Appeals court upholds proposed warning labels for cigarette packs, but sends case back down to decide a procedural issue

Three of the proposed warning labels for cigarette packs and ads

By Kevin McGill
Associated Press

A federal rule to require cigarette packs and advertising to include graphic illustrations that demonstrate the effects of smoking — including pictures of smoke-damaged lungs and feet blackened by diminished blood flow — does not violate the First Amendment, an appeals court ruled Thursday.

The ruling from a three-judge panel of the 5th U.S. Circuit Court of Appeals was a partial victory for federal regulators seeking to toughen warning labels. But the court kept alive a tobacco-industry challenge of the rule, saying a lower court should review whether it was adopted in accordance with the federal Administrative Procedure Act, which governs the development of regulations.

The appeals-court panel rejected industry arguments that the rule violates free speech rights or that it requires images and lettering that take up so much space that they overcome branding and messaging on packages and advertisements.

The ruling overturns a lower court order from a federal district court in Texas, where a judge found that the requirements did violate the First Amendment.

“We disagree,” Judge Jerry Smith wrote for the 5th Circuit panel. “The warnings are both factual and uncontroversial.”

In addition to Smith, who was nominated to the court by former President Ronald Reagan, the panel included judges Jennifer Walker Elrod, nominated by George W. Bush, and James Graves, nominated by Barack Obama.

While reversing the lower court's key finding, the panel noted that the judge had not ruled on the Administrative Procedures Act question. It sent the case back to the district court to consider that issue.

The images in question include a picture of a woman with a large growth on her neck and the caption “WARNING: Smoking causes head and neck cancer.” Another shows a man’s chest with a long scar from surgery and a different warning: “Smoking can cause heart disease and strokes by clogging arteries.”

Nearly 120 countries have adopted larger, graphic warning labels. Studies from those countries suggest the image-based labels are more effective than text warnings at publicizing smoking risks and encouraging smokers to quit. About 23% of Kentuckians smoke, the second highest rate in the nation.

Uncle Sam wants you ... to help stop health-insurance companies from using misleading tactics to sell Medicare Advantage plans

iStock/Getty Images Plus illustration via KFF Health News

By Susan Jaffe
KFF Health News

After an unprecedented crackdown on misleading advertising claims by insurers selling private Medicare Advantage and drug plans, the Biden administration hopes to unleash a special weapon to make sure companies follow the new rules: you.

Officials at the Centers for Medicare & Medicaid Services are encouraging seniors and other members of the public to become fraud detectives by reporting misleading or deceptive sales tactics to 1-800-MEDICARE, the agency’s 24-hour information hotline. Suspects include postcards designed to look like they’re from the government and TV ads with celebrities promising benefits and low fees that are available only to some people in certain counties.

The new rules, which took effect Sept. 30, close some loopholes in existing requirements by describing what insurers can say in ads and other promotional materials as well as during the enrollment process.

Insurance companies’ advertising campaigns are in high gear because Dec. 7 is the end of open-enrolment season, when seniors can buy policies that take effect Jan. 1. People with traditional government Medicare coverage can add or change a prescription drug plan or join a Medicare Advantage plan that combines drug and medical coverage. Although private Advantage plans offer extra benefits not available under the Medicare program, some services require prior authorization and beneficiaries are confined to a network of health care providers that can change anytime. Beneficiaries in traditional Medicare can see any provider.

Catching Medicare Advantage plans that step out of line isn’t the only reason to keep an eye out for marketing scams. Accurate plan information can help avoid enrollment traps in the first place.

Although insurers and advocates for older adults have generally welcomed the new truth-in-advertising rules, compliance is the big challenge. Expecting beneficiaries to monitor insurance company sales pitches is asking a lot, said Semanthie Brooks, a social worker and advocate for older adults in northeast Ohio. She’s been helping people with Medicare sort through their options for nearly two decades. “I don’t think Medicare beneficiaries should be the police,” she said.

Choosing a Medicare Advantage plan can be daunting. In Ohio, for example, there are 224 Advantage and 21 drug plans to choose from that take effect next year. Eligibility and benefits vary by county.

“CMS ought to be looking at how they can educate people, so that when they hear about benefits on television, they understand that this is a promotional advertisement and not necessarily a benefit that they can use,” Brooks said. “If you don’t realize that these ads may be fraudulent, then you won’t know to report them.”

Meena Seshamani, CMS’s Medicare director, told KFF Health News in a written statement that the agency relies on beneficiaries to help improve services: “The voices of the people we serve make our programs stronger,” she said, noting that complaints from policyholders prompted the government’s action. “That’s why, after hearing from our community, we took new critical steps to protect people with Medicare from confusing and potentially misleading marketing.”

Although about 31 million of the 65 million people with Medicare are enrolled in Advantage plans, even that may not be enough people to monitor the tsunami of advertising on TV, radio, the internet, and paper delivered to actual mailboxes. Last year more than 9,500 ads aired daily during the nine-week marketing period that started two weeks before enrollment opened, according to an analysis by KFF. More than 94% of the TV commercials were sponsored by health insurers, brokers, and marketing companies, compared with only 3% from the federal government touting the original Medicare program.

During just one hourlong Cleveland news program in December, researchers found, viewers were treated to nine Advantage ads.

This year, for the first time, CMS asked insurance and marketing companies this year to submit their Medicare Advantage TV ads to make sure they complied with the new rules. Officials reviewed 1,700 commercials from May 1 through Sept. 30 and nixed more than 300 they deemed misleading, according to news reports. An additional 192 ads out of 250 from marketing companies were also rejected. The agency would not disclose the total number of TV ads reviewed and rejected this year or whether ads from other media were scrutinized.

The new restrictions also apply to salespeople, whether their pitch is in an ad, written material, or a one-on-one conversation. Under one important new rule, the salesperson must explain how the new plan is different from a person’s current health insurance before any changes can be made.

That information could have helped an Indiana woman who lost coverage for her prescription drugs, which cost more than $2,000 a month, said Shawn Swindell, the State Health Insurance Assistance Program supervisor of volunteers for 12 counties in east-central Indiana. A plan representative enrolled the woman in a Medicare Advantage plan without telling her it didn’t include drug coverage, because the plan is geared toward veterans who can get drug coverage through the Department of Veterans Affairs instead of Medicare. The woman is not a veteran, Swindell said.

In New York, the Medicare Rights Center received a complaint from a man who had wanted to sign up just for a prepaid debit card to purchase nonprescription pharmacy items, said the group’s director of education, Emily Whicheloe. He didn’t know the salesperson would enroll him in a new Medicare Advantage plan that offered the card. Whicheloe undid the mistake by asking CMS to allow the man to return to his previous Advantage plan.

Debit cards are among a dizzying array of extra nonmedical perks offered by Medicare Advantage plans, along with transportation to medical appointments, home-delivered meals, and money for utilities, groceries, and even pet supplies. Last year, plans offered an average of 23 extra benefits, according to CMS. But some insurers have told the agency only a small percentage of patients use them, although actual usage is not reportable.

This month, CMS proposed additional Advantage rules for 2025 plans, including one that would require insurers to tell their members about available services they haven’t used yet. Reminders will “ensure the large federal investment of taxpayer dollars in these benefits is actually making its way to beneficiaries and are not primarily used as a marketing ploy,” officials said in a fact sheet.

Medicare Advantage members are usually locked into their plans for the year, with rare exceptions, including if they move out of the service area or the plan goes out of business. But two years ago, CMS added an escape hatch: People can leave a plan they joined based on misleading or inaccurate information, or if they discovered promised benefits didn’t exist or they couldn’t see their providers. This exception also applies when unscrupulous plan representatives withhold information and enroll people in an Advantage policy without their consent.

Another new rule that should prevent enrollments from going awry prohibits plans from touting benefits that are not available where the prospective member lives. Empty promises have become an increasing source of complaints from clients of Louisiana’s Senior Health Insurance Information Program, said its state director, Vicki Dufrene. “They were going to get all these bells and whistles, and when it comes down to it, they don’t get all the bells and whistles, but the salesperson went ahead and enrolled them in the plan.”

So, expect to see more disclaimers in advertisements and mailings like this unsolicited letter an Aetna Medicare Advantage plan sent to a New York City woman: “Plan features and availability may vary by service area,” reads one warning packed into a half-page of fine print. “The formulary and/or pharmacy network may change at any time,” it continues, referring to the list of covered drugs. “You will receive notice when necessary.”

The rules still let insurers to boast about their CMS one-to-five-star ratings, even though the ratings do not reflect the performance of specific plans that may be mentioned in an ad or displayed on the government’s Medicare plan finder website. “There is no way for consumers to know how accurately the star rating reflects the specific plan design, specific provider network, or any other specifics of a particular plan in their county,” said Laura Skopec, a senior researcher at the Urban Institute, who recently co-authored a study on the rating system.

And because ratings data can be more than a year old and plans change annually, ratings published this year don’t apply to 2024 plans that haven’t even begun yet — despite claims to the contrary.

How to spot misleading Medicare Advantage and drug plan sales pitches (and what to do about it)

The Centers for Medicare & Medicaid Services has new rules cracking down on misleading or inaccurate advertising and promotion of Medicare Advantage and drug plans. Watch out for pitches that:

• Suggest benefits are available to all who sign up when only some individuals qualify.
• Mention benefits that are not available in the service area where they are advertised (unless unavoidable because the media outlet covers multiple service areas).
• Use superlatives like “most” or “best” unless claims are backed up by data from the current or prior year.
• Claim unrealistic savings, such as $9,600 in drug savings, which apply only in rare circumstances.
• Market coverage without naming the plan.
• Display the official Medicare name, membership card, or logo without CMS approval.
• Contact you if you’re an Advantage or drug plan member and you told that plan not to notify you about other health insurance products.
• Pretend to be from the government-run Medicare program, which does not make unsolicited sales calls to beneficiaries.

If you think a company is violating the new rules, contact CMS at 1-800-MEDICARE, its 24-hour information hotline. If you believe you chose a plan based on inaccurate information and want to change plans, contact CMS or Kentucky's State Health Insurance Assistance Program at 1-877-293-7447 or online at https://chfs.ky.gov/agencies/dail/Pages/ship.aspx. For more information about protecting yourself from marketing violations, go to www.shiphelp.org/about-medicare/blog/protecting-yourself-marketing-violations.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at the Kaiser Family Foundation, an independent source of health policy research, polling and journalism. Reporter Susan Jaffe is at Jaffe.KHN@gmail.com.

Beshear win pressures legislature to put exceptions for rape and incest, topic of impactful TV ad, into state's near-total abortion ban

Hadley Duvall, a Midway University senior, appeared in a TV commercial for Gov. Andy Beshear.

By Deborah Yetter

Kentucky Lantern

Standing before cheering supporters on election night, Kentucky Gov. Andy Beshear wrapped up his re-election celebration with a round of thanks.

“First to my parents,” he said, embracing Jane and Steve Beshear — his father himself a former, two-term governor.

The Democratic incumbent, who defeated Republican Attorney General Daniel Cameron by 5 percentage points, next thanked his wife, Britainy and their children, Will and Lila.

Then Beshear thanked a young woman in the crowd who appeared in a television ad that became the flashpoint of his campaign — describing her childhood rape and pregnancy and blasting Cameron for his support of Kentucky’s near-total ban on abortion.

“To tell a 12-year-old girl she must have the baby of the stepfather who raped her is unthinkable,” Hadley Duvall sayid in the ad.

“Hadley is here tonight,” Beshear said of the 21-year-old Midway University senior from Owensboro who appeared in what political observers say was a devastatingly effective ad. “Because of her, this commonwealth is going to be a better place and people are going to reach out for the help they need. Thank you, Hadley.”

Abortion remains essentially illegal in Kentucky under a pair of laws enacted by the Republican-controlled General Assembly that provide no exceptions for pregnancies from rape or incest — laws Cameron, as attorney general, has defended.

The laws took effect after the U.S. Supreme Court last year struck down the landmark Roe v. Wade decision of 1973, establishing abortion as a constitutional right.

The Republican supermajority in the state legislature has shown little interested in changing Kentucky’s laws, even to add exemptions for rape or incest. But supporters of abortion rights are hopeful that Beshear’s reelection in a deep red state marks a turning point in attitudes about access to abortion as well as an awakening among voters about the real-life impact of laws that ban it.

“I think it is very obvious that abortion has become an issue that people are not afraid to talk about any longer and that certainly does drive people to the polls,” said Angela Cooper, communications director for the American Civil Liberties Union of Kentucky.

Tamarra Wieder, state director for Planned Parenthood Alliance Advocates Kentucky, noted that the Nov. 7 re-election of Beshear, a supporter of abortion rights, came the same day that voters in Ohio, also a conservative state, approved a ballot measure establishing a state constitutional right to abortion.

And Beshear’s win comes one year after Kentucky voters rejected a ballot measure that would have declared Kentucky’s constitution creates no right to abortion. About 52% of the state’s voters opposed the measure — about the same share of voters who elected Beshear to a second term, Wieder said.

“I don’t think it’s a coincidence that those numbers are the same,” Wieder said. “Abortion is a winning issue.”

Political observers say it’s likely Beshear would have won for other reasons — his overall popularity, his advantage as the incumbent, and his management of crises in his first term including the Covid-19 pandemic and devastating tornadoes and deadly flooding.

But the abortion issue — in particular, the ad featuring Duvall — deepened the contrast between Beshear and Cameron.

While Beshear has said he supports abortion access previously conferred by Roe v. Wade, as he ran for re-election he stressed that the law contains no exemptions for rape or incest, calling it “cruel.”

Cameron, who has defended Kentucky’s laws, was left struggling to explain his stance, giving conflicting responses to the issues raised in the ad. And that worked to Beshear’s benefit, said Danny Briscoe, a long-time Democratic consultant from Louisville.

“You can’t say she won the campaign for him but you can say she played an awfully valuable role,” Briscoe said of Duvall. “They put the ball in Cameron’s court and he never really got rid of it.”

UPDATE, Nov. 13: Polls indicated the ad would be the most effecitve in moving voters from Cameron to Beshear, campaign manager Eric Hyers told Politico: “It cemented and locked in where the race was and made it so that it was going to be very, very difficult — if not impossible — for him to get to a majority because people were so repulsed.” He also said voters who moved the most were older Republican, non-college educated men in rural areas, Madison Fernandez reports.

Tres Watson, a GOP campaign consultant, said Republicans who once confidently campaigned on ending abortion are in an awkward spot now that it is effectively banned in 14 states and restricted in 11 more.

“I think it’s a new reality,” said Watson, a co-host of the Kentucky Politics Weekly podcast. “I don’t think the general public has changed. Who’s on the offense and who’s on the defense have changed.”

Most Americans oppose the decision overturning Roe v. Wade and continue to support at least some measure of access to abortion, according to a Marist College poll in April.

Addia Wuchner, executive director of Kentucky Right to Life, which endorsed Cameron through its Victory PAC as “an unwavering defender of Kentucky’s pro-life laws,” noted that Republicans won the other five statewide constitutional offices on the Nov. 7 ballot were won by Republicans and all were endorsed by Right to Life, including Russell Coleman, who will replace Cameron as attorney general.

As for the outcome of the governor’s race in Kentucky, Wuchner said, “We’re still trying to evaluate everything.

Whether the Kentucky General Assembly will consider adding exemptions to the state’s stringent abortion laws remains in question.

Two laws are in in effect: A “trigger law” that banned all abortions once Roe v. Wade was overturned and another that bans abortions after six weeks, before many women realize they are pregnant. Neither law has exemptions for rape or incest and allow abortion only in rare instances to save the life or prevent disabling injury of a pregnant patient.

Beshear called on lawmakers the day after the election to add exceptions for rape or incest, calling Kentucky’s laws among the “most extreme” in the nation.

Rep. Jason Nemes, R-Louisville, filed such a measure only to have it ignored by lawmakers in the 2023 legislative session. “I think our people believe in the exemptions,” he said. “And at some point, we’re representatives of the people, and we have to do what their demands are.”

However, “Exceptions for rape and incest are the minimum,” said the ACLU’s Cooper. “It’s really not enough.” Wieder, with Planned Parenthood, agrees.

She said Planned Parenthood will continue work to educate voters that the decision now rests with state lawmakers. “People think the bans are national,” Wieder said. “They don’t realize it’s their local leaders.”

Beshear defends pandemic work as Cameron cites learning loss, makes false claim about founder of Planned Parenthood

Candidates' supporters at KET Monday night (Kentucky Lantern photo by Matthew Mueller)

By Al Cross
Kentucky Health News

In their next-to-last debate before the Nov. 7 election, Gov. Andy Beshear defended his response to the Covid-19 pandemic against criticism from Republican Attorney General Daniel Cameron. Appearing for an hour on KET, the candidates also debated each other's positions on abortion, and Cameron made  a false claim about the founder of Planned Parenthood.

Moderator Renee Shaw opened the "Kentucky Tonight" forum by asking Cameron how he would have handled the pandemic that hit the state in March 2020. He said he would have "done like other red-state governors" and tried to get businesses "open as quickly as possible."

Asked if he would have shut down schools at any point, he did not say, but said "I wouldn't have infringed on your constitutional rights." That was a reference to court decisions, some successfully sought by Cameron, that said a few of Beshear's state-of-emergency restrictions went too far.

Beshear was asked if he had any misgivings about the strength and duration of his restrictions, specifically the application on Easter Sunday of his ban on mass indoor gatherings.

He did not address that specific point, but said, "This is about leadership. I showed people during the pandemic I was willing to make the hard decisions, even if it cost me. I put politics out the window, and I made the best decisions I could to save as many lives as possible.”

Asked if he would do it all over again the same way, Beshear didn't answer directly, but said "I believe we made the best decision we did with the information we had," and said he was the first governor to prioiritized teachers for immunizations when vaccines for Covid-19 became available.

Cameron claimed that Beshear "said he had no regrets," and said he would not admit regret "because of pride."

Noting repeatedly that Beshear closed schools, Cameron said "Your kids are behind because of this short-sighted decision," and noted his "catch-up plan" to help them.

Beshear, asked if he has a strategy for that, said he does, but tried to spread blame to the Republican-controlled legislature: "This is something that was happening before the pandemic, primarly because of not enough educators," due to low pay causing teacher shortages.

He also shifted blame when asked if he would take responsibility for the huge backlog in unemployment claims during the pandemic. He noted the downsizing of the agency under his GOP predecessor and said "If we'd had the resources that were there in the last administraton we could have done much better."

Abortion

Cameron has said that if the legislature sent him a bill to put rape and incest exceptions into the state's abortion ban, he would sign it. Asked to say "yes or no" if he personally favors such exceptions, he repeatedly declined to answer, and made a false claim about the founder of Planned Parenthood.

Cameron, an African American, noted the organization's strong support of Beshear, and said its founder, Margaret Sanger, favored the extermination of his race. This claim has been made and debunked several times, but Cameron said Sanger "said I didn't deserve to live." UPDATE, Oct. 25: In a debate Tuesday night, Cameron put it another way: "Margaret Sanger wanted to destroy the Black community," and said 79% of abortion clinics are in Black neighborhoods. 

Sanger believed in eugenics, which taught white superiority and discouraged reproduction of races and ethnicities it deemed inferior. In 1939 she started a project to expand birth-control services for African Americans in the South. In a letter, she told a director of the program that it should hire African American doctors and ministers to gain trust in Black communities because “We do not want word to go out that we want to exterminate the Negro population ...”

That was “inartfully written” but was “frequently taken out of context to suggest Sanger was seeking to exterminate blacks,” The Washington Post reported in 2015. The Reuters news service said in a fact check last year, "Sanger’s concern was to avoid a suspicion that the program’s objective was to stop Black people having babies, which having white people in charge could create."

Sanger's full quote was, “We do not want word to go out that we want to exterminate the Negro population, and the minister is the man who can straighten out that idea if it ever occurs to any of their more rebellious members.”

During the debate on abortion, Shaw noted that Cameron and 18 other attorneys general signed a letter in June opposing a proposed federal privacy rule that would keep state officials from getting information on any reproductive health-care services that in-state residents obtained outside the state, and asked if he wants to criminalize women seeking abortions.

"Absolutely not," Cameron replied, returning to the attack: "Andy Beshear is trying to gaslight you tonight. . . . He wants no limits on abortion." Not so, Beshear said.

Asked if a woman be allowed to terminate a pregnancy at any point, Beshear said his long-held position is that "I am in favor of reasonable restrictions on abortion, especially late-term abortions. . . . He signed a letter saying that he should be able to come after your medical record if you go out of state for care."

On another hot-button social issue, Beshear was asked about an early campaign commercial in which he said that transgender surgeries are not performed on minors in Kentucky. A letter from UK HealthCare, written in March but not released by state Rep. James Tipton, R-Taylorsville, until August, said UK had “a small number of non-genital gender reassignment surgeries on minors, such as mastectomies for older adolescents.”

Shaw asked Beshear if he knew that when he made the ad. He said, "No, I didn't know."

Numerous pro-Cameron commercials have used the ad and the letter to argue that Beshear was lying. Immediately after Beshear answered, Cameron claimed, "The governor just told you a lie," because Beshear vetoed this year's Senate Bill 150, which banned transition surgeries for minors after the legislature overrode the veto.

Beshear said the bill "had a lot more in it" than the ban, but "Our parents should be able to make complicated medical decisions, rather than the government . . . This was all passed just for political points."

The candidates' final debate is scheduled for 7 p.m. ET Tuesday on Lexington's WKYT-TV and on sister Gray Television stations in Evansville, Ind., and Bowling Green.

What's new in Medicare plans? 'Check, check and double check'

Photo illustration by iStock/Getty Images via KFF Health News

By Julie Appleby

KFF Health News

Consumers know it’s fall when stores start offering Halloween candy and flu shots — and airwaves and mailboxes are filled with advertisements for Medicare options. (Editor's note: One of the latest ads plays off a "viewer" saying she's tired of the ads.)

It’s annual open enrollment time again for the 65 million Americans covered by Medicare, the federal health program for older people and some people with disabilities.

From Oct. 15 to Dec. 7, enrollees in either the traditional program or Medicare Advantage plans, which are offered by private insurers, can change their coverage. (First-time enrollees generally sign up within a few months of their 65th birthday, whether that’s during open enrollment season or not.)

There are a few new features for 2024, including a lower out-of-pocket cost limit for some patients taking expensive drugs.

No matter what, experts say, it’s a good idea for beneficiaries to examine their current coverage because health and drug plans may have made changes — including to the pharmacies or medical providers in their networks and how much prescriptions cost.

“The advice is to check, check, and double check,” said Bonnie Burns, a consultant with California Health Advocates, a nonprofit Medicare advocacy program.

But as anyone in the program or who helps friends or relatives with coverage decisions knows, it is complicated.
Here are a few things to keep in mind.

Know the basics: Medicare vs. Medicare Advantage

People in traditional Medicare can see any participating doctor or hospital (and most do participate), while those in Medicare Advantage must select from a specified list of providers — a network — unique to that plan. Some Advantage plans offer a broader network than others. Always check to see if your preferred doctors, hospitals, and pharmacies are covered.

Because traditional Medicare doesn’t cover prescriptions, its members should also consider signing up for Part D, the optional drug benefit, which includes a separate premium.

Most Advantage plans include drug coverage, but make sure before enrolling, because some don’t. These private plans are advertised heavily, often touting that they offer “extras” unavailable in traditional Medicare, such as dental or vision coverage. Read the fine print to see what limits, if any, are placed on such benefits.

Those 65 and older joining traditional Medicare for the first time can buy a supplemental, or “Medigap,” policy, which covers many out-of-pocket costs, such as deductibles and copays, which can be substantial. Generally, beneficiaries have a six-month window after they enroll in Medicare Part B to purchase a Medigap policy.

So, switching from Medicare Advantage back to traditional Medicare during open enrollment can raise issues for those who want to buy a supplemental Medigap policy. That’s because, with some exceptions, private insurers offering Medigap plans can reject applicants with health conditions, or raise premiums or limit coverage of preexisting conditions.

Some states offer beneficiaries more guarantees that they can switch Medigap plans without answering health questions, although rules vary.

Making all of this more confusing, there is a second open enrollment period each year, but it’s only for those in Medicare Advantage plans. They can change plans, or switch back to traditional Medicare, from Jan. 1 to March 31.

Drug coverage has changed — for the better

Beneficiaries who signed up for a Part D drug plan or get drug coverage through their Medicare Advantage plan know there are a lot of copays and deductibles. But in 2024, for those who require a lot of high-priced medications, some of these expenses will disappear.

The 2021 Inflation Reduction Act places a new annual limit on Medicare beneficiaries’ out-of-pocket costs for drugs.

“That policy is going to help people who have very expensive medications for conditions like cancer, rheumatoid arthritis, and hepatitis,” said Tricia Neuman, senior vice president and head of the Kaiser Family Foundation's Medicare policy program.

The cap will greatly help beneficiaries who fall into Medicare’s “catastrophic” coverage tier — an estimated 1.5 million Americans in 2019, according to KFF.

Here’s how it works: The cap is triggered after patients and their drug plans spend about $8,000 combined on drugs. KFF estimates that, for many patients, that means about $3,300 in out-of-pocket spending.

Some people could hit the cap in a single month, given the high prices of many drugs for serious conditions. After reaching the cap, beneficiaries don’t have to pay anything out-of-pocket for their medicines that year, potentially saving them thousands of dollars annually.

It’s important to note that this new cap won’t apply to drugs that are infused into patients, generally at doctor’s offices, such as many chemotherapies for cancer. Those medicines are covered by Medicare Part B, which pays for doctor visits and other outpatient services.

Medicare next year is also expanding eligibility for some low-income beneficiaries to qualify for low- or zero-premium drug coverage that comes with no deductibles and lower copayments, according to the Medicare Rights Center.

Insurers offering Part D and Advantage plans might have also made other changes to drug coverage, Burns said.

Beneficiaries should check their plan’s “formulary,” a list of covered drugs, and how much they must pay for the medications. Be sure to note whether prescriptions require a copayment, which is a flat dollar amount, or coinsurance, which is a percentage of the drug cost. Generally, copayments mean lower out-of-pocket costs than coinsurance, Burns said.

Help is available

In many parts of the country, consumers have a choice of more than 40 Medicare Advantage plans. That can be overwhelming.

Medicare’s online plan finder provides details on the Advantage and Part D drug plans available by ZIP code. It allows users to drill down into details about benefits and costs and each plan’s network of health providers.

Insurers are supposed to keep their provider directories up to date. But experts say enrollees should check directly with doctors and hospitals they prefer to confirm they participate in any given Advantage plan. People concerned about drug costs should “check whether their pharmacy is a ‘preferred’ pharmacy and if it’s in network” under their Advantage or Part D plan, Neuman said.

“There can be a significant difference in out-of-pocket spending between one pharmacy and another, even in the same plan,” she said.

To get the fullest picture of estimated drug costs, Medicare beneficiaries should look up their prescriptions, the dosages, and their pharmacies, said Emily Whicheloe, director of education at the Medicare Rights Center.

“For people with specific drug needs, it’s also a good idea to contact the plan and say, ‘Hey, are you still covering this drug next year?’ If not, change to a plan that is,” she said.

Additional help with enrollment can be had for free through the State Health Insurance Assistance Program, which operates in all states.

Beneficiaries can also ask questions via a toll-free hotline run by Medicare: 1-800-633-4227, or 1-800-MEDICARE.

Insurance brokers can also help, but with a caveat. “Working with a broker can be nice for that personalized touch, but know they might not represent all the plans in their state,” said Whicheloe.

Whatever you do, avoid telemarketers, Burns said. In addition to TV and mail advertisements, telephone calls hawking private plans bombard many Medicare beneficiaries.

”Just hang up,” Burns said.

Ky. children 10-17 have nation's 2nd highest obesity rate, 19.6%; adult rate of 37.7% is 9th highest, a slight improvement from 2021

Map from Trust for America's Health State of Obesity report

Kentucky Health News graph from state data

By Melissa Patrick

Kentucky Health News

Kentucky ties with Wisconsin for the nation's ninth-highest adult obesity rate, an improvement from second-highest last year, but Kentucky children aged 10-17 still have one of the nation's highest rates, No. 2, after ranking first last year.

The 20th annual State of Obesity report from Trust for America's Health says 37.7% of Kentucky adults are obese and nearly 72% of the state's adults are either obese or overweight, tied for sixth place with Delaware. Among the state's high-school students, 19.6% of them are obese and 16.2% are overweight.

Nationally, the report says the number of obese adults continues to rise, noting that 22 states had an 2022 adult obesity rate at or above 35%, up from 19 states in 2021. A a decade ago no state had an adult obesity rate at or above 35%, the report says.

"Since TFAH’s initial report, published in 2004, the national adult obesity rate has increased by 37 percent and the national youth obesity rate increased by 42 percent," says the report. 

The national adult obesity rate is 42% and the national rate for children ages 2 to 19 is nearly 20%, according to the report.  

The good news is that from 2021 to 2022, Kentucky's adult obesity rate declined 6.4%, or 2.6 percentage points, to 37.7% from 40.3%. But that was still above the levels of 2018, 2019 and 2020.

West Virginia (41%), Louisiana (40.1%), Oklahoma (40.0%), and Mississippi (39.5%) have the highest rates of adult obesity. The District of Columbia (24.3%), Colorado (25.0%), and Hawaii (25.9%) have the lowest adult obesity rates.

“It’s critical to recognize that obesity is a multifactored disease involving much more than individual behavior,” Dr. J. Nadine Gracia, president and CEO of Trust for America's Health, said in a news release. “In order to stem the decades-long trend of increasing obesity rates we have to acknowledge that the obesity crisis is rooted in economic, health, and environmental inequities. Ensuring all people and communities have equitable opportunity and access to healthy food and physical activity is fundamental to addressing this crisis.”

Kentucky continues to struggle with all of these conditions. It ranks fifth worst for the percentage of adults with diabetes (15%) and hypertension (40.3%), and nearly 27% of its adults are physically inactive, ninth worst. 

The report shows that more adult men than adult women are obese in Kentucky: 38.7% of men and 36.7% of women, a switch from last year's report. Kentucky's adult men have the second highest obesity rate in the nation; its women rank 18th, tied with Texas.

By age, Kentucky adults between 45 and 64 have the highest obesity rate, 42%. That's followed by those 25-44 (41.2%), 65 and older (33.7%) and 18 to 24 (24.1%). 

"Solving the nation’s obesity crisis will require addressing the economic and structural factors that impact where people live and their access to employment, transportation, healthcare, affordable and healthy food, and places to be physically active," says the report, which includes policy steps to address the crisis that they say should be taken by federal, state and local officials and stakeholders. They include: 

• Fully fund the Centers for Disease Control and Prevention's proven chronic disease and obesity prevention programs so they reach every state.
• Make healthy school meals available for all students and increase access to Supplemental Nutrition Assistance Program (SNAP) and other nutrition support programs.
• Implement a mandatory front-of-package labeling system on food packaging to help consumers make informed choices.
• Close tax loopholes and eliminate business-cost deductions for advertising unhealthy food to children.
• Make physical activity and the built environment safer and more accessible for everyone, including by increasing federal education funding for health and physical education and investing in active transportation projects like pedestrian and bike paths.

Medicare Advantage TV ads and other marketing will have to follow new rules aimed at stopping deception of beneficiaries

Cover of report asking Medicare to act

Kentucky Health News

Those incessant ads and phone calls about Medicare, and other marketing devices that the federal government considers deceptive, are about to get makeovers. At least that's what the feds have in mind.

On April 5, the Centers for Medicare and Medicaid Services "finalized a slew of Medicare Advantage marketing reforms for the upcoming 2024 Medicare open enrollment season, including plans to crack down on general television advertisements after concerns over such marketing kicked into high gear last year, Michalle M. Stein reports for Inside Health Policy.

CMS said last fall that it was worried about marketing practices, particularly concerned about TV commercials for Medicare Advantage, which most Medicare beneficiaries now have. Private insurance companies run MA plans, making money by getting a flat fee from Medicare for covering each beneficiary, then controlling costs by limiting claims payments and taking other measures.

"The Senate Finance Committee fanned those flames with a report that alleged bad actors in 14 states were taking advantage of loopholes and lax rules around marketing and enrollment, “badgering seniors on the phone, confusing them on television, and inundating them with mountains of mail,” and noting complaints to CMS doubled between 2020 and 2021.

"Widespread television advertisements with celebrities claim that seniors are missing out on benefits, including higher Social Security payments," the report said, calling the ads deceptive. It urged CMS to act.

CMS said, “The proliferation of certain television advertisements generically promoting enrollment in MA plans has been a specific topic of concern. To address these concerns, CMS is prohibiting ads that do not mention a specific plan name as well as ads that use words and imagery that may confuse beneficiaries or use language or Medicare logos in a way that is misleading, confusing, or misrepresents the plan.”

The proposed regulations would, also require insurers to:

• Notifying enrollees annually and in writing of their ability to opt out of phone calls regarding Medicare Advantage and Part D;
• Explain the effect of an enrollee’s enrollment choice on their current coverage when they make an enrollment decision;
• Simplifying plan comparisons by requiring medical benefits be in a specific order and listed at the top of plans’ Summary of Benefits;
• Ban marketing of savings information based on a comparison of typical expenses for uninsured individuals or the unpaid costs of beneficiaries eligible for both Medicare and Medicaid;
• Limit the use of the Medicare name, logo and card in ads.

Craft says empty chair at table was a 'close family member' who 'was able to overcome the addiction and move on with their life'

A Kelly Craft campaign ad shows tables with an empty chair. After this scene, she says, “As a mother, this is personal to me, because I have experienced that empty chair at my table. This has to stop.”

By Al Cross
Kentucky Health News

For 10 days, Kentuckians have seen and heard this message from Kelly Craft, one of the Republican candidates for governor:

“All across Kentucky, an empty chair. A place missing at the table. Families suffering because fentanyl and other dangerous drugs have stolen our loved ones away. As a mother, this is personal to me, because I have experienced that empty chair at my table. This has to stop. We need leadership. And as your governor, I’ll back up our police and stop drugs at our border. So there’s no spot missing at the family table.”

The 30-second television commercial has left some viewers wondering who formerly occupied that empty chair, when, and what happened to them.

In an interview with Mark Vanderhoff of Louisville's WLKY last week, Craft declined to identify the person and said the ad refers to “a family member that has had an addiction.” Then, in an impromptu interview, Craft told Ricky Sayer of Lexington's WLEX that the family member is living.  

In a statement Sunday to Kentucky Health News, Craft's campaign identified the person as "a close family member" who lived in her household, "battled addiction and went to rehab. By the grace of God, that family member was able to overcome the addiction and move on with their life, but we all know the struggle never ends for a family and remains ongoing."

The statement added, "An empty chair represents a long road of pain, whether caused by the passing of a loved one or years away from the table. It’s insensitive and malicious to think an empty chair implies only death, and shows that those implying such don’t understand the pain caused by the drug epidemic."

That last line could be taken as a reply to Nick Storm of Kentucky Fried Politics, an online newsletter that said Craft's explanation that the family member is still living showed that the ad "is hyperbole," which Webster's Dictionary defines as "extravagant exaggeration." The Oxford Languages Dictionary, which Google uses, calls it "exaggerated statements or claims not meant to be taken literally." The ad makes no specific claim.

Craft, a former ambassador to Canada and the United Nations, told WLKY, “It was very painful at first to be able to open myself up. It's very emotional. But after traveling throughout the state of Kentucky, my pain is minuscule compared to what I'm hearing and that's because we have a crisis in this state.”

In 2021, Kentucky documented a record 2,250 drug-overdose deaths, 15 percent more than 2020, which had 54% more than 2019. Toxicology reports showed that fentanyl was involved in 73%, or 1,639. That was 16% more than the 1,413 overdose deaths involving fentanyl in 2020.

"Ambassador Craft is really putting her finger on one of the most important issues in Kentucky," Kentucky Public Radio Frankfort reporter Ryland Barton told "Kentucky Edition" host Renee Shaw on Jan. 18. "There was some question there, you know, who exactly was she talking about, you know, how close actually is she to this issue?"

That was the central question asked by Kentucky Health News. The written reply from Craft's campaign began, "As a mother, Kelly knows that the pain caused by the drug epidemic affects almost every family in Kentucky. Kelly has dealt with the chaos addiction causes, first hand. She knows what it means to miss a close family member at the dinner table. Kelly knows the pain that is felt as a family member misses holidays, family dinners, church, school, work, and family events as they confront an addiction ravaging their life."

In interviews, Craft has criticized Gov. Andy Beshear for not mentioning the drug problem in his State of the Commonwealth speech to the legislature on Jan. 5. Her latest ad says Beshear and President Biden are "ignoring the border crisis," which she connects with the importation of fentanyl.

Beshear began his weekly press conference Thursday, Jan. 19, by inviting Kentucky communities to apply for "Recovery Ready" certification, which measures their prevention, treatment and recovery support to residents seeking help for drug or alcohol addiction.

Thursday night in London, Craft called drugs the No. 1 issue in Kentucky and possibly in the U.S. That was the first clip from her in Sayer's three-and-a-half minute report on WLEX, which began by saying that Craft was "choosing to keep private part of a story she made public."

University of Kentucky political-science professor Stephen Voss told WLEX, "I think most people seeing the ad likely inferred that she's saying that a family member died, but that's really sort of on the audience. It doesn't say that. She says there's an absent family member. She doesn't say why they're absent. The important thing for the electorate is, she's claiming a special understanding of the policy issue."

Voss, who was a newspaper reporter in Louisiana before becoming a political scientist, defended the reporters' questions: "Once a candidate brings a family member into the debate and tries to use them to try to establish some kind of expertise or some kind of competence or understanding of an issue, then it's hard for election watchers not to demand, 'Who is this family member? What are you actually saying you experienced with them?'"

Spending reports by health-care lobbying interests reflect their success at having their way in the Kentucky General Assembly

The legislature meets in the Capitol. (State photo)

Kentucky Health News

Seven of the top eight spenders on lobbying the General Assembly last year had health-care issues in play. Most of the seven were mainly focused on health issues, and most of them were successful.

Lobbying reports to the Kentucky Legislative Ethics Commission showed the Kentucky Chamber of Commerce, which lobbies on some health issues, ranked first by spending $408,301, mainly for the 16 lobbyists it employs. The Kentucky Hospital Association was second at $304,707.

"Included in the hospital advocacy group's spending was $23,000 on digital advertising for its priority legislation that passed into law after stops and starts, loosening requirements on ambulance services to improve slow response times," notes Joe Sonka of the Louisville Courier Journal. "KHA also successfully lobbied for two bills providing incentives to attract and retain nurses and health care workers and one to expand hospitals' remote access to pharmacy databases."

The third-place spender, at $269,685, was tobacco company Altria, parent of Philip Morris USA. Altria "successfully lobbied to block a bill raising taxes on cigarettes and vaping products and another that would give local governments the ability to add extra regulations on the display of tobacco and vaping products," Sonka reports.

The fourth-ranking spender was the ACLU of Kentucky, at $195,489. Among other things, it lobbied unsuccessfully against bills to restrict abortion.

The main lobbying group for doctors, the Kentucky Medical Association, ranked fifth at $157,416. KMA spent $30,000 "for polling it commissioned late in the year to craft messaging for one of its top legislative priorities" in the session that begam Jan. 3 and will resume Feb. 5. "The KMA has a website promoting a "physician-led, team-based care model," urging people to contact legislators and oppose legislation to lift limits on services that can be provided by nurse practitioners," Sonka rpeorts.

Hospital firm HCA Healthcare, which has hospitals in Bowling Green and Frankfort, was seventh in lobbying spending at $146,548. LifePoint Health, which has hospitals in Flemingsburg, Georgetown, Lebanon, Mayfield, Maysville, Paris, Somerset, Versailles and Winchester, reported spending $110,002, ranking it 17th. 

The Pharmaceutical Care Management Association ranked eighth, at $142,257. The group represents pharmacy benefit managers, who are middlemen between drug manufacturers and insurance companies; the managers have come under much legislative scrutiny in recent years. The group successfully oppposed a bill to rein in in pharmacy benefit managers; House Bill 457 "breezed through the House by an 88-3 vote but then ground to a halt in the Senate without any readings or committee hearings — all while the association spent more than $52,000 on advertisements urging legislators to defeat the bill," Sonka writes. "Senate President Robert Stivers said the bill stalled after his caucus began to hear concerns from the business sector about the measure increasing the costs of health plans, mirroring the association's messaging."

The other lobbying group in the top eight was the Kentucky League of Cities, which ranked sixth at $151,308. Its main legislative interest, a constitutional amendment to give cities more taxing options, including sales taxes, was defeated by the No. 9 group, the Kentucky Retail Federation, which reported spending $142,237. Overall lobbying expenses hit a record $24.3 million in 2022.

Analysis: First TV commercial from anti-abortion group has misleading and inaccurate wording, Herald-Leader writer says

Image from TV ad, provided by Yes for Life

The first television spot from the main group supporting the anti-abortion proposal on Kentucky's Nov. 8 ballot "relies on conservative buzzwords and phrases that are aimed at grabbing viewer attention but are ultimately misleading and inaccurate," writes Alex Acquisto of the Lexington Herald-Leader.

The 30-second ad by Yes for Life begins, “Radical, out-of-state activists want to spend your tax dollars on late-term abortions, even up to the moment of birth.”

Taxpayer funding of abortion "is already illegal under Kentucky law and regulated by federal law," Acquisto notes. "The Hyde Amendment bars the use of federal aid programs, like Medicaid, to pay for abortion."

As for “late-term abortions,” the term "typically refers to an abortion at roughly 21 weeks of pregnancy," Acquisto writes. "Rarely, and typically only for medically-necessary reasons, are abortions provided later than that. Late-term abortions 'even up to the moment of birth' is largely a misnomer. In Kentucky last year, 26 of the 4,441 total abortions provided — or about 0.6% — were at 21 weeks of pregnancy, according to the state Office of Vital Statistics. There were no other abortions reported at a later stage of pregnancy in 2021. Of the 18,614 total abortions reported in Kentucky since 2017, 13 were at or beyond 22 weeks of pregnancy."

The spot tells viewers that a “yes” vote for Constitutional Amendment No. 2 is a “reasonable, common sense vote.”

The amendment would place in the state constitution a statement saying that the document shall not be construed to "secure or protect a right to abortion or require the funding of abortion." Its intent is to leave Kentucky abortion law up to the state legislature, and keep state courts from finding in the constitution a right to abortion.

Voters' approval of the amendment would render moot a case the state Supreme Court is scheduled to hear Nov.15, a week after the election.

The lawsuit by abortion-rights supporters challenges the "trigger law" that virtually banned abortion in Kentucky when the U.S. Supreme Court overturned its 1973 Roe v. Wade decision, and another law banning abortion after the sixth week of pregnancy. The immediate question before the court is whether to reinstate an injunction blocking those laws passed by the legislature.

The injunction has been blocked by a Court of Appeals judge. It was issued by Jefferson Circuit Judge Mitch Perry on grounds that the lawsuit was likely to succeed, based on sections of the state constitution that guarantee religious freedom and say Kentuckians have “the right of seeking and pursuing their safety and happiness” and “Absolute and arbitrary power over the lives, liberty and property of freemen exists nowhere in a republic, not even in the largest majority.” Kentucky courts have found in those words a limited right to privacy, which was the basis for Roe v. Wade and similar decisions in other states.

In a news story, the Courier Journal's Deborah Yetter calls the spot's claims "questionable" and writes, "The new ad brings a new level of rhetoric from amendment supporters."

Pharmacy benefit managers' group ranked No. 7 in spending for lobbying the General Assembly, after laying out $53,634 for ads

Commonwealth Fund flow chart, amended by Kentucky Health News to include patients and employers

By Al Cross
Kentucky Health News

The lobbying organization for pharmacy benefit managers, the middlemen between insurance companies and drug manufacturers, spent $86,168 in its successful effort to defeat a bill in the recent legislative session that would have reined them in. They prevailed over pharmacists with the help of insurers, who argued that the bill would raise costs.

The Pharmaceutical Care Management Association ranked seventh in spending by lobbying interests in the session that ended in mid-April, mainly because it spent tens of thousands of dollars in television commercials attacking the bill. The ads started the day the bill overwhelmingly passed the House, where a pharmacist-legislator was the sponsor. PCMA said it spent a total of $53,634 on TV, internet and newspaper ads.

The bill got nowhere in the Senate, where President Robert Stivers said "When it got here, we started getting, from business sector and provider sector, various questions and comments about what the overall cost would be to various plans."

Tom Stephens, executive director of the Kentucky Association of Health Plans, cited a state Department of Insurance statement that a family of four would have paid up to $167 more a year for coverage if the bill had passed.

House Bill 457 would have ensured that patients could pick their pharmacy, instead of being required to use one affiliated with a pharmacy benefit manager; increase transparency between insurers and PBMs; and ban PBMs from retroactively denying a pharmacy claim after adjudication, commonly referred to as "clawing back." It passed the House 88-3.

The Federal Trade Commission voted Tuesday to investigate how pharmacy benefit managers affect the cost of prescription drugs and consumers' access to the drugs.

Several other health-care interests, or lobbying groups with interests in health care, were big spenders on lobbying the session, according to their post-session reports. The Kentucky Chamber of Commerce was again No. 1, spending $183,949; the Kentucky Hospital Association was second with $149,046. Third and fourth were the American Civil Liberties Union of Kentucky, whose issues include abortion rights, $128,258, and Altria Client Services (Philip Morris Cos.), $126,793. Insurer Anthem Inc. ranked 10th by spending $70,597.

Other big health spenders were the Kentucky Medical Association, 16th, at $54,044, and HCA Healthcare, 22nd at $48,832. The state Legislative Ethics Commission’s searchable register of lobbyists, employers and lobbying expenses is online at http://apps.klec.ky.gov/searchregister.asp.

TV commercials from aging quarterbacks and others for private Medicare plans don't tell the whole story, such as high deductibles

Joe Namath, in image from Medicare Advantage TV commercial aired in Fall 2020

By Trudy Lieberman

It seems nothing ever changes when it comes to hawking insurance to fill gaps in Medicare coverage. The fervent sales pitches, the misinformation, and the incomplete and deceptive information continue to proliferate.

For the last several weeks I’ve heard ad after ad urging older viewers to call 800 numbers to learn about the latest and greatest Medicare Advantage (MA) plans. Retired football star Joe Namath says you need to “get everything you’re entitled to.” Namath rattles off a bunch of extra benefits MA plans offer – dental, vision, hearing, prescription drug coverage – “all at no extra cost.” He urges viewers to “call the number on your screen now. It’s free.”

These are new benefits the government has let private insurers sell in hope of getting more seniors to leave traditional Medicare for a privatized system. By transferring more costs to seniors, the government saves taxpayers money.

Another commercial promises “free eyeglasses and free rides,” presumably to doctors’ offices. Yet another tells viewers they “may qualify” to get $144 added back to their Social Security benefits. The Medicare Part B premium for 2021 is $148.50, which is, presumably, what the commercial promises to save those who choose the privatized system.

I suspected those ads were misleading and deceptive come-ons, designed to persuade listeners to call. So I made some calls. The 800 numbers lead to an insurance brokerage firm or agency that apparently has a network of licensed agents located around the country. Callers are asked to give their ZIP code and then are transferred to an agent who can give the “free benefits” review.

I have heard close to 100 Medicare sales pitches over the years and know that those free consultations are meant to result in a sale, whether or not the senior needs the insurance or is really getting a better plan.

Seldom is there talk about making sure people are covered for the huge amounts doctors and hospitals sometimes charge and Medicare doesn’t cover. What are the trade-offs, for example, between buying an MA plan, which pays those charges after you satisfy a large out-of-pocket maximum ($6,700 per person next year) or buying a traditional Medigap insurance supplement Plan G, which covers those charges right away? A couple with Medicare Advantage could pay as much as $13,400 a year before their plan would pay for anything!

With so many choices, what’s a consumer to do? I rang up Bonnie Burns, one of the best Medicare consumer advocates in the country, for advice.

“It’s just too complicated,” she said. “No wonder people throw up their hands. That’s why people sign up for an Advantage plan with little or no premium and find out what the costs really are as they use benefits through the year.” She added, “It would be so much easier if Medicare Advantage plans and drug plans were standardized so people could figure this out.”

Congress could do that, but hasn't, resulting in today’s chaotic marketplace. Congress wanted to allow every insurer in the universe to throw something out there so the companies could make money and could entice more people to leave traditional Medicare. The goal was to reduce taxpayer costs, all the while side-stepping any action to control run-away medical costs.

Congress did standardize Medigap policies in the early 1990s because that market was as chaotic and misleading then as the MA market is today. I like to think of that action as the high-water mark of consumer protection, and I have no illusions that anything like it will happen again anytime soon.

One final bit of crucial advice is missing in today’s ads. Even after you enroll in an MA plan, perhaps enticed by a few dollars in savings for a pair of glasses, you can return to traditional Medicare in the future. But in all but four states (New York, Connecticut, Massachusetts, and Maine) state laws prohibit you from buying a Medigap plan without an insurer scrutinizing your health status.

If you have developed a pre-existing condition, you may be ineligible for a Medigap policy. I’ve met many people over the years who bought an Advantage plan, got sick, and needed to go to out of network for treatment. They learned the hard way they were shut out of the Medigap market for good.

Trudy Lieberman wrote this in 2020 for the Community Health News Service.

'Take It From Me' campaign has 18 new video public-service announcements to promote coronavirus vaccination

The "Take It From Me" campaign of public service video announcements has released 18 more videos urging Kentuckians to get a coronavirus vaccine. The campaign is a partnership between the Kentucky Medical Association, its Kentucky Foundation for Medical Care, the Kentucky Hospital Association, the Kentucky Primary Care Association and the Foundation for a Healthy Kentucky.

"The partners encourage community organizations, health providers, and others to download and share the PSAs with their networks," the foundation said in a press release. To watch and download the videos, click here.

Insurance companies managing Medicaid start a sweepstakes for beneficiaries to win Disney World vacations for getting vaccinated

Washington Post chart, adapted by Ky. Health News, shows the latest available vaccination data.

Kentucky's health insurers have started a sweepstakes in which Medicaid beneficiaries can win vacation packages for getting vaccinated for Covid-19.

The Kentucky Association of Health Plans sweepstakes is open to enrolled Medicaid members 21 and older who receive their first dose of vaccine between Sept. 6 and Sept. 30 -- and enter by visiting visit KAHP.org.

Twenty winners will each receive a vacation package for four including airfare, a three-night hotel stay, and three-day park passes to "the most magical place ever in Orlando," a KAHP news release said. KAHP spokesman Tyler Glick said the vacation packages are for Disney World.

"In addition to the KAHP sweepstakes, Medicaid members may also be eligible to receive an incentive offered by their health plan," the release said.

Medicaid managed-care plans have offered cash incentives for vaccination for months, with little effect. In late July, only about 27 percent of Kentucky Medicaid members had received at least one dose of vaccine, compared to 51 percent of the total population. About a third of Kentuckians are on Medicaid.

The insurers have been promoting vaccination among the total population in various ways for months, and have recently targeted their efforts. Last month in Clay County, home of state Senate President Robert Stivers, they and Volunteers of America started “Take 1 for the Team,” an outreach and incentive campaign using digital advertising with local influencers such as pastors, coaches and doctors, plus offers for free food, drawings for cash prizes, and a competition between local schools for $6,000 in sports equipment.

“We’ve had several months of very successful promotions,” KAHP Executive Director Tom Stephens said in the release. “Just being around the state at our events, I can say that it is heartening to meet so many people who decide to receive the vaccine after they hear about our various incentive programs or were touched by our outreach efforts.”

The commercial insurers and Medicaid managed-care organizations who comprise KAHP are also reaching members through their own advertising, incentives, transportation coordination, pop-up clinics (some with bilingual personnel), homebound vaccination visits, text and email campaigns, yard signs, billboards, direct mail, telephone calls, personalized assistance and follow-up on second dose-appointments based on claims data, the release said.

McConnell using his campaign funds to run pro-vaccine ads

McConnell (Reuters photo by Joshua Roberts)

U.S. Sen. Mitch McConnell will use funds from his campaign to run 60-second advertisements on more than 100 radio stations in Kentucky to promote vaccination for the coronavirus, Reuters reports.

McConnell, the leader of Senate Republicans, has blamed misinformation for the low rate of vaccination among Americans, "which are fueling a rise in coronavirus cases, particularly in Republican-dominated states," Reuters notes.

"There is bad advice out there," he told Reuters. "Apparently you see that all over the place: people practicing medicine without a license, giving bad advice. And that bad advice should be ignored."

In Kentucky, the daily average of vaccinations is 28 percent higher in the last seven days than the previous seven, but remains below the level seen at the start of the month, and that was lower than June. Just under 52% of Kentuckians have received at least one dose of vaccine; the U.S. figure is 57%.

"Not enough people are vaccinated," McConnell said. "So we're trying to get them to reconsider and get back on the path to get us to some level of herd immunity."

In the radio ad, McConnell notes that he is a survivor of polio and says the Covid-19 vaccine is "nothing short of a modern medical miracle" and says, "Every American should take advantage of this miracle and get vaccinated. It's the only way we're going to defeat Covid."

Christina Wilkie of CNBC writes, "It is highly unusual for members of Congress to use campaign funds for anything outside of their re-election efforts. But McConnell’s decision reflects the looming crisis posed by Delta-variant Covid infections in states with low vaccination levels."

McConnell, 79, is widely expected not to seek re-election in 2026, and has $7 million in his campaign treasury. He has promoted vaccinations since he got one in December, but has passed up chances to criticize other Republicans who have refused to say whether they've been vaccinated and "attacked the shots as unnecessary or dangerous," as Reuters puts it.

But in the Reuters interview, McConnell endorsed recent remarks by Alabama Gov. Kay Ivey, who told reporters last week that it is "time to start blaming the unvaccinated folks" for the surge in cases, as well as criticizing people spreading misinformation about the vaccines.

McConnell, a native of Alabama, told Reuters, "I was encouraged by what the governor of Alabama said."

Ivey wrote in The Washington Post that those "pushing fake news and conspiracy theories about this vaccine are reckless and causing great harm," adding that many of the unvaccinated are "being lied to."

Reporter David Morgan of Reuters notes, "About 40% of Republicans are uncertain about the vaccine or are unwilling to be vaccinated, polling data published by the Morning Consult showed. That is more than double the 16% of Democrats who voiced those concerns."

Frank Luntz, a Republican pollster advising the Biden administration on vaccine persuasion, said he has been warning for months about politics being an obstacle to vaccination.

"The key here is to ensure that no one feels like they have to do it," Luntz told Morgan. "They have to want to do it. So, insulting them or mandating them won't work. Political messages won't work, unless you're Donald Trump. If Trump were to say to them: 'Hey, get the vaccine.' That would make a difference. But he doesn't do that. All he does is complain about the election."

Last week, Trump said, "People are refusing to take the vaccine because they don't trust (Biden's) administration, they don't trust the election results."