enough information to understand the impact of the law on themselves, and opinions remain split, the numbers reporting positive personal and family impacts have increased as provisions of the law have gone into effect," said Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, which sponsors the survey.

The poll has asked the same question of Kentucky adults since 2010: "Given what you know about the health reform law, do you have a generally favorable or generally unfavorable opinion of it?"

Last year, opinion was almost evenly split, with 41 percent unfavorable and 39 percent favorable. This year, 46 percent were unfavorable and 41 percent favorable. Because the poll's error margin is plus or minus 2.4 percentage points, which applies to each number, there is little or no statistical difference in the two years' results.

The significant change was in the share of people who said they didn't have an opinion about the law. That dropped to 14 percent this year from 20 percent last year.

Political affiliation continues to be reflected in opinions of the law. The survey found that 61 percent of Democrats had favorable views of it and 66 percent of Republicans had unfavorable views. Among independents, 42 percent had unfavorable views and 43 percent were favorable.

Kentuckians' opinions are virtually the same as those found in a national survey taken at about the same time. The September 2015 Kaiser Health Tracking Poll found that 45 percent of U.S. adults had unfavorable views of the law; 41 percent were favorable; and 14 percent did not know or refused to answer.

The number of Kentucky adults who reported the law had a positive effect on their family increased to 23 percent, up from 18 percent in 2014. The percentage who said the law had negatively affected them or their family remained steady at 23 percent.

Kentucky's adoption of the law expanded eligibility for the Medicaid program to households with incomes up to 138 percent the federal poverty level. Among such people, 37 percent said the law had affected them positively.

People with incomes from 138 to 400 percent of the poverty level are eligible for private-insurance subsidies. Among those with incomes between 138 and 200 percent of the FPL, 27 percent said the law had positively affected them; it was 12 percent among above 200 percent of the FPL.

As for Kynect, the state's online marketplace for health insurance, 35 percent said they had heard a lot about it; 22 percent had heard "something" about it; and 43 percent had heard only a little or nothing at all.

The poll was conducted among a random sample of 1,608 Kentucky adults Sept. 17 through Oct. 7 for the foundation and Interact for Health, formerly the Health Foundation of Greater Cincinnati, by the Institute for Policy Research at the University of Cincinnati. It used landlines and cell phones.

National health scorecard shows Kentucky making improvements

Graph from The Commonwealth Fund Scorecard website

By Melissa Patrick
Kentucky Health News

Kentucky remains in the bottom fourth of a states' health ranking released Dec. 8, but it was one of the states that saw the greatest improvements of individual health indicators in the first year of full federal health reform.

The Commonwealth Fund Scorecard on State Health System Performance looks at five areas: medical-care access and affordability, prevention and treatment of disease, avoidable hospital use and hospital cost, health status and "health equity."

Kentucky ranked 40th overall, but improved on 13 indicators and worsened on only three. Louisiana, Oklahoma and Rhode Island were the only other states to improve on more indicators.

Kentucky's top rankings were in access and affordability (28th) and prevention and treatment (20th), but it remained near the bottom for avoidable use of hospitals and cost of care (49th), health status (44th) and equity (45th).

Although states such as Kentucky have a long way to go, "they also have more to gain from improvement," Douglas McCarthy, senior research director for The Commonwealth Fund, told Laura Ungar of The Courier-Journal.

Some measures in which Kentucky saw substantial improvement were:

• Adults who went without care because of cost in the previous year;
• Adults 50 and older who got recommended screenings and preventive care;
• High-risk nursing home residents with pressure sores;
• Readmissions to the hospital in 30 days among Medicare patients;
• Breast cancer deaths;
• Infant mortality
• The percentage of insured adults. David Radley, the senior scientist tracking health system improvement for The Commonwealth Fund, told Ungar that Kentucky led the nation in declines among uninsured adults. Other research has found likewise.

This year’s scorecard is the fourth in a series, and the first to measure the effects of the Affordable Care Act, looking at changes during 2013 and 2014 to assess the early effects of the law’s 2014 health insurance expansions. It also measures payment reforms and incentives to reduce re-admissions to the hospital.

"The effects of the ACA are not yet full reflected in the 2015 Scorecard results," says the report. "It may take many years to see the resulting changes."

Ungar writes, "Dr. David Blumenthal, president of The Commonwealth Fund, said he "can't with scientific precision" attribute all the gains in his organization's report to the ACA, but several positive trends do coincide with the implementation of the law."

Visit the U.S. Health System Data Center at datacenter.commonwealthfund.org for interactive maps, state profiles, and comparisons of state performance.

Beshear defends Kynect and Medicaid, asks Bevin to 'look at this from a business standpoint, if not from a human standpoint'

By Melissa Patrick
Kentucky Health News

Armed with data and an unusual dose of emotion, outgoing Gov. Steve Beshear urged Gov.-elect Matt Bevin to reconsider his positions and keep the state's Medicaid expansion and insurance exchange during a Friday news conference at the Capitol.

His voice cracking, Beshear said, "For the health of our families, the future of this state, we cannot throw away the progress we have made and start over, just to make a political point. This is not about President Obama. This is not about Steve Beshear. It is about the people of Kentucky, improving their health, improving a stronger workforce, growing our economy."

Bevin said during his campaign and his post-election news conference that he would dismantle the Kynect exchange and shift clients to the federal exchange because "It is a redundancy that we as taxpayers in this state are paying for twice." Kynect is funded by a 1 percent fee on all Kentucky health-insurance policies; the federal exchanges levies a 3.5 percent fee on its policies.

After first saying he would abolish the expansion of Medicaid to those with incomes up to 138 percent of the federal poverty line, which covers 400,000 people, Bevin has said he plans to apply for a federal waiver to require clients to have some "skin in the game" through premiums, co-payments, deductibles or health savings accounts. He has suggested that the income limit could be lowered, but no state has been allowed to do that.

Beshear said, “During election season the political rhetoric tends to be strong and the promises bold. But the fun and games are over, and it is time to get serious.”

In his plea for Bevin to reconsider, Beshear said there are only two factors to consider about the health reforms in Kentucky: are they working and can we afford them? He and Lt. Gov. Crit Luallen said they are working, and the state can afford it: "That answer is just as clear and just as definite, provided you put unsupported opinion and ideology aside and look at facts and figures."

Beshear said getting rid of Kynect, which has been called a national model, makes "no sense." He said, "It is inconceivable to me why, just to make a partisan political statement, Kentucky would want to go backward and become the first state to decommission a successful exchange. . . . It would be stupid to turn our backs on it because it would lose us money."

He said moving to the federal exchange would waste the $283 million in federal grants used to create Kynect; would cost at least $23 million in Kentucky tax funds to dismantle it; would take away Kentucky's oversight; would add months of delay and duplication to the process; and would get rid of the locally responsive Kynectors, located in every county, and replace them with a customer service team that is located "hundreds of miles away." He said health-care providers, insurance companies and other business interests (including the Kentucky Chamber of Commerce) want to keep Kynect.

On Medicaid, Beshear said a waiver wouldn't have much effect on the program's costs, and said there is another side to the "skin in the game" argument.

“If I’m only making $30,000 a year and I’m supporting a family of four and everybody’s well right now and I can take $30 a month or $50 a month that I would have to pay in in order to be covered here and use it to feed my family or buy the textbooks that our kids need to go to school, people are tempted to say, ‘Well, I really don’t need this health care right now. I need this money to support my family’,” Beshear said.

The governor tried to contradict Bevin's assertion that the Medicaid expansion is "unsustainable." The federal government pays the full cost of the expansion through next year. In 2017, states will pay 5 percent, rising in annual steps to the law's limit of 10 percent in 2020.

Beshear walked the audience through experts' estimates of how the expansion would more than pay for its estimated $257 million cost in the next two-year budget: $265 million in state General Fund savings for services that the federal government now covers under the expansion; $246.8 million in additional revenue from new jobs and taxes created by expanding the health industry; and $45.7 million in "restricted fund" revenue, from a new 1 percent assessment on Medicaid manage-care organization and insurance companies. He said the expansion will net the state $300 million that is sorely needed for other programs in the state.

Beshear cited the Deloitte Consulting study that used data from 2014, the first full year of the expansion. The report said the expansion created 12,000 jobs and generated at least $1.3 billion in payments to health-care providers, a number that has risen to $2.9 billion through July 2015. The study predicted the expansion would add $30 billion to Kentucky's economy and have a positive budget impact of $820 million over eight years for state and local governments, even after the state match for Medicaid cost is phased in, Beshear said.

Beshear said that by improving the health of Kentuckians, the expansion is also improving their quality of life, economic capacity, worker productivity, school attendance and even the state's public image.

"The more we improve our health and the more we improve our economy, the less we will need to rely on programs like Medicaid," he said. "This is a long-term plan for improving Kentucky, but you won't see it if you are blinded by short-term political ambitions or concerns."

He encouraged Bevin to look at other Republican governors, like Ohio Gov. John Kasich, who have gone against most of their party colleagues to expand Medicaid.

"At the end of the day, folks, we have to pull important policy decisions out of the vat of corrosive acid called partisan politics and we all have to answer for how we treat each other," he said, calling on Bevin to “look at this from a business standpoint, if not from a human standpoint.”

Beshear said he and Bevin have met privately once since Bevin was elected and had agreed to not publicly share details of the meeting, but did say that he encouraged Bevin and his aides to "just look at the facts" as well as what is best for the people of the state.

“My impression is that he’s willing to look at the data and look at the facts, and you know, he made no promises one way or another,” Beshear said. “But he’s a business guy and he’s used to looking at facts and figures and that’s what I would encourage him to do.” (For video clips of Beshear's press conference, from cn|2, click here.)

In reply, Bevin spokeswoman Jessica Ditto said, “Governor-Elect Bevin has laid out a health-care vision for Kentucky that will encourage personal responsibility and focus on expanding access to quality, affordable health care coverage. His administration will move forward in addressing Kentucky’s health-care needs in a deliberate and thoughtful fashion, consulting with Kentucky’s health-care stakeholders, his Cabinet appointees and the General Assembly.”

Republican Senate President Robert Stivers said in July that the legislature would decide the shape of the Medicaid expansion, and said after the election that his staff had consulted with its counterparts in Indiana about that state's expansion.

Sharing the stage with Beshear was Luallen, chairwoman of Kyhealthnow, a program Beshear created in 2014 to set seven major health goals and reach them by 2019. She said improving Kentuckians' health must remain a priority.

"On this issue, we simply cannot afford to go backward," Luallen said. "This is a once-in-a-lifetime opportunity to change the future of Kentucky. We have demonstrated that improving the health of our people is affordable. It's time to move the discussion from saving money to saving lives."

Luallen shared the final progress report from the kyhealthnow initiative, including:

• More than 90 percent of Kentuckians now have access to health coverage. The uninsured rate has fallen to 8.5 percent from 20.4 percent, the largest drop in the nation.
• More Kentuckians are using their coverage for preventive services, with the number getting preventive dental care and breast and colon cancer screenings doubling from 2013 to 2014.
• Adult smoking rates have only decreased slightly, to 26.1 percent from 26.5 percent. Youth smoking has dropped to about 17 percent, from about 18 percent.
• Kentucky's adult obesity rate has dropped to 31.6 percent from 33.6 percent, causing Kentucky's ranking to drop to 12th from fifth in the 2015 State of Obesity Report. 
• There has been a drop in cancer and cardiovascular deaths.

State to wind up operations of federally funded Kentucky Health Cooperative, says it will not assume liability for losses

By Melissa Patrick
Kentucky Health News

The Kentucky Department of Insurance is taking control of the day-to-day operations of the failed Kentucky Health Cooperative, but will not assume any of its liabilities, according to a state news release.

Franklin Circuit Judge Phillip Shepherd signed the order Thursday to place the co-op into rehabilitation, and makes Insurance Commissioner Sharon P. Clark the rehabilitator. The order also appointed Jeff Gaither and David Hurt, both on contract with the department, as special deputy rehabilitators, department spokeswoman Ronda Sloan said in an e-mail. Glen Jennings has said that he will continue to serve as the acting Kentucky Health Cooperative CEO through Nov. 8, when his contract expires, according to Sloan.

Clark said in the release, “Today’s action placing KYHC into formal rehabilitation was necessary to ensure DOI is in a position to protect consumers and providers. Our central concerns are making certain policyholders receive the services to which they are entitled, and that the providers offering those services honor existing contracts and receive payment.”

The co-op announced in early October that it would be closing, but would meet its obligations to its members through Dec. 31.  Co-op members must apply for coverage with a different insurance company by Dec. 15 to have coverage on Jan. 1. Open enrollment runs between Nov. 1 and Jan. 31.

Two insurers, Anthem and UnitedHealthcare, will offer plans in all 120 Kentucky counties. Some counties will have up to seven choices, with expanded provider networks offering 86 different plans.

Kentucky Health Cooperative lost $50.4 million last year, but had only lost $4 million by the end of June, and said it fully expected to overcome its losses, through payments the federal government makes to companies for insuring sicker populations. But last year's federal budget deal limited those "risk corridor" payments and destroyed that hope. The co-op was hoping to get $77 million in risk-corridor money and got $ 9.7 million. 

Cooperative policyholders and providers with complaints or other issues related to the rehabilitation action should call the Insurance Department at 800-595-6053.

KET's Clearing the Smoke' explores smoking issues in Kentucky; guests called for smoking ban, note concerns about teens

An old tobacco barn in Magoffin County, seen by thousands daily
on the Mountain Parkway, has found a new purpose – to help people
stop smoking. Tobacco barns It once advertised Mail Pouch tobacco.
Abbie Conley, tobacco coordinator for the county health department,
told KET, “Alot of parents feel like, well, it's not as bad as drug use or
not as bad asalcohol. I've even heard of parents buying cigarettes for
their kids.”Shelia Salyer, the owner of the barn, said that the last
tobacco grownon her farm was 12 years ago and smoking has taken a toll
on thecounty: “I have lost a lot of people I know to smoking, to lung cancer.”

By Melissa Patrick
Kentucky Health News

About one in four Kentuckians smoke, but the habit affects everyone in the state -- if not directly through the many diseases associated with smoking or second-hand smoke, then economically: through increased taxes, higher insurance premiums and decreased worker productivity. The best way to address this is a comprehensive ban on smoking in workplaces.

That was the message of “Clearing the Smoke,” a Kentucky Educational Television "Health Three60" episode that first aired Oct. 19.

Host Renee Shaw opened the program with state Health Commissioner Stephanie Mayfield and Dr. Chizimuzo Okoli, director of the Division of Tobacco Treatment and Prevention at the University of Kentucky.

Smoking in Kentucky

Mayfield told Shaw that while Kentucky's smoking rate has been trending down, it still has the second highest rate in the country at 26 percent, well above the national rate of 19 percent, prompting her to say, “We have a lot of work to do."

At least 70 percent of smokers want to quit, Okoli told Shaw, but said, "It is important to remember that smoking is actually an addictive disorder," and smokers need access to smoking cessation tools to be successful.

Mayfield jumped in and said with enthusiasm, "That is exactly what we have done with enhanced health-insurance access," noting that the state's embrace of federal health reform has allowed more Kentuckians to have access to smoking cessation programs. "Health insurance helps tremendously," she said.

The two also touched on the many diseases linked to smoking: diabetes type 2, rheumatoid arthritis, lung cancer, colon cancer, leukemia, birth defects, respiratory diseases, asthma, breast cancer, oral cancers, other organ cancers, bone loss... with Mayfield noting that these diseases are associated with both smoking and second-hand smoke.

"Second-hand smoke can kill you," Mayfield said.

Okoli pointed out that smoking has a direct impact on unborn children. He said 70 percent of women quit smoking when they find out they are pregnant, and some studies show that those who continue to smoke sometimes have mental illness or addictive disorders.

Mayfield agreed, saying, "Those with pre-existing behavioral health and mental disorders, we find that their smoking rates can be as high as 50 percent compared to our general population."

Support for smoke-free legislation

Mayfield and Okoli said they support statewide smoke-free legislation to ban smoking in enclosed public places.

“I think our people deserve this,” Okoli said, noting that a ban would protect against the preventable diseases associated with smoking, decrease cigarette consumption and discourage young people from starting to smoke.

Ashli Watts, director of public affairs for the Kentucky Chamber of Commerce, said 92 percent of the chamber's members support statewide smoke-free legislation.

“This is not just a health care issue, it is an economic development issue,” Watts told Shaw, noting that businesses look at the health of the workforce, productivity levels and the cost of insurance when they are deciding where to locate.

Watts also pointed out that almost $600 million of Medicaid taxpayer money went directly to pay for smoking related issues and said, "We can simply no longer afford to ignore the issue. Smoking is not only killing us, it is bankrupting us."

The importance of tobacco cessation programs

Audrey Darville, a certified tobacco treatment specialist with UK HealthCare, told Shaw that it is important to get evidence-based help to stop smoking, with only three to five people out of 100 successful when trying to stop “cold turkey.”

Darville said that people who engage in cessation counseling, tobacco cessation medications and individual counseling have a 40 to 60 percent success rate of “staying quit.”

She explained that nicotine hits the brain within 10 seconds of smoking and causes a release of dopamine, which stimulates pleasure, making it hard to quit.

“We tend to place a lot of the responsibility for quitting or being successful with quitting on the person or some personal characteristics, but we have to have a healthier respect for how addictive this drug (is) and how miserable people feel when they don't have it when they are trying to quit,” Darville said.

Bobbye Gray, tobacco cessation administrator for the state Department of Public Health, said the Kentucky Quit Line is available to those 15 and older who are ready to quit smoking. Smoking cessation coaching is also available through the Quit Line for those without insurance, who, Gray said, can get nicotine replacement products free of charge. Smoking cessation programs are also available through local health departments.

Smoking and Teens

“Some people are more addicted (than others), especially young people and teenagers,” Gray said, “They are more sensitive to the nicotine, therefore more susceptible to the addiction.”

About 18 percent of high school students smoke traditional cigarettes, and 24 percent use e-cigarettes, said Elizabeth Hoagland, youth tobacco-policy specialist with the state health department, adding that 30 percent of youth who experiment with smoking will go on to become daily smokers.

Hoagland said that most people aren't aware that even teenagers have health consequences from smoking, even if they aren't daily smokers, including insulin resistance and reduced lung growth.

“You have reduced lung growth. The lung is kind of like the brain, the lungs keep maturing and growing until the age of 25. So, if you are a smoker, your lungs don't grow to their full capacity, and they don't work as well as they would for a non-smoker,” she said.

Hoagland expressed concern about the growing use of electronic cigarettes, saying that there was “a lot of misinformation” out there. She made it clear that the vapor off of an e-cigarette is not a water vapor, but is an aerosol, “And these are completely unregulated products so we don't know what is in them,” she said.

She said that we know e-cigarettes contain nicotine and formaldehyde, in addition to ultra-fine particles, which can cause “lung inflammation and lung damage,” and noted that some flavorings like diacetyl, which is used in microwave popcorn, is used in 60 percent of e-cigarettes and has been proven not safe to breathe.

Programs like Teens Against Tobacco Use at Tates Creek High School in Lexington allow high school students to visit elementary and middle schools and talk to the students about the dangerous effects of tobacco use using hands on activities.

At Bourbon County High School, students brought e-cigarettes to the staff and school board's attention, leading the effort to have them included in their tobacco-free policy at school. Lynlea Kiser, a student in the school who is involved in smoke-fee education, said that many of the staff didn't know what e-cigarettes were until the students brought them to their attention.

Cyndi Steele of the Bourbon County Health Department said that because the schools already had a tobacco-free policy in place, the culture has shifted. “The students were not willing to tolerate the vapor from the second-hand smoke,” she said.

Hoagland said that schools that are smoke-free have a 30 percent reduction in youth smoking, “So every school district should have one,” she said, also noting the importance of a statewide comprehensive smoke-free law, which would “really have a huge impact on our youth smoking.”