Share of Kentuckians testing positive for the coronavirus drops below 6%, but Beshear says daily new cases are still too high

 Dept. for Public Health graph, adapted by Ky. Health News; first-month figures are unreliable due to few tests.

This story has been updated to correct an editor's statistical error.

By Melissa Patrick

Kentucky Health News

The metrics to measure the coronavirus in Kentucky continue to improve, most notably with the percentage of Kentuckians testing positive for the virus in the last seven days dropping below 6%, to 5.84%.

"Things continue to move in the right direction and [are] moving there quickly," said Gov. Andy Beshear as he began his weekly Covid-19 press conference. 

But he closed with a warning that the case numbers are still "too high" and reminded Kentuckians that there is still a deadly variant of the virus out there, and that not enough people are vaccinated. 

The state reported 544 new cases of the virus Monday, the lowest daily number since July 25, when the it reported 504 cases. The seven-day average for daily cases is now 1,390.1,308. 

Dept. for Public Health graph, adapted by Ky. Health News; to enlarge any image, click on it.

Beshear said Kentucky's weekly coronavirus case numbers dropped to their lowest level in 11 weeks, dropping to 9,749 in the week ended Sunday, the first such week since July 27-Aug. 2 that there have been fewer than 10,000 weekly cases. 

“We are almost decreasing in cases at the speed that we increased,” said Beshear. “That is a very good sign." 

Kentucky hospitals reported 919 Covid-19 patients; 281 of them in intensive care; and 157 on mechanical ventilation.  

Beshear said Covid-19 hospitalizations decreased 20% in the last seven days, but 53 of the state's 96 acute care hospitals still report critical staffing shortages. 

Eight of the state's 10 hospital regions are using more than 80% of their intensive-care beds, with the northern region at 100%. 

The New York Times ranks Kentucky 18th among states for its seven-day infection rate and says the rate has declined 33% in the last two weeks. 

The state-reported infection rate fell to 24.39 daily cases per 100,000 residents, placing more than half of the state's counties out of the highest category of transmission. Counties with rates more double that rate are Owsley, 71.2; Cumberland, 64.8; Russell, 63.8; Jackson, 60.0; Letcher, 56.3; Powell, 53.2; Adair, 52.1; and Mercer, 50.8.

The Washington Post reports that in the last week, Kentucky averaged 10,158 doses of coronavirus vaccine per day, a 29% decrease over the previous seven days. So far, Kentucky has administered at least one dose to 2.8 million people, or 73.4% of the eligible population, 12 and older. 

The state vaccine dashboard shows that 80% of the population in Woodford and Franklin counties have received at least one dose of a vaccine.

Beshear encouraged Kentuckians 65 and older, people with significant underlying health conditions and people who have high exposure to others at work to get a booster. 

Rebecca Dutch, professor at the University of Kentucky College of Medicine, explained why it is so important for eligible Kentuckians to get a booster shot. She said that over time, a vaccinated person's immune response to the virus slowly decreases. She added that while the protection against getting severe Covid-19 and hospitalization remains, the protection against the virus wanes. 

To decrease the chances of getting the virus, she said it's important to get the booster, calling it a "protective mechanism." 

The state reported 23 more Covid-19 deaths, raising the death toll to 9,640. The seven-day death average is 34.1 deaths per day. 

Asked why Kentucky has had a higher case rate than the rest of the nation, while its death rate is just below the national average, Beshear attributed much of the state's success to his father Steve Beshear's decision as governor to expand Medicaid, noting that many of the states that did not expand the program have higher Covid-related death rates than Kentucky. He also pointed to Kentuckians working to protect each other and to the hard work of the state's health-care workers. 

"I think we have worked very hard to stay safe," he said. 

Beshear recommended that the General Assembly use $400 million in federal relief funds for bonuses to "essential workers" and asked legislators to participate in a working group to work out the details. He said leaders of the legislature's Democratic minorities sent him names for this working group on Friday but the ruling Republicans said "No, thank you" and asked him to go through the committee process. He said he would move forward with this incentive plan and will work with the parts of the legislature that are willing to work with him. 

In other pandemic news Monday:

• Beshear reminded Kentuckians that the Federal Emergency Management Agency is offering financial assistance for Covid-19 related funeral expenses incurred after Jan. 20, 2020. For more information, go to DisasterAssistance.gov or call 1-844-684-6333.
• In August, Kentucky had the the highest number of people quitting their jobs, at 4.5%. Asked about that, Beshear said it also had fifth-highest hiring rate in the country, which was a percentage point higher than the quit rate -- which he said reflects several things, including people looking for a different work environment, a desire for better work conditions, or better pay. He said it has nothing to do with unemployment pay, because people who quit don't qualify for unemployment benefits.

Map by The Washington Post, adapted by Kentucky Health News

Pandemic made chronic shortage of nurses in Ky. an acute shortage; now 1/4 of Ky. nurses say they plan to leave their jobs

Nurse Cydney Kanis at Baptist Health Lexington
(Photo by Alex Slitz, Lexington Herald-Leader)

One in four Kentucky nurses say they plan to leave their job in the next three months, saying they are "exhausted, overworked and underpaid," writes Alex Acquisto of the Lexington Herald-Leader, reporting on a survey of 850 licensed nurses this month by the Kentucky Nurses Association.

The poll found that 73% "said the driving factor behind their burnout and the overall workforce shortage was untenable patient loads and too few nursing staff, while just over 40% cited insufficient pay," Acquisto reports. "A quarter said it was 'likely' or 'extremely likely' they would leave their current position in the next three months, and 16% said they were likely to leave the profession altogether.

“I don’t want to leave the nursing field, but I cannot imagine being a nurse in five years with no change,” one unnamed nurse said in her response to the survey.

At a press conference about the poll, "Nurses and leaders of state health-care associations proposed that Kentucky allocate $100 million in federal pandemic money to aid in the nursing workforce shortage," Acquisto reports.

Gov. Andy Beshear has asked the legislature to provide bonuses to front-line essential workers who stayed employed throughout the pandemic, using $400 million in pandemic relief, and the nurses' prescription calls for the state to a forth of that for nursing, including $50 million for retention bonuses, $20 million for loan forgiveness for nursing faculty, students and graduate nurses who work in under-served areas.

The pandemic has pushed nurses to their physical and emotional limits, Kristin Pickerell, director of critical care and emergency services at Norton Healthcare in Louisville and past president of the Kentucky Organization of Nurse Leaders, said at the press conference.

“We started this pandemic with nurses being heroes — it was really a rallying point for the public,” she said, but in recent months, “It’s really kind of morphed into something different,” she said, citing occasional instances of “violence against nurses in the hospital, all because of the pandemic and one’s belief that [Covid-19] isn’t real.”

KNA board president Donna Meador said that due to frequent cases of “physical and verbal abuse,” at least one health-care employer in Kentucky issued “panic buttons” to its nursing staff during the pandemic, which she said is “almost unbelievable.”

Of the nurses who responded to the survey, "61% had more than 21 years of experience," Acquisto reports. "Roughly a quarter said physical exhaustion and fear of spreading coronavirus to a loved one was also contributing to the shortage. A majority cited better pay, financial incentives and more staffing support as critical solutions."

Doctors, including one in Lexington, say Covid-19 denial and misinformation make it exasperating to treat the unvaccinated

Dr. Ryan Stanton (Baptist Health photo)

Health-care workers "are growing weary of Covid-19 denial and misinformation that have made it exasperating to treat unvaccinated patients during the Delta-driven surge," The Associated Press reports after interviewing doctors from across the country, including one in Kentucky.

"They describe being aggravated at the constant requests to be prescribed the veterinary parasite drug Ivermectin, with patients lashing out at doctors when they are told that it’s not a safe coronavirus treatment," reports AP's Heather Hollingsworth. "People routinely cite falsehoods spread on social media, like an Illinois doctor who has people tell him that microchips are embedded in vaccines as part of a ploy to take over people’s DNA. A Louisiana doctor has resorted to showing patients a list of ingredients in Twinkies, reminding those who are skeptical about the makeup of vaccines that everyday products have lots of safe additives that no one really understands."

Dr. Ryan Stanton, an emergency physician in Lexington, "recently had a patient who began their conversation by saying, 'I’m not afraid of any China virus.' From that point on, he knew what he was up against in dealing with the patient’s politics and misguided beliefs about the virus."

Stanton, who makes frequent media appearances, "blamed people like far-right conspiracy theorist Alex Jones for spreading some of the misinformation that has taken root among his patients. Among them is that the vaccine contains fetal cells. Another said it 'is a simple fact that the vaccine has killed millions'."

“In fact,” he told the AP, “that couldn’t be more wrong.”

Hollingsworth reports, "It’s tough to watch, especially after living through the early surges. . . . There was hope after the vaccines arrived, but then came the delta variant and a slowdown in immunizations."

“Really,  it amazes me, the number of people who have this huge fear, conspiracy theory about vaccines and will, honest to God, try anything, including a veterinary medicine, to get better,” Stanton said.

Anthem funds scholarships for Eastern Kentucky health workers

By Leon Lamoreaux

President, Anthem Kentucky Medicaid

For generations, Kentucky’s rural communities have been built by families, separated by miles and miles from the nearest city. Those miles of separation are both a blessing and a burden. Families enjoy wide open spaces and a different pace of life, but amenities like hospitals and health specialists can be far from home. Visiting a doctor or hospital can be a challenge because of the distance and expense. Here in Kentucky, that distance and availability of healthcare resources put rural residents at a health disadvantage.

Today, Kentucky hospitals report a 10 to 40 percent vacancy rate of nursing positions, with the highest need found in rural areas. Health-care researchers estimate that Kentucky’s rural communities will need another 40 primary-care professionals to properly serve the population. That shortage translates to some 102,000 Medicaid beneficiaries in Kentucky who lack sufficient access to a primary care provider.

The Kentucky Center for Statistics estimates that Eastern Kentucky alone will require nearly 2,000 more nursing jobs by 2024 — less than three years from now.

Leon Lamoreaux

Kentuckians who live in rural communities deserve reliable access to adequate healthcare, and to meet those needs, we must expand the pipeline of healthcare professionals. That’s why Anthem Blue Cross and Blue Shield is launching the Anthem Rural Medicine Scholarship program with two Eastern Kentucky educational institutions. By funding education for future healthcare workers, we can grow the number of practicing professionals in rural Kentucky, improve health outcomes and strengthen the communities we serve.

The scholarships at Hazard Community and Technical College and Eastern Kentucky University are drawn from new Anthem-funded endowments, which means the funds for supporting new health-care students will last for years, not just for the next few semesters.

Scholarship recipients are required to practice in a federally recognized shortage area for a minimum of three years post-graduation, creating primary care access to at least 7,500 rural Kentuckians each year.

Leslie County native Kimberly Caldwell was among the first scholarship recipients. “This scholarship will allow me to work toward my dreams to become a nurse, without having to worry about the financial burden that can come with getting an education,” said Ms. Caldwell.

I was honored to meet Ms. Caldwell and congratulate her on serving the region she loves.

Rural Kentucky is full of unparalleled natural beauty as well as thousands of hardworking families and individuals who treasure their small towns. By funding education for future rural health providers, Anthem is helping to build brighter futures for all Kentucky families — no matter where they live.

Lamoreaux runs Anthem Blue Cross and Blue Shield's Kentucky Medicaid plan, which serves more than 160,000 beneficiaries.

Public-health director asks people in his county to respect and trust people in health care, as they did when he was growing up

Joshua Embry

By Joshua Embry

In graduate school I wrote a paper about the violence that health-care workers experience at the hands of patients. I had witnessed such behavior while working in a hospital environment. I had also heard nurses talk about patients whom had physically assaulted them, put their hands on them in inappropriate places, threw things, or made inappropriate comments. At the conclusion of the paper, I was alarmed to see the amount of disrespect that was occurring in our nation’s hospitals by the very people who nurses and doctors sacrifice so much for.

I wrote this paper in 2016. Fast forward to today, as we struggle to break free from the grip of Covid-19, we see evidence that the disrespect has grown stronger.

As a child, I was taught to respect doctors, nurses, and those in the health-care field because they were knowledgeable and caring. After all, they had sacrificed countless hours in preparation, spent thousands of dollars to attend school, and crammed for exams that were nerve-wracking. However, something has shifted in our society. As evident today, a good portion of the American population trust social media more than their medical providers. Furthermore, they value the opinions of news organizations and politicians more than they value valid medical research and proven data.

How did we get here—and where did we go wrong? The answer to that question I am unsure of, to be honest. However, I do know that the disrespect shown toward our medical professionals must change if we want to continue to thrive as a society.

I worry about what the children of today are learning. They see some adults, those whom they trust to raise them up and show them how to best thrive, refusing medical advice and life saving vaccines because of something posted on social media or something they read by an online blogger. What will this do to future generations? Will they have any respect for healthcare providers? Will they trust the facts they are taught in school such as America is a democratic nation? What information will they hold valid—and refuse to acknowledge simply because a politician tells them not to believe it?

Health-care professionals are not perfect; like any field there, are those who practice medicine for the wrong reasons. However, the field itself, the field of medicine and science, must be respected and trusted. We need to transfer that respect and trust to future generations so that they can apply medical facts to their own lives and make the best decisions related to their health.

Winston Churchill said, “We make a living by what we get, but we make a life by what we give.” Let’s give the future generations the opportunity we were given by our grandparents and parents. Let’s give them the opportunity to respect those who have given so much, in some cases their all, to provide medical care to those in need.

Joshua Embry is public health director of the Grayson County Health Department in Leitchfield. He wrote this for the Grayson County News.

Agenda for session includes aid for hospitals and nursing homes, and making it easier for doctors' offices to get and give vaccines

By Melissa Patrick
Kentucky Health News

As the Kentucky General Assembly prepares to use its new powers in a special session to deal with the pandemic, its joint health committee meeting held a special meeting Thursday, at which hospitals and nursing homes sought help to deal with staffing shortage and a patient surge that is overwhelming hospitals.

The three-hour meeting concluded with a list of what to expect from the legislature in a session that could begin as early as Tuesday.

Sen. Ralph Alvarado

"We've got to start finding out how are we going to address the immediate crisis, which is our unvaccinated patients who are acutely ill and require hospitalization or acute treatment of an active infection," said Republican Sen. Ralph Alvarado of Winchester, chair of the Senate Health and Welfare committee.

Alvarado told leaders of the hospital and nursing-home associations that the legislature will work on funding to help retain and recruit staff, including nurses, aides, respiratory therapist and emergency medical service providers. 

Alvarado said legislators will also work to provide more rapid coronavirus testing, extend liability protections and open regional clinics to administer monoclonal antibodies, a treatment for Covid-19 if given early. He also mentioned flexibilities that would allow paramedics to work in hospitals and expanding the emergency scope of practice for other health professionals.

As for increasing vaccinations, Sen. Danny Carroll, R-Paducah, asked that the lawmakers find ways to reduce the red tape required to give Covid-19 vaccines in doctor's offices, saying he had talked to physicians who chose not to offer it because there was too much paperwork involved. 

Alvarado, a physician, agreed with Carroll. Earlier, he said shaming unvaccinated people into getting immunized is not effective, and it is more likely they would be convinced by their personal health-care provider to get a shot. 

"We're going to be asking probably for an easier way to be able to get those [vaccines] in to doctor's offices, because that one-on-one conversation happens and somebody says, 'Okay, I'll take it,' you can give it right then and there instead of sending them someplace else where they might lose their courage or change your mind," Alvarado said.

Legislators are preparing for a session to pass their own pandemic response plan, under a state Supreme Court ruling that upheld laws they passed last winter to limit the governor's emergency powers. 

The testimonies from the hospital and nursing-home lobbies were concerning.

Nancy Galvagni

Nancy Galvagni, president of the Kentucky Hospital Association, said Covid-19 hospitalization across the state have grown from around 500 patients at the end of July to more than 2,000 at the end of August, a 340% increase as hospitals suffer from "a devastating shortage of nurses and other qualified workers" to care for patients.

"The number of Covid hospitalizations is now higher than what we saw at the previous peak last November and December," she told the committee. "And I hate to say, with each passing day, the situation is getting worse." 

She said Covid patients occupy half of all beds in Kentucky's intensive-care units, and only 135 staffed ICU beds were available Wednesday, with 54% of hospitals having no openings and 35% having fewer than five.

Galvagni said beds used for medical and surgical patients aren't much more available, with only 17% of these staffed beds free on Wednesday. She said many hospitals are postponing "medically necessary procedures," including knee replacements and certain cancer treatments. 

"The facts on the ground are very harsh, I can assure you," she said. "Our hospitals are filled with real patients, not theoretical ones. Our hospitals are being overwhelmed by an absolute deluge of patients with Covid-19. Hospital beds across the state are full or nearly full."

She asked the legislature to continue to Beshear's declared state of emergency, with its relaxed regulations; to pass laws to temporarily provide some flexibility to expand the scope of practice for some health-care workers; and to provide money to help hospitals cover the rising cost of staff. 

Betsy Johnson

Betsy Johnson, president of the Kentucky Association of Health Care Facilities, which represents 272 long-term care providers, said their main issue is staffing, a problem that pre-dates the pandemic: "Our primary need and the reason we're here today is to ask for support to build back our workforce."

Johnson said her members fear staff losses from the coming federal mandate that all nursing homes must require their employees to get vaccinated for Covid-19 or lose their essential funding from Medicare and Medicaid, because they can move to other health-care facilities that don't have such a mandate. 

She said a recent survey found that 43% of their corporate members said they expect 11% to 20% of their staff will leave due to the mandate. She said about 85% of the state's long-term care residents are vaccinated, but only 51% of the long-term care workforce has been.

"Unless this federal mandate is applied to all health-care providers, this mandate is going to negatively impact our skilled nursing facility, workforce, and most importantly, the care that our elders receive." Eleven major hospital systems in Kentucky are imposing vaccine mandates, and others may be.

She added, "Due to staffing shortages, some of our members are reporting that they're shuttering their beds due to staffing concerns and are unable to accept transfers from our overwhelmed hospital systems."

Johnson said that while wages have improved in nursing homes and other long-term-care facilities because of federal pandemic funding, they are still below what many fast-food places offer.

Johnson asked the lawmakers to consider how other states have provided funding for the long-term-care workforce, including travel and relocation costs for new hires and covering the cost of using staffing agencies, "which have skyrocketed during the pandemic."

Morehead hospital is so desperate for staff that it may put coronavirus-positive nurses back to work, in its Covid-19 units

Drs. Adam Howard and William Melahn (St. Claire photo)

St. Claire Regional Medical Center in Morehead is so desperate for staff that it may bring back to work nurses who have tested positive for the coronavirus, and assign them to care for patients with Covid-19, Dr. William Melahn, the hospital's chief medical officer, said in a radio interview.

"If things get much worse, Melahn says St. Claire's will have to bring back nurses who have tested positive for Covid just to keep things running," Sheena Goodyear reports for the Canadian Broadcasting Corp.

"Yes, we have a plan for that, actually," and it's approved by the state Department for Public Health, Melahn told CBC's Peter Armstrong. "If we have Covid-positive staff who are … feeling well, that we can use them in Covid-only units. We have two Covid-only units that we can do that with, and that's certainly on the table already. I don't think we're doing it today, but it's on the table."

"We've hired two nurses in six weeks," Melahn said. "And nobody can find [nurses]. There's a really big hospital up the road about 100 miles from us. They are short 200 nurses." Cincinnati is 100 miles from Morehead.

Asked if there are nurses or doctors or hospital staff that could come from other parts of the U.S. to help, Melahn said, "What we're finding is everyone around is going through the same thing. That doesn't mean that all hope is lost. This week we declared, actually, an official disaster, and that allows us to make some flexible changes. We're a health system, so we have a system of rural clinics around us. We've already pulled all those nurses and some of those doctors in."

Sperling's Best Places map

Melahn noted that the hospital will be one of five in Kentucky to get help from the National Guard, a step Gov. Andy Beshear announced Monday. He said Thursday that the hospital "is in disaster mode."

The hospital's Covid-19 patient count has exploded. "Thirty-one days ago, we had one in-patient with Covid," Melahn said. "We usually take care of a total of 75 in-patients per day, all told. This afternoon, I have 67 Covid inpatients."

He said that's due to low vaccination rates in the area, which are driven by bad information. "We are not upset at our patients," he said. "We're upset about the disinformation or misinformation that's out there that really fills them with fear. What we have observed is this is a pandemic driven by fear. I mean, these people are afraid of being vaccinated."

Armstrong asked Melahn, "Do you have hope? Do you have a sense how to get to a brighter, better day?" Melahn replied, "Usually, in an infectious-disease pandemic, the more rapidly it rolls out, the more rapidly it falls off. So … if you want to call that a positive, that's something that we're looking forward to."

Governor promotes Health Care Heroes Appreciation Week

Beshear honors health-care workers at Morehead; state reports 994 new virus cases Friday, with positive-test rate of almost 7%

A screenshot of the crowd showed at least one masked person, at far left. (WKYT; click to enlarge)

Hundreds of front-line health-care workers gathered at St. Claire Regional Medical Center in Morehead Wednesday night to get thanks from Gov. Andy Beshear and others for their work during the pandemic.

“You all engaged in one of the most remarkable acts of heroism that I've ever seen,” Beshear said, speaking in the past tense – though he said the next day that the recent surge of coronavirus cases poses the prospect that the health-care system in some places could be overwhelmed.

Showing emotion, Beshear said, “The hardest thing I've ever done in my life is to read out the ages and the counties and the genders of those we lost over and over every day. But I showed up every day because I didn't want anybody else to have to do that. But you were sitting there holding their hands and you knew their names and you were going to talk to their family members. And that is something so special that we needed you for above and beyond your regular jobs. You are all super-heroes.”

The state no longer lists the age, sex and county of Kentuckians who die from Covid-19. Deaths are averaging fewer than four per day; two months ago, the average was about eight per day. But deaths are a lagging indicator of the pandemic, which has resurged with a more contagious variant of the virus.

Friday, Kentucky reported 994 new cases, raising its seven-day average to 713, more than double what it was 10 days ago. The share of Kentuckians testing positive for the virus rose for the 29th straight day, to 6.97%. The seven-day infection rate rose to 15.09 per 100,000 residents, more than triple what it was two weeks ago.

Few masks were visible at the Morehead event. Beshear said at his press conference the next day that everyone wore a badge saying they had been vaccinated for the virus. However, the more contagious Delta variant is causing many cases in vaccinated people, and it generates a much heavier viral load, which is amplified in large crowds, and people can spread the virus without knowing they have it.

At the event, though, the accent was on the positive.

Dr. Steven Stack, who became state public-health commissioner about a month before the pandemic hit, told the workers, "Up until March last year, I would have been in an emergency department. I would have been on the front lines with all of you. So as much as this has been difficult and hard, and as much as I've had this incredible privilege to get to serve with and advise a governor and support a state, it does feel in a way like I've been on the sidelines throughout this. Because I would have been in the Emergency Department with all of you. So I want to thank you very much for what you have done.”

Nikita Gibbs, a registered nurse who has worked at the Morehead's coronavirus testing site every day received a "Service Above Self" award. “She has seen over a hundred thousand nostrils, and she is exposed herself almost 3,000 times to Covid-positive patients. We all know her as the girl and scrubs the wears cowboy boots,” said Donald H. Lloyd II, the hospital's president and CEO.

"Gibbs said the journey has been a difficult one," reports Karyn Czar of WUKY. "But like all her counterparts, one she felt called to do." She told Czar, “It was definitely pretty terrifying at first because I do have a four year-old at home, and she's my pride and joy. So taking that home to her, I was definitely on edge about that. I just wanted to make sure that I help serve my community and the best way that I could.”

Gibbs and other health professionals told Czar that the best way you can thank them is by getting vaccinated. “I really encourage you to get vaccinated, because it is not just for you but the people around you and your loved ones … All my family is vaccinated,” Gibbs said. “I have strongly supported it. Every friend that I talk to, I strongly support getting it.”

The local star at the event was Beshear's senior adviser, Rocky Adkins of Sandy Hook, who was a state representative in the area for many years before challenging Beshear in the 2019 gubernatorial primary. He tearfully thanked St. Claire employees for helping his father, Jess Adkins, then 84, survive Covid-19 last year.

“My father started his journey of whipping Covid at Saint Claire,” Adkins said. “If any of you are in this room that treated my father, thank you from the bottom of my heart because I want to report to you your good work. My father has fully recovered. My father is on a tractor. My father is plowing, disking, and raising a half-acre garden and doing it without any oxygen whatsoever. My father is healed because of your good work, and I appreciate that from the bottom of my heart.”

Information for this story was also gathered from WUKY and WKYT-TV.

CDC: Outbreak of more contagious virus strain in nursing home began with unvaccinated employee; vaccines can prevent such

In state health department video, nursing-home staff say why they got a shot.

This story has been updated with comments from state officials.

By Melissa Patrick
Kentucky Health News

Coronavirus vaccines protect residents and staff in skilled nursing facilities against more contagious variants of the virus, according to a Centers for Disease Control and Prevention study of an outbreak of a more contagious variant in a Kentucky nursing home.

The study reported that the first case identified was in a health-care worker at the facility who had symptoms of Covid-19, the disease caused by the virus, but had not been vaccinated. Only 53 percent of the health-care workers at the facility had been vaccinated, the study said, while 90% of the residents had.

The outbreak and the study provided a test of vaccines against the more contagious variant, which had not been identified until the outbreak.

The study found that the vaccine was 87% protective against Covid-19 symptoms in both residents and staff. It also found that the risk of infection among unvaccinated residents and staff, respectively, was 3 and 4.1 times greater than the risk among the vaccinated.

For prevention of infection by the virus, the vaccine was 66% effective among residents and 76% effective among staff. It was 94.4% effective against hospitalizations and deaths for residents. "Vaccinated persons were significantly less likely to experience symptoms or require hospitalization," the study says.

In the outbreak in early March, "Three residents died, two of whom were unvaccinated," the study report says. Four possible reinfections were identified," in a resident and three workers, one of whom was vaccinated. All four had Covid-19 symptoms. One resident, who had been infected last May and had nine consecutive negative tests before reinfection, including two within 30 days of the outbreak, "was hospitalized and died," the study says.

Life Care Center of Morehead (Company photo)

When the outbreak was first reported, the Kentucky Department for Public Health only identified the facility as being in Eastern Kentucky, but by all indications, including day-to-day, facility-specific data published by the department, it occurred at the Life Care Center of Morehead.

Bill Hurst, the facility's executive director, referred questions to the department, which again refused to identify the nursing home. Department spokeswoman Susan Dunlap said in an e-mail, "As a general operating principle throughout this pandemic, we have tried to respect the privacy of individual persons and facilities."

Health Commissioner Steven Stack said as he discussed the study at Gov. Andy Beshear's briefing Thursday afternoon, "The facility didn’t do anything wrong. They participated and did all the things they were supposed to do."

Beshear, asked why he hadn't required nursing-home workers to get vaccinated, said "There are some legal concerns with making it mandatory," and said any such mandate might cause a further decline in vaccinations. It is unclear whether the vaccines can be required because they are authorized for emergency use.

Beshear said nursing-home operators "need to make an extra push to get their people vaccinated," showing them the harm that can result from not doing so, but wasn't sure whether state officials have suggested that that the operators make it mandatory.

Louisville Business First reported in January that some facilities, such as Louisville-based Atria Senior Living, are mandating vaccines, but others are hesitant to do so, largely for fear of driving away employees in an industry that struggles with chronic shortages of workers.

The study says all of the staff and residents in the nursing home had been offered the two-dose Pfizer-BioNTech vaccine in three separate clinics, offered in every long-term care facility in the state as part of a federal program.

Genomic sequencing determined that the virus that caused the outbreak was an R.1 variant, which is not currently identified as a "variant of concern."  The study says that despite "multiple spike protein mutations" in the variant, which makes it more contagious, vaccinated residents and staff were 87% less likely to have symptomatic Covid-19 compared to those who were unvaccinated.

The researchers note that coronavirus vaccines are not 100% effective against the virus and that some breakthrough infections are expected. On April 13, the CDC reported about 5,800 such infections in the U.S.; at the time, nearly 77 million people had been fully vaccinated. That is 0.007%, less than one in 1,000.

They said the hospitalization of four unvaccinated residents, and the deaths of two, underscores the importance of the CDC's advice "that all persons, including those who have recovered from Covid-19, be vaccinated." They add later, “A continued emphasis on strategies for prevention of disease transmission, even among vaccinated populations, is also critical.”

Staff vaccines are 'imperative' but not required 

In conclusion, they say vaccines are "imperative" to protect residents and staff from skilled nursing facilities from the virus.

The Department for Public Health was asked why the state hasn't required coronavirus vaccines among long-term care staff to be vaccinated. It has not responded to the question.

According to a state Office of the Inspector General survey of all nursing homes in March, 73% of residents and 41% of staff were fully vaccinated, and 6% of the residents and 3% of the staff had received one dose of a vaccine.

Betsy Johnson, president of the Kentucky Association of Health Care Facilities, said her organization and the Kentucky Center for Assisted Living strongly urge those in long-term care to get vaccinated, but "Due to workforce challenges in this difficult profession, members are choosing not to mandate but instead incentivize, educate, and strongly encourage each employee to be vaccinated."

Dunlap, who is executive director of public affairs for the Cabinet for Health and Family Services, said the cabinet is working with its Long-Term Care Advisory Task Force to refine targeted messages to facilities' staff to promote the benefits of vaccination.

Now that the federal vaccination program is over, cabinet Inspector General Adam Mather has said, the state has a "maintenance program" to ensure that new residents, new staff, and reluctant residents and staff are able to get a shot.

Even with so many long-term care staff unvaccinated, deaths in such facilities have plummeted. Prior to vaccinations, which began with the facilities and other health-care workers, about 68% of the state's Covid-19 deaths were in long-term care, but that number has dropped to about 36%. 

“Our members have seen great strides since the vaccines entered their buildings," Johnson said. "The number of deaths and illnesses in these facilities has drastically decreased and residents can see their loved ones for the first time in months."

Medicare starts to overhaul the way it pays providers, rewarding them for quality, penalizing them for shortcomings

By Molly Burchett
Kentucky Health News

The Obama administration on Monday set a timeline for historic changes in how it pays doctors, hospitals and other health providers under Medicare, shifting away from the program's traditional fee-for-service model and towards a model that rewards care quality.

Rather than give the usual yearly fee increases to Medicare doctors for every procedure or service, the Department of Health and Human Services will tie 30 percent of traditional, fee-for-service payments to models like "accountable care organizations," which base payments (and penalties) on patients' health outcomes. The goal is for half of all Medicare payments to be handled this way by 2018, reports Jason Millman of The Washington Post.

"Today's announcement is about improving the quality of care we receive when we are sick, while at the same time spending our health-care dollars more wisely," said HHS Secretary Sylvia Burwell. "We believe these goals can drive transformative change, help us manage and track progress and create accountability for measurable improvement."

Medicare is the country's largest payer for health-care services, so these payment changes will affect doctors' offices and hospitals across the country. Many experts have viewed this broader shift to rewarding care quality as long overdue, but it's still uncertain how well the approach will work.

"We still know very little about how best to design and implement [value-based payment] programs to achieve stated goals and what constitutes a successful program," concluded a 2014 Rand Corp. study funded by HHS, Millman reports.

Some health-care professionals said Medicare is just aligning with what is already working in the private sector by moving away from fee-for-service, reports Alex Wayne of Bloomberg Businessweek.  “The private sector is further ahead than Medicare right now,” said Justine Handelman, vice president for legislative and regulatory policy at the Blue Cross and Blue Shield Association.

Since Medicare is already limiting payments as part of the 2010 health-reform law, the government must “ensure that only reforms proven to be efficient and effective are put in place,” Chip Kahn, CEO of the Federation of American Hospitals, told Wayne. “Further cuts would undermine our ability to invest in delivery system innovations needed to continue this trend.”

The announcement marks the first time that goals have been set to fundamentally change the way Medicare pays for health care, giving providers incentives to reduce unnecessary services.

Dr. Douglas Henley, CEO of the American Academy of Family Physicians, told CNBC: "We're all partners in this effort focused on a shared goal. Ultimately, this is about improving the health of each person by making the best use of our resources for patient good. We're on board, and we're committed to changing how we pay for and deliver care to achieve better health."

UK's Gill Heart Institute joins Appalachian Regional Healthcare to advance specialty heart care in Eastern Kentucky

Appalachian Regional Healthcare, the Appalachian Heart Center and UK HealthCare’s Gill Heart Institute announced a new collaboration to deliver cardiovascular care to Eastern Kentuckians, which will extend the UK's sub-specialty care footprint and increase access to cardiovascular expertise in the area.

Cardiologists Dr. Vidya Yalamanchi, Dr. Rao Podapati and Dr. Srini R. Appakondu from Hazard's Appalachian Heart Center will team up with UK to provide advanced treatment options not before available in the eastern part of the state.

“We look forward to the opportunity to work closely with the physicians and health care providers at Gill Heart Institute to enhance cardiology services to patients in Eastern Kentucky,” said Dr. Yalamanchi. “This partnership is an example of teamwork that emphasizes a commitment to providing exemplary patient care.”

In addition to the combined efforts in Hazard, UK and ARH have also agreed to jointly administer and manage cardiovascular services at ARH hospitals in Harlan, Whitesburg, McDowell, Hyden and Williamson, W.Va.

 “The goal of this collaboration is to expand the scope of cardiology services provided within our community,” said Joe Grossman, president of ARH. “By providing a range of comprehensive cardiology services, including inpatient and outpatient services to residents of Eastern Kentucky, we hope to improve lives in a region where patients suffer from some of the highest rates of mortality in the nation from heart disease and stroke.”

UK officials have said their hospital must expand its geographical reach to ensure access to quality care for Kentuckians. This collaboration represents a step towards achieving both this goal and the goal of being the hospital destination for sub-specialty care in the state and region.

“This alliance further expands the UK HealthCare mission to improve access to quality health care delivery for all Kentuckians in a cost effective and responsible manner,” Dr. Michael Karpf, UK executive vice president of health affairs, said in the release. “But the real benefit for many patients and their loved ones will be the ability to stay close to home for complex cardiology care.”

Health Watch USA hosts chief medical director of Center for Medicare and Medicaid Services in Lexington and online July 31

Dr. Patrick Conway, chief medical director of the federal Center for Medicare and Medicaid Services, will be presenting to Kentucky-based Health Watch USA on July 31 at 5 p.m., and with a few clicks on the computer, you can attend virtually.

Conway will be discussing CMS goals and the results of its value-based quality improvement programs, physician fee schedule quality proposals and future opportunities for CMS collaboration aimed to drive health-care quality.

Using your computer, you can attend and participate in the discussion through an online chat while listening to Conway's presentation and viewing the slides. Just click here to log into the conference's webpage and Adobe Connect will download to your computer free of charge.

The online login will be active 15 minutes before the presentation on July 31, and the presentation slides will be available to download as a PDF from the conference page. You can also attend the presentation at the Northside Library in Lexington. Click here for more information.

Health Watch USA, based in Somerset, was founded by Dr. Kevin Kavanagh to promote health care transparency and patient advocacy, says its website.

U.S. News gives Kosair Children's Hospital a national ranking; 11 other Kentucky hospitals make 'high-performing' list

Each year, U.S. News and World Report publishes its "Best Hospitals" guide for people seeking a high level of specialty care. The only Kentucky hospital to be nationally ranked in the report for 2014 is Kosair Children's Hospital in Louisville. It received national rank in these areas of specialty care: heart, lung, neurology, cancer, orthopedics and urology.

While no Kentucky hospitals were nationally ranked in adult specialty categories, 11 Kentucky hospitals made the cut for meeting standards of strong performance within the state:
     1. St. Elizabeth Edgewood - 11 high-performing specialties
     2. Baptist Health Louisville - 10 high-performing specialties
     2. University of Kentucky Albert B. Chandler Hospital - 10
         high-performing specialities
     4. Baptist Health Lexington - 9 high-performing specialties
     5. Jewish Hospital in Louisville - 7 high-performing specialties
     6. Norton Hospital in Louisville  - 5 high-performing specialties
     7. University of Louisville Hospital - 2 high-performing specialties
     8. King’s Daughters Medical Center in Ashland - 1 high-performing specialty
     8. St. Elizabeth Florence - 1 high-performing specialty
     8. St. Elizabeth Fort Thomas- 1 high- performing specialty
     8. St. Joseph East- 1 high-performing specialty

To read more about specialty rankings for each hospital, click here for an article in The Lane Report or here for the U.S. News report.

Lexington internist, Dr. Ardis Hoven, becomes president of the AMA, the nation's largest physician organization

Ardis Dee Hoven, M.D., an internal medicine and infectious disease specialist in Lexington, was installed as president of the American Medical Association at its annual meeting Tuesday night in Chicago. The AMA is the nation's largest physician organization.

Dr. Hoven is a graduate of the University of Kentucky medical school, and she has served in numerous leadership position for the AMA, including her first presidential term in 1993-94. Hoven has also served at the UK’s Bluegrass Care Clinic, which treats infectious diseases including HIV/AIDS, reports Business Lexington.

The AMA is headquartered in Chicago, and since 1847 it has aimed "to promote the art and science of medicine and the betterment of public health," says its website. Furthermore, the organization's strategic focus is aligned with many of the health care issues now facing Kentucky, which are improving health outcomes, accelerating change in medical education and enhancing the sustainability of medical practice.

UK Board of Trustees OKs $31 million plan to outfit another floor of new hospital with eye toward federal certification for heart work

The University of Kentucky Board of Trustees has given UK HealthCare the green light for its $31 million plan to outfit the eighth floor of Pavilion A at UK Chandler Hospital over the next few months to make room for a growing cardiovascular program and to clear the way for a federal "Center of Excellence" certification.

After the project is complete, the floor will hold 64 beds, including 24 intensive-care beds for the cardiovascular program that offers heart transplantation, artificial hearts and ventricular devices, reflecting UK's focus on receiving the federal certification.

In the near future, such a designation will be necessary to get enough referrals from doctors and smaller hospitals to maintain important services, including cardiovascular services, and to guarantee that Kentuckians can get the care they need inside the state, Dr. Michael Karpf, executive vice president for health affairs, said in an interview with Kentucky Health News this spring.

Karpf and other UK HealthCare officials are also recommending a $30 million cost-reduction program for their system because Medicare and Medicaid reimbursements are expected to decline as competition stiffens over the next few years, reports Linda Blackford of the Lexington Herald-Leader.

In response to these forces, UK has a goal to secure half the available business from out-of-state competitive areas over the next 10 years to remain viable in a highly competitive market. And, focusing on complex care should drive revenue for the hospital because UK makes money on the complex stuff, Karpf told KHN.

Read more here: http://www.kentucky.com/2013/06/10/2673382/uk-healthcare-using-30-million.html#storylink=cpy

The $592 million, 12-floor patient tower has remained half-empty since 2010, and when the estimated $530 million project to fully occupy the tower is added to the initial cost of constructing Pavilion A, the total price tag will top $1 billion over 20 years, reports Blackford.

The overall construction and expansion is expected to support patient care for the next 100 years, says a recent UK press release. Once it's fully occupied, the the 1.2 million-square-foot facility will include 512 private patient rooms.

Read more here: http://www.kentucky.com/2013/06/10/2673382/uk-healthcare-using-30-million.html#storylink=cp

Reports show impact of health-care industry in each of Kentucky's 120 counties

It's not often that such detailed data is broken down to the county level, but a new report looks at the economic impact of the local health-care system in each of Kentucky's 120 counties.

The reports, compiled at the University of Kentucky, look at the number of health-care jobs, as well as the revenue and income generated by the local health-care system. In many rural counties, the authors note, health care is the second largest industry, second only to local government.

The most important economic role of the health-care sector is to "keep local health-care dollars at home," the report says. If private insurance, consumer out-of-pocket payments and Medicare and Medicaid transfer payments aren't kept local, an outmigration of health-care services can take place. "This bypass of local health care remains an important issue for many rural health care providers and rural communities."

Conversely, if the local health-care sector can attract patients from outside the area, health care "can act as an export industry," the authors note. Because doctors and other providers can help improve the health and productivity of the local workforce, the health-care sector can also help an area recruit new and retain existing business.

The county reports include a comparison of household income with the state and nation, and indicates how that income is earned. In Boyle County, for example, 55.6 percent was earned through place-of-work earnings, while 22.6 percent was from transfer payments, such as those from Social Security, Medicare and Medicaid. The reports also break down how much income is generated according to industry type, from 2000 to 2008.

Income earned by Boyle County residents working in the health-care sector increased 42 percent in those years, one of the largest areas of gains in the county. In all, health care accounted for 13 percent of industry in Boyle and generated more than $322 million in sales, more than $151 million in labor income and nearly 3,500 jobs in the area.

The report, available here, was compiled by Dr. Alison Davis, director of the Community and Ecomomic Development Initiative in Kentucky, part of UK's College of Agriculture. It was funded by the Foundation for a Healthy Kentucky.

Kentucky hospitals say they gave back $1.67 billion to their communities in 2010, mostly by absorbing losses and bad debts

By Tara Kaprowy
Kentucky Health News

With the downturn in the economy part of the reason, Kentucky's hospitals say they gave back a whopping $1.67 billion to their communities in 2010, mainly by providing care for which they were never paid.

That's 13 percent more than the hospitals reported last year, and just one of many figures in the latest annual report from the Kentucky Hospital Association, which runs a little over a year behind because it takes a long time to compile the data from more than 100 hospitals.

KHA's 2010 Community Benefits Report shows hospitals absorbed $435.5 million in bad debt in 2010, which accrued when patients came to the hospital and were treated but did not pay their bills.

Shortfalls in Medicare and Medicaid payments cost even more — $456.2 million — because the federal government reimburses Kentucky hospitals for about 85 percent of the cost of Medicaid patients and 95 percent for those on Medicare. That's big, because 71 percent of patient days in Kentucky are covered by one of these programs, said Pam Mullaney, KHA's director of membership services. Hospitals also gave $274 million to charity-care programs that are set up to include free or discounted care to people who are unable to pay. Those three categories of losses increased by more than $158 million over 2009. KHAcalls them community benefits because "you're not getting any type of margin," Mullaney said.

A 2009 Thomson Reuters study showed the average U.S hospital reported an operating profit margin of 3.7 percent. The average operating margin at Kentucky hospitals was 2.44 percent in 2009. Forty percent of hospitals lost revenue from patient services that year, Mullaney said. Still, reported community benefits increased by 13 percent, a total of $190 million.

This is the third year of the report, which was based on a voluntary survey to which 104 of 123 hospitals responded (Eight hospitals were not surveyed because they treat limited types of patients, such as veterans, children or psychiatric cases.) Mullaney said the number of hospitals turning in figures "has grown a little bit each year, but it’s not consequential."

Hospitals are asked to describe and put a value on the programs and activities they provide at or below cost that help their community. Though community benefits are "the greatest single affirmation of not-for-profit hospitals' tax-exempt status," Mullaney said data show Kentucky's 26 for-profit hospitals "do every bit as much as the not-for profits."

In the past two years, Pikeville Medical Center has absorbed $70 million in charitable care and bad debt. The Murray-Calloway County Hospital is in the ninth healthiest county in Kentucky, but has felt the crunch too. From 2010 to 2011, bad debt increased from $7 million to $7.8 million and charity care increased from $5.1 million to $6.2 million.

T.J. Samson Community Hospital in Glasgow has also seen bad debt increase and business decrease when the economy crashed and then stagnated. "Our elective procedure volumes have come down. Patients often wait until they're sicker before they come in," said Laura Belcher, director of planning, marketing and development. The hospital has responded by cutting costs, adopting the "lean philosophy" of eliminating waste and streamlining processes.

Interestingly, the hospital is also pushing for more preventive care since the economy went south. "People ask us, 'Aren't you putting yourself out of business?' But we really want people to be proactive about their health. We've done a lot more health fairs, more screenings," Belcher said.

Indeed, the report shows Kentucky hospitals spent $500 million in 2010 to actively help their communities, through such activities as health screenings, support groups, research, training of nurses and doctors, addiction recovery and neonatal intensive care, or simply donating money to community functions. Many of these programs "are provided at no cost or at a financial loss and would not be provided if the decision was based on monetary decisions," Mullaney said.

Realizing there was a need in the area for children with special needs, the Glasgow hospital set up C.A.M.P. T.J. Kids, a weeklong day camp in the summer for children with special needs. "These children often receive services through school and during school," Belcher said. "But we found many of the families could not afford or handle the transportation to get here during the summer. This is almost like a summer booster."

The camp falls under the umbrella of the Discovery Academy, funded by the hospital and money raised by volunteers. The academy also hosts an annual overnight camp for children with autism. While the children swim in the hotel pool or interact with each other, parents are "in a conference setting to learn about ways they can learn to be better parents" to kids with autism, Belcher said. "In the evening, while children are being supervised, the parents get to go for a quiet, romantic dinner."

When tornadoes struck Kentucky March 2, Pikeville Medical Center kicked into high gear and co-hosted a radio-a-thon that raised $200,000. "We allowed our employees to donate their vacation time, which we converted to actual dollars based on their rate of pay, and we offered employees the ability to do payroll deductions to contribute to the cause," said Cindy Johnson, director of public relations and the Medical Leader, the hospital's community newspaper.

The Murray hospital has increased its community outreach efforts and adopted a mission to provide the local school system with athletic trainers, whose salaries are paid entirely by the hospital, as well as school nurses, which are partly hospital funded. The goal is to promote health and wellness, said marketing director Melony Bray.

The KHA's Mullaney said the annual report reminds people what their hospital does. "A lot of times people think of their hospital as a place to go when they need emergency help," she said. "They don't think of the hospital as one of the big providers in the community for health fairs, health professional education, types of efforts in the community to help improvements like playgrounds and common spaces. Those are things that hospitals often get overlooked for but they do that because they are part of the community."

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Cost of an MRI in America? $1,080. France? $280. Why? providers 'largely charge what they can get away with'

Why does getting an MRI in the United States cost $1,080 when it only costs $280 in France? The answer comes down to how the prices are set, reports Ezra Klein for The Washington Post.

"That may sound obvious," he writes. "But it is, in fact, key to understanding one of the most pressing problems facing our economy. In 2009, Americans spent $7,960 per person on health care. Our neighbors in Canada spent $4,808. The Germans spent $4,218. The French, $3,978."

The difference in expenditures isn't linked to the idea that Americans just use more health-care services (the opposite is actually true) or that we are sicker. A 2003 study on international heath-care costs and a survey released Friday by the International Federal of Health Plans both concluded it comes down to pricing. The latest survey showed that in 22 of 23 medical services, whether that was a routine doctor visit or coronary bypass surgery, Americans paid more than other developed countries.

The difference is based on the way the pricing is set. "Other countries negotiate very aggressively with the providers and set rates that are much lower than we do," said Gerard Anderson, who was involved in the 2003 study. In Canada and Britain, prices are set by the government. In Germany and Japan, the prices are "set by providers and insurers sitting in a room and coming to an agreement, with the government stepping in to set prices if they fail," Klein reports.

Outside of Medicare and Medicaid, which are cheaper than the commercial average, "it's a free-for-all" in the U.S., Klein wriotes. "Providers largely charge what they can get away with, often offering different prices to different insurers, and an even higher price to the uninsured."

Because the customer often doesn't have choice in whether or not he or she will purchase health care — one could be unconscious or very ill — "sellers of health-care services in America have considerable power to set prices, and so they set them quite high," Klein reports.

Fixing the problem is fraught with complication, Klein writes, because "centralized bargaining cuts across the grain of America's skepticism of government solutions." The prices are also set by very powerful industries. The federal health care reform law is not expected to fix the issue, Klein writes, though might spread awareness since there are provisions to expand transparency; hospitals will have to publish their prices, for example. "But this is, for the most part, a fight the bill ducked, which is part of the reason that even its most committed defenders don't think we'll be paying anything like what they're paying in other countries anytime soon," Klein write. (Read more)

A look at the history of U.S. health care and health insurance

Health insurance in the U.S. has some of its roots in the World War II shipyards of Henry J. Kaiser, who built 747 vessels for the Navy. The war made workers scarce, so Kaiser needed a way to attract them and, once there, keep them healthy. He couldn't pay them more because wages were frozen, so he offered them health care, which was provided by doctors at company clinics and hospitals. In turn, he asked employees to kick in 50 cents a week for the benefit. (Photo: Kaiser Shipyards in Richmond, Calif., courtesy of SanPedro.com/Permanente Metals Corporation)

"The war ended, the workers quit the shipyards, leaving behind hospitals and doctors but no patients," Bob Rosenblatt reports for the Los Angeles Times. "So the company decided to open the system to the public — and that's how generations of Californians who never heard of Kaiser shipyards have since gotten medical care."

Kaiser's story is just one example of how America's health insurance system developed, Rosenblatt writes. As at the shipyards, most people still get coverage through their jobs and, unlike the rest of the industrialized world, not from the government.

In fact, there has long been a fight against having the government in charge of providing care, Rosenblatt contends. In 1918, when California proposed a constitutional amendment that would have organized a state-run program, doctors said "compulsory social health insurance" was "a dangerous device invented in Germany." The amendment lost, but many presidents pursued the issue. Franklin D. Roosevelt "flirted with the idea but never threw political muscle behind it," Rosenblatt reports. Harry S. Truman asked Congress to provide national health insurance, but could not bring it to a vote.

It was the model exemplified in the shipyards that was adopted, and "health insurance became a standard feature in labor contracts," Rosenblatt writes.

Things changed in 1965, when President Lyndon B. Johnson pushed through a heavily Democratic Congress what Rosenblatt calls "a legislative three-layer cake:" Medicare Part A, Medicare Part B, and the federal-state Medicaid program. The legislation was controversial, with fears that doctors would refuse to see Medicare patients and hospitals would refuse to dismantle segregated wards. "The doctors didn't strike," Rosenblatt writes. "And the hospitals were immediately integrated without protest."

In 1993, President Bill Clinton wanted to extend national health insurance to everyone, but Rosenblatt says "Congress felt excluded and insulted, and the plan never came to a floor vote in the House or Senate."

President Obama did the opposite and relied on the congressional process. "Key to the plan was a mandate that everyone buy into the system; it was the best way to spread out the costs of illness," Rosenblatt writes. It's that mandate up for debate in the Supreme Court next month, but even if the Affordable Care Act is subsequently thrown out, "people already enjoy some benefits and won't want to give them up," Rosenblatt writes.

"It seems a safe bet that some provisions in the Affordable Care Act will stay on the law books," Rosenblatt concludes. "This places a few more patches on the national healthcare quilt. That's the American way." (Read more)