State doctors' group calls for more gun control, repeal of Second Amendment 'sanctuary' law; passes resolutions on many topics

By Melissa Patrick

Kentucky Health News

The Kentucky Medical Association called mass shooting and gun violence "a public-health crisis" and called for more gun control in one of nine resolutions on the topic at its annual convention.

Voting delegates representing the state's doctors also adopted resolutions addressing sex education, abortion care and more at their meeting Aug. 25-27 in Louisville.

Kentucky has the “14th-highest rate of gun deaths” in the nation, according to one of the resolutions.

 

KMA joined several other groups in declaring the public-health crisis, in a resolution that supports "A ban of assault (semi-automatic) weapons and killing-enhancement features, including high-capacity magazines, rapid-fire increases ('bump stocks'), silencers, and guns without serial numbers ('ghost' and 3-D printed guns)."

The resolution also calls for background checks without loopholes, waiting periods and safety training on all firearm transfers (retail, internet, gun-show purchases, lending and gifts); and extreme-risk protective orders ('red flag' laws) "to disarm persons who pose risks of gun violence to self or others."

Before the convention, Alex Acquisto of the Lexington Herald-Leader talked to KMA Executive Vice President Patrick Padgett about how KMA passes resolutions and what it means. 

Padgett said the association, by definition, is an advocacy organization to promote the well-being of patients, doctors and the community at large, and the resolutions represent the consensus of an organization that represents thousands of doctors statewide. Padgett said KMA members regularly conduct grassroots advocacy with legislators about health-related bills.

The group's rules say any KMA member can propose a policy change, which is then reviewed by a group of more than 100 doctors in KMA’s House of Delegates, which votes on resolutions in deliberations that are closed to the public. KMA is a private organization, not a public agency coveregd by the state Open Meetings Act.  

Acquisto notes that the KMA's suggested firearm legislation goes against the long-prevailing views in the General Assembly. 

Other resolutions support creation of a statewide gun-safety office to reduce firearm-related deaths;  eliminating ghost-gun loopholes; supporting legislation that promotes the implementation of "domestic violence prohibition laws;" screening during medical visits for presence of guns in the home; and research and educational campaigns about firearms, including safe storage.

"Gov. Andy Beshear, a Democrat, has called for the legislature to pass  to this end multiple times since he became governor — as far back as 2019 after two mass shootings in El Paso, Texas, and Dayton, Ohio, left dozens of people dead, and again this year, after a gunman in downtown Louisville killed five people," Acquisto reports.

Such laws are not popular "in a state that has historically championed the proliferation of and freedom to possess firearms," she adds. "Beshear’s predecessor, Republican Gov. Matt Bevin, said in 2019 that red flag laws are an 'erosion of our constitutional rights' and signed" into a law a bill repealing the requirement for a separate permit or training to carry a concealed deadly weapon.

"In 2020, a bipartisan bill to enact a red-flag law in Kentucky failed to get traction," Acquisto notes. "Earlier this year, legislators enacted a law making Kentucky a 'Second Amendment Sanctuary' state."

The legislation, which Beshear allowed to become law without his signature, says local and state officials and their employees shall not "enforce, assist in the enforcement of, or otherwise cooperate in the enforcement of a federal ban on firearms, ammunition, or firearm accessories."

One of the KMA resolutions calls for Kentucky to repeal the law, saying it and one to ban local gun laws "substantially weaken protection of our schoolchildren, citizens and police officers from mass shootings and gun violence." 

Abortion resolutions

Last year's KMA meeting, two months after the U.S. Supreme Court overturned federal abortion protections, allowing Kentucky's trigger law banning abortion except to save the life of the mother to become law, "could not reach consensus to take a bold stance in opposition to state laws restricting it," Acquisto reports. 

Five abortion-related resolutions were proposed at that meeting, and most were not adopted. This year, the KMA House of Delegates passed two of three abortion-related proposals. 

The first one "supports the protection of OB/GYN residents in Kentucky to have comprehensive education and training in obstetrics and gynecology," stating that without such training, "residents will compromise the future of OB/GYN health care and failure to incorporate abortion training in the resident curriculum will lead to a generation of physicians ill-equipped to fulfill their duty to care for patients." 

The other resolution calls for "revisions to relevant state statutes that restrict access to abortion-inducing medications for women who experience underlying medical conditions concurrently with life-threatening pregnancies."

That is aimed at 2022 House Bill 3, which "prohibits doctors from providing abortion-inducing medication to patients with certain medical histories, including if they have a history of ectopic pregnancies, are taking steroid hormones for rheumatoid arthritis, or are on a blood thinner medication for a heart condition, for example," Acquisto writes.  

The resolution says “The unintended consequences of HB 3 could adversely impact women and risk their lives during a life-threatening pregnancy.” 

A resolution to support comprehensive reproductive health care for women, including the opportunity to choose a medical or surgical abortion, was not adopted. 

Transgender health care and sex education 

Acquisto reports that last year, before most Republican-controlled states "began outlawing gender-affirming care for transgender youth, KMA adopted a policy supporting access to hormones and puberty blockers, and the preservation of the doctor-patient relationship in such settings, devoid of political tampering. According to the current policy handbook, KMA 'advocates against any prohibition of physicians or other health care providers (from) socially affirming gender identity or discussing evidence-based therapies for management of gender dysphoria with their patients and their parents.' The association also supports behavioral-health options and "non-surgical treatment provided to youth by appropriately trained and experienced health-care providers."

This year, the General Assembly passed Senate Bill 150, outlawing all forms of gender-affirming medical care for trans youth, contradicting the advice of the KMA and all oyther major U.S. medical associations.

None of this year's KMA resolutions addressed gender-affirming care, but two dealt with sex and health education in direct response to SB 150. One says "KMA supports legislation to remove age limits for health education in schools."

The other says "SB 150 . . . has raised the question of whether teaching students human health-related curriculum, including puberty and menstrual health education, is permitted in Kentucky before 6th grade." It amended KMA policy to say the group opposes the sole use of "abstinence-only education by providing information about condoms, birth control, and other means of preventing pregnancy and sexually transmitted diseases," and "supports age-appropriate anticipatory education related to menstruation and puberty for elementary school students," as well as "age-appropriate sexual education in schools to include information on sexual assault, consent communication, and dating violence prevention" and "age-appropriate sexual education in schools to include reference to non-traditional (LGBTQIA) practices for safe sex, in the interests of equality and prevention of sexually transmitted disease."

The resolution says KMA "will work with appropriate agencies, including but not limited to the public-school system, to ensure that sex education is age-appropriate, evidence-based, led by well- trained individuals, and subject to periodic evaluation and improvement." 

Other resolutions 

The House of Delegates also adopted resolutions to :

• Encourage swimming lessons for children, promotion of fences around swimming pools and direct supervision of children around water by a responsible individual, amid increased focus on an increased drowning risk of children with autism.
• Encourage caution in pediatric melatonin consumption and to promote physician-led education to caregivers regarding pediatric use of melatonin. 
• Increase skin cancer prevention, noting that "from 2016 to 2020, Kentucky was in the top 10 states with incidence rates of melanoma." 
• Support efforts to educate health care professionals and the public about the frequency and severity of eating disorders and weight stigma, and stated that it supports evidence-based treatment for eating disorders and the removal of insurance barriers designed to deny or restrict such treatment. 
• Promote efforts to decrease the rate of physicians' moral injury in Kentucky, defined as “the challenge of simultaneously knowing what care patients need but being unable to provide it due to a variety of constraints that are beyond a physician’s control.”
• Support improvements in mental health care services for the postpartum period to improve maternal and infant health outcomes; and supports advocating for funding of programs that aid postpartum depression research.
• Support use of anti-obesity medications if they are safe, effective and have a sustained impact with lifestyle modifications; and to advocate for better access to anti-obesity medications for all patients appropriately prescribed those medications.
• Urge an increase research on the safety and efficacy of Kratom and to support increased regulation on the sale and purchase of Kratom. The resolution states that while Kratom is legal to buy, sell and own in Kentucky, "The opioid and stimulant properties of Kratom make it an option for treating opioid withdrawal, but subsequently comes with risk for abuse, addiction, and overdose." It also supported a resolution to ban over-the-counter sales of Kratom in Kentucky and that it supports increased education regarding its misuse and negative health effects.
• Encourages and support expanding representation of darker skin tones in medical education, especially in printed texts and textbooks. 

Click here for a list of the adopted resolutions and for the "Kentucky Medical Association Gun Violence and Firearm Safety Work Group Report to the 2023 KMA House of Delegates."

Herald-Leader reports on why Ky.'s main doctors' lobby has taken no real stance on abortion despite many doctors' worries: politics

Despite unwavering opposition to Kentucky's near-total abortion ban from the American Medical Association, the American College of Obstetricians and Gynecologists, the American Academy of Pediatrics, and dozens of others, the Kentucky Medical Association's governing body chose to not adopt multiple evidence-based statements that abortion is an essential part of health care for Kentucky women. 

"The reason, according to half a dozen physician KMA members interviewed for this story, was largely political, and an attempt to strike a balance between competing opinions," Alex Acquisto reports for the Lexington Herald-Leader in a 2,564-word story. 

She writes, "In a state like Kentucky, where broad support of those laws is often buttressed by Christian doctrine rather than peer-reviewed research, many doctors are pinned between their ethical obligation to publicly advocate for patients and a need to compromise and avoid alienating the political party in power that passes those laws." Republicans have supermajorities in both legislative chambers. 

Acquisto adds, "Kentucky’s criminal penalty for violating the trigger law adds another layer of reluctance to speak up, doctors said." 

They are reluctant at a time when "Kentuckians are looking to physicians to cut through the political jargon, religious ideology and misinformation swirling around abortion access, and weigh in as health care professionals, especially with Constitutional Amendment No. 2 on the ballot in November," she writes. The proposal would prevent courts from finding in the state constitution a right to abortion or funding of it. 

The KMA "largely sidestepped" taking a stance on the issue at its annual meeting in August, she reports. "While doctors said restoring access to the full spectrum of reproductive health care is still their end goal, KMA sacrificed its pointed vocal opposition to laws not rooted in health care in order to preserve its working relationship with the Kentucky General Assembly." Doctors have long held sway in the legislature, especially in the Senate, and have been leading financiers of legislators' campaigns. 

Acquisto reports on five policy resolutions related to abortion that were considered by KMA's House of Delegates at its meeting in late August. 

A KMA spokesperson told Acquisto that the annual meeting debate proceedings are private and so are the lists of delegates and other attendees. 

"Three of the five were overtly critical of the Kentucky state legislature for banning abortion in all cases except medical emergencies by way of a trigger law." The delegates chose not to adopt any of the three "biting policy statements," but instead adopted one that does not mention abortion or “reproductive health care,” but urges passage of health-care policy that is “evidence-based.” 

It also adopted one titled "Improving Maternal Health" that more generally says KMA will "advocate for improved reproductive health care and resources" for Kentucky women, Acquisto reports. 

She reports that the Herald-Leader reached out to 19 KMA members for the story and six agreed to be interviewed. All said they either helped write the three rejected resolutions, participated in debate on them at the meeting, or cast votes. 

They told Acquisto that, despite the consensus among obstetrician-gynecologists on the importance of access to abortion, there is division in KMA over public advocacy of reproductive rights, often stemming from religious convictions and political beliefs among doctors outside that specialty.

"But a prevailing reason KMA didn’t take a stronger public stance," she reports, "was fear that lawmakers, seeing it as a slight, would refuse future input from the association on abortion policy."

Sen. Ralph Alvarado, M.D.

Acquisto reports that during debate at the meeting, Sen. Ralph Alvarado, R-Winchester, a KMA member, "was matter-of-fact in his warning: the legislature would be much less inclined to work with the KMA if it publicly bucked GOP lawmakers and their abortion laws, according to three people in the room who said it sounded threatening."

Alvarado, a family physician who ran for lieutenant governor in 2019 with then-Gov. Matt Bevin and has celebrated the fall of Roe v. Wade, gave Acquisto a statement saying he felt “uniquely positioned, qualified and obligated to offer my consultation” at the meeting and spoke “plainly about how an effective, collaborative working relationship between KMA and the General Assembly could and should occur,” adding that the association “cannot and should not be defined by a single policy issue.”

After the debate, the resolutions “took a more neutral position,” one that “better reflects current KMA members’ views,” Alvarado said. 

In other Southern states, such as Tennessee and South Carolina, doctors have been more assertive in asking their legislatures to reconsider their abortion bans, Acquisto reports: "In mid-June, at its annual meeting in Chicago, the American Medical Association publicly declared abortion a 'human right,' with 100% support' from Kentucky’s official delegation, said Dr. Coy Flowers, a Lexington OB-GYN who oversaw that local support."

But Flowers told Acquisto that it's not as easy [to take such a stance] back home in Kentucky, though, where it’s a “game of chess, not checkers in terms of politics and public advocacy." 

Flowers is one of 14 OB-GYNs nationwide to serve as an American College of Obstetrics and Gynecology delegate to the AMA.

Acquisto also writes about challenges faced by doctors because they are unsure how to interpret Kentucky's abortion ban. It forbids abortion except to prevent the woman's death, a “substantial risk of death due to a physical condition,” or “serious, permanent impairment” of a “life-sustaining organ.”

The law does not define those terms, nor does legal guidance exist on the range of conditions for which an abortion is medically necessary even if a the woman's life is not imminently threatened. Attorney General Daniel Cameron issued a second advisory opinion Oct. 26 to clarify the scope of the ban, but it "didn't provide clarification on a litany of other medical conditions and treatments impacted by those laws," Acquisto reports. Doctors told her that this is yet another reason that the KMA should more strongly assert itself.

Dr. Monalisa Tailor, an internal-medicine physician in Louisville, is the new president of the Kentucky Medical Association

Dr. Monalisa Tailor
Norton Healthcare photo

Dr. Monalisa Tailor, a Louisville internal-medicine physician, is the new  president of the Kentucky Medical Association. She is both the youngest and first female president of color in the association's history. She was sworn in as the 172nd president at the organization's annual meeting. 

Tailor, a native of Bowling Green, is board-certified in internal medicine and advanced cardiac life support, and is employed by Norton Healthcare. She previously served as vice speaker of the KMA House of Delegates as well as on numerous KMA commissions and committees. 

She was president of the Greater Louisville Medical Society in 2020-2021 and now chairs the GLMS board. She has received several community leadership awards. 

In her inaugural address, Tailor discussed her goals for the year, including a focus on “rejuvenating medicine,” given the challenges the profession has faced over the last several years.

“For those of us working in healthcare, the Covid-19 pandemic has left an indelible mark on our lives. Stress and burnout are at an all-time high in our profession, while mistrust and misinformation among our patients could be considered an epidemic in itself," Tailor said in a news release. "Now more than ever, we need to come together as physicians to combat these issues and reinvigorate ourselves so that we can continue to provide the best care for the people of the commonwealth." 

Ben Chandler awarded Kentucky Medical Association's advocacy award for his work on flu prevention and tobacco-free efforts

Dr. Bruce Scott (L), Ben Chandler (R)
Kentucky Medical Association photo.  

The Kentucky Medical Association awarded Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, with its advocacy award for his efforts around tobacco-free policies and partnership in the 2018 "Focus on Flu" campaign.

The award is presented to individuals who have effected positive change in the healthcare space through their advocacy efforts, a KMA news release said. Chandler received the award at the association's 2019 annual meeting on Sept. 21 in Louisville.

Through his work with the foundation, Chandler has partnered with numerous outside organizations, including the KMA and its Kentucky Foundation for Medical Care. Together, these groups launched a “Focus on Flu” campaign last year to mitigate the effects of another deadly flu season in Kentucky.

Chandler is chair of the Coalition for a Smoke Free Tomorrow, made up of various stakeholders from across the state. In 2018, the coalition successfully secured a 50-cent increase in the state’s tobacco tax, to $1.10 per pack, and in 2019 helped pass a statewide tobacco-free schools law.

This year, the foundation, KMA and KFMC have once again partnered to offer campus signage at no cost to schools who comply with the law, which takes effect next summer.

The release notes that flu prevention and smoking cessation are two of the focus areas of KMA’s “AIM for Better Care: Administrative Improvements in Medicine” initiative.

Dr. Maurice Oakley, an ophthalmologist from Ashland, is the new president of the Kentucky Medical Association

Dr. Maurice Oakley

Dr. Maurice Oakley, an ophthalmologist from Ashland, is the new president of the Kentucky Medical Association, an organization with over 7,000 members.

Oakley will focus on "breaking down barriers to good health and active involvement from physicians in doing so," with an emphasis on the opioid issues plaguing the state, says the news release.

“There are so many barriers within our medical system to people receiving good care that actually addresses the most important issues impacting Kentuckians,” Oakley said in the release. “Smoking is one such issue, and we addressed it in part through passage of legislation in 2017 that makes smoking cessation products and services more available. We need to take the same principles of breaking down barriers to smoking cessation and apply them to the opioid problem.”

Oakley was sworn in Aug. 26 at the organization's annual meeting, which was designed around Dr. Oakley's areas of focus, including a two-day meeting that educated physicians about the opioid epidemic and for the first time, participants were given time to give direct feedback to policymakers who were in attendance, and make suggestions about possible KMA actions around the opioid issue.

During his inaugural speech, Oakley also addressed barriers to care, including minimizing the administrative tasks required by physicians that "have little or nothing to do with improving care.

"That has to change. Administrative tasks should be meaningful to making the patient healthier rather than simply documenting some mandated action," he said.

Oakley is a graduate of the University of Louisville School of Medicine and has practiced in Ashland since 1978. He has been an active member of the KMA, having held several leadership positions. He is the first KMA president from Ashland in 47 years and will hold this position for one year.

Retired UK professor Dr. Ardis Dee Hoven elected first female chair of World Medical Association

Retired University of Kentucky professor Dr. Ardis Dee Hoven, who was the president of the American Medical Association in 2013-14, was elected the first female chair of the World Medical Association at the organization's 200th council meeting in Oslo, Norway

For the past few years, Hoven was the chair of the AMA's delegation to the WMA and will now serve as the chair of the WMA for a two-year term. WMA represents physicians from 111 national medical associations.

"I feel fortunate to have the opportunity to do this," Hoven said in a UK news release. "I see myself not so much as a woman in this role but as a leader of a global organization of physicians who are working to support their peers around the the world and improve the lives of their patients."

Hoven earned an undergraduate degree in microbiology then a medical degree from UK. She finished her internal medicine and infectious disease training at the University of North Carolina at Chapel Hill. Now she is a member of the American College of Physicians and the Infectious Disease Society of America.

Hoven has received the University of Kentucky College of Medicine Distinguished Alumnus Award and the Kentucky Medical Association Distinguished Service Award, and in 2015, she was inducted into the Hall of Distinguished Alumni for UK. "Hoven hopes for the WMA to raise its profile internationally and increase the impact of its policies and advocacy on behalf of physicians and patients," the release says.

"I want to make our footprint bigger and our voice stronger," Hoven said.

Health-care forum examines 'incredible change' in Kentucky's health-care system, looks forward to more access to care

By Molly Burchett and Al Cross
Kentucky Health News

What does health-care reform mean to Kentucky? What impact has Medicaid expansion had? Can we work together to do care differently in Kentucky? Answers to these questions and more were offerd by national, regional, and local health care experts Sept. 16 in Louisville at the Foundation for a Healthy Kentucky's annual Howard L. Bost Health Policy Forum.

This year's topic was "Doing Care Differently," but as foundation chair David Bolt, deputy director of the Kentucky Primary Care Association, told the crowd, "It could have just as easily been named after the Bob Dylan song, 'The Times They Are A-Changin'."

As a health-care provider for 44 years, Bolt said, "I have lived through almost every change since the implementation of Medicare and Medicaid. And I am actually excited about the changes I see on the horizon." He said he thinks the late Dr. Bost would look at what Kentucky is doing and say," It's about time we moved away from a treat-'em-and-street-'em mentality to integrated health care delivery services and systems rooted in accountable outcomes and founded in a value-drive system of improving health."

One of the biggest recent changes in Kentucky health care is Gov. Steve Beshear's expansion Medicaid at the beginning of the year, which offered coverage to Kentuckians under 65 in households up to 138 percent of the federal poverty level. As a result, Medicaid is now the largest health-care payer in the state, serving 1.1 million Kentuckians, one out of every four, Cabinet for Health and Family Services Deputy Secretary Eric Friedlander told the crowd.

"We had incredible enrollment. It's an incredible change." said Friedlander. "We hope it is a change for the better."

Friedlander said enrollment in every county exceede estimates for the state by the accounting firm PriceWaterhouse Coopers, based on estimates from the Congressional Budget Office. Those estimates anticipated 55 percent of eligible persons enrolling in the first year, leveling out at 70 percent in future years. Instead, enrollments through June were almost double the prediction.

Medicaid paid more than $284 million to Kentucky health-care providers in the first half of this year for treating the newly eligible Medicaid beneficiaries, with hospitals receiving 48 percent of those reimbursements, Friedlander said. He said that number will be $1 billion to $2 billion by the end of the year. (Medicaid payments sometimes take months to complete.)

The federal government is paying the entire cost of the newly eligibles through 2016. State officials have said that they won't be able to update cost estimates for 2017 a few more months because additional data must be collected about enrollees after the insured population has stabilized.

"Medicaid expansion is not static," Friedlander said. "It is dynamic, and the individuals that make up that enrollment are constantly changing."

Friedlander said employment in Kentucky health care has increased by 3,800 jobs, but the study estimated that 7,600 jobs would be added in the first year. This means enrollment is almost double what was projected yet job expansion is almost half. That undercuts Beshear's contention, based on the study, that Medicaid expansion will pay for itself by adding heath-care jobs.

As more Kentuckians get insurance, there may be shortages of primary-care doctors, especially in rural areas of states like Kentucky, reports Kaiser Health News. That need could be overstated, Sheila Schuster, a clinical psychologist and executive director of the Advocacy Action Network, said at the forum.

Kentucky has 3,929 advanced practice registered nurses, Schuster said, 54 percent more APRNs than in 2010. A new state law that took effect July 15 "removed a barrier that was keeping them from opening practices," she said. The law allows APRNs to prescribe non-narcotic drugs independently after they have prescribed under physician supervision for four years.

The law was passed after negotiations among the Kentucky Medical Association, the Kentucky Academy of Family Physicians and the Kentucky Coalition of Nurse Practitioners and Nurse Midwives. Schuster suggested that other such compromises are needed to expand access to health care.

"We aren't playing very well with each other in the sandbox," she said, adding that turf battles need to be set aside to keep health-care innovation people-centered.

The forum was co-sponsored by KET, Louisville's Health Enterprises Network, the Kentucky Health Information Exchange, the Kentucky Medical Association and Leadership Kentucky.

In wake of pill-mill regulation fight, Beshear has chance to craft a medical licensing board more to his liking

Gov. Steve Beshear

Gov. Steve Beshear is in a position to reshape a state medical board that has played a central and controversial role in recent efforts to crack down on prescription drug abuse. Mike Wynn of The Courier-Journal  reports that the terms of three members of the Kentucky Medical Licensure Board expired Aug. 31, and two other members’ terms await action after ending last year.

The licensure board drew criticism in 2011 "for not taking more aggressive action against so-called pill mills and corrupt doctors who supply Kentucky’s drug epidemic," Wynn writes. "The medical industry also has criticized the board in recent months for writing what doctors view as overly complex and excessive prescription regulations under HB 1, a landmark bill from the 2012 General Assembly that takes aim at abuse of drugs."

Beshear spokeswoman Kerri Richardson said the appointments are under review but did not indicate how the governor might proceed other than noting that he will consider qualifications and recommendations. Current board members serve until Beshear makes any new appointments. (Read more)

Legislators hear about serious problems in managed-care system

The switch to the new Medicaid managed-care system is proving to be a nightmare, health officials told lawmakers Wednesday, with long delays in payment to providers and treatment for patients.

"It appears to me the only place the savings can come from is the delay and denying of care," said Dr. Shawn Jones, president of the Kentucky Medical Association and physician in Paducah. "Patient care is being delayed and, in some cases, simply prevented." (Video from cn|2)

Jones was one of several officials who testified at a meeting of the Senate Health and Welfare Committee. The new system requires pre-authorization for procedures that were once routinely covered, so patients spend hours in waiting rooms or are told to go home and return after their procedures have been given the go-ahead. In one instance, a woman in labor came to the hospital to deliver "and the managed-care company insisted that her care be pre-authorized," reports Deborah Yetter of The Courier-Journal.

"Fourteen days later, mom and baby are home and we still have no pre-authorization," said Joe Grossman, chief financial officer of Appalachian Regional HealthCare.

Problems started Nov. 1 when the state turned its Medicaid program outside the Louisville region to three managed care companies. (Louisville-area recipients have long been managed by Passport Health Plan.) The move is intended to save the state money and fill a hole in the Medicaid budget. But officials said the three companies — CoventryCares of Kentucky, Kentucky Spirit Health Plan and WellCare of Kentucky — seem to be purposefully delaying claims payments, though the state has already paid them $135 million since Nov. 1.

"I feel like I've become a bank to these out-of-state insurance companies," said Grossman, whose eight-hospital chain is owed $8 million. "I've lent them money."

The managed care companies did not testify Wednesday, but issued statements saying they intend to address the issues at hand. Neville Wise, the state's acting Medicaid commissioner, " said he believes the issues are just temporary bumps that can be ironed out," Ryan Alessi of cn|2's "Pure Politics" reports. The requirement that childbirth be pre-authorized, for example, has since been rectified, Yetter notes. State Sen. Julie Denton, R-Louisville, asked Wise, "How many more ludicrous scenarios can there be?" (Read more)