Do you appreciate Kentucky Health News? Here's a chance to help make it even better, and get your gift matched!

By Al Cross, Publisher, Kentucky Health News

Director emeritus, Institute for Rural Journalism, University of Kentucky

For more than a dozen years, Kentucky Health News has provided news you can use, to help keep you and your family healthy, or get healthier. We have also kept Kentuckians up to date on their health-care system and things that affect it, including government actions.

Melissa Patrick and Al Cross of Kentucky Health News

We hope you appreciate our work, which is done mainly by a part-time reporter, Melissa Patrick, and funded by the Foundation for a Healthy Kentucky. Now we have a way for you to show your appreciation and expand our efforts, with a contribution that will be matched — for a limited time.

Kentucky Health News has joined NewsMatch, the largest collaborative fundraising campaign to support independent, nonprofit journalism in the United States. Its annual matching-gift campaign runs through Dec. 31.

Through the end of the year, NewsMatch will double your donation to Kentucky Health News, up to $1,000 and a total match of up to $13,000. That amount would increase our budget by almost 30 percent and enable us to do more of our important work, such as covering health issues in the legislature.

No one covers health issues in Kentucky like we do, and the news coverage is badly needed, because Kentucky is a state with poor health status. One key to raising that status is reliable information, especially at a time when some health topics have become polluted with misinformation, even disinformation. You can count on us to bring you the facts, plus the opinions of qualified experts. We keep our opinions out of our news stories, which are republished by news outlets all over the state.

Please help us expand our work. Donate today by clicking here. All donations to the Institute for Rural Journalism's enrichment fund through Dec. 31 will go to support Kentucky Health News. If you or your organization would like to discuss how you might provide continuing support, email al.cross@uky.edu.

A Covid-19 reporter gets the disease, and learns some lessons

Sarah Ladd took this photo of herself as she suffered from Covid-19.

By Sarah Ladd
Kentucky Lantern

For more than three years, I’ve written about Covid-19. The people who caught it and those who kept it longer than they should have. The people who bought into misinformation. And, worst of all, those who died from it.

Finally, I tested positive myself.

Don’t get me wrong, I’ve had several Covid-19 scares over the last few years. In early 2020, before tests were available to young and healthy people, my doctor at the time believed me to have it. But she couldn’t spare a test for me, so we never knew for sure. Since then, I’ve had several flu-like bouts, but always got “negative” back from Covid-19 tests.

That changed on Wednesday, Oct. 4, 2023. And now that I have hard confirmation of a Covid-19 infection, I see that nothing I experienced before compared to this. Does that mean this is my first true bout with the disease? Maybe I’ll never know.

Here’s what I do know. I’ve come to understand Covid-19 during my time in isolation in a way I never did before.

There’s a sick sort of forced independence in this illness. No one can rub your back when you ache or hold a cool rag to your fevered head. Getting a comforting hug? Out of the question.

While lying on my back in air that felt heavier than it ever had before, I thought to myself: No wonder Covid-19 is so divisive. We deal with it alone. Without seeing a smile or feeling a pat on the back. Without humanity.

Similar isolation is true for other illnesses, but this was all new to me.

All these things I knew — in theory. I’ve sat through enough press conferences with infectious disease specialists to know Covid-19’s symptoms backwards and forwards. But I think I fell into the age-old trap of never expecting a thing that affects other people to affect me as bad or the same. And my idea of a Covid-19 infection was, I realize now, very clinical. Distanced.

I’d been renovating my house the day I tested positive. All day long, I scraped old paint from 100-year-old wooden door frames. Too busy to check in with myself, I never stopped to question why I kept having to sit down because I felt like I might pass out.

By the end of the work day, my throat burned and the air was heavy around me. I gasped for air, but thought maybe I was just tired from a day of physical labor. Better take a test just to be safe, I thought. My nose burned and throbbed when I stuck the cotton swab up one nostril, then the next.

My 15-minute timer wasn’t two minutes in when a deep red dash popped on the second line of the at-home test. A “positive” indicator. Oh well, the instructions say not to read the test before 15 minutes. So, I left the bathroom and came back at the 15-minute mark. Two bright red lines. Positive.

I had a few thoughts in quick succession: I just unknowingly exposed my friend to the virus the night before and needed to let her know. I’d have to miss another friend’s birthday party over the weekend. And, finally, well, I’m young and healthy. This will run right through me.

It was a mistake to think that. Over the next few days I’d lose my sense of smell and taste. I’d grow weaker until I could barely walk across a room without a break. All of my strength disappeared. I’d go on Paxlovid within days.

Through all this, I abandoned the subconscious idea that people under 30 don’t suffer. But – I still consider myself extremely fortunate to not have ended up in a hospital, like so many have before me.

After testing positive, I withdrew to the attic to isolate away from my dog and spouse for the recommended five days.

In isolation I felt humanity slipping from me. My friends can tell you I am a notorious introvert. But this level of aloneness was new, unwanted. I heard my dog, Ronon, cry for me at the bottom of the stairs. He could not understand why we had to be apart, that he could catch it. I was afraid to touch anything in my bedroom, worried I’d contaminate everything and hyper aware that anything I touched now would need to be sanitized later.

I feel like a walking plague, I texted my friends.

So, I cataloged my very existence. I touched the door handle to the bathroom, my jewelry box. What have I forgotten? What have I breathed on?

With no smell or taste, I laid strong mint toothpaste across my tongue to try and feel. Nothing. Covid-19 is the first illness that ever robbed me of my senses. It was disorienting and depressing. I grasped at sensations but found little to satisfy. The Paxlovid made my eyes burn. So for days, I did little but sleep. Eyes closed. No strength, no scents, no taste — except for the disgusting “Paxlovid mouth.” All this felt like a horrible limbo, like my life had stopped at the door to the upstairs. 

I decided to post on social media about having the virus. I thought little of it, until comments riddled with misinformation about Covid-19 poured into my mentions.

The rhetoric from 2020 and 2021 about vaccines not working, Covid-19 being nothing more than a cold, and more flowed in after I posted about my experience. It was frustrating to hear the debunked myths thrown at me in a moment of vulnerability.

Much of my role as a Covid-19 reporter has been — and still is — unpacking misinformation. But my mentions after posting about my Covid infection told me we have a long way to go in educating people about the virus.

Indeed, three years in, I wonder if we may never fully get there. But I promise to keep trying.

How can we face a pandemic in unity and with compassion when they’re stripped from us when the virus comes for us? I don’t know the full answer to that, but I think it involves putting in a lot of work toward empathy. As we continue to deal with Covid-19 and its fallout, I hope we can try to come together on that one singular point, if nothing more.

As for me, I’ll never again take for granted the smell of a pumpkin candle in the fall, the greasy french fries at my favorite restaurant, or the way it feels so good to move my legs.

My strength is returning a bit more each day, and I’m able to go for walks again and wrestle my dog. I feel my other senses returning, too, despite being a bit slower than I’d like.

Every day, I feel such gratitude to be alive, to breathe.

Sarah Ladd covers health for the Kentucky Lantern. This story was first published Oct. 23.

Amid misinformation, few adults put significant trust in any health institution or media to be accurate about health topics, poll finds

Many falsely believe that a dewormer can treat Covid-19.
(Photo by Dimas Ardian, Bloomberg, via Getty Images)

By Darius Tahir
KFF Health News

Around 3 in 10 Americans still believe ivermectin, a dewormer for animals, is an effective treatment for Covid-19. And few of them place significant trust in any form of news media or official institution to accurately convey information about health topics, from covid treatments and vaccines to reproductive health issues. So says a new poll from the Kaiser Family Foundation, an independent source of health-policy research, polling and journalism.

The confusion about what’s true — and who’s telling the truth — is of critical importance to public health, experts in political science said. “Misinformation leads to lives being lost and health problems not being resolved,” Bob Blendon, a professor emeritus of public health at Harvard University, said in an interview. Blendon was not associated with the survey.

The KFF poll of 2,007 U.S. adults found that nearly a third said ivermectin was definitely or probably an effective treatment for Covid-19. It’s not. Numerous randomized controlled trials have found otherwise. But only 22% in the poll thought ivermectin was definitely ineffective.

A fifth of those polled thought it was definitely or probably true that the Covid-19 vaccine had killed more people than the virus itself. Under half, 47%, thought that claim was definitely false, which it is. And 30% of respondents thought parents should not be required to vaccinate their children against measles, mumps and rubella, which all states do.

The prevalence of vaccine misinformation is “alarming,” said Brendan Nyhan, a professor of government at Dartmouth College who has spent years studying the transmission of false information.

Lunna Lopes, a senior survey analyst at KFF and one of the poll’s authors, said the results show wide exposure to, but limited uptake of, false claims. “Just because they’re exposed to it doesn’t mean they’re buying into it,” she said. Still, the din of misinformation might leave the populace unsure what to believe. “You might be less trusting, and less likely to outright reject false information.”

The poll also found only grudging trust, at best, for media sources of all kinds and the federal government. The limited trust the survey recorded is colored by wide partisan gaps, noted Nyhan.

KFF Health News graph; for a larger version, click on it.

Respondents did not have “a lot” of trust in the information relayed by any news media institution. Just over a quarter had this high level of trust for local TV news, and that was the highest mark of the news media tested, which ran the ideological and stylistic gamut from MSNBC to The New York Times to Fox News and Newsmax. More people had just “a little” trust in each of these institutions.

For Blendon, the mildness of the trust is a problem. It suggests that “we are short” of trusted sources of news about health.

He said journalists and editors should consider that there’s “something about the way you’re presenting information that’s not seen as credible by viewers.” Seventy percent of those in the poll said news media don't do enough to limit the spread of health misinformation, and 69% said social-media companies weren't doing enough.

Blendon said the public conversation about these topics tends to focus on the often-extreme declarations and wild claims featured on social media and on corporate and government attempts to regulate the medium. 

While the poll shows Americans use social media quite frequently, they have very little faith in the health information they see there. No social media outlet enjoyed a double-digit percentage of respondents saying they had “a lot” of trust in it.

Even so, said Lopes, a significant slice of the public — about a quarter — turn to these platforms for health information and advice. “That stood out to us,” she said. Latinos and the young are especially likely to use the forums.

KFF Health News graph; for a larger version, click on it.

The picture is similarly bleak for official institutions. Around a quarter of respondents said they had “a great deal” of trust in the Centers for Disease Control and Prevention’s recommendations. That dropped to a fifth when it came to the Food and Drug Administration. The Biden administration and Donald Trump lagged behind.

Asked about state and local public-health officials, 13% said they trusted them "a great deal" and 51% said "a fair amount, ranking their overall trust just behind the FDA and the CDC.

Those numbers, combined with the partisan gaps in trust, were especially discouraging for Nyhan. “They will be essential sources of information in future pandemics despite their errors and misjudgments during the pandemic,” he said of public-health institutions.

By far the most highly trusted source of health information? One’s own doctor. Forty-eight percent of respondents had a great deal of trust in their recommendations.

The survey, the KFF Health Misinformation Tracking Poll Pilot, was conducted May 23 through June 12, online and by telephone among a nationally representative sample of U.S. adults in English and Spanish.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF.

Almost all of Kentucky has a low risk of Covid-19, CDC says; N.Y. Times ends daily data updates, citing states' less frequent reports

Centers for Disease Control and Prevention map

By Melissa Patrick
Kentucky Health News

All but five of Kentucky's 120 counties have a low risk of Covid-19 transmission, according to the latest federal risk map. 

The Centers for Disease Control and Prevention map, which is based on new corinavirus cases and Covid-19 hospital numbers, shows that the only Kentucky counties with a medium level of Covid-19 risk are Rowan, Elliott, Menifee, Morgan and Pike, shown in yellow on the map.

The CDC advises those in medium-risk counties, and those anywhere who are at high risk of getting very sick, to wear a well-fitting mask when indoors and in public; and to consider getting tested before having social contact with someone at high risk for getting very sick, and consider wearing a mask when indoors when you are with them.

In the week of March 16-22,  The New York Times ranked Kentucky's new-case rate 24th among the states, with a 10 percent drop in the last two weeks. 

Earlier in the week, the Times announced that after more than three years of daily reporting on the number of Covid-19 cases and deaths in every county in the U.S., it will be ending its daily Covid data-gathering operation. The Times will continue to report virus data from the CDC weekly on a new set of tracking pages. 

"This change was spurred by the declining availability of virus data from state and local health officials," the Times said. "Since few states report more than once a week (and some no longer report data to the public at all), the weekly data reports from the CDC have become the most reliable source of information on the virus’s spread." 

Centers for Disease Control and Prevention map

The CDC also provides a community level transmission map, largely used by health-care facilities and researchers, that shows the level of virus in each county, at one of four levels. The latest map shows five counties with a low level of transmission and 57 with a medium level; the rest are either substantial or high. The state says residents should take their guidance from the other map.

A study revives debate on masks: Twitter explodes, public is 'befuddled;' prevention may depend on how they're worn

To be effective, masks need to be worn correctly. (Jacek Poblocki, Unsplash)

Haven't the questions about masking been asked and answered? "Or at least that we had all agreed to disagree, but no such luck," writes Felice J. Freyer of The Boston Globe. "The debate over whether masks limit Covid-19 transmission recently reignited after a new review of the research came out, drawing out skeptics and defenders, and — as so often happens — leaving the ordinary citizen befuddled."

How did this get started — again? "A British outfit known as the Cochrane Library put out a new report on masking. When the Cochrane Review, which is highly respected in medical circles, tackled the mask question, it found that "wearing a mask may make little to no difference in how many people caught a flu‐like illness/Covid‐like illness," Freyer writes. "But the review encompassed primarily studies conducted before the pandemic, which examined the spread of influenza. The flu is far less contagious than Covid-19, which could lead to underestimating the effects of masks. The review also mixed studies of health-care workers with those involving the general public, and included studies that couldn’t answer the question of whether people actually wore their masks correctly."

Who's causing the fuss? "Twitter erupted with criticisms. Then one of the Cochrane Review authors was quoted in a Substack newsletter article saying of masks, "There is just no evidence that they make any difference. Full stop." . . . The Substack interview prompted New York Times columnist Bret Stephens to scold all those who favored mask mandates, saying they owed the world an apology. That unleashed another round of social media outrage. . . . But as others have pointed out, there’s no evidence that masks don’t make a difference. The big problem is that there isn’t enough evidence, period."

Wait a minute; what do masks prevent? “We have good evidence from laboratory studies [that] if you’re wearing a mask correctly and you’re in the presence of the virus, the mask will protect you,” Jennifer Nuzzo, professor of epidemiology at Brown University School of Public Health, told Freyer. Commenting on the Cochrane Review, Freyer added, “The appropriate conclusion is, we don’t have great evidence showing that masks change infection rates in populations. But we don’t know why that is. It’s probably not to do with masks themselves, but how they’re worn.”

What did Dr. Anthony Fauci, former director of the National Institute of Allergy and Infectious Diseases, say about the Cochrane study? “It’s a meta-analysis of a very large number of studies, many of which had nothing to do with Covid, and many of which did studies with masks that were not regularly worn every day and properly,” Fauci told Freyer. “There were only two studies in that entire meta-analysis that were exclusively looking at masks with Covid.”

Could I get a straight answer? "The basic advice hasn’t changed. Wear a mask in situations where you think you’re at risk of infection, such as a crowded indoor setting, especially during a time when Covid transmission is high," Freyer reports. "The level of that risk is determined by the level of transmission in your community, your own vulnerability to severe illness, the vulnerability of people you expect to come in contact with, and your personal tolerance for risk."

Final thoughts? Fauci told Freyer, “Everyone is different. Everyone’s risk for a complication is different. So there’s no set rule.”

Robert Slaton dies at 81; was a catalyst for many health projects, including Passport Health Plan and Kentucky Health News

Robert Slaton, Ed.D.

Robert Slaton, a health-care consultant and former Kentucky public-health commissioner who was a catalyst for various health-improvement projects in the state, including Passport Health Plan and Kentucky Health News, died Dec. 27 after suffering a stroke a few days earlier. He was 81 and lived in Louisville.

Slaton, who had master's degrees in education and social work and a doctorate in education administration, was state health commissioner in 1978-79, then ran the Public Service Institute at Kentucky State University and was external-affairs administrator for Trover Clinic, now Baptist Health Deaconness Madisonville, his hometown, from 1983 to 1989. While at the University of Louisville, he was Gov. Brereton Jones' special assistant for health-care reform, executive director of the university's primary-care center, executive director of the Medical School Practice Association and executive vice president of University Health Care, retiring in 2007. As primary-care director, Slaton was part of a small group that planned, developed, and implemented Passport Health Plan, which started in 1997 and became a national model for managed care of Medicaid patients.

As a member of the national advisory board of the Institute for Rural Journalism and Community Issues at the University of Kentucky, he was the catalyst for funding of the institute's Kentucky Health News by the Foundation for a Healthy Kentucky. Sitting with Institute Director Al Cross and then-Foundation President Susan Zepeda at a Kentucky Chamber of Commerce luncheon in 2010, he said, "Al, you ought to ask Susan for some money." When Zepeda asked what the money would be for, Cross (who had no idea the proposition was coming) replied that the goal would be improving health coverage in Kentucky news media. The foundation continues to fund Kentucky Health News.

Slaton later chaired the advisory board, helping the Institiute develop a strategic plan. He was a member of the foundation's Community Advisory Council and chair of the chamber's Health Care Policy Council. In 2018, he won the Russell E. Teague Award from the Kentucky Public Health Association for his achievements and contributions to public health.

"Throughout his career in both public service and as a health-care consultant, he provided a politically savvy perspective and an astute management style that enabled institutions and organizations to make significant headway in policy change to improve the health of Kentuckians," his obituary says. "Robert always believed that health care was a right, not a commodity, and he worked very hard in a variety of settings to help move it in that direction."

As health commissioner, "He demonstrated an understanding of social and structural determinants of health that was ahead of its time," the obituary says. "Robert was a consensus builder and a natural organizer who was described as generous and down-to-earth. His talents included problem solving, strategic planning, and organizing a group of people to get a project done. He was proud that over his career he had helped young staff members develop beyond what they thought they could do. He could often see what needed to be done before most people, and he could handle personalities and egos to bring about change in organizations. Robert focused much of his career on building linkages and coalitions between different groups. This was eased by his genuine rapport with people. Robert’s strategic planning skills, insightful opinions, and wise counsel were valued by many leaders in the business, nonprofit, and political world."

He was co-author of two books about management, From Green Persimmons to Cranky Parrots, and Caught in the Middle Management. At the time of his death, he was working on a book about his mother’s life, based on the diaries she kept for decades. As he moved into assisted living, Robert was already making plans for his next book, stories of his colorful adventures as a parole officer in Western Kentucky in the 1960s. He was a delegate to the 1992 Democratic convention.

Slaton is survived by five adult children, Andrea, Lyle, Tom, Danny (Elizabeth), and Mike (Jake), and three grandchildren: Thia, Henry, and Lila. He is also survived by his companion, Mary B. Bradley, and her two children, whom he very much thought of as his own: Lizi Hagan and Clay McClure.

A memorial service will be held at 10 a.m. ET Saturday, Dec. 31 at Pearson’s, 149 Breckenridge Lane, Louisville. Visitation will be held from 4 to 7 p.m. ET Dec. 30 at Pearson’s. In lieu of flowers, donations may be made to Down Syndrome of Louisville, the Foundation for a Healthy Kentucky, or the Institute for Rural Journalism and Community Issues.

Federal audits reveal widespread overcharges, other errors in Medicare Advantage plans; Humana and United stand out

Illustration by Eric Harkleroad, Kaiser Health News, from federal Medicare data

By Fred Schulte and Holly K. Hacker
Kaiser Health News

Recently released federal audits reveal widespread overcharges and other errors in payments to Medicare Advantage health plans, with some plans overbilling the government more than $1,000 per patient a year on average.

Summaries of the 90 audits, which examined billings from 2011 through 2013 and are the most recent reviews completed, were obtained exclusively by Kaiser Health News through a three-year Freedom of Information Act lawsuit, which was settled in late September.

A review of the audits reveals that health insurers that issue Medicare Advantage plans have repeatedly tried to sidestep regulations requiring them to document medical conditions the government paid them to treat.

UnitedHealthcare and Louisville-based Humana, the two biggest Advantage insurers, accounted for 26 of the 90 contract audits over the three years.

Eight audits of United plans found overpayments, while seven others found the government had underpaid. Humana's 11 audits with overpayments included plans in Florida and Puerto Rico that CMS had audited twice in three years.

The Florida Humana plan also was the target of an unrelated audit in 2021 by the Department of Health and Human Services inspector general. That audit, which covered billings in 2015, concluded Humana improperly collected nearly $200 million by overstating how sick some patients in its Medicare Advantage plans were. Officials have yet to recoup any of that money, either.

In an email, Humana spokesperson Jahna Lindsay-Jones called the audit findings "preliminary" and noted they were based on a sampling of 2015 claims.

"While we continue to have substantive concerns with how CMS audits are conducted, Humana remains committed to working closely with regulators to improve the Medicare Advantage program in ways that increase seniors' access to high-quality, lower cost care," Lindsay-Jones wrote.

Medicare Advantage is an alternative to original Medicare and is primarily run by major insurance companies. As it has gained popularity among seniors, CMS has fought to keep its audit procedures, and the mounting losses to the government, largely under wraps. That approach has frustrated both the industry, which has blasted the audit process as "fatally flawed" and hopes to torpedo it, and Medicare advocates, who worry some insurers are getting away with ripping off the government.

Insurers can have some claims excluded from the audit by claiming hardship, such as the closure of clinics where the services were rendered. Hardship requests and other documents obtained by KHN in the lawsuit shed light on the secretive audit process.

Reacting to the audit findings, Iowa Sen. Chuck Grassley called for “aggressive oversight” to recoup overcharges. Grassley is the top Republican on the Senate Finance Committee, which oversees health insurance. He said, “CMS must aggressively use every tool at its disposal to ensure that it’s efficiently identifying Medicare Advantage fraud and working with the Justice Department to prosecute and recover improper payments.”

How Medicare Advantage works

Medicare reimburses Medicare Advantage plans using a complex formula called a risk score that computes higher rates for sicker patients and lower ones for healthier people. But federal officials rarely demand documentation to verify patients' conditions. Only about 5% of Advantage plans are audited each year.

When auditors came calling, the previously hidden CMS records show, they often found little or no support for diagnoses submitted by the Advantage plans, such as chronic obstructive pulmonary disease, diabetes, or vascular disease. Though auditors look at the records of a relatively small sample of patients, they can extrapolate the error rate to the broad population of patients in the Medicare Advantage health plan and calculate millions of dollars in overpayments.

Overall, CMS auditors flagged diagnostic billing codes — which show what patients were treated for — as invalid more than 8,600 times. The audits covered records for 18,090 patients over three years.

In many cases, auditors found that the medical credentials of the health-care provider who made the diagnosis were unclear, the records provided were unacceptable, or the record lacked a signature as required. Other files bore the wrong patient’s name or were missing altogether.

The rates of billing codes rejected by auditors varied widely across the 90 audits. Seven health plans had fewer than 10% of their codes flagged, but the rate of invalid codes topped 80% at a defunct New York HMO.

One Medicare Advantage health plan submitted 57 hardship requests, more than any other insurer, though CMS approved only six. In three cases, the health plans said the records were destroyed in floods. Another cited a warehouse fire, and two said the records couldn’t be turned over because a doctor had been convicted for his role in illegally distributing millions of oxycodone pills through his network of pain clinics.

Other Medicare Advantage health plans said they had no luck retrieving medical records from doctors who had moved, retired, or died — and in some cases been arrested or lost their licenses for misconduct.

CMS found most excuses wanting, telling health plans that it granted exceptions only in “truly extraordinary circumstances.” CMS said it receives about 100 of these requests for each year it audits and approves about 20% of them.

Dara Corrigan, a CMS deputy administrator, said that as a “general matter,” its Medicare Advantage audits “are not designed to detect fraud, nor are they intended to identify all improper diagnosis submissions.”

Protecting Taxpayers

The costs to taxpayers from improper payments have mushroomed over the past decade as more seniors pick Medicare Advantage plans. CMS has estimated the total overpayments to health plans in the 2011-13 audits at $650 million, but how much it will eventually claw back remains unclear.

Payment errors continue to be a drain on the program. CMS has estimated net overpayments to Medicare Advantage plans triggered by unconfirmed medical diagnoses in 2022 at $11.4 billion.

“This isn’t a partisan issue,” said Sen. Sherrod Brown (D-Ohio). “I’ve requested a plan from CMS as to how they plan to recoup these taxpayer-funded overpayments and prevent future overbilling.”

Leslie Gordon, acting director of health care for the Government Accountability Office, the auditing arm of Congress, said CMS needs to speed up the audit and appeals process to get quicker results.

“That is money that should be recovered,” Gordon told Kaiser Health News.

As Medicare Advantage faces mounting criticism from government watchdogs and in Congress, the industry has tried to rally seniors to its side while disputing audit findings and research that asserts the program costs taxpayers more than it should.

America's Health Insurance Plans, an insurance industry lobby, criticized Kaiser’s reporting on the newly released audits as “misleading,” while the pro-industry group Better Medicare Alliance said the audits were “in some cases, more than a decade old.”

Jeff De Los Reyes, a senior vice president at the GHG Advisors health-care consulting group, said he believes the health plans have improved their documentation in recent years. But, he said, “Coding is never 100% perfect and there will be errors despite the best of intentions.”

Rep. Katie Porter, a Democrat from Southern California and a critic of Medicare Advantage, countered: “When big insurance bills taxpayers for care it never intends to deliver, it is stealing our tax dollars.”

Kaiser Health News is a national newsroom that produces in-depth journalism about health issues. Together with policy pnalysis and polling, KHN is one of the three major operating programs of the Kaiser Family Foundation, an endowed nonprofit organization providing information on health issues to the nation.

Had trouble with a health-insurance claim? An appeal? National, nonprofit newsroom ProPublica wants you to help its reporting

Photo illustration from ProPublica

ProPublica, the national, nonprofit, investigative newsroom, wants Americans to help it report why health insurance claims are denied, what the consequences are for patients, and how the appeal process works. It says it has heard from hundreds of people about the obstacles they have faced when denied health care.

"Take Alyssa Miller, a hospital-based nurse," ProPublica reports. "When she was 16, she was diagnosed with cancer and had to undergo radiation treatment. Given her now-increased cancer risk, her oncologist said she’d have to get a mammogram by 25. But when she went to get the procedure, Miller’s insurer denied her claim because, per its policy, it only covers mammograms when patients are 40 or older. She fought back with an appeal backed by a note from her doctor. That was denied, too."

Miller told ProPublica, “I was just really frustrated and confused by the whole appeals process. I feel like I’m supposed to know how this works being a health care provider. I almost gave up.”

Miller was able to get her mammogram covered by asking her employer’s human-resources office to get involved, ProPublica reports, "but she is among just a small percentage of people who appeal these denials. . . . Even insurance company employees, doctors and nurses have to battle insurers for coverage for themselves and their family members."

ProPublica said it has heard from "more than 100 people who work in health care or insurance and have had difficulty getting care covered, including:

• A doctor whose son has a speech disorder but had to stop speech therapy because insurance would not cover it.
• A nurse practitioner with long COVID whose treatments are being denied by insurance.
• An ophthalmologist whose uncle had a detached retina, which can cause blindness without treatment. The insurer denied the surgery because it concluded the procedure was not emergent.

Now we are hoping to hear from more people who can help us understand what is happening on the inside as these decisions are made. If you or someone you know works in health insurance, please fill out this form." If not, use the link in the first paragraph of this story.

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

Image from TV ad, provided by Yes for Life

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

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

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

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

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

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

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

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

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

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

18% more Kentucky youth (ages 5 to 19) went to hospital emergency rooms for self-harm injuries in 2021 than in 2020

Ohio Valley ReSource graph from Ky. Injury Prevention and Resource Ctr. data; click it to enlarge.

Kentucky hospital emergency rooms are increasingly becoming the go-to destination for Kentucky youth who have mental-health problems and harm themselves.

The Kentucky Injury Prevention and Resource Center says 1,396 Kentuckians ages five to 19 visited emergency departments for self-harm injuries in 2021, up 18 percent from the 1,182 reported in 2020.

"The data also shows more Kentucky youth died by suicide compared to youth who are killed in homicides," Corinne Boyer of WEKU-FM reports for Ohio Valley ReSource, a consortium of public radio stations in Kentucky, Ohio and West Virginia. "Between 2010 and 2021, a total of 430 suicide deaths were reported and 302 homicides were recorded among Kentuckians ages five to 19."

Lindsay Ragsdale, M.D.

Dr. Lindsay Ragsdale, chief medical officer at Kentucky Children’s Hospital in Lexington, told Boyer that she’s seen an increase in patients seeking mental health treatment.

“Every single day, we have patients that come into our ER for evaluation for mental health crisis, and whether that's suicidal attempts, or thoughts, some more anxiety related diagnoses [and] eating disorders,” Ragsdale said, adding that the pandemic cut off social connection for children.

“There's a lot of fear and concern, and this has really upended a lot of kids' lives.”

The hospital, part of the University of Kentucky, is working on a psychiatric unit that it hopes to have completed by November, Boyer reports: "But Dr. Amy Meadows, the child and adolescent psychiatry director at UK, said the demand for mental health treatment means the new unit won’t have enough beds."

“Not only do we need more inpatient, but we also need a better system of care to help manage kids out of the hospital, keep them at home when it's at all possible,” Meadows said, adding that means many options.

“From schools where kids are doing education about emotions and mental health, to being able to have outpatient therapy,” she said. “We need more psychologists, therapists, social workers, to having available psychiatrists in the community.”

The problem is widespread. The Children’s Hospital Association reported last fall last that self-harm injuries among children rose significantly in the first six months of 2021, with a 45% increase in the number of self-injury and suicide cases in 5-to-17-year-olds, compared to 2019.

CHA President Amy Wimpey Knight "said the numbers indicate a mental health crisis," Boyer reports.

“Basically, if a child presents to the emergency room in a mental health crisis, that cannot safely be discharged home, they often need to be — some can — but many often need ongoing care,” Wright said. “And there's not enough mental health beds right now and/or intensive outpatient programs.”

Registration for July 14 Rural Health Journalism Workshop in Chattanooga is open through July 7; pay no more than $30

The Association of Health Care Journalists is hosting a Rural Health Journalism Workshop on July 14 in Chattanooga for its members, and it's easy to join and attend. This year marks the first in-person rural health workshop since 2019.

The focus of the free workshop will be the medical challenges of rural areas. The sessions will touch on a range of topics, including how to find data and research about rural health, impacts of the pandemic, telemedicine in rural America, new models for rural health care, the opioid-settlement dollars, and building a rural health-care pipeline. 

Stephanie Boynton, vice president and chief executive officer of Erlanger Western Carolina Hospital and Erlanger Bledsoe Hospital in Pikeville, Tenn., will talk about how a hospital just days away from closing its doors found a path to survival and what that has meant to a community.

The workshop is open to members of AHCJ, but there is a limited-time offer for journalists who are not members but would like to attend. You can register for the conference and get a six-month AHCJ membership for $30. 

Click here to register. The registration deadline is 5 p.m. CT Thursday, July 7. The association still has some travel assistance money available to help pay for gas or a hotel room, even though the deadline to apply for this assistance has passed. There are a limited number of slots for those who work in public relations or are public information officers. The cost for these individuals is $50.

Panel discusses a post-Roe v. Wade America; journalists are encouraged to treat abortion as a health issue, not a political one

By Melissa Patrick
Kentucky Health News

Two days before the leak of a U.S. Supreme Court draft opinion that proposes to overturn abortion rights under its 1973 Roe v. Wade decision, a panel of experts participated in a roundtable discussion anticipating such a decision. It was titled "Women's reproductive health in a post-Roe world." 

At the 2022 Association of Health Care Journalists conference in Austin, the experts largely discussed what's happening in Texas -- which has a near-ban on abortions since abortions are now illegal after fetal cardiac activity is detected, usually around six weeks of pregnancy and before most women know they are pregnant -- as a way to paint a picture of what it could look like if the Supreme Court strikes down Roe.  

Sonja Miller, interim managing director of Whole Woman's Health Alliance in Austin, a nonprofit abortion provider that has unsuccessfully challenged the new law, talked about how the clinic has had to deny abortion care to the "vast majority of Texans" who come to the clinic since the law took effect. 

"Our staff are constantly in the position of having to look at another human being in the eye and telling them that they can't help them," she said. "We have not seen an abortion ban this inhumane since pre-Roe v. Wade." 

She added that the Texas law, which also deputizes private citizens to sue anyone who aids or abets an abortion after fetal cardiac activity has been detected, has a chilling effect and has placed everyone who works in abortion "on extreme alert." She said it has resulted in many of their patients seeking care long before they have even missed a period or have any idea that they are pregnant and forced many of their patients who don't "qualify" for an abortion to ask: "Where do I go now? What's next?" 

To meet patients' needs, she said the clinic launched the Abortion Wayfinder Program to help pregnant people travel out of state for an abortion. The health alliance has clinics in Texas, Minnesota, Indiana and Virginia. 

Another challenge is that by the time a woman finds out she's pregnant in Texas, which is often beyond the six-week ban, and is able to make out-of-state travel arrangements -- coordinating transportation, housing, care for existing children, time off work and ensuring they have enough money to pay for the procedure -- they are often in their second trimester, which begins at 14 weeks of pregnancy, said Dr. Crystal Berry-Roberts, an obstetrics and gynecological physician at Austin Regional Clinic. 

This matters, she said, because an abortion provided in the second trimester comes with an increased risk of bleeding and infection.  

Further, she said most offices don't offer new obstetric visits until eight to 10 weeks into a pregnancy, and that the first time a woman can find out if there is something genetically wrong or lack of brain development is around 11 or 12 weeks. 

"We're talking about an unrealistic timeline," Berry-Roberts said, referring to the six-week abortion ban. 

Berry-Roberts, who only provides medically indicated abortions, added that laws that limit abortion and the political discourse around this topic increases stigma, drives pregnant people seeking abortion "into the shadows" and makes it harder for women to talk candidly about their pregnancy with their physicians. "It is unfair, it is unrealistic and it is doing harm," she said about the Texas law

Dr. Lisa Harris, an obstetrician-gynecologist at the University of Michigan, pointed to a long list of things that must be considered beyond the impacts on reproductive health care for pregnant people if Roe is overturned, including: issues of equity; medical providers concerns about whether they are breaking the law if they counsel patients to end their pregnancies; increases in births and maternal deaths; and the implications of restrictive laws on self-managed abortions. 

Further, she said the language is vague in states where abortions would be permitted if the mother's life is at risk. "How much risk does someone need to take on to have an abortion count as life saving?" she asked. 

"For example, there are patients with cardiac disease who we will quote a 25 to 30% chance of dying if they continue the pregnancy and give birth. Is that enough of a risk of dying to have qualified, I guess, to use that word, to qualify for an abortion? Or does it need to be 50% or 100%? How are we to know this?" she asked 

Advice for journalists covering abortion

Image from healthlaw.org

Sophie Novack, an independent journalist who has closely covered reproductive rights for the Texas Observer, encouraged journalists at the conference to cover abortion as a health issue, not a political one. 

"So often coverage of it is siloed from other areas of reproductive health care," she said. 

Novack encouraged journalists to look at abortion through the lens of health-care access, and to offer context around percentages of people who are uninsured, teen pregnancy trends, state funding for family planning services, access to maternal health care, access to public assistance, and information that helps audiences understand how abortion restrictions affect the overall, long-term health of women.

"So thinking about all those kinds of factors together and how they fit together in the context of someone's ability to terminate the pregnancy and hurdles that exist," Novack said.

She also encouraged journalists to use medically accurate language. For example, she said the Texas law is not a "fetal heartbeat law" because an embryo does not have a heart at six weeks of pregnancy. 

The Associated Press has recently updated its Stylebook:

Pregnant people
Phrasing like "pregnant people" or "people who seek an abortion" seeks to include people who have those experiences but do not identify as women, such as some transgender men and some nonbinary people. Such phrasing should be confined to stories that specifically address the experiences of people who do not identify as women. See gender, sex and sexual orientation.

And our long-standing entry on abortion:
Abortion
Use the modifiers anti-abortion or abortion-rights; don't use pro-life, pro-choice or pro-abortion unless they are in quotes or proper names. Avoid abortionist, which connotes a person who performs clandestine abortions. Instead of pregnant women, use "pregnant people" or "people who seek an abortion" in stories that specifically address the experiences of people who can get pregnant but are not women. Such phrasing seeks to include people who have those experiences but do not identify as women, such as some transgender men and some nonbinary people.

The Supreme Court is expected to rule on the case of Dobbs v. Jackson Women's Health Organization by the end of June, which will determine the constitutionality of Mississippi's 15-week abortion ban, which raises the issue of whether a state can ban abortion before fetal viability. The court could do that without fully overturning Roe, by setting a stricter standard, but Justice Samuel Alito wrote in a leaked draft opinion that there is no constitutional right to abortion.

'Misinformation is now our leading cause of death,' FDA boss says

FDA Commissioner Robert Califf, M.D., speaks with an
attendee at the event. (AHCJ photo by Paola Rodriguez)

Newly confirmed Food and Drug Administration Commissioner Robert Califf says "the issue that keeps him up at night . . . is the proliferation of false and misleading health information, particularly online — and the distrust in institutions, data and expertise that it has wrought."

So reports Alice Miranda Ollstein of Politico for the Association of Health Care Journalists, from an interview AHCJ patient-safety team leader Kerry Dooley Young conducted with Califf on Friday in Austin at Health Journalism 2022, AHCJ’s annual conference.

“I believe that misinformation is now our leading cause of death,” Califf said, citing resistance to Covid-19 vaccination, the number of people taking the anti-parasite drug Ivermectin, and increasing use of electronic cigarettes.

“Historically, the FDA has been relatively quiet and puts out definitive information through guidance or labels or regulatory actions … that would be transmitted to consumers and patients through trusted intermediaries,” he said. “But the world has changed at this point.”

The shift has fueled the drop in Americans' life expectancy compared to other wealthy nations, Califf said, and he "urged reporters to avoid clickbait, lean into fact checking, make sure the headline matches the copy, and take other steps to responsibly convey news about Covid-19 and other pressing health concerns," Ollstein reports.

Califf said, “People are distracted and misled by the medical information Tower of Babel, but journalists like yourselves play an important role here and your work has a tremendous impact on public trust.”

USA Today reports on its analysis of Covid-19 deaths in nursing homes last winter, with a focus on Trilogy Health Services

Some Trilogy Health Services residents who died of Covid-19 (Photos contributed to USA Today)

USA Today recently published its findings from an in-depth analysis that looked at Covid-19 nursing home deaths during the 2020-21 winter surge, with a focus on one company that had twice the national average of deaths for nursing homes and has as many as 20 facilities in Kentucky. 

The year-long analysis was done by Letitia Stein, Jayme Fraser, Nick Penzenstadler and freelancer Jeff Kelly Lowenstein. It was published mid-March as a series of  stories, titled "Dying for Care."  

USA Today says, "In a first-of-its-kind analysis, they identified nursing-home ownership webs invisible to consumers. They scored the performance of every nursing home in America to probe questions of corporate responsibility left unanswered by government regulators and dozens of research papers on the pandemic's 140,000-plus nursing home deaths."

The series opens with pictures of people who died in nursing homes of Trilogy Health Services, found to have the "highest death rates reported by any large nursing home chain at the height of the pandemic."  

The analysis found that residents in Trilogy's 115 homes died of Covid-19 last winter at twice the national average for nursing homes, based on figures facilities must file weekly with the federal government. 

After being presented with USA Today's findings, the company told the newspaper that it had mistakenly reported hundreds of deaths during the surge and offered a revised tally that reduced the count by more than 40 percent, but it declined to provide documentation of those claims. It has since "filed new numbers with the federal government and hired a consultant to help it review its death count," the newspaper reports. 

But even with those lower numbers, the paper found Trilogy's Covid-19 death rates were "well above the national average" during the winter surge. 

The paper's analysis found that the deaths were not driven by residents who were older or more fragile, and could not be explained solely by the company's presence in states hard-hit by the virus. An unusual distinction was that Trilogy had been acquired by a company specializing in real estate in a test of a business model new to large nursing-home chains. 

The analysis found that "millions of dollars continued to flow from Trilogy to a California-based real estate venture busy preparing its next investment pitch – a stock listing expected to launch this year." 

The story digs into the business model behind these nursing homes and their efforts to increase profits, including staff cuts. It says Trilogy "went further than any other major chain in shrinking care hours delivered to residents before the pandemic," that "half of its facilities were cited by health inspectors for violating Covid-19 safety rules in 2020" and that "Trilogy's poor Covid outcomes stood out by measure after measure." 

The company divided its facilities "into red, yellow and green zones to limit exposure to the virus," the story says, but "Eyewitness interviews and the reports filed by health inspectors indicate this safety regimen was often a charade." The story also includes interviews with families of those who died. 

The series also includes short stories about some of the Trilogy residents who died and another includes a video of families reflecting on their loss. In addition, there is a link to share the story of how you lost a loved one in a nursing home due to Covid-19. 

Also in the USA Today "Dying for Care" series: 

The reporters break down their findings into four key things to know about their investigation into nursing home failures during Covid-19, including why Trilogy stood out, impact of staffing on care, impact of ignoring safety lapses pointed out in inspections, and impacts from the real-estate business model. 

In response to the story, federal nursing home regulators have said they need to collect better information about real estate ownership model's like Trilogy's, they report. Further, President Joe Biden  proposed reforms in February that would track problem owners across states  and shed light on Wall Street profits from nursing homes. 

The analysis revealed ownership webs invisible to consumers and said "problems across chains eluded federal officials overseeing nursing homes, who were focused on individual facilities during the pandemic." 

A story by Fraser walks through the details of how they did the analysis. She writes that USA Today took a closer look at nursing-home performance in the winter surge from October 2020 to February 2021 because half the nation's 140,000 Covid-19 deaths in nursing homes happened during that period, "months after best practices were established and federal aid issued for coping with the coronavirus." 

Another story, written by Penzenstadler, offers a guide to choosing the right nursing home for a loved on in three steps. 

Penzenstadler also explores the question, "When does a nursing home Covid-19 death count?" 

There is also a section that allows you to look up nursing-home ratings from the analysis and see how they fared during the pandemic's winter surge, 2021-21. 

There are no Kentucky data in the spreadsheet; USA Today reports there are 13 Trilogy Health Services facilities in Kentucky, but its website lists 20: Cooper Trail Senior Living in Bardstown; Cedar Ridge Health Campus in Cynthiana; Walker's Trail Senior Living in Danville; The Willows at Harrodsburg; The Springs at Oldham Reserve in La Grange; The Willows at Citation in Lexington; The Willows at Fritz Farm in Lexington; The Willows at Hamburg in Lexington; Forest Springs Health Campus in Louisville; Franciscan Health Care Center in Louisville; Glen River Health Campus in Louisville; Park Terrace Health Campus in Louisville; The Legacy at English Station in Louisville; The Springs at Stony Brook in Louisville; The Willows at Springhurst in Louisville; Westport Place Health Campus in Louisville; Sanders Ridge Health Campus in Mt. Washington; Calumet Trace Senior Living in Owensboro; Shelby Farms Senior Living in Shelbyville; and Boonesboro Trail Senior Living in Winchester. 

Kentucky's two clinics suspend abortions as lawsuits challenge new law that is called 'one of the most restrictive in the nation'

Rep. Randy Bridges, R-Paducah, gives a thumbs down to abortion advocates who chanted "Bans off our bodies" at the state Capitol April 13. (Photo by Ryan C. Hermens, Lexington Herald-Leader) 

By Melissa Patrick
Kentucky Health News

Kentucky's Republican-majority legislature overrode Democratic Gov. Andy Beshear's veto of legislation with strict requirements that advocates say have forced the state's only two abortion clinics to stop providing abortions -- and lawsuits by the clinics to nullify the new law.

The law, passed as House Bill 3, bans mailing of medications that have become the means for most abortions in Kentucky, strengthens parental-consent rules, increases reporting requirements, requires aborted fetuses to be cremated or buried, and bans abortion after the 15th week of pregnancy, mimicking a Mississippi law that is awaiting a decision from the U.S. Supreme Court.

That decision, expected in June, could overturn or roll back Roe v. Wade, the landmark 1973 ruling that has guaranteed the constitutional right to an abortion until a fetus can live outside the womb, roughly 23 to 24 weeks. The high court court not only lower that to 15 weeks but take Roe off the books.

Since Republicans took over the House in 2017, they have steadily passed legislation that has been setting up Kentucky to ban abortions altogether. In 2019, the legislature passed a "trigger law" that would ban abortion immediately if Roe is overturned. In 2021, it voted to add to the state constitution a statement that it does not secure or protect a right to abortion or funding of abortion, if voters approve it as a constitutional amendment this November. 

Rep. Nancy Tate, R-Brandenburg, the sponsor of HB 3, has said the purpose of her bill, dubbed the "Humanity in Healthcare Act 2022" is to better protect the health of women and minors seeking abortion, but opponents disagree. 

"Make no mistake, the Kentucky legislature's sole goal with this law is to shut down health centers and completely eliminate abortion access in this state," leaders of Planned Parenthood and the American Civil Liberties Union of Kentucky said in a statement.

Beshear said he vetoed the bill because there were no exemptions for rape or incest and because it is likely unconstitutional, among other reasons. 

“Rape and incest are violent crimes,” Beshear said in his veto message. “Victims of these crimes should have options, not be further scarred through a process that exposes them to more harm from their rapists or that treats them like offenders themselves.”

The governor said a 12-year-old girl "raped and impregnated by her father" couldn't get an abortion without notifying him and her mother at least 48 hours before having the procedure or going through a court hearing if they did not allow it.

Kentucky's only two abortion providers said they had to stop conducting the procedure because other restrictions and reporting requirements in the 72-page bill went into effect as soon as it was finally passed, under an emergency clause. The legislature sent Beshear the bill March 30 after overwhelming votes for it.

EMW Women's Surgical Services and Planned Parenthood, both abortion providers in Louisville, have filed separate federal lawsuits challenging the new law and asking a judge to suspend it. 

The ACLU said in a news release, "The lawsuits argue that the law would create unnecessary abortion requirements while simultaneously making those requirements impossible to comply with given the immediate effective date of the law, forcing providers in the state to stop offering abortion services. Because the law is impossible to comply with, it amounts to a de facto abortion ban, thus violating patients’ federal right to abortion under Roe v. Wade." 

Kentucky's Republican attorney general, Daniel Cameron, said he is ready to defend the new law. 

“The General Assembly passed HB 3 to protect life and promote the health and safety of women, and we are prepared to earnestly defend this new law against the legal challenge from Planned Parenthood and the ACLU," he said in a statement. 

Alex Acquisto of the Lexington Herald-Leader breaks down four key points in the new abortion law, which Caroline Kitchener of The Washington Post says is "one of the most restrictive in the nation." 

Kitchener adds in a separate online newsletter that more than 500 anti-abortion measures are moving through state legislatures this year and that as more states enact strict abortion restrictions, patients who can afford to cross state lines will be forced to travel further. The Post tracks new action on abortion legislation in real time  across the states on its abortion legislation tracker.

Alecia Fields, an abortion provider at Planned Parenthood in Louisville, told Kitchener that among the most difficult restrictions to comply with is the new rule on fetal remains, which will likely require the hiring of more people to facilitate "an elaborate and medically unnecessary burial process for each abortion performed" as well as contracting with funeral homes, which may not be willing to open themselves to the backlash from the community. 

Both Kentucky abortion providers are still taking calls from patients, and Planned Parenthood says it is directing Kentucky women seeking abortion to other states, Deborah Yetter reports for the Louisville Courier Journal in an article with a headline asking, "Did Kentucky ban abortion?"

Planned Parenthood spokeswoman Nicole Erwin said Thursday, "Any patients seeking abortion care in Kentucky are still advised to reach out to us for their first appointment so that we can coordinate care in Indiana or another state that can provide the care they need. Planned Parenthood's doors are and will remain open in Kentucky and will continue providing all other reproductive care."

As conservative states continue to pass anti-abortion laws, "Eliminating rape and incest exceptions has moved from the fringe to the center of the antiabortion movement," Jennifer Haberkorn reports for the Los Angeles Times. 

"Over the last four years, 10 states have enacted abortion bans in early pregnancy without rape or incest exceptions: Alabama, Arkansas, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, Ohio, Tennessee and Texas. All were blocked by courts, except Texas’ law, which is in effect," Haberkorn reports.

Haberkorn added in her April 8 article that U.S. Sen. Mitch McConnell of Kentucky, who said he supported exemptions for rape and incest in 2019 when Alabama passed an abortion law without those exceptions, declined to comment on the current legislation. 

Mian Ridge of The Economist writes that if the Supreme Court overturns Roe, "Decisions on abortion would return to the states and at least half would probably ban it. That would exert a particularly heavy toll on poor women. Many of the states that are keenest on banning abortion are among those that offer the least help to low-income mothers and their children." 

"Whatever the laws may say, history has shown that women will continue to have abortions," Jessica Bruder writes for The Atlantic, in a deep dive into what the future of abortion in America may look like. It explores how a covert network of activists are preparing for the end of Roe.