Events, trends, issues, ideas and independent journalism about health care and health in Kentucky, from the Institute for Rural Journalism at the University of Kentucky
Drug-overdose deaths spiked following Kentucky’s Covid-19 stay-at-home and business-closure orders in 2020, but the industries that suffered the most overdose deaths were surprising, according to research conducted by the Kentucky Injury Prevention and Research Center at the University of Kentucky College of Public Health.
In the years leading up to the study, Kentucky’s service-industry employees experienced the most drug-overdose deaths. However, workers outside service industries were more likely to die by drug overdose in the months following the Covid-related shutdowns of 2020, the researchers found.
The study was published in the peer-reviewed journal Injury Prevention in 2023 and funded by the National Institute of Occupational Safety and Health, part of the Centers for Disease Control and Prevention.
Graph by Kentucky Injury Prevention Research Center
Analyzing drug-overdose death certificates and toxicology tests from 2018 through 2021, researchers found a significant increase in deaths rates for both sectors. In 2019, the rate per 100,000 employees was 46.7 and 45.7 for service and non-service industries, respectively. In 2021, those rates were 76.2 and 81.9.
Service occupations with the highest drug-overdose death rates were restaurant wait staff (10%), cooks (7%), landscaping and groundskeeping workers (6%) and auto-service technicians and mechanics (6%). Among non-service-industry jobs, overdose deaths occurred most often among construction laborers (15%), carpenters (7%) and freight, stock and material movers and hand occupations (7%).
From 2018 through 2021, there were 1,789 drug overdose deaths among service-industry workers in Kentucky, compared to 2,838 for non-service workers.
Terry Bunn, lead author of the study and director of the injury-prevention center, said “Service-related industry employees may have been more resilient and adaptable to changes in employment status compared to non-service-related industries and could find employment in other essential industry sectors during the pandemic such as the home improvement and building materials industry and the grocery store industry sector.”
Fentanyl was the most commonly identified drug in overdose deaths in both industry groupings, with 44% of identified substances among service-related industry deaths and 48% of identified substances among non-service-related deaths. The second most common drug with elevated frequencies detected in drug-overdose deaths was methamphetamine, with 24% of identified substances among service-related industry deaths and 28% of identified substances among non-service-related industry deaths.
Bunn hopes the results will alert employers in all industries to the need for a plan to handle on-site drug overdoses and substance use. “It is important for businesses to know about local community resources for timely linkage to substance use disorder treatment and to recovery support services as well as availability of on-site naloxone,” she said.
More than 150 attended the Recovery in the Workplace Conference. (Ky. Chamber of Commerce photo)
By Melissa Patrick
Kentucky Health News
A June 21 conference to encourage Kentucky businesses to offer second-chance employment to Kentuckians who are in addiction recovery featured stories of success, with advice and resources to help.
Mark LaPalme, founder and CEO of Isaiah House, a treatment and recovery center, told Kentucky Health News that efforts to help people in recovery involves not only creating a healthy recovery community, but also placing them in healthy communities as part of their next steps.
"So the first thing that we need to do is instill hope, because that gets them through the next day," LaPalme said. "I think the next thing that we've got to do is work on helping them define their purpose in life. And that involves everybody, you know. . . . So hope, opportunity, purpose, employment and education are really those holistic things that make it all work."
Isaiah House was presenting sponsor of the fourth annual Kentucky Chamber of Commerce Kentucky Recovery in the Workplace Conference in Lexington.
LaPalme encouraged employers to give people in recovery a second chance, saying they are dedicated and articulate "and they will absolutely be your best employees because they're appreciative, they're faithful, and they know that they've been given that second chance or that third chance. So they turn out to be your best employees."
Van Ingram, executive director of the state Office of Drug Control Policy, opened the conference with an overview of the recent report that showed 2,250 Kentuckians died from a drug overdose in 2021, 14.6% more than in 2020.
"These are people that didn't have to die," he said. "This is a preventable death. Statistically, six people will die today in the state. . . . We have got to do more."
Ingram discussed several programs supported by his office, including the Chamber's three-day "Fair Chance Academy" to help employers foster second-chance employment. The program graduated its first class in June, which included 20 business leaders with 20,000 employees. He said "That is huge!"
He also noted recent legislation aimed at getting people in recovery back to work, including one to create "Recovery Ready Communities" that will create a list of programs and services a community needs to support people in recovery, like access to recovery and treatment care, and recovery housing and transportation access.
"That's how we're going to beat this addiction [crisis], one community at at a time," he said.
Ingram also pointed to a new law for a pilot program to let low-level offenders in 10 counties who have a substance-use disorder to choose treatment instead of incarceration: "It's a chance for us to show the General Assembly and to show the state that treatment will yield better outcomes than prison."
Morgan Kirk, director of the Kentucky Chamber Foundation Workforce Recovery Program, spoke to the need to get this population back into the workforce, noting that Kentucky ranks 43rd in workforce participation.
Kirk walked through a list of programs offered by the foundation, including the Kentucky Transformational Employment Program, authorized in 2020 to lessen the risk of liability to employers who hire or retain people with substance-use disorders. So far, she said, 70 businesses have signed up for the program, representing nearly 13,000 employees who could be affected.
"It's the right thing to do, but it is so good for your business to do this," Kirk said. "We see statistically what a difference it can make when you hire someone who's in recovery or with justice involvement and how much they want to show the gratitude and just show up and be an amazing employee for you."
Advice from businesses that offer second-chance hiring
A persistent theme among businesses that already offer second-chance hiring is the need for "wrap-around services," such as transportation, housing, and flexibility in traditional workplace policies.
Rob Perez, founder and owner of Lexington's DV8 Kitchen, which is based on second-chance hiring, talked about his company's journey. One key lesson, he said, was to not be driven by the traditional, transactional rules of business, but to adopt a business model that focuses on relationships.
"We have gotten to the point where relational leadership is paying dividends," he said, ticking off a list of "amazing results" among its bakery employees, all of whom are in recovery, including an 11-month average tenure, which he called "huge in the restaurant business."
Jamie Johnson of Dorman Products stressed the need for employers to educate themselves and their employees about the misconceptions around substance-use disorders. In addition, he said his company offers peer support services and created its own Narcotics Anonymous program and allowed some flexibility in scheduling for their employees to attend.
“Don’t fool yourself into believing you’re insulated from this problem because over 70 percent of those struggling with a substance-use disorder are currently working,” Johnson said. “You are a fair chance employer; it’s just whether you admit it or not.”
Rena Sharpe, COO of Goodwill Industries, said her company offers career coaching for their employees and companies that contract with them. Another Goodwill program allows an employee who relapses to sign an agreement saying they are seeking treatment and their job will be waiting on them when they're able to return.
Patrick Bryant, recruitment manager at AppHarvest, and Johnson talked about creating a culture that invites this population to apply for a job. Bryant stressed that it's important for people to be able to look at your "career page" and know they are welcome to apply.
"There's a lot of people out there with criminal records or in addiction recovery and they're ashamed. They're scared. They don't want to come forward, " he said. "But if you give them that opportunity . . . invite them by having it on your career page that you're a fair chance employer, that's going to help them take the first step."
Support systems, well-paying jobs needed
Alex Elswick, founder of Voices of Hope and assistant extension professor at the University of Kentucky, talked about his "privilege" of having all kinds of "recovery capital," resources and supports, available to him. His parents' church found him a home, one of his father's patients found him a job, and he was able to see a therapist.
“There’s really nothing special about my addiction, but in so many ways there’s something special about my recovery. Because I had access to the things I needed."
Elswick expanded on the value of being offered that first job after coming out of recovery.
"I didn't deserve it. I didn't earn it. It wasn't based on an illustrious CV or resume. I didn't even have a resume," he said. "But somebody gave me an opportunity and it made all the difference in my life because as soon as I had a job, I had benefits. I had health insurance and since I had health insurance, I could meet with a therapist."
Lisa Lourie, owner and CEO of Spy Coast Farm, said she supports her employees from the Blackburn Correctional Facility with some basic items before they leave the facility by making sure they have appropriate clothing to come to work in. Further, she said she ensures that they had housing and transportation.
Kim Moore, founder and CEO of Joshua Community Connectors, a grant-funded community building project in Louisville that works on issues of mental health, housing and employment, also talked about the value of support systems in her road to long-term recovery. She has been sober for 24 years, according to her short biography.
"I stand here today . . . because I had supportive services," she said. "I'm who I am because people believed in me, people pushed me."
LaPalme opened the conference by talking about the need for second-chance employees to have well-paying jobs. He also said it is time to get rid of the "scourge" in the treatment industry of hiring interns who have gone through the residential part of a program and paying them less than the minimum wage and calling it a stipend, a practice not allowed at Isaiah House. He said the practice keeps them "tied to food stamps and keeps them on Medicaid."
Moore also talked about the need for well-paying jobs, saying that you have to pay a person more than they can make selling drugs if you want them to move away from that lifestyle.
The foundation of the Kentucky Chamber of Commerce is offering a three-day "Fair Chance Academy" to help employers foster employment opportunities for Kentuckians in recovery from substance use disorders who are ready to re-enter the workforce.
“Employment is a critical component of long-term recovery, and the business community has an important role to play in helping individuals return to the workforce and reducing stigma around recovery in the workplace,” Morgan Kirk, director of the Kentucky Chamber Foundation’s Workforce Recovery Program, said in a news release. “We’re excited to begin offering this training to help employers transform lives, and we encourage businesses of all sizes and across all industries to apply.”
The Chamber will select 15 companies to participate in the inaugural Fair Chance Academy which will involve three, full-day training workshops at the Kentucky Chamber Headquarters in Frankfort on May 11, May 25 and June 8. Applications for the academy close on Friday, April 15. Click here to apply.
Following the training, participants will spend three months implementing actionable steps within their companies to become fair chance employers, a practice that reduces many of the roadblocks that make it difficult for candidates in recovery or with a criminal conviction to get hired.
"Certifying employers as ‘fair chance’ can provide stable employment for someone, which is a critical component of long-term recovery," Van Ingram, executive director of the Kentucky Office of Drug Control Policy, said in the release. "This can provide Kentuckians with the purpose and motivation they might need to stay in remission and get their lives back.”
Employers will also have the opportunity to participate in a discussion with Sam Quinones, author of “The Least of Us,” who has been nationally recognized for his writings on the opioid crisis.
The Fair Chance Academy is part of the foundation’s Transformational Employment Program, which launched last year. This program provides a bridge from recovery to employment by lessening the risk of employers who hire or retain people with substance-use disorder, if the employees sign up for treatment and complete it. To date, 55 Kentucky employers are signed up, which impacts more than 11,000 employees.
New York Times map, adapted by Ky. Health News, shows cases increasing with colder weather. To enlarge any image, click on it; for the interactive version of this map, with local data, click here.
By Melissa Patrick Kentucky Health News
Gov. Andy Beshear has signed an executive order to allow all Kentucky adults to get a Covid-19 booster shot, citing the recent upticks in coronavirus cases and Covid-19 hospitalizations as the reason for this change.
“Folks, you really need to get vaccinated and get this booster, and now it should be fairly easy. It’s going to make you much safer over the next several months,” Beshear said in a news release.
Previously, boosters were officially available only to people 65 and older, adults at high risk of severe Covid-19, and those with high exposure to the virus through their jobs or living situation.
At least five other states (Arkansas, California, Colorado, New Mexico and West Virginia) have expanded eligibility, the release says. So has New York City. The U.S. Food and Drug Administration is expected to authorize Pfizer-BioNTech Covid-19 booster shots for all adults this week, The New York Times reports.
Under Beshear's order, all adults in Kentucky may get a Covid-19 booster six months after their second Moderna or Pfizer shot, or two months after the single-dose Johnson & Johnson vaccine.
As of Wednesday, more than 437,000 Kentuckians had received a booster and 2.6 million, or 59% of the total population, had received at least one shot.
The state reported 2,195 new coronavirus cases Wednesday, raising the seven-day average by 31 (2.2 percent), to 1,431. Of Wednesday's new cases, 29% are in people 18 and younger.
The share of Kentuckians testing positive for the virus jumped more than half a percentage point, to 6.24% from 5.73% on Tuesday. The rate is the highest since Oct. 21. Beshear has cautioned that the rate is not the best measurement of the pandemic because it tends to rose when there is an increase in disease in communities because more people get tested.
A more reliable metric, the seven-day infection rate, is 27.94 daily cases per 100,000 residents. That's a noticeable jump from Tuesday's 27.08. Counties with rates more than double that rate are Magoffin, 98.7; Breckinridge, 82.3; Robertson, 81.3; Bourbon, 72.2; Monroe, 61.7; Powell, 61.3; and Harrison, 58.2.
Seventy-three of the state's 120 counties have rates over 25, considered a high level of transmission and represented by red on the state infection map. That's six more than Tuesday.
The New York Times ranks Kentucky's infection rate 25th among the states and says it has increased 16% in the last 14 days.
Kentucky hospitals reported 757 Covid-19 patients, 18 more than Tuesday (up 2.4%); 200 of them in intensive care (down 4); and 100 on mechanical ventilation (down 15). Eight of the state's 10 hospital regions are using at least 80% of their intensive-care beds, five of them more than 90%.
Kentucky reported 36 more Covid-19 deaths Wednesday, raising the pandemic death toll to 10,354.
Other pandemic news Wednesday: "Active Covid-19 cases among Warren County Public Schools students have more than tripled since the district dispensed with its universal masking policy Nov. 1," the Bowling Green Daily Newsreports. The district has 73 cases; Bowling Green Independent Schools, "which has chosen to keep its universal masking requirement for at least one more month – reported 17 active student cases on its district dashboard Tuesday morning."
To increase immunization among young adults, "Some public health experts are turning to ad campaigns that feature 20-somethings talking about their struggles with fatigue, memory loss and other symptoms associated with long Covid," the term used to describe lingering effects after basic recovery from the disease, reports Derek Hawkins of The Washington Post. "The testimonials are devastating. One 20-year-old chokes up as she describes how she can't remember first dates with her boyfriend, even after looking at photos."
U.S. Sen. Rand Paul of Bowling Green issued a report on the economic cost of President Biden's vaccine-or-test mandates in Kentucky, saying 677,458 Kentucky workers, or 34% of the state's workforce, are at risk of losing their jobs if they do not comply with the mandates for employers of more than 100. It says 35% of retail workers risk losing their job if they resist the mandate. A report for all 50 states will be released tomorrow, said the release from the Republican senator, who is seeking re-election.
The Occupational Safety and Health Administration has suspended enforcement of the mandate for businesses with more than 100 employees after a federal appeals court upheld a stay of it last week, The Hillreports.
Kentucky has launched a new program that will lessen the risk of liability to employers who hire or retain people with substance-use disorder -- if employees sign up for treatment and complete it.
"This program is the bridge between recovery and employment," LaKisha Miller, executive director of the Kentucky Chamber of Commerce's Workforce Center, told Kentucky Health News. She said the Kentucky Transformational Employment Program could be a model for the rest of the nation. "This has never been done before."
The program "ultimately provides a pathway for businesses and employers to help more Kentuckians reach long term recovery, while supporting fair-chance employment," Miller said.
"Fair chance" or what some call "second-chance" hiring is an important and necessary tool to address the staffing shortages across Kentucky, Miller said in a news release: "Kentucky currently ranks 48th nationwide for workforce participation, and the Covid-19 pandemic has only exacerbated this problem. Research shows that when the nation’s unemployment rate increases by just 1 percent, the opioid overdose death rate rises by 3.6%."
In the interview, Miller spoke about the importance of employment for those in recovery. She acknowledged that employment is not the "silver bullet" to solve the addiction crisis, but "It is a big piece of the puzzle."
The program is made possible by Senate Bill 191 of the 2020 legislative session, which, among other things, established a framework for employers to retain and hire people who are in addiction recovery and provides legal-liability protections for those employers that adhere to the established framework.
The liability protections are key, Miller said, adding that strong legislation allows for strong programs like KTEP.
For example, she said a company that is enrolled in KTEP, and has enrolled eligible employees in it, is protected against legal action if the employee with a substance-use disorder "is using" and has a mishap.
"So that's the power of Senate Bill 191," MIller said. "It's removing that legal liability from you; whereas, before you would have been open to that."
She said the program also lets employers "pause the employment process" to allow applicants time to enter treatment, and is also meant to decrease stigma in the workplace related to addiction, treatment and recovery.
Once an employer has signed up for KTEP, Miller said, a dedicated staff person helps with the process, including resources, guidelines, training videos and for review and revision of the firm's drug and alcohol policies.
"We want to make sure that that businesses aren't just focused on giving somebody a fair chance, but are truly committed to creating an a transformative workplace," Miller said. To ensure the program is working as intended, data will be collected regularly from participating employers.
KTEP is sponsored by the Chamber's foundation, the state Cabinet for Health and Family Services, the Kentucky Office of Drug Control Policy, the Kentuckiana Health Collaborative and Kentucky Opioid Response Effort.
KODP Director Van Ingram said in the news release, “We see a real opportunity for this program to do some good, and we encourage employers across Kentucky to make a positive impact in their communities. Stable employment is a critical component of long-term recovery and can provide Kentuckians with the purpose and motivation they might need to stay in remission and get their lives back.”
Miller said the state was already leading the way in fair-chance employment through the Kentucky Chamber of Commerce Foundation's "Who's Hiring" campaign, which has recruited 19,000 fair-chance positions in the last year and a half. More information, including training resources for employers and a form for businesses to sign up for the program, can be found online at kentuckycomeback.com/KTEP.
By Jacqueline Pitts The Bottom Line, Ky. Chamber of Commerce
Kentuckians who are in recovery from substance-use disorder, and people who are trying to help them, talked about their efforts Tuesday at an annual conference designed to encourage employers to help.
Employment, assistance, wrap-around services and trainings were just some of the items discussed at the Kentucky Chamber of Commerce’s third annual Recovery Conference in Lexington.
Ashley McCarty, the Chamber’s Workforce Recovery director, spoke about her own personal struggles with substance-use disorder and how she is now using her experience to help Kentucky companies fix their outdated personnel policies to allow for a fair chance and notice early warning signs.
McCarty, who is seven years in active recovery from opioid addiction, said she was among the top five pharmaceutical sales representatives in the country when she had a few surgeries for which she was prescribed opioids for pain. Everything began to fall apart as she developed a dependency on those medications, her performance plummeted, and she even attempted suicide.
Recovery, McCarty said, taught her she could change by being open and transparent, working to build others up, and working on herself and her own struggles.
Keeneland cook Krystal Grimes talked about her recovery. (Photographs by Sawyer Coffey, Kentucky Chamber of Commerce)
Krystal Grimes, a line cook at Keeneland, is four years into her active recovery and shared her powerful story with the conference.
Grimes said that to understand her addiction, it is important to understand her childhood and the sexual abuse she suffered at the hands of family members at a very young age. She was turned away by adults like school counselors, and abusers told her it was her fault. She then tried to take her own life. When she woke up, her first feeling was sadness that the attempt had not worked, and while the abuse stopped at that point, her feelings did not, and she sought out ways to numb the pain.
As she got older, she married a man who also struggled with addiction and they had three children. She was prescribed an opioid after each Caesarean section that made her feel like “Super Mom,” and her tolerance grew. After many years of struggles, Krystal and her husband lost their children and their home and she thought she didn’t think she had anything else to lose. Then she found heroin, and things continued to get worse as she attempted to stop the pain.
Eventually, she started treatment with Suboxone and eventually began attending classes, where she met McCarty, who inspired her to use the medication correctly and start doing the work of recovery.
With Keeneland since 2014, Grimes said the company has seen her struggle, but continues to believe in her and provide stability, support, and much more which she said has been critical to her recovery.
Jason Roop, Director of the Technology Training Center at Campbellsville University, presented research showing that people with substance-use disorder are often goal-oriented, resilient, adaptable, and persistent. He studied characteristics of those in leadership roles who have struggled with addiction and found transformational, authentic leaders are making a powerful difference in the business community and many other sectors.
How employers can help employees
Isaiah House Treatment Centers President Mike Cox shared their goals for effective treatment, including meaningful employment. Cox said when a business gives an individual in recovery a second chance, a sense of loyalty is automatically created. Isaiah House has partnerships with multiple businesses willing to employ individuals in active recovery.
Ed Early of Isaiah House discussed the critical role of the employer in the recovery process. It begins with reducing stigma in the workplace, he said. Employers should treat those in recovery in the same manner as other staff members: be welcoming, provide education and training, understand how to reward and hold employees accountable, and know when to retain, terminate and advance employees.
“It’s all about the opportunities they are given and the support they are shown,” said Early.
Landmark Recovery National Business Development Manager Zachary Crouch talked about why individuals don't seek help from employers: “The real reason is stigma.” Crouch said the cost of not treating substance use and mental health is too expensive not to address, since each replacement of an employee costs them six to nine months’ salary. He encouraged businesses to seek ways to engage employees when they are struggling with substance abuse and mental health and to encourage vulnerability, diversity, and inclusion in the workplace.
Representatives of Goodwill Industries of Kentucky, which has developed second-chance policies through removing barriers to employment for individuals in recovery and/or leaving incarceration, talked about new efforts to help individuals overcome re-entry and recovery challenges. One project is a program in which participants can learn soft skills, financial literacy, digital literacy, communications skills, resume writing, mock interviews to address criminal history and gaps in resumes, health and nutrition, and much more. Learn more about the program here.
Heather Lowe, founder of Ditched the Drink, shared her testimony as Susan Rider of Preventia Group listened.
More than 70% of people with addiction issues are working, said Heather Lowe, founder of Ditched the Drink. She said it is critical to have vulnerable conversations, know the signs of a substance-use disorder, and implement successful treatment options in the workplace.
Saying it's critical to treat alcohol the same as a drug to address its abuse, Lowe shared her testimony of heavily using alcohol in workplace settings, which moved to her abusing alcohol at home.
Susan Rider of Preventia Group said studies show businesses that have adopted organizational change around alcohol often report improvements in morale and productivity, and a decrease in absenteeism, accidents, downtime, turnover, and theft. Also, various options for substance use disorder treatment can help lead to reduced health care costs for businesses
As employers heard about the ways addressing substance use disorder in the workplace can save them money, the Kentucky Career Center highlighted its services that can help. Learn more about programs like the Work Opportunity Tax Credit, the Kentucky Unemployment Tax Credit, Federal Bonding Programs, and Kentucky Essentials Skills Training by visiting kcc.ky.gov or by emailing Workforce@ky.gov.
HEALing Communities Study, other efforts
Dr. Sharon Walsh of the University of Kentucky reported on the HEALing (Helping End Addiction Long Term) Communities Study, a four-year, $87 million effort, funded by the largest federal grant UK ever received, to reduce opioid overdose deaths in 16 Kentucky counties.
Walsh said many "silos" separate medical care, behavioral health and recovery housing, which can make it difficult for people to find what they need. To address this, the study is evaluating the impact of various interventions, including education and distribution of naloxone; effective delivery of medication for substance use disorder; and safer opioid prescribing and distribution.
Walsh pointed to the rise of illicit fentanyl from China in U.S. markets as a reason that naloxone training and distribution, and a focus on medically-assisted treatment for substance-use disorder, remain critical to helping Kentuckians reach recovery.
RECON Kentucky, a consortium for recovery in Kentucky, announced its first inductees into the Kentucky Recovery Hall of Fame. U.S. Rep. Hal Rogers of Somerset and Jay Davidson, founder of The Healing Place, were honored for their work to solve the state’s struggles with substance-use disorder.
Van Ingram, executive director of the Kentucky Office of Drug Control Policy, stressed that Kentucky’s struggle with substance-use disorder must be addressed at the community, person-to-person level. He highlighted areas of success the state has seen in recent years including his office’s partnership with the Chamber’s Workforce Recovery initiative, which is training more than 5,000 Kentucky business leaders on the importance of being a recovery-friendly workplace.
While Kentucky is doing many things right, Ingram said, there is bad news as well. His office will soon release a report showing a 40 percent increase in overdose deaths, much of which can be attributed to a rise in the use of fentanyl. To get Kentucky back on track, Ingram said Kentucky must re-evaluate all efforts to ensure the state is saving as many lives as possible.
Senate Republican Leader Mitch McConnell said efforts the federal level to combat substance-use disorder have broad, bipartisan support in Congress. He emphasized the importance of people getting back to work, especially those struggling with substance use disorder, and said the continuation of additional unemployment benefits is an obstacle to that.
The Bottom Line is a news service of the Kentucky Chamber of Commerce. This story was independently edited and published by Kentucky Health News.
Courier Journal graph, adapted by Kentucky Health News
Kentucky workers filed 45 percent more occupational safety and health complaints in 2020 than in 2019, but only 8 percent of them have been investigated, reports Matt Mencarini of the Courier Journal.
The increase could have had causes other than the pandemic, since the volume of complaints can be cyclical, the state Labor Cabinet told Mencarini. But he cites examples, such as a November complaint against the Kroger Distribution Center in Louisville, alleging that employees had Covid-19 and managers were not informing others about it.
The state's low investigation is actually above the national average, Mencarini reports. "Across the U.S., complaint investigations decreased dramatically during the pandemic," he writes. "Critics for years have derided weak worker safety laws and enforcement, decrying dwindling budgets and staffs in worker safety agencies. The pandemic only exacerbated the problem, they say."
Bill Londrigan, executive director of the state AFL-CIO, told Mencarini, "There needs to be some sort of recognition that even though the rates
of transmission and death from Covid have decreased due to the increase
in the vaccination rates, that certainly it is not in the rearview
mirror. Protections should still be in place."
"Many of the complaints lodged in 2021 suggested the national polarization around masks extended to the workplace," Mencarini reports. "As Covid rates drop and more people return to workplaces, new challenges are arising." Londrigan told him that some workplaces shouldn't abandon mask-wearing, though "no one really likes it."
A National Rural Business Summit webinar on Thursday, June 3, will discuss how major rural employers and small businesses can engage with employees and residents to play a meaningful role in increasing the rural coronavirus vaccination rate. Strategies include sharing fact-based information, sharing personal vaccination stories, and supporting community vaccination efforts.
The free webinar will begin at 1 p.m. ET and is presented by the Rural Assembly in partnership with the Health Action Alliance, The Daily Yonder, the National Rural Health Association, The Rural America Chamber of Commerce, and other organizations. Click here to register.
In related news, a new episode of the Rural Assembly's Everywhere Radio show is all about how to overcome vaccine hesitancy in rural America. Host Whitney Kimball Coe, director of the Rural Assembly, talks with Jeff Eastman, CEO of Remote Area Medical, a nonprofit that provides free health care to those in need. Listen to the episode here.
Kentucky adults were divided in late winter when asked whether coronavirus vaccines should be required for employment or attending in-person school, according to a recent poll.
The poll, taken Feb. 11 to March 12, found 47% of Kentucky adults said it was a good idea to require school children to be vaccinated before in-person schooling, and 50% said it was a bad idea.
“It’s expected for parents to have lots of questions and be concerned about their child’s health,” said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which sponsored the poll. “We encourage you to talk with your child’s pediatrician, your doctor, pharmacist or local health department to get the facts about what the vaccine means for your teen. And, talk to your teenager about what they want to do.”
By far, more Democrats (68%) than independents (43%) or Republicans (28%) said it was a good idea to require children to get a vaccine in order to attend in-person school.
This idea was most supported by Kentuckians 65 and older (56%) and least supported by those 30 to 45 (36%). There was also a divide between households without children (54%) and those that did (32%).
The poll was taken many weeks before the Pfizer-BioNTech vaccine was approved for use in children 12-15. This age group became eligible to get the vaccine Wednesday, with the first doses given Thursday in Kentucky. The vaccine has been authorized for people 16 and older since December.
A spokesperson for the state health cabinet, Susan Dunlap, told WFPL that “there are no current plans for the Covid-19 vaccine to become a mandatory immunization for Kentucky’s school children/youth.”
Allison Adams, the health foundation's vice-president for policy, said the poll shows how important it is for families to hear from trusted health-care providers as they decide about Covid-19 vaccination for children.
"They want to hear on a personal level how vaccine could impact their family members from someone who knows them, their situation and their community," Adams said at an online news conference. "That's why it's so important right now for local healthcare providers to be getting factual information out to their patients."
And even if the vaccine is not mandatory, Adams said there is value in offering the vaccine at schools because studies show the more readily available a vaccine is, the better the uptake will be.
A nationwide poll, taken in April, found three in 10 parents of children ages 12-15, or 30%, said they would get their child vaccinated for Covid-19 as soon as the vaccine was authorized. The Kaiser Family Foundation poll found 23% said they would definitely not get them vaccinated.
Polling on business
Gov. Andy Beshear announced Friday that he will allow all Kentucky businesses to open to 100% capacity June 11. He said waiting a month allows children 12-15 time to get fully vaccinated, which means they have received their second shot and two weeks have passed after receiving it.
The Kentucky poll also asked whether the respondents thought it was a good or bad idea for businesses to require employees to get a Covid-19 vaccine before being allowed to work in person. To this question, 52% said it was a good idea and 44% said it was a bad one.
Again, Democrats were most likely to support required Covid-19 vaccines to return to in-person work, at 74%, followed by independents at 56%, and Republicans at 35%.
This idea was also most supported by those 65 and older (65%) and least supported by those 30-45 (40%).
"Research shows that vaccines help keep people from spreading Covid-19 to others and they are a critical tool as we work against the clock before more variants come along. . . . That's why we all need to get vaccinated," said Adams.
The foundation's poll was conducted by the Institute for Policy Research at the University of Cincinnati. The poll's error margin is plus or minus 3.5 percentage points. It surveyed a random sample of 807 Kentucky adults in landline and cellphone interviews.
Written as "an open letter to friends and colleagues," this essay offers hope and insight for people and families facing serious health challenges.
By Wes Irvin
Over the last seven years, I have been on a medical journey that has unfortunately taken me away from many folks who I still miss working with on a daily basis in Washington, D.C.
I’m sure many of you have wondered if I just fell off the face of the earth. Well, I have fallen along the way many times, and this journey has been a rollercoaster in every sense of the word, but I remain thankful to still be here every day.
Wes Irvin
Here’s my story: In September 2012, my life took an unexpected turn. Since then, I have undergone 60 surgeries and survived abdominal flesh-eating bacteria, five septic episodes, and multiple pulmonary embolisms. I also lost my spleen and gallbladder. I’ve been treated (and my life saved, more than once) in hospitals in Baltimore, Cleveland, Houston, and Rochester. I could go on, but you get the picture. It’s an understatement to say that there is no playbook for what my family and I have undergone. Thankfully, my underlying health was strong and it’s a big part of my story of survival.
I write not to seek sympathy, but to share some reflections born from this journey of compounded trauma, emotional healing and wellness, patience, perseverance, faith, and forgiveness—and also to thank some of the people closest to me who have been so supportive.
1. Yes, it is the journey, not the destination. As Robert Hastings writes in The Station, life really is about the journey. If you look out over the horizon, and try to figure out everything in your life, you’ll simply outrun yourself and miss living the gift of today. We exhaust ourselves by overreaching for the future—becoming less and less aware of what’s directly in front of us.
2. Today is the real deal. We all get excited about opening a Christmas present, a wedding present, or a birthday present. Right? There is so much anticipation and enthusiasm around a new gift. I have learned after losing hundreds of days since 2012—and from coming in and out of the woods—that I needed to open my “daily present” a bit more mindfully. I’ve realized that yesterday is in the rear-view mirror, tomorrow is uncertain, but today is for real: it’s a gift; it’s here. We should open today with excitement, surprise, and thanksgiving. Grab on and enjoy! As Eleanor Roosevelt wisely said, Tomorrow is a mystery. Today is a gift. That is why it is called the present.
3. Find the pony in the pile. It sounds crass, but I’ll say it anyway: Find the pony in whatever pile of crap you unexpectedly wander into—and work tirelessly to find it. When horrible things happen to us, believe it or not, there is good we can find. I encourage you to hone in on that. If you can approach adversity with this mindset—and it isn’t easy—then you can ride that pony to the finish line. What I’m saying is find the positive, that morsel of goodness inside what may seem the deepest, darkest place in the issue you are facing.
4. Love is not just for “loved ones.” It is so important not only to love yourself, and your family, but to love people from all walks of life, every day, because I assure you that one day it may take all walks of life to save yours. Since day one of my ordeal, I have reminded the very kind folks who cleaned my rooms from the ICU to the ER in every hospital where I’ve stayed, how critical their jobs are. They, too, are busy with the work of saving lives. I hope you will look around for individuals working to ensure we can open the gift of today and tomorrow—folks working tirelessly to keep us safe, get us where we’re going, to ensure we get food. The list is endless. . . .
5. Forget politics—we’re all people. The America in 2012 when I fell sick is not the America I recognize today, in terms of the rhetoric. As politicized and divided as the country is today, I have seen up close the incredible professionalism, courage and skill of medical teams whose only concern is the care of their patients. My caregivers have been from all walks and stations of life and from countries around the world. I have been blessed that they call America their home. It’s because of the microsurgeon from Turkey, the nurse from India, and so many others who treated and helped me, that I am here. All of them worked and continue to work to find ways to put Humpty Dumpty back together. And I remain grateful to all of them.
6. Giving thanks, with gratitude. Finally, I want to thank the people who have accompanied me on this journey: First, my wife Tricia and our children, Ashby, Jack, and Mary Rose. Trish has navigated the unimaginable with grace and forgiveness—and our children have done so as well. I also want to add that Trish did all this while serving our community in multiple roles over the years. They have all been a blessing and extremely understanding during rough times and managed to pick themselves up—and often me as well—every day while moving forward.
I also want to thank my former bosses who helped me along the way. They have either sat by my bedside or helped to keep my focus balanced and strong. And speaking of bedsides, Secretary Norman Mineta was also an inspiration to me as I watched him, too, bravely navigate a serious illness while managing his leadership duties from a hospital bed. So thank you: Secretary Mineta, Ernie Fletcher, Frank Wolf, Jay Timmons and the National Association of Manufacturers, Jim Simpson, Mike DeWine, Bill Schubert, and Dave Camp. You were there for me, and it has meant the world.
I have been enveloped by a spiritual guiding light and have felt all the prayers and positive thoughts over the years from so many of you reading this. My heartfelt thanks to you all. As I like to say, “Thankful is simply every day.” The S.S. Irvin remains afloat, and we are working hard to mindfully navigate it every single day. Our family, knowing we are all survivors from this journey, has so much to celebrate and to continue to be thankful for.
Wes Irvin is a former Lexington resident who was congressional, campaign and gubernatorial press secretary for Ernie Fletcher. He lives in Annapolis, Md., and says he is an evolving survivor who advocates for the disabled and focuses his volunteer time on
emotional wellness issues, due to a multi-year health journey.
President Trump wore a mask on a private tour of a Ford plant Thursday but refuses to do so in public.
By Melissa Patrick
Kentucky Health News
Wearing a mask when out in public is even more important as Kentucky reopens its economy, medical professionals advise. Many Kentuckians are skeptical.
Rebecca Dutch, chair, UK Department of Molecular and Cellular Biochemistry (UK Photo by Mark Cornelison)
"It is actually, primarily, so that if you happen to have the virus and you don't know it -- which happens very frequently now -- you're not breathing it out, coughing it out on other people," said Rebecca Dutch of the University of Kentucky, who has spent more than 30 years studying viruses.
"Every person we add into our interactions is someone we might either get it from or pass it to, or take it home to our families," Dutch said. "Remember that the risk is still there, so think carefully about whether what you are doing is something that is a good idea."
Dutch is a professor and the chair of the Department of Molecular and Cellular Biochemistry at UK, and leader of the Covid-19 Unified Research Experts (CURE) Alliance team, which advises on covid-19 patient care and clinical trials at the university.
She said the novel coronavirus has a relatively high infection rate, with each infected person causing three more infections if there are no restrictions on activities and contacts. Emergency restrictions imposed by Gov. Andy Beshear have reduced Kentucky's infection rate to 0.87, according to a model created by the co-founders of Instagram, which displays each state's rate at rt.live. A rate of less than 1 means the virus should eventually stop spreading.
It will be important to watch this number as the state has fewer restrictions and more contacts; Beshear has refused to say how the infection rate drives his decisions, but New York Gov. Mario Cuomo has said a rate of 1.1 or above would be a trigger for him to reimpose restrictions.
As he allowed opening of Kentucky's stores and restaurants, and social gatherings of 10 or fewer people, Beshear used the rhyme "Hands, face and space" to summarize the medical advice: Keep your hands washed; don't touch people not in your immediate family; wear a mask in close quarters; avoid touching your face; keep six feet of separation; and to entertain outside, if at all possible.
"All of these are mechanisms just to try to stop as much spread as we can," said Dutch. "So that is why the governor is now asking people to mask."
The official message also came with a warning that some Kentuckians may have become complacent about their risk of getting the virus. "Some may conclude that the danger is not still there, and I’ve got to urge you, the danger is still there. If we take our eye off the ball . . . we could find ourselves in late June paying very dearly for our actions today," Health Commissioner Steven Stack warned May 22.
The most controversial piece of advice is to wear a mask, so Beshear is asking Kentuckians to say on social media posts why they wear one, and to talk to others about it.
"Some people have objected to masks, and the challenging part about that is you can object to a mask on your own personal health, but it is not your own personal health that it is going to impact," Beshear said May 19. "It is other people's health, so it is more about your willingness to protect other people if you are wearing or not wearing one."
The governor regularly points out that masks are recommended by the White House and the Centers for Disease Control and Prevention. At one point he said they shouldn't be a partisan issue.
A Kaiser Family Foundation Poll released May 22 found that Democrats are about twice as likely as Republicans to say they wear a mask every time they leave their house: 70% and 37%, respectively. Majorities of each party said they wear a mask "most of the time."
Kaiser Family Foundation chart; click on it to enlarge. More data and poll questions are here.
The poll also found that while 72% of Americans think President Trump should wear a mask when meeting with others, only about half of Republicans, 48%, agree. The report says that the partisan difference in largely driven by Republican men.
A pushback on several levels
Trump says he doesn't need to wear a mask because he is tested daily for the virus, but critics say he is missing an opportunity to set an example that would save lives. Thursday, he refused to wear a mask in front of news cameras while touring a Ford plant in Michigan, saying "I didn't want to give the press the pleasure of seeing it." He wore a mask when news cameras weren't around, but someone on the tour took a picture of him and it was widely circulated.
Senate Majority Leader Mitch McConnell regularly wears a mask, bit U.S. Sen. Rand Paul, an ophthalmologist, says he won't wear one because he has had the disease and is immune. However, experts warn that this hasn't been proven, and there have been reports of people testing positive weeks after they have recovered, and that it is uncertain if they are contagious or not.
Fourth District U.S. Rep. Thomas Massie weighed in on Twitter yesterday, saying "There is no authority in the Constitution that authorizes the government to stick a needle in you against your will, force you to wear a mask, or track your daily movements. Anyone who says you have to right to avoid those things fundamentally misunderstands the 9th" Amendment, which says the Constitution's language "shall not be construed to deny or disparage others retained by the people."
Lexington Herald-Leader photo
And in a move that got national notice, a Manchester convenience store posted a sign banning masks. Alvin's responded to complaints by saying it was a "joke," the Lexington Herald-Leader reported. Later, it clarified the statement in a Facebook post, saying it would not turn away mask-wearing customers and "It's your choice to wear one or not, not our government's choice for us." Newsweek reports that the sign has since been taken down.
Earlier, Chris Kenning and Sarah Ladd of the Louisville Courier Journaltook a look at who was or wasn't wearing masks around Kentucky and found a low percentage of compliance in one of the hardest-hit parts of the state.
Mason Barnes, Judge-Executive of Simpson County, just south of Warren County, which continues to have one of the state's highest infection rates, told the CJ, "I'd say 70 percent to 80 percent of the people are not wearing masks when they're out and about."
Beshear has said Kentuckians will not be cited or arrested for not wearing a mask in public.
So, why should you wear a mask? The simple answer is because the virus is primarily spread by tiny droplets from infected people, not just coughing and sneezing, but from talking and breathing. A mask can stop the spread of those droplets, especially from people who have the virus but don't know that they do.
Stack, the health commissioner, said May 18 that about 25 percent of people with the virus have no symptoms. Later in the week, the Centers for Disease Control and Prevention estimated the number at 35 percent.
UK HealthCare photo
Dutch, the UK virologist, pointed out that people can be very infectious just before they get symptoms.
She said, "When people can spread it before they know they are sick, we actually have to take extra precautions because we all have to think, 'Oh, I might have this, what do I need to do to protect people when I go out?'"
More than 40% of Kentucky adults are at higher risk of serious illness if infected with the virus because they have heart disease, chronic obstructive pulmonary disease, uncontrolled asthma, diabetes or a body mass index of 40 or more, indicating morbid obesity, according to the Kaiser Family Foundation. It did not include people with another risk factor, cancer, in which Kentucky is a national leader.
The value of wearing a mask is illustrated by a new study, published in The Proceedings of the National Academy of Sciences. It shows how normal speaking can launch thousands of droplets that can remain suspended in the air for eight to 14 minutes, allowing them to be inhaled by others. "There is a substantial probability that normal speaking causes airborne virus transmission in confined environments," the study report says.
The researchers said in a letter to The New England Journal of Medicine that the same experiment, using scattered laser light, found that use of a cloth face mask blocked nearly all droplets emitted when talking. They posted a video, the last part if it in slow motion, to show their finding.
The latest study to confirm the effectiveness of cloth masks was published May 22 in the peer-reviewed journal Annals of Internal Medicine.
Science supporting mask wearing is so strong that more than 100 prominent health experts have asked governors to require them. They write that the research "strongly suggests that requiring fabric mask use in public places could be amongst the most powerful tools to stop the community spread of covid-19."
So why did the CDC recommend not wearing a mask two months ago? The Mayo Clinicsays face masks were not recommended at the start of the pandemic because experts didn't know the extent to which people with covid-19 could spread the virus before symptoms appear, nor was it known that some people have covid-19 but don't have symptoms.
The CDC now recommends the use of reusable cloth masks so that surgical masks and N95 respirator masks, which continue to be in short supply, can be saved for health-care workers.
The CDC guidance says cloth masks should: fit snugly but comfortably against the side of the face; be secured with ties or ear loops; include multiple layers of fabric; allow breathing without restriction; and be able to be laundered and machine-dried without damage or change to shape. It also cautions that they should not be placed on children under age 2, anyone who has trouble breathing, or anyone who would have trouble removing the mask without help. The Mayo Clinic recommends that cloth face coverings be washed after every day of use.
Beshear's "healthy at work" rules require businesses to have employees to wear a cloth mask, unless it is a health or safety hazard to do so, or if they are working alone or in an enclosed space, or if they are working in an area that allows for appropriate social distancing. The order also encourages customers to wear masks, and allows businesses to refuse to serve customers not wearing them.
Dutch urged caution as the state reopens its economy, saying that the "long road ahead of us" will require all of us to make smart choices if we are to slow the spread of this virus, like continuing to practice social distancing and wearing a mask.
"I think it is really critical that people understand that as we are reopening the economy, we've done a good job of slowing down the rate of infections, but the virus is not gone," she said.
She added later, "The best we can do is anything that can just slow down how often people spread this virus from them to someone else, and that's how we win. Hopefully we will do well. We will see."
Gov. Andy Beshear wants Kentucky employers who don't allow paid sick leave to change that policy, to prevent spread of the coronavirus.
“We have got to make sure that people stay home when they’re feeling sick until we move past this,” Beshear told journalists, adding that it is only a matter of time before Kentucky sees a case of covid-19, the disease caused by the virus.
“I would encourage all those businesses that are out there that don’t currently offer paid sick leave, absolutely consider it for the next several months,” Beshear said.
The Courier Journalreports, "Kentucky sits in a region with some of the lowest rates of access to paid sick leave in the country, according to Jason Bailey, head of the Kentucky Center for Economic Policy, a left-leaning think tank. Some 62% of private sector workers in Kentucky, Tennessee, Alabama and Mississippi receive paid sick days, compared with 91% of workers in the Pacific Northwest, Bailey said. That's partly because Kentucky has a greater number of low-wage employers — factories and retailers."
But it’s also because the 2017 General Assembly banned local governments from imposing sick leave requirements, Bailey told the Louisville newspaper: “Cities like Louisville are actually barred from doing that. So that creates additional risk because a lot of those workers who do not have paid sick days are also the ones who are in those jobs with regular contact with the public. … We have created a situation through that and other policies that increase our risk.”
Kentucky's Andy Beshear is one of 12 Democratic attorneys general suing the federal government over its new rules allowing "association health plans," a product long advocated by Republican U.S. Sen. Rand Paul and recently approved by President Trump.
Paul argues that AHPs would make health insurance more affordable and accessible, but the Democrats say the administration's rules allowing them would undermine "essential protections such as coverage of pre-existing conditions, newborn,
maturity and pediatric services, substance abuse treatment and oral and vision
care," a Beshear press release said.
The attorneys general are
asking a federal judge to reject a Department of Labor rule allowing AHPs for employers, on grounds that it redefines "employer" in a way that conflicts with the Patient Protection and Affordable Care Act of 2010, generally known as Obamacare.
Beshear said, “If the rule allows spin-off
employer association health groups that meet the ACA’s requirement of minimum
essential health care coverage, then employees in these groups will lose their
ability to garner federal tax credits.This will increase the
cost of health care coverage for many Kentuckians.”
Dan Diamond of Politico notes, "In announcing the new rules last month, the administration said they would make it easier for small businesses to band together to purchase cheaper health insurance — and, not coincidentally, serve as a key part of the president's strategy to destroy Obamacare. Today's complaint puts that point in legal terms — from the opposite side."
Nearly one in four Kentucky adults with health insurance worry that they could lose their health coverage -- less than last year, when almost one in five said they were concerned, according to the latest Kentucky Health Issues Poll.
The survey, taken by telephone Oct. 24 to Dec. 2, found that the share of Kentuckians with public insurance (such as Medicaid, Medicare or veterans' benefits) in 2017 moved back up to its 2015 rate of 35 percent. It had dropped to 29 percent in 2016.
The share of Kentuckians with employer-provided insurance dropped to 39 percent, continuing a bumpy decline that began in 2014, when the rate was 50 percent. About 11 percent of Kentucky adults reported they bought health insurance on their own or through a parental plan.
The decline in employer-sponsored insurance could be significant, because part of Gov. Matt Bevin's strategy in adding work rules to Medicaid is to encourage those on the program to find jobs that offer insurance. Most of those who will be affected by the work rules already work, but many at low-paying jobs that don't offer insurance.
In 2014, when then-Gov. Steve Beshear expanded Medicaid to those who earn up to 138 percent of the federal poverty level, the share of Kentuckians without health insurance dropped from 25 percent to 12 percent. The rate rose to 15 percent in the latest poll, after two years at 13 percent, but those numbers were within the poll's error margin of plus or minus 2.4 percentage points.
The survey also found that an additional 6 percent of Kentucky adults who had health insurance at the time they were polled were without it at some time during the prior 12 months.
"Health insurance and good health go hand in hand," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll with Interact for Health, a Cincinnati foundation. "Preventive care and wellness checks are as necessary as treatment for chronic illness, and too many Kentucky adults are still going without the care they need due to lack of insurance."
Health Secretary Vickie Yates Brown Glisson on KET
By Melissa Patrick
Kentucky Health News
Gov. Matt Bevin's proposal to overhaul the state's Medicaid program, with its latest modifications, says it would leave 95,000 fewer Kentuckians on Medicaid in five years than there would be otherwise.
Exactly what that means depends on whom you ask.
"No one is going to be pushed off of Medicaid, no one is losing their benefits," Health Secretary Vickie Yates Brown Glisson told Renee Shaw on KET's "Connections with Renee Shaw."
Glisson's comment prompted a Twitter storm from Dustin Pugel, a research and policy associate for the liberal-leaning Kentucky Center for Economic Policy: "What happens when someone fails to report that they got a couple extra shifts, or their tips lowered their wages? . . . What happens if someone fails to make their $1-$37.50 monthly premium one month? . . . What happens if someone works 19 hours one week instead of 20 and can't find an extra hour of qualifying volunteer work? . . . What happens if someone loses track and doesn't re-enroll at the end of a year's coverage? Kicked off."
Asked to clarify Glisson's comment, Doug Hogan, spokesman for the Cabinet for Health and Family Services, said in an e-mail: "Kentucky HEALTH does not change income eligibility thresholds. People who participate in the program will have access to the same health coverage and benefits they have today." He added, "There will be no changes in benefits for certain low-income adults, caregivers, children, pregnant women, the elderly, and those with disabilities."
Pugel said in an interview, "If you add these new requirements that people can't meet, those requirements are responsible for people losing coverage." He added, "Indiana’s requested work requirement is very similar to ours, and it states that a quarter of the people who must comply with a work requirement will lose coverage because they are unable to meet it. Also in Indiana, the premiums they charge led to tens of thousands either losing coverage or never getting coverage to begin with because people didn’t pay them."
Glisson said on KET that with the help of a "continuum of services" to be offered in the new Medicaid plan, called Kentucky HEALTH, able-bodied adults without dependents who are on Medicaid will eventually transition to better paying jobs that offer employer health insurance.
"We need to connect you with the jobs, we need to get you the training for those jobs. And if you chose to, we're hoping that you're going to be able to transition to an employer-sponsored insurance product," Glisson said.
In the separate interview, Pugel argued that the high-paying jobs with health benefits that the Bevin administration expects these able-bodied adults to move to simply don't exist in Kentucky.
He said many Kentucky counties have fewer jobs than they did before the recession, and the handful of counties that have seen some job growth are seeing it in temporary-agency work, which he said "nearly never" offers benefits like health insurance.
"There are a lot of folks who live in areas where there just aren't jobs, let alone the kind of jobs that would offer the kind of benefits she is talking about, Pugel said.
He added that employers don't offer health insurance as a benefit nearly as much as they used to, especially in the kinds of jobs held by people who earn near the Medicaid income limit, $16,400 for an individual. He said the share of Kentucky workers who received insurance through their employer has fallen from 70 percent in 1980-82 to 53.7 percent in 2011-2013. The Kaiser Family Foundationreported that only 47.8 percent of private sector firms in Kentucky offer health insurance in 2015.
"These folks work in jobs like construction and child care and restaurants. These are not jobs where employers offer coverage, or coverage that these folks can afford," Pugel said. "Medicaid fills a role. It really does for working Kentuckians."
Kentucky submitted its proposal to overhaul the state's Medicaid program to the federal Centers for Medicare and Medicaid Services about 11 months ago. Glisson told Shaw that the state expects to submit its final version in mid- to late August.
The proposal, which is expected to be approved, focuses on "able-bodied" adults without dependents who qualify for Medicaid under the expansion of the program to those who earn 138 percent of the federal poverty level, under the 2010 Patient Protection and Affordable Care Act.
Kentucky has 1.4 million people on Medicaid, with around 470,000 of them covered under the expansion. Bevin has said the state can't afford to pay for this expanded population (the state's share is 5 percent this year, rising in annual steps to the ACA's 10 percent limit in 2020) .
The new plan is designed to not only save Kentucky money, but to also encourage participants to have some "skin in the game" through premiums and work or community engagement requirements that encourage people to have a higher level of involvement in their care.
The state proposed modifications to the original proposal in July. Glisson called the changes that strengthened the work and community engagement requirements and added a six-month lock-out period for those who fail to report changes in their work and employment status within 10 days of the change, "fairly minor."
To this, Pugel tweeted, "The 'minor changes' she's referring to kicks an extra 9,050 people off Medicaid and reduces spending by tens of million." Actually, the "kicked off" number is the difference between the number who are expected to be on the program in five years and the number expected to be on it if no changes are made.
More than 1,000 Kentuckians submitted comments about the added changes to the proposal, and almost all of them opposed it.
