In a report for PBS, KET's Renee Shaw looks at the influence of health-care reform on the U.S. Senate race

Kentucky is a state "where both the economy and health care poll as high issues and where the state’s exchange under the health care law ... has a very different reputation than the law does when it’s called Obamacare," KET's Renee Shaw reports in a segment for PBS "NewsHour."

Courier-Journal Political Writer Joe Gerth explained the disconnect for the national audience: "Five letters, O-B-A-M-A. You have to look at the polling on Obama. His favorability rating in Kentucky is somewhere around 29 percent. He’s not liked. People don’t like his policies. They don’t like him personally. And that’s played a huge role in why Obamacare is viewed so negatively."

Shaw interviews small-business owner Charles Howard of Chaplin, who doesn't like the law, and Kendell Nash of Louisville, who does. Shaw concludes, "Kentucky is full of strong feelings on the health care law, but it’s not clear how much those will affect the election. Like much of the nation, the state is getting ready for the next round of open enrollment on its health care exchange. That will be the next test of the health care law here. Enrollment starts two weeks after the midterm election."

Obamacare seems to be no plus for Kentucky Democrats, perhaps mainly because of the word's first three syllables

Though the federal health-reform law has helped cover more than half a million Kentuckians and cut the state's uninsured population by half, "there is little evidence it will help" Kentucky Democrats in the Nov. 4 elections, reports Abby Goodnough of The New York Times, who has been following Obamacare's implementation in the state.

“The campaign by the Affordable Care Act’s critics against it has been very effective in demonizing the phrase Obamacare and anything to do with the president,” Democratic Gov. Steve Beshear told Goodnough. “So I think you find a reluctance on the part of people, even though the law is benefiting them, to publicly acknowledge it.” Beshear noted that President Obama is highly unpopular in the state, and Goodnough notes that no one applauded during the six minutes that he spoke about the law at the Kentucky Farm Bureau's Country Ham Breakfast at the state fair last month.

Interest groups and Republican candidates in Kentucky "have run more than 10,000 broadcast television spots here since January 2013 that mention the law in a negative way, according to Kantar Media’s Campaign Media Analysis Group," Goonough reports. "Kantar found only one positive television ad, from Elisabeth Jensen, the Democrat challenging Rep. Andy Barr in the state’s Sixth Congressional District."

Many Democrats have urged their nominee for the U.S. Senate, Secretary of State Alison Lundergan Grimes, to use the issue, but "far from flaunting Kentucky’s strong enrollment numbers, Democratic candidates — most notably Ms. Grimes — have remained reticent about the law, even its successes."

Republican Sen. Mitch McConnell's re-election campaign hasn't run any advertising lately about the law, but still calls it the worst legislation in American history and says he wants it repealed "root and branch." But he has yet to explain, if that unlikely event happened, what would happen to the state exchange where more than 521,000 people got on Medicaid or bought private insurance policies.

Goodnough says McConnell has "hedged" on that, and links to an earlier story by her Times colleague, Jonathan Martin, who wrote: "When I pressed him about the politics of taking away Medicaid from those individuals that now have it, he suggested that was unlikely – even while still faulting Beshear for the decision. 'I don’t know that it will be taken away from them,' McConnell said of the expanded Medicaid coverage. Speaking about Beshear and Kentucky’s state government, he added: 'They’ve made the decision to expand it; they’re gonna have to pay for it.'"

Hospitals say too many of the newly insured are using emergency rooms for primary care; state says it's working on the problem

By Melissa Patrick
Kentucky Health News

More people with health insurance, a shortage of primary-care physicians and a steep learning curve for the newly insured all add up to more patients than ever using emergency rooms for non-emergency purposes.

More than 413,000 Kentuckians are newly enrolled in health care coverage under the Patient Protection and Affordable Care Act, and nearly three out of four of those enrolled under the Medicaid expansion, which covers residents earning up to 138 percent of the federal poverty line.

Because many of these newly insured are using the emergency room for non-emergency reasons, emergency rooms are feeling the strain, Don Weber reports for cn|2's "Pure Politics," a service of TimeWarner Cable.

"In the past three months, we are seeing about a 12 percent increase per month in our emergency room visits," Sheila Currans, CEO of Harrison Memorial Hospital in Cynthiana, told Weber in a broadcast.

“Many of the patients that come have multiple chronic conditions that have been undeserved," Currans said in the broadcast. "Diabetic. Obesity. Vascular disease. And so they come with chronic conditions and they don’t really have a primary-care physician. And so the ability to get them into a primary-care setting, into specialty-care settings, becomes more difficult without that primary-care person to refer and to kind of coordinate and manage that care."

Currans added, “Primary-care physicians have got to lead this transformation in health care, because  … they can take care of the whole patient. We have to reform the payment system so that the primary-care physician can spend 30 minutes with you and/or can spend 15 minutes with you, but can hand you off to a professional within their office that can help educate, continue to educate, re-mediate.”

Norton Hospital in Louisville has also seen a 12 percent spike in the number of patients, many for non-emergency reasons, Laura Ungar reported in The Courier-Journal. Weber reports that the 12 percent increase in emergency room visits is "pretty consistent with the state average."

This is not a new problem, according to Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services.

“Kentuckians suffer poorer health than many other Americans, and have traditionally utilized emergency rooms at a higher rate. This is not a new phenomenon," Midkiff said in an e-mail. She said Kentucky is working on the problem, focusing on so-called "super-utilizers" who use ERs at least 10 times in a year.

"Last summer, Kentucky was one of seven states chosen to participate in the National Governors Association Policy Academy on emergency-room utilization, with particular focus on managing super-utilizers," Midkiff said.

People who have never had insurance often don't know how to use their benefits, which also adds to the number of people using the emergency room instead of seeking a primary care physician, Midkiff said. "There is a steep learning curve to navigating the healthcare system and all providers and the insurance companies must help educate the newly insured," she said.

Part of that effort is being handled by the companies that manage the care of Medicaid patients under contracts with the state that reward them when expenses are less than expected.

The Kentucky Health Benefits Exchange, branded as Kynect, "is developing some very basic 'Insurance 101' materials to help educate the newly insured about how to find a primary care physician, when to seek health care services, when to visit the ER, how to use pharmacy benefits, as well as providing a glossary of commonly used insurance terms," Midkiff said. "We think this fills a real need and will help consumers more appropriately and efficiently use their health-care coverage."

Midkiff said emergency rooms have long been considered the "de facto primary care center," with some hospitals even advertising the average wait times on websites and remote-controlled billboards. "This provides a confusing message to those who are newly covered," she said. "Many hospitals across the country have revised their health-care delivery model to include both emergency services and immediate care to adapt to the increased and changing demand for services."

Many hospitals around the country have done that, and are profiting. "Hospital chains and insurers are making more money, more patients using ERs are paying for their care, and the country as a whole is enjoying slower growth in its health-care spending," Alex Wayne and Shannon Pettypiece of Bloomberg News report, on the basis of public filings by hospital chains.

Young people are more likely to be diagnosed with advanced cancer if they are uninsured, national study finds

By Melissa Patrick
Kentucky Health News

Adolescents and young adults who don't have insurance are more likely to be diagnosed with advanced cancer than their peers who have health insurance, says the American Cancer Society, in what sounds like a warning to an age group that is key to the success of health reform.

Anthony Robbins, the society's director of health services research, and other researchers found that uninsured females were twice as likely, and males half again as likely, as insured people of the same age to be diagnosed with advanced cancer.

An advanced cancer diagnosis means that the cancer has spread to multiple parts of the body or is considered not curable, the society said in a press release. It is more difficult and expensive to treat and more deadly. The study, published in the March issue of Cancer, sampled data from nearly 260,000 cancer patients ages 15 to 39 in the National Cancer Database between 2004 through 2010.

Uninsured patients tended to be younger and male, and were more likely to be black or Hispanic, and more likely to reside in the South. They were also more likely to have lower income and education levels.

Young adults have experienced the least benefit from recent progress in the fight against cancer, but federal health reform could mitigate that, the study's authors said.

"The findings suggest that policies such as the Affordable Care Act that increase the number of people in America with health coverage will result in fewer late-stage cancer diagnoses and save lives," the authors said. "However, the success of these efforts may be directly tied to the fate of the Medicaid expansion component."

Kentucky is among the states that have expanded Medicaid's eligibility to people with incomes up to 138 percent of the federal poverty threshold. About 48 percent of the enrollees in Kynect, the state online marketplace for health insurance, are under the age of 35, according to a press release from Gov. Steve Beshear's office.

Substantial enrollment of people under 35, who often go without insurance because they think they are in good health and will remain that way, is considered essential for the success of  health reform, because premiums from healthy people subsidize care for the less healthy, many of whom were unable to get affordable insurance before reform.

Invisible health panel could help Ky., if it had money and met

A panel charged with helping devise solutions to the nation’s health-care workforce crisis, which includes ensuring rural areas have enough health-care providers, is having a workforce crisis of its own: It hasn’t been funded, and it’s never met, writes Kyle Cheney of Politico. 

The National Health Care Workforce Commission was created by Congress nearly three years ago under the Affordable Care Act, the panelists were appointed, but that’s about it. The lack of action was noted at a hearing Tuesday of a subcommittee of the Senate Special Committee on Aging, convened by Sen. Bernie Sanders (I-Vt.), chairman of the Subcommittee on Primary Health and Aging.

Sanders issued a report estimating that 57 million Americans lack ready access to primary care. Since  millions are expected to gain coverage when the reform law goes into full effect next year, there is a looming concern over whether there are enough doctors, physicians' assistants, nurse practitioners, nurses and so on. Most of the worry relates to the lack of primary-care providers in underserved areas, which could be a huge problem for Kentucky.

In addition to exploring the health workforce needs in rural and “medically underserved” settings, the commission was supposed to address the capacity of the nursing workforce, graduate medical education policies, education and loan programs for health-care professionals and the “mental and behavioral health care workforce capacity,” writes Cheney.

Since the 15-member panel was appointed in September 2010 by the U.S. comptroller general, 10 members’ terms have expired, and they’ve been reappointed for another three years each, Cheney reports. No funding has been approved, although both Senate Democrats and President Barack Obama have proposed $3 million funding packages.

“In order for the promise of expanded coverage passed into law by ACA to become a reality, the provisions designed to reach those goals must be fully funded and implemented,” Sanders said. “We need to make sure that our health care system has the infrastructure in place to provide the care necessary to prevent diseases and improve the health of all Americans.” (Read more)

134,000 Kentucky families will split $15.3 million in health insurance rebates

About 134,000 families in Kentucky will get money back from their health insurance companies this summer. The families, representing about 249,000 people, will get a total of $15.3 million in rebates, which averages out to about $114 for each family. The returns are the result of the Patient Protection and Affordable Care Act.

"As part of the controversial 2010 health insurance overhaul pushed by President Barack Obama, insurance companies must spend 80 percent of all premiums they collect to pay claims or improve health outcomes," reports Beth Musgrave for the Lexington Herald-Leader. "The remaining 20 percent may be spent on administrative costs, such as salaries and advertising."

Insurance companies that did not meet that standard must return the money by Aug. 1. How much each family gets depends on their health insurance policy. (Read more)

Obama changes health-insurance rule to placate religious groups that oppose birth control

In an effort to quell a firestorm of controversy, President Obama announced today that his administration change its new rule that requires employers to offer free birth-control coverage in their health insurance plans. The rule has outraged some Roman Catholic leaders, whose tenets prohibit artificial contraception. (Associated Press photo by Susan Walsh)

Today's change essentially requires insurers, rather than religious employers, to cover the cost of coverage for contraception. "Any employer who has a religious objection to providing contraception will not have to provide that service to employees, but in those cases the insurer will be required to reach out directly to the employee and offer contraceptive care free of charge," report Christi Parsons and Kathleen Hennessey of the Los Angeles Times.

Yesterday at the Conservative Political Action Conference, Senate Republican Leader Mitch McConnell of Kentucky joined several other speakers in lambasting the original version of the rule, calling it "an assault on religious liberty," reports James R. Carroll of The Courier-Journal.

Obama's adjustment did not appear to placate most critics, but Sister Carol Keehan, president of the Catholic Health Association, said, "The framework developed has responded to the issues we identified that needed to be fixed." (Read more)