New study finds smoking and vaping dual use increases lung cancer risk; expert says it increases risk for other diseases too

By Melissa Patrick
Kentucky Health News

People who use electronic cigarettes and smoke traditional cigarettes are more likely to develop lung cancer than people who just smoke, according to a new study.

Centers for Disease Control and Prevention photo 

The Ohio State University study, published in the Journal of Oncology Research and Therapy, found that vaping combined with cigarette smoking was eight times more common in the cases with lung cancer than the control subjects, and the risk of developing lung cancer was four times higher among those who combined vaping and cigarette smoking than those who only smoked. These findings were consistent across genders and races and for all major cell types of lung cancer.

 

"This study presents clear evidence showing that vaping in addition to smoking can increase your risk for lung cancer," Marisa Bittoni, lead author and researcher at Ohio State's College of Medicine, said in a news release. "This is especially concerning given the rate of youth and young adults using these products." 

Dr. Randall Harris, co-author and professor of epidemiology at Ohio State's College of Public Health, added that while most people know that tobacco smoke contains cancer-causing chemicals, there is less known about the chemicals inhaled through vaping products. 

“Our findings provide the first evidence that smoking in combination with vaping significantly increases the risk of lung cancer compared to smoking alone," Harris said. 

Dual use and other chronic diseases

Amanda Bucher, director of tobacco policy research and outreach at the University of Kentucky College of Nursing, explained that because e-cigarettes contain a different mix of toxic chemicals than cigarettes do, including some new compounds that are formed when the chemicals are heated, people who are dual users are exposed to a broader range of toxins than they would be if they just used one device or the other. 

"Using both e-cigarettes and traditional cigarettes is associated with a higher risk of developing other diseases too, a higher risk than just smoking traditional cigarettes," Bucher said. "So not just a higher risk of developing lung cancer, but also cardiovascular disease, stroke, metabolic dysfunction, asthma, COPD and oral diseases."

Smoking cessation, prevention and lung cancer screening

Bucher said the good news is that Kentucky ranks second among states for lung cancer screening, but the bad news is that there is more work to be done because Kentucky continues to lead the nation in the rate of new lung cancer cases and deaths from it. 

Lung cancer screening with annual low-dose CT scans is recommended for people who: 

• are 50 to 80 years old
• smoke or have quit smoking within the past 15 years
• have at least a 20-pack-year smoking history, which means a pack a day for 20 years or two packs a day for 10 years, and so on. A pack year is the number of packs smoked per day multiplied by the number of years the person smoked.

According to the Centers for Disease Control and Prevention, around 30% of adult smokers in the United States are dual users. In Kentucky, the Truth Initiative, a tobacco-control advocacy group,  reports that 10.5% of adults use e-cigarettes and 17.4% are smokers. Among the state's high-school students, 4.9% are smokers and 21.9% vape. All of these Kentucky rates are higher than the national averages.

Bucher encouraged anyone trying to quit smoking and/or vaping to reach out to the Kentucky Quit Line at 1-800-QUIT-NOW, go to QuitNowKentucky.org or text QUITKY to 797979. 

She said help can also be found with a primary care provider who can offer counseling support and access to U.S. Food and Drug Administration-approved medications to help with cessation. 

"Research definitely shows that using medicines to help with tobacco treatment can double your chances of successfully quitting," she said. 

In addition, she said 39 local health departments receive funds to support cessation and prevention programs. Asked why all of the state's 61 district and county health departments don't offer this service, she said they used to, but reductions in funding from the state tobacco program have led to fewer of them offering such programs. 

"We know that almost 50% of Kentucky adults who smoke have tried to quit in the last year," she said. "It's really important for us to do everything we can to support those individuals." 

Bucher said policy matters when it comes to decreasing lung cancer rates and deaths in Kentucky.  

"We know that individuals who live in a Kentucky community with a comprehensive smoke-free workplace law are 8% less likely to be diagnosed with lung cancer," she said. "So just living in a place that has a certain kind of law means that you're less likely to get lung cancer. It doesn't matter what behavioral choices you are making." 

She added that only 38.1% of the state's population is covered by a comprehensive smoke-free workplace law, which means there is a lot of opportunity for communities to pass such laws to provide protections for their citizens. 

Further, she said, "We know that smoke-free laws make it easier for people to quit because they aren't exposed to those triggers. And, we also know that when fewer people are smoking and vaping inside public places, youth are less likely to start using tobacco products. So a smoke-free policy can also be something that is protective." 

Kentucky Center for Smoke-Free Policy honors communities, groups and individuals who help create smoke-free communities

The Kentucky Center for Smoke-Free Policy at the University of Kentucky and the Kentucky Department for Public Health’s Tobacco Prevention & Cessation Program honored communities, groups and individuals from across the state who are leading the way to enact smoke- and tobacco-free policies at the 2024 Kentucky Tobacco Control Conference held April 23-24 in Lexington. 

“While tobacco use has decreased across the general population, disparities persist by geographic location, socioeconomic status, race, ethnicity, sexual orientation, gender identity, disability status, and mental health status,” Amanda Bucher, director of tobacco policy research and outreach in the College of Nursing at UK, said in a news release. “This is in part due to the tobacco industry’s targeted marketing of these populations. Our vision for a tobacco-free Kentucky must promote health equity and eliminate these disparities.”

Sydney Shaffer, the 2024 Smoke-free Youth
Advocate of the Year, poses with Lexington
Mayor Linda Gorton. (Photo by Tim Webb)

Sydney Shaffer, a high-school student from Scott County, received the Smoke-free Youth Advocate Award for excellence in promoting smoke-free policy and education about secondhand smoke. Shaffer has advocated for lung-health policies and youth-vaping prevention since losing her grandfather to lung cancer. She has spoken to policymakers about the importance of tobacco control policies at the local, state and national levels.

The Northern Kentucky towns of Corinth and Highland Heights received the Everette Varney Smoke-free Indoor Air Excellence Award for their "exceptional leadership" and collaborative efforts in promoting the health of their citizens by enacting comprehensive smoke-free workplace ordinances.

Dr. Timothy W. Mullett, medical director of UK's Markey Cancer Center Network, received the Lee T. Todd Jr., Smoke-free Hero Award for his courage, leadership, perseverance, and continuous commitment to smoke- and tobacco-free environments in the face of adversity.

Centre College received the Tobacco Free Campus Award for its exceptional leadership and collaborative efforts in promoting healthy campus environments by implementing a tobacco-free campus last year.

Jelaine Harlow, health-education coordinator for the Lake Cumberland District Health Department, received the Ellen J. Hahn Lifetime Achievement in Tobacco Control Award for an exceptional life devoted to leadership in advocacy and public service contributions in tobacco control.

Jessica L. Burris, UK Department of Psychology and Markey Cancer Center received the Timothy W. Mullett M.D. Lung Cancer Prevention Award for her leadership, devotion, and passion toward preventing lung cancer through policy change in tobacco control.

Dr. Michael Gieske, diredctor of lung-cancer screening at St. Elizabeth Healthcare in Northern Kentucky, received the David B. Stevens M.D. Smoke-free Advocate of the Year Award for excellence in promoting secondhand smoke education and smoke-free policy.

The event was also sponsored by UK Healthcare, the Kentucky Health Collaborative, the Kentucky Asthma Management Program, Aetna Better Health of Kentucky, the Kentucky Office of Community Health Workers, Appalachian Regional Healthcare, the Kentucky COPD Program, CHI Saint Joseph Health and Kentucky Voices for Health, a coalition of health-advocacy organizations.

Bills to become law on vaping, pharmacy reform, vaccinations, drugs, at-home blood testing, coverage of cancer screening, more

Kentucky State Capitol (Photo via Wikipedia)

By Melissa Patrick
Kentucky Health News

In its 2024 session the Kentucky General Assembly has passed dozens of health-related bills that address a range of topics. With one day left in the session, here are some of them: 

Vaping: House Bill 11 limits legal sale of vaping products to those approved by the U.S. Food and Drug Administration. It also creates a database of retailers that sell the products and sets fines for retailers, manufacturers and wholesalers who violate the law.

HB 142 requires school districts to adopt specific policies that penalize students for possession of "alternative nicotine products, tobacco products or vapor products" and report nicotine-related incidents to the state Department of Education. Changes in the Senate, accepted by the House, allow schools and their governing bodies to apply for grants related to nicotine usage and remove the mandate that schools suspend students with a third possession violation. 

Pharmacy reform: Senate Bill 188 changes laws governing commercial pharmacy benefit managers, with requirements aimed at saving the state's independent pharmacies from closing.  It provides for dispensing fees, bans PBMs from forcing patients to get their drugs through mail order, and keeps them from steering patients to pharmacies that they own.

The bill, sponsored by Sen. Max Wise, R-Campbellsville, also prohibits a PBM from reimbursing a pharmacy that it owns at a higher rate than a community pharmacy, or from keeping a community pharmacy from filling a 90-day prescription for a maintenance drug. And a PBM will not be able to penalize a community pharmacy from sharing information with a patient on the cheapest option to pay for their medications.

Reducing barriers to screening

Cancer detection: HB 52 will require health-insurance plans to cover all preventive cancer screenings and tests that are consistent with nationally recognized clinical practice guidelines without requiring patients to pay any cost-sharing requirements, including a deductible charge for the services.

The sponsor, Rep. Deanna Frazier Gordon, a Republican from Richmond, told Kentucky Health News in February that the cost for screenings is often a barrier for people who often don't get screened because they don't have symptoms.

HB 115 will eliminate co-payments and cost-sharing requirements for high-risk individuals who need follow-up diagnostic imaging to rule out breast cancer. Currently, screening mammograms are covered by insurance, but follow-up exams are often not. 

“Thousands of Kentuckians require diagnostic and supplemental breast imaging every year, yet many forgo them due to out-of-pocket costs. Not any more,"  Molly Guthrie, vice president of policy and advocacy at the breast-cancer foundation Susan G. Komen, said in a news release. "This life-saving legislation means they will now receive the breast imaging they require, leading to an earlier breast cancer diagnosis and often better health outcomes."

Vaccines and drugs  

Vaccinations: HB 274 will allow Kentucky pharmacists to order and administer vaccinations to children as young as 5. The state's routine vaccination rates for kindergarteners remain below pre-pandemic levels.

Pseudoephedrine: HB 386 will raise the annual purchase limits on pseudoephedrine to help people with chronic allergies legally obtain enough of the medication to meet their needs. The bill changes the current 24-gram annual limit to an 86.4 grams, and remove the limit on the number of packages per transaction, said sponsor Robert Duvall, R-Bowling Green.

Kratom: HB 293 will regulate kratom, a natural herbal supplement that is not currently regulated. It is often used for anxiety, pain, PTSD and opioid withdrawal. The bill defines kratom, prohibits sales to people under 21, puts it behind the counter and provides guidelines for manufacturing and labeling. It also says federal law supersedes state law on the matter. 

Blood thinners: HB 31 allows Medicaid patients in Kentucky who are on blood thinners to use at-home machines to test their blood. Patients on some blood thinners, like warfarin, now require a weekly trip to the doctor's office for blood work that looks at how fast their blood clots.

Amanda Crabtree, a registered nurse at University of Kentucky Chandler Hospital, told WKYT-TV that she hopes that other states will follow Kentucky's example in this legislation. Crabtree said she expects that Medicaid patients could receive their at-home machines as soon as this summer.

Health-care business issues

Provider liability: HB 159 will protect health-care providers from criminal liability when a medical error harms a patient unless the harm results from gross negligence or wanton, willful, malicious or intentional misconduct. 

This effort was led by the Kentucky Nurses Association, which said the bill "will prevent health-care professionals from being charged criminally for making a medical error; that makes it good for nurses and nursing, and puts Kentucky at the forefront of developing laws to protect health-care workers." 

Workplace violence: HB 194 extends to contract workers, such as travel nurses, the law that makes violence against health-care workers a third-degree assault. It also extends this protection, now limited to hospitals, to contract employees at health clinics, doctor offices, dental offices and long-term care facilities. 

Sepsis: HB 477 establishes diagnostic criteria for sepsis allow hospitals to preserve current rules used for reimbursement of sepsis care, which allow payment when it is detected early, instead of only allowing reimbursement after organ failure occurs. 

"We know that if sepsis is caught early, the likelihood of survival is great," Jim Musser, vice president for policy with the Kentucky Hospital Association, told Kentucky Health News in March. "But for every hour that we wait, the chance of mortality increases by 7 percent." In sepsis, "The body responds improperly to an infection," says the Mayo Clinic. "Sepsis may progress to septic shock . . . When the damage is severe, it can lead to death."

Other health bills that passed

Youth medical records: HB 174 allows parents have access to their child’s medical records until they turn 18. Right now, children 13 and older must sign a waiver for parents to have access to them. HB 174 also updates the state's Medical Orders for Scope of Treatment form, which defines a person's end-of-life wishes.

Veteran suicide prevention: HB 30 calls on the state Department of Veterans Affairs to create a suicide prevention program for service members, veterans and their families.

Stuttering: SB 111 eliminates some insurance coverage limits on speech therapy for stuttering. It was promoted by former UK basketball star Michael Kidd-Gilchrist, who has overcome stuttering.

Medicaid: SB 71 is designed to keep people from coming to Kentucky to establish residence so that they can sign up for drug treatment to be paid for by Medicaid. One challenge resulting from this practice, according to Rep. Shane Baker, R-Somerset, is that when they leave the program, they are often homeless. 

SB 280 will allow Level II trauma centers that partner with a  university to get the university-hospital rate for services delivered as part of that residency program.

Beshear wants lawmakers to be empathetic on controversial issues like abortion; sees better health for Ky. as possible legacy

Gov. Andy Beshear during his interview with Kentucky
Health News in the Capitol's State Reception Room

By Melissa Patrick
Kentucky Health News

In an interview Wednesday with Kentucky Health News, Gov. Andy Beshear said he would be pleased if one of his legacies as governor was improving the health of Kentuckians, and looked forward to the upcoming legislative session.

Beshear acknowledged that if Kentucky has clearly improved its health status when his term ends in 2027, he would have to share that legacy with his father, Steve Beshear, who expanded Medicaid coverage in Kentucky to 600,000 people when he was governor from 2007 through 2015.

"I'd love for both Beshears to be remembered for that," he said. 

Beshear's comments came after he was asked why he thought Kentucky showed a slight upward trend in the latest America's Health Rankings by the United Health Foundation.

The foundation ranks Kentucky 41st for overall health, up from 43rd in the last two rankings (2022 and 2019; the rankings were not made in 2020 and 2021 due to the pandemic). The state was 45th in 2018, 42nd in 2017, 45th in 2016, 44th in 2015 and 47th in 2014.

Beshear said increasing access to health care has been key to improving the health of Kentuckians, not only as a way to improve the quality of their lives, but  as a way to improve the state's workforce. 

"I believe that we are doing better, and that we will do better for a couple of reasons," he said. "First, especially coming out of the pandemic, we are seeing expansion of health-care access all over Kentucky." 

As examples, he pointed to the first hospital being built in West Louisville in 150 years, the expansion of the Bullitt County hospital and the new clinic that  Morehead-based St. Claire HealthCare is building in Morgan County. He said health-care systems are "recognizing that the overall health of our people is a shared responsibility." 

Other examples, "especially over the last four years," he said, are "the leaps we have made in treating addiction, especially the number of treatment beds." He said Kentucky has the most treatment beds per person in the country, and that has improved the overall health of Kentuckians. 

"That's a big start towards getting people healthy," he said. 

Beshear agreed that his father's 2014 expansion of Medicaid to people who earn up to 138 percent of the federal poverty level, under the 2010 Patient Protection and Affordable Care Act, has played a key role in improving access to care. He noted that his administration has extended post-birth Medicaid coverage from 60 days to 12 months, and expanded dental, vision and hearing benefits.

Outcome-based payments? Looking forward, Beshear said it will be important to find a way to use "significant dollars" to incentivize and reimburse Medicaid providers who have good patient outcomes, as opposed to the current model of reimbursing them only for the care they provide. 

"How do we create the best platform and structure to make this happen?" he pondered. "And that's going to be what we're looking at, really closely. . . .  Again, if we can move towards a model where we reward outcomes, I think we can do significantly better." 

Beshear also spoke about the importance of preventive screenings as a way to improve health outcomes, pointing to Lt. Gov. Jacqueline Coleman's experience as an example of their importance. Coleman recently underwent a double mastectomy after concerns were raised during a routine physical examination. 

"That shows just how critical and important that is," he said. 

Legislative issues: When it comes to controversial health issues, like "red-flag" laws or abortion, Beshear said it's important to approach these topics from a place of "basic human empathy" where people can find common ground.  

Beshear said he supports a red-flag law, which allows temporary confiscation of an individual's firearms if a judge finds that person is a risk to themselves or to others. A bipartisan bill to enact a version of the law is planned for introduction in the General Assembly session that begins Tuesday, Jan. 2.

But first, the governor said, he would like to stop the auctioning of murder weapons to the highest bidder. He said his support for such laws has grown stronger since the loss of a close friend, Tommy Elliott, in a mass shooting at the Old National Bank in downtown Louisville. 

"I know what it's like to lose a very close friend in a mass shooting," he said. "I know what it feels like to have someone who you love and care about murdered and taken from you." 

Beshear said it is imperative for the legislatuire to add rape and incest exceptions to the state's near-abortion ban, along with an exception for non-viable pregnancies. 

"There are kids right now that have been raped and impregnated by family members that don't have any options," he said. "Hadley said it right, she wasn't the first and she wasn't the last. There are Hadleys out there right now and they deserve better." 

Hadley Duvall, who was sexually abused by her stepfather for years and became pregnant at age 12 and eventually miscarried, appeared in an ad for Besehear's re-election campaign where she said, “To tell a 12-year-old girl she must have the baby of her stepfather who raped her is unthinkable.”

Beshear's Republican opponent, Attorney General Daniel Cameron, responded to that attack by asking Beshear in a debate and afterward how far into a pregnancy a woman should be allowed to get an abortion.

In his campaign and in the interview, Beshear wouldn't say, and turned the tables: "I believe in access, but that's not what we're going to see from this General Assembly," he told Kentucky Health News. "I believe in access with reasonable restrictions. That's not where we are. We are at zero access." 

In the interview and several others this month, the Democratic governor said he thinks he and Republicans who run the legislature can have a more cooperative relationship because he can't seek re-election in 2027.  

"This is the period of time when we can get these things done and not to be seen as a benefit or a detriment, politically," he said. "And I'm already seeing a little difference in tone, and that's everyone. . . . I think we're seeing just a different tone and willingness to talk or to . . . talk differently."

Legislators expect to address youth vaping, maternal mortality, insurance issues and maybe abortion in upcoming session

State Rep. Kim Moser, Sen. Stephen Meredith, Rep. Rebecca Raymer and moderator Mark Marsh of Owensboro Health discuss issues at the Legislative Preview Conference. (Photo by Melissa Patrick)

By Melissa Patrick
Kentucky Health News

State legislators expect to address youth vaping, workplace violence, data collection, maternal mortality, and prior insurance authorization for medical procedures during the legislative session that begins Jan. 2.

And they could deal with abortion. So said lawmakers who participated in a health panel or otherwise attended the Kentucky Chamber of Commerce's 2024 Legislative Preview Conference Nov. 13.

Sen. Stephen Meredith, R-Leitchfield; Rep. Kim Moser, R-Taylor Mill; and Rep. Rebecca Raymer, R-Morgantown, spent the early part of the discussion talking about  health-care workforce issues and what could come out of the legislature's Certificate of Need Task Force.

Meredith and Moser agreed that the push to remove CON requirements as a way to level the playing field to create a true free market competition doesn't fit the current payment system, but the legislature could find efficiencies in the application process for health-care facilites.  

"Whatever comes out of our task force will probably be more administrative in nature," said Meredith. 

Raymer said she would be working on a bill that would address youth vaping, noting that it would likely include an education component, and a bill to get more sexual assault nurse examiners in rural areas. 

Moser said she will work on a bill to decrease maternal mortality.  One way to do this is to consider a bill that ensures women have health insurance during pregnancy. Since working on this issue, she said she has learned that pregnancy is not considered a qualifying life event that makes a person eligible to enroll in a federally subsidized or "qualified health plan" through Kynect during a special enrollment period. Having a baby or adopting a child are both considered qualifying life events. 

"We know that because of Kentucky's poor health metrics around obesity, hypertension, heart disease, cancer, that . . . those issues are affecting our maternal mortality," she said. "And so the best way to address that is with better prenatal care, and identifying those issues when you can control them." 

Other elements of a maternal-mortality bill would involve increasing access to psychiatric care, expanding the HANDS (Health Access Nurturing Development Services) program, a voluntary home-visitation program for new or expectant parents, and also include a section about doulas, women who provide assistance during labor.

Moser also said she will introduce another prior-authorization bill to reduce administrative burdens on health-care providers and provide better patient care. "I think this is the year that we're going to get that passed," she said. 

Around the issue of data collection, Moser said she was "looking at data and how we collect data around health care, how we better utilize it, and what's the best way to provide some transparency, and better inform policy decisions." One way to do that would be through an all-payer claims database, which is a policy priority of the Foundation for a Healthy Kentucky. 

Moser said when it comes to health-care workforce issues, she is working on a workplace-violence initiative. And she said she would "love to work on liability reform, tort reform" to limit lawsuits but says this is difficult because there needs to be a constitutional amendment to make meaningful changes. 

"I don't foresee that in the near future, but certainly, I think that's a conversation that we need to have," Moser said. "It really does affect the practice of medicine and the ability to attract and to retain our health-care workforce." 

The health panel did not discuss abortion, but after the meeting House Speaker David Osborne and Senate President Robert Stivers told the Lexington Herald-Leader that they were open to adding exceptions for rape and incest to the state's near-total ban on abortions.

“There is some interest in our caucus in passing those exceptions,” Osborne said, adding that opinions range widely among Republicans who control the House. They also control the Senate.

Stivers told the Herald-Leader, "We’re getting ready to have our caucus and kind of go through this. This will be a decision that everybody has varying opinions as to what should happen or what shouldn’t happen. . . . It is such a personal issue to people, we’re gonna have to have that type of discussion amongst ourselves and then collaborate with the House."

Abortion was a key issue in the recent governor's race, won by Democratic Gov. Andy Beshear, who criticized Republican Attorney General Daniel Cameron's opposition to rape and incest exceptions. Cameron then said he would sign such a bill if the legislature passed one.

Loneliness poses a public-health threat, prompting a rare advisory from the surgeon general, with a plan to rebuild social connections

By Melissa Patrick

Kentucky Health News

The physical and societal harms that come from loneliness are so bad that America's top public-health official has issued a rare advisory with a framework to rebuild social connection and community in the U.S. 

"Loneliness is more than just a bad feeling," Surgeon General Vivek H. Murthy writes in an opinion piece for The New York Times. "When people are socially disconnected, their risk of anxiety and depression increases. So does their risk of heart disease (29%), dementia (50%), and stroke (32%). The increased risk of premature death associated with social disconnection is comparable to smoking daily — and may be even greater than the risk associated with obesity."

Social disconnection was worsened by the pandemic. 

“What Covid did is really pour fuel on a fire that was already burning,” Murthy told Fenit Nirappil of The Washington Post. “I want the entire country to understand how profound a public-health threat loneliness and isolation pose.”

Murthy's opening letter in the public-health advisory, titled Our Epidemic of Loneliness and Isolation, adds, "The mortality impact of being socially disconnected is similar to that caused by smoking up to 15 cigarettes a day . . .  And the harmful consequences of a society that lacks social connection can be felt in our schools, workplaces, and civic organizations, where performance, productivity, and engagement are diminished." 

To further this point, the advisory says, "Data across 148 studies, with an average of 7.5 years of follow-up, suggest that social connection increases the odds of survival by 50%." 

In the Times, Murthy tells the story of his own experience with loneliness after his first term as surgeon general and how, with the help of others, he found his way out of it. Research shows he was not alone in this feeling, he reports: "About one out of every two Americans is experiencing measurable levels of loneliness. . . . Its invisibility is part of what makes it so insidious." 

Murthy goes on to say that loneliness and isolation have led us to a place where we "are less invested in one another, we are more susceptible to polarization and less able to pull together to face the challenges that we cannot solve alone." And this, he says, "has fueled other problems that are killing us and threaten to rip our country apart." 

For all of these reasons, Murthy writes, "rebuilding social connection must be a top public-health priority in our nation." To do this, he offers three key suggestions in the op-ed, which are outlined in greater depth in the 68-page advisory. 

First, Murthy says we must strengthen our social infrastructure, such as school-based programs that teach children about building healthy relationships and workplace design that fosters social connection.

Second, we must figure out how to create space in our lives without our electronic devices so that we can be more present with each other, with a commitment to promote conversation that amplifies understanding. 

Third, we need to take steps to rebuild our connections to each other, reaching out to people we care about, talking to our neighbors, checking in with co-workers who may be having a hard time, and seeking opportunities to serve.

Murthy has long advocated treating loneliness as a public-health issue wrote a 2020 book, Together: The Healing Power of Human Connection in a Sometimes Lonely World.

Research cited in the advisory shows that nationally, social connection decreased between 2003 and 2020 as time alone increased: Isolation increased by 24 hours per month and social engagement with friends dropped 20 hours per month.

Research also shows that loneliness and isolation are most prevalent in people with poor physical or mental health, disabilities, struggling financially or living alone, says the advisory. It adds that younger and older populations struggle the most. 

"For example, while the highest rates of social isolation are found among older adults, young adults are almost twice as likely to report feeling lonely than those over 65," it says. 

The advisory provides a national strategy to advance social connection that involves six pillars and the report goes on to lay out a detailed plan for how to support them. They include: strengthening social infrastructure in local communities; enacting pro-connection public policies; mobilizing the health sector; reforming digital environments; deepening our knowledge; and building a culture of connection. 

Graphic from Our Epidemic of Loneliness and Isolation public health advisory 

The report says, "We can choose, in short, to take the core values that make us strong—love, kindness, respect, service, and commitment to one another—and reflect them in the world we build for ourselves and our children. This strategy shows us how to create the connected lives and the connected world we need."

Murthy talked to Christina Caron of the Times about how to build meaningful social connections in an increasingly lonely world. He offered five tips: 

• Reconnect with people: "To get started, take 15 minutes each day to contact a friend or a relative. Put a reminder in your calendar, if needed, so that it remains a priority. Your relationships cannot thrive unless they are nurtured," she writes
• Minimize distractions: For a more satisfying quality time, put the devices down and give your full attention.“Focus on the conversation,” Murthy told Caron. “Listening is as important as what we say.”
• When people call, pick up the phone: Even if you are busy, he said. Pick it up, make a time to talk later, and do it. "That 10 seconds feels so much better than going back and forth on text," he said. 
• Serve others: Studies show that volunteering can ease feelings of loneliness and broaden our social networks, she writes. “When we help other people we establish an experience or a connection with them — but we also remind ourselves of the value that we bring to the world,” he told her. 
• Get help: Murthy said to tell someone if you are struggling with loneliness, whether that be a relative, a friend, a counselor or a health care provider. And, if you are having thoughts of harming yourself, call the 988 crisis hotline.

Free online forum to discuss state health legislation Tue., Jan. 31

Kentucky Voices for Health legislative panel 

Kentucky Voices for Health, an advocacy group, will hold a legislative forum at 3 p.m. ET Tuesday, Jan. 31. The forum will be held online and is free to attend, but requires registration to gain access. Click here to register. 

The panel will include Sen. Gerald Neal, D-Louisville, the minority Floor Leader; Sen. Danny Carroll, R-Benton, chair of the Senate Families & Children Committee; Sen. Stephen Meredith, R-Leitchfield, chair of the Senate Health Services Committee; Rep. Kim Moser, R-Taylor Mill, chair of the House Health Services Committee; Rep. Samara Heavrin, R-Leitchfield, chair of the House Families and Children Committee; and Rep. Lisa Willner, D-Louisville, member of the Families & Children Committee and the Health Services Committee. 

KVH describes this event as a " unique opportunity to dive into some of the most important issues facing the 2023 Kentucky General Assembly."  Kentucky lawmakers will reconvene Feb. 7.  

The panel discussion, led by KVH board chair Sheila Schuster, will include:

• New committee structures, jurisdiction, and how to engage your legislator.
• Legislators' priorities and predictions for the 2023 session.
• The ongoing physical and behavioral health impact of both the pandemic and recent natural disasters on Kentucky's families and children.
• The state's 2021 Minority Health Status Report and opportunities to improve the delivery of high-quality healthcare services in order to reduce ongoing health disparities.
• Fixing the "benefits cliff" for working Kentuckians.
• Strengthening Kentucky's families through investments in childcare, housing, transportation, and other public services.
• Strides in expanding and reinforcing Kentucky's network of certified Community Health Workers, social workers, nurses, and other frontline community professionals.

Cutting barriers to tobacco-quit treatment helped, but not enough; Ky. has wide differences among regions, and not enough money

Photo: healthyplace.com

By Melissa Patrick
Kentucky Health News

Since Kentucky passed a law in 2017 that reduced barriers to tobacco treatment and counseling, Kentucky Medicaid providers have diagnosed more people with tobacco use and there has been a 30 percent increase in counseling, but in several parts of the state these improvements remain very modest, according to a new policy brief. 

"The good news is that the state law has increased access to counseling and medication. However, we have more to do. We need to invest in implementing this law so that more people have access to tobacco treatment.," said Ellen Hahn, a University of Kentucky nursing professor and the director of the university's BREATHE (Bridging Research Efforts and Advocacy Toward Healthy Environments) initiative. 

The 2017 law requires insurers, including Medicaid, to cover all seven tobacco-cessation medications approved by the U.S. Food and Drug Administration, and counseling services recommended by the U.S. Preventive Services Task Force. It also eliminated co-payments for medication and counseling, requirements tying medication coverage to counseling, and limits on length of treatment. 

The law is meant to reduce barriers to smoking-cessation help for the 23.4% of Kentuckians who smoke, a rate that is even higher among Medicaid participants. Nationally, the overall smoking rate is 14%.

The researchers analyzed Medicaid claims to see how often Kentucky health-care providers diagnosed tobacco use and treatment. The analysis looked at Medicaid claims from November 2014 to December 2019, before and after the law took effect.  

The study found that there was a slight but statistically significant decline, from before the law to after the law, in the prevalence of tobacco use among Medicaid patients.

But it also found that even though health-care providers regularly used codes to indicate tobacco use by Medicaid patients, they didn't use counseling codes as often, indicating a shortage of counseling.

Regional differences

The decline in tobacco use among Medicaid patients was not consistent across the state's 15 area development districts. For example, the brief notes that tobacco use increased significantly in the Pennyrile district (Caldwell, Christian, Crittenden, Hopkins, Livingston, Lyon, Muhlenberg, Todd and Trigg counties) while it decreased significantly in the Kentucky River district (Breathitt, Knott, Lee, Leslie, Letcher, Owsley, Perry and Wolfe counties).

But the Kentucky River district showed a significant decline of 37% use of counseling services, while statewide use of those services was rising 30%.

Hahn added that there was great variability between ADDs when it came to claims for counseling services. For example, she noted that claims rose 79% in the Fivco district (Boyd, Carter, Greenup, Lawrence and Elliott counties) while the Cumberland Valley district (Bell, Clay, Harlan, Knox, Laurel, Rockcastle and Whitley counties), saw just a 5% increase. Hahn said others had "very minimal" increases.

The brief points out that benefits for evidence-based tobacco treatment are underutilized in Kentucky. Hahn said health-care providers may need a better understanding of what they can bill for. For example, she said, providers may not know that they can be reimbursed for tobacco counseling. 

The brief recommends that Medicaid providers need to receive systematic and standardized training on tobacco treatment-related diagnosis, including what billing codes to use. It also recommends increased training in evidence-based tobacco treatment, particularly in ADDs with low tobacco-cessation claims.

"Regular tracking and monitoring claims data for counseling interventions will ensure Medicaid beneficiaries receive the full scope of evidence-based treatments (i.e., medications plus behavioral support)," the brief says. 

Hahn noted that a prior policy brief found a desire for more tobacco treatment and cessation training, but only about one-third of health-care practices report that their providers have received continuing education about tobacco treatment in the past two years. 

"Tobacco is such an important risk factor and the cause of so many chronic diseases; it affects literally every organ in the body; it really needs to be a priority for all providers," Hahn said. "And so they need that kind of ongoing training, to make sure they're using evidence-based practice and that they understand the medications as well as the treatment for behavioral-health modalities."

State's tobacco-control efforts relatively weak

Hahn said the state needs stronger tobacco-control policies to decrease its smoking rate. She noted that the state regularly gets failing grades from the American Lung Association in its "State of Tobacco Control" report. 

"If you go to states where the excise tax for tobacco products is high, where they spend closer to what the CDC recommends for tobacco prevention and treatment, and places that have restrictions on smoking, smoke free laws, and also have access to tobacco treatment -- those states do better and they have, therefore, lower smoking rates," Hahn said.

Kentucky offers a 1-800-QUIT-NOW hotline for free tobacco cessation services.  Hahn said this number is under-utilized mainly due to lack of funding to promote it, so Kentuckians don't know about it. She said Oklahoma spends $3 million a year on media campaigns to promote its quit line and they get 30,000 callers a year. Kentucky's quit line gets only 3,000 calls a year, she said. 

"We've had a 43% cut in tobacco funding since fiscal year '21," she said. "So that doesn't help." 

The brief was issued by the University of Kentucky College of Nursing, with support from the Cabinet for Health and Family Services on behalf of the Department for Medicaid Services.  

It is the third in a series of four. The other ones address tobacco dependence treatment, increasing treatment capacity and practice recommendations for managed care organizations, which provide care for Kentuckians on Medicaid. 

Annual policy forum will focus on role of education in health

Individual and public health are influenced by many things, including the educational characteristics of people and their communities. Education will be the focus of the Foundation for a Healthy Kentucky’s 2022 Howard L. Bost Memorial Health Policy Forum, to be held virtually from 9:30 a.m. to 4:30 p.m. Oct. 17.

The forum will look at the connection between educational opportunities and health outcomes of Kentuckians, as one of the social determinants of health. Presenters and panelists will consider education as a cornerstone of Kentucky’s health outcomes. It is offred free of charge. Register here.

“Education is more than what happens between the four walls of a school building,” said Ben Chandler, president and CEO of the foundation. “Educational factors that influence health outcomes include everything from life skills — mental health, emotional literacy, financial literacy, and nutritional literacy — to local community programs, such as out-of-school care and workforce training, to equity issues. It’s important we consider all the factors of health to find ways to make a positive impact.”

Looking beyond the K-12 education system, panelists and presenters will discuss programs that can enhance education and provide more equitable access, while leading to better health outcomes for individuals and communities. Attendees will learn about replicable community-oriented collaborations and coordination between sectors that have led to improved health overall.

The 2022 Kentucky Teacher of the Year, Willie Carver, will give the keynote address. Sessions will include:

• Making the Case for Funding, in Education and Beyond: Considering education as a social determinant of health, panelists will discuss school funding, social safety net programs’ impact on education, and real examples from urban and rural schools.
• Literacy for Life (Critical Lessons for Positive Health): They’re lessons most don’t receive in school but can mean the difference between addressing and overcoming life’s challenges or becoming overwhelmed. Panelists will discuss mental health and emotional literacy, financial literacy and navigating systems, and how nutrition education impacts hunger long-term.
• Linked but Addressable; Helping Families Overcome Obstacles: A look at how family income plays a critical role in the academic outcomes of students, and therefore, the lifelong health of individuals.
• Breaking Down Barriers; Real Examples of Kentucky Communities Making Positive Change: Learn how local communities are lifting up families. Panelists will share about connecting families with early childhood intervention services; public schools and public health collaborating on mental health services; and, how a community is working to chart paths for non-traditional career building.

The forum is designed to raise awareness of the health issues impacting Kentuckians and highlights model strategies and policy opportunities to improve Kentucky’s health. The foundation created it to honor Dr. Howard L. Bost, a notable health economist and a founding member of the foundation’s board of directors. It welcomes a range of audiences, inside and outside the health industry – including health care advocates, providers and educators, business professionals, civic leaders, policy makers and more.

Updates on the forum are at Healthy-KY.org/bost-forum-2022.

 

Ky. Voices for Health sets sessions across state to give updates on policies affecting the health and well-being of Kentuckians

Kentucky Voices for Health and its Thrive KY advocacy partners are hosting regional events to provide updates on state and federal policies that impact the health and well-being of Kentuckians. 

The two-hour sessions will cover important updates on the economy, Medicaid, KCHIP, SNAP, housing, transportation, child care, public health, behavioral health, and suicide prevention, as well as new tools available to assist community members with meeting basic needs, and tips on being a more effective advocate in your community.

The first event was held July 12 in Lexington. Events are scheduled for 10 a.m. to noon local time at:

• July 26: Owensboro, Green River Area Development District
• Aug. 2: Louisville, location to be announced
• Aug. 16: Bardstown, Nelson County Public Library
• Aug. 23: Independence, Kenton County Public Library Branch
• Aug. 30: Paducah, McCracken County Public Library
• Sept. 6: Hopkinsville, Hopkinsville-Christian County Public Library
• Sept. 13: Bowling Green, Warren County Public Library Main Branch
• Sept. 20: Somerset, Pulaski County Public Library
• Sept. 27: Corbin (event at 10:30 a.m.), Corbin Public Library
• Oct. 4: Whitesburg, Harry M. Caudill Memorial Library
• Oct. 11: Paintsville, Johnson County Public Library
• Oct. 18: Ashland, Boyd County Public Library Main Branch
• Oct. 25: Flemingsburg, Fleming County Public Library
• Nov. 1: West Liberty, Gateway Area Development District

KVH says continuing education and/or professional development credit will be available and that the event is open to anyone who serves their community, including community leaders, public employees, nonprofit organizations, frontline service providers, outreach workers, educators, faith leaders and counselors.

Appalachian Food for Health Diabetes Prevention virtual event is Tuesday, April 26; it's free, but registration is required

The fourth Appalachian Food for Health Diabetes Prevention event will take place Tuesday, April 26 from 10 a.m. to 12 p.m. ET.

The virtual event will focus on food and nutrition policy that impact diabetes. It will also include a discussion about diabetes prevention and how better access to fresh, healthy foods can play a role in deterring this disease. The event is free, but registration is required. Click here to register. 

The agenda for the event includes presentations from Tyler Offerman, food justice organizer for the Kentucky Equal Justice Center, who will give an overview of 2022 Kentucky legislation related to food and nutrition; Martin Richards and Kimberly Ishmael of the Community Farm Alliance, who will discuss the healthy farm and food fund; and Pamela Spradling, director of planning and grant management at Big Sandy Health Care, who will discuss community health workers and diabetes prevention. 

The Appalachian Food for Health Diabetes Prevention Convening series is a collaboration between the Community Farm Alliance, the Foundation for a Healthy Kentucky and Shaping Our Appalachian Region, the regional economic-development group for Kentucky's 54 Appalachian counties. 

Health bills were among those that passed (some with overrides of vetoes) and failed in the last two days of the legislative session

By Melissa Patrick
Kentucky Health News

The Republican legislature overrode more than two dozen of Democratic Gov. Andy Beshear's vetoes Wednesday and Thursday, including a wide-ranging abortion bill that was immediately challenged in court and another that sets new rules for public-assistance programs, including Medicaid. 

Tulips in front of the state Capitol

The General Assembly ended its session after passing a number of health-related bills on a wide range of topics, including youth mental health, increased access to mental health and addiction recovery care, a behavioral-health pilot program for low-level offenders, postpartum care for low-income Kentuckians, research into medical marijuana, and the recruitment and retention of health-care providers. 

The anti-abortion measure, House Bill 3, bans mailing of medications that have become the means for most abortions in Kentucky, strengthens parental-consent rules and bans abortion after the 15th week of pregnancy, mimicking a Mississippi law that is awaiting a decision from the U.S. Supreme Court. 

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

Kentucky's only 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 because of an emergency clause.

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

The American Civil Liberties Union of Kentucky 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," the 1973 Supreme Court decision creating a constitutional right to abortion before a fetus can live outside the womb. 

Lawmakers also overruled Beshear's veto of HB 7, a public-assistance reform bill aimed at reducing fraud and getting able-bodied adults without dependents back into the workplace. Beshear vetoed the bill because, among other things, he said it will result in making it harder for people who need the benefits to get them and will result in people losing benefits. 

Health bills that passed in the last days of session

HB 44, sponsored by Bobby McCool, R-Van Lear (Johnson County), allows local school boards to include mental health as a reason for an excused absence. Rep. Lisa Willner, D-Louisville, praised the passage of this bill, noting that it came from students at several Kentucky schools. This bill also removed part of a new law that would have created criminal penalties for teachers who didn't teach racial history the way called for by the new law, Senate Bill 1, also passed over a veto. 

Senate Bill 102, sponsored by Sen. Max Wise, R-Campbellsville, requires local school superintendents to provide a yearly census of all school-based mental-health providers and their duties to the state Department of Education, not just a list of school counselors. 

SB 90, sponsored by Sen. Whitney Westerfield, R-Crofton, creates a pilot program to divert some qualifying low-level offenders away from jail and into treatment for substance-use disorder or mental-health issues. 

Negotiated in a late House-Senate conference committee, the bill gives the project $11 million a year from the settlement that Kentucky and other states received from opioid manufacturers and distributors.

HB 573, sponsored by Rep. Kim Moser, R-Taylor Mill, establishes the Healthcare Worker Loan Relief Program for qualifying health-care workers with jobs that require four-year degrees. This program is meant to help recruit and retain healthcare workers in rural and underserved areas of Kentucky.

The program would be aligned with the Kentucky State Loan Repayment Program and administered by the University of Kentucky's Center for Excellence in Rural Health. The budget has $2 million in each fiscal year from the American Rescue Plan Act of 2021, the last pandemic-relief bill.   

SB 178, sponsored by Sen. Julie Raque Adams, R-Louisville, ended up being a catch-all bill for several health-related issues. It requires Medicaid to provide coverage to new mothers up to 12 months after giving birth; sets new rules for certification of alcohol and drug counselors; allows licensed narcotic treatment programs to use buprenorphine products to treat patients; and requires third-party oversight over the state's single Medicaid pharmacy benefit manager; and bars termination of parental rights of a mother whose child suffers from neonatal abstinence syndrome if the mother agrees, prior to discharge from the hospital, to participate in a court-ordered treatment program that includes peer supports. 

HB 604, sponsored by Moser, also became a catch-all bill that at its core establishes the Kentucky Center for Cannabis Research at the University of Kentucky. The budget allocates $2 million in the fiscal year that begins July 1 to start the center. Other health provisions in this bill create the mobile crisis services fund and to the Commonwealth West Healthcare Workforce Innovation Center. 

Health bills that got stuck in the Senate

HB 136, sponsored by Rep. Jason Nemes, R-Louisville, which would have legalized medical cannabis in Kentucky did not gain any traction in the Senate after passing out of the House. Senate President Robert Stivers has long said that he believes more research is needed before such a bill should pass. 

HB 354, sponsored by Rep. Russell Webber, R-Shepherdsville, would have created a path for Kentucky's advanced practice registered nurses to prescribe controlled substances independently. "I'm sure that bill will come back some time in the future," said Senate Majority Floor Leader Damon Thayer in the closing hours of the session.

Ky. Center for Smoke-Free Policy honors communities, groups and individuals who work to create smoke-free communities

McCracken County Family, Career and Community Leaders of America got the Smoke-free Youth Advocate Award for pushing secondhand-smoke education and smoke-free policy. (Univ. of Ky. photo)

By Melissa Patrick

Kentucky Health News

The Kentucky Center for Smoke-free Policy at the University of Kentucky honored communities, groups and individuals from across the state who are making progress in creating healthier, smoke-free communities Aug. 3 at a virtual awards ceremony.

“The actions taken by these remarkable government, health, and youth leaders to protect the public health is truly inspiring,” Ellen Hahn, professor of nursing and KCSP director, said in a news release. “Despite challenges, all sectors of the community are coming together to attack the massive health and economic threat from tobacco use in the commonwealth.”

The event was also hosted by the Kentucky Tobacco Prevention Program, the state Department for Public Health and the UK College of Nursing. 

State Health Commissioner Steven Stack opened the meeting with praise for the advocates who work to promote smoke-free policies across the state, while acknowledging that there is more work to be done.

"You have saved lives and improved health and well-being in the Commonwealth of Kentucky through your efforts and your actions," he said. 

This year's awards include: 

The McCracken County chapter of Family, Career and Community Leaders of America earned the Smoke-free Youth Advocate Award for excellence in promoting secondhand-smoke education and smoke-free policy.

The Lee T. Todd Jr. Smoke-free Hero Award was presented to Anthany Beatty, retired assistant vice president for public safety at UK, for his courage, leadership, perseverance, and continuous commitment to smoke- and tobacco-free environments in the face of adversity.

Felicia Troutman of Owensboro Health, received the Timothy W. Mullett, M.D., Lung Cancer Prevention Award for her leadership, devotion, and passion toward preventing the disease.

The Lifetime Achievement in Tobacco Control Award was presented to Donna Teegarden, retired health promotion manager with the Bracken County Health Department, for her exceptional leadership in tobacco control.

Rebecca Horn of the Green River District
Health Department was named the David B. 
Stevens Smoke-free Advocate of the Year.

Madison County Schools received the Tobacco-free Campus Award for their leadership and collaborative efforts in promoting a healthy campus environment by implementing a 100% tobacco-free campus policy.

Knott County received the Everette Varney Smoke-free Indoor Air Excellence Award for enacting a comprehensive smoke-free workplace ordinance.

Rebecca Horn, public health services manager at the Green River District Health Department, was named the David B. Stevens, M.D., Smoke-free Advocate of the Year for excellence in promoting secondhand smoke education and smoke-free policy. 

Three additional advocates were nominated by their peers for this award: Shirley Roberson Daulton (Lake Cumberland District Health Department), Sherrie Stidham (Kentucky River District Health Department), and Breanna Williams (Northern Kentucky District Health Department).

State ranks 14th in childhood trauma; a coalition called Bloom Kentucky has formed to seek statewide policies to change that

By Melissa Patrick
Kentucky Health News

A collaboration of 31 grantmaking organizations across Kentucky have launched an initiative to focus on statewide policy changes to prevent and lessen the impacts of childhood trauma, also called adverse childhood experiences, or ACEs.

Barry Allen, president and treasurer of The Gheens Foundation, one instigator of the Bloom Kentucky coalition, said it will move grant- making organizations from across the state out of their comfort zone and into actively advocating for policy changes to prevent and reduce ACEs. 

"Each of you and your organizations, through this initiative, are giving the current and future generations of the commonwealth's children and families reasons for hope," Allen said at the Aug. 4 announcement. 

ACEs are traumatic or stressful events that occur before age 18, such as abuse or neglect, substance-use issues in the household, or separation from a parent due to incarceration. More than one in five Kentucky children, 22%, have experienced at least two ACEs, ranking the state 14th in the nation.

ACEs can have lifelong effects on health and well-being. They are linked to chronic health problems, mental illness, substance-use problems in adulthood, and can limit education, job opportunities and earning potential. 

It's easy to think that the issues impacting ACEs are just too complex to tackle, but this coalition "absolutely rejects that notion," said Terry Brooks, executive director of Kentucky Youth Advocates, the backbone organization for the Bloom Kentucky initiative.  

"ACEs can have multi-generational impacts, which means we need holistic, multi-generational solutions," Brooks said in a news release. "Systemic policy change can influence every Kentucky community to foster opportunities for kids and families to flourish. We urge our state lawmakers to think upstream and prioritize policies and investments that prevent these traumatic experiences from happening in the first place." 

Brooks stressed that the work to get these policies in place will require persistence, saying that this is not a "microwave proposition," but instead a "crock-pot effort." The organizers said they would announce its policy priorities for the 2022 General Assembly this fall.

Bloom Kentucky honored three Kentucky leaders for their historic efforts to address ACEs: Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, for "pioneering this effort;" state Health Secretary Eric Friedlander, who was the first to "pound the pulpit" on this issue; and Sen. Max Wise, R-Campbellsville, chair of the Senate Education Committee, for his efforts to bring trauma informed care into schools after the 2018 Marshall County High School shootings. 

Wise said the issues that contribute to ACEs are not defined as rural or urban, but as "commonwealth issues," and said he was committed to working with Democratic lawmakers and Gov. Andy Beshear on policies around the School Safety Resiliency Act and ACEs.

General Assembly has passed more than 35 health bills; several more could get passed, and a few are dead until next year

By Melissa Patrick

Kentucky Health News

Kentucky legislators have passed more than 35 health-related bills, addressing a range of topics such as health departments and pensions, substance-use disorder, immunizations, insurance co-payments and Alzheimer's disease. 

The bills now await Gov. Andy Beshear's signature or veto, he has already signed a few into law. Legislators can pass more bills when they wrap up the 2021 legislative session March 29 and 30, but they will be subject to a veto without the opportunity for an legislative override.

Here's a roundup of some of the health bills that have passed: 

Substance-use disorder: HB 219, sponsored by Rep. Danny Bentley, R-Russell, allows pharmacies to sell hypodermic syringes and needles without a prescription. This change was made to increase access to clean supplies for people who inject drugs, which will help to decrease the risk of blood-born diseases like hepatitis C and  HIV/AIDS. 

HB 219 would repeal requirements for pharmacies to keep records of sales of syringes and needles and allow their sale without a prescription, with a limit of 30 of each and proof that the purchaser is 16 or older. It would require pharmacies offering syringes and needles to provide educational materials on their safe and proper disposal, and referral information for syringe exchange programs and treatment of substance-use-disorder; and to offer naloxone, which is used to reverse opioid overdoses. 

The bill also allows for a specific-type of off-site pharmacy-related work that does not involve any dispensing.

Diabetes: HB 95, sponsored by Bentley, would cap the monthly out-of-pocket cost for a 30-day supply of insulin at $30 for Kentuckians covered by state-regulated health plans. The price cap would apply regardless of the amount or type of insulin the person with diabetes needs.

Health departments: HB 8, sponsored by Rep. Jim DuPlessis, R- Elizabethtown, would have quasi-governmental entities, including health departments, pay only what the Kentucky Retirement Systems needs to cover their employees' pensions instead of using the current "percentage of pay" formula. The effect on individual health departments varies widely.

Immunizations: Senate Bill 8, sponsored by Sen. Mike Wilson, R-Bowling Green, would allow several exemptions for "any child or adult" who doesn't want to receive a vaccine that the state mandates during an epidemic, including religious grounds, medical reasons or a "conscientiously held belief."

Drivers' sight: HB 439, by Rep. Kim Moser, R-Taylor Mill, would require a vision screening test be taken for renewal of a driver's license. Drivers could be screened at the renewal office or a medical office. 

Insurance: SB 55, sponsored by Sen. Stephen Meredith, R-Leitchfield, would get rid of all co-payments required by Medicaid.

SB 45, sponsored by Sen. Ralph Alvarado, R-Winchester, would limit the use of copay-accumulator programs by health plans, which prevent cost-sharing amounts paid on behalf of enrollees from counting towards their maximum out-of-pocket limits. 

SB 44, sponsored by Alvarado, ensures that any insurance payments made on behalf of an individual by a nonprofit organization are counted just as if the patient made it themselves. 

The Senate agreed to House changes in SB 44 that give providers until 2025 to tell women whose X-ray mammograms show dense breast tissue that such tissue is not abnormal, but slightly increases the risk for developing breast cancer. Providers are also asked to encourage "digital mammography" which provides a three-dimensional image of the breast. It also agreed to House changes that make sure the insured is responsible for payment, even if it is made by someone else, and prevent providers from paying premiums for their patients.

HB 48, sponsored by Bentley, a retired pharmacist, would allow pharmacists to be reimbursed by commercial insurance for providing medical care that other providers typically bill for, such as rapid flu tests, smoking cessation counseling or immunizations. Beshear signed the bill March 18. 

Telehealth: HB140, sponsored by Rep. Deanna Frazier, R-Richmond, would permit telehealth services that were allowed to expand due to the pandemic to remain in place after it ends. A key part of the bill would continue to allow audio-only visits, which is important because the state has many places without high-speed internet and many patients who are not adept at using technology.

Organ donation: HB 75, sponsored by Rep. Shawn McPherson, R-Scottsville, would keep insurance companies from increasing rates on organ donors or dropping their coverage. It would also encourage the cabinet to develop educational materials relating to organ donation. 

SB 12, sponsored by Alvarado, would prohibit a person from selling or purchasing human organs or tissue and ban for-profit entities from procuring any eye, cornea, eye tissue, or corneal tissue.

Alzheimer's disease: SB 61, by Meredith, would require six hours of dementia-specific training and three hours of annual continuing education for home-health aides and personal-service aides who provide care for Alzheimer’s or dementia, an often frustrating line of work with a very heavy turnover.

SB 74, by Alvarado, would establish but not fund a dementia services coordinator in the Cabinet for Health and Family Services to manage the Alzheimer’s Disease and Related Disorders Council, be in charge of the state plan to address Alzheimer’s in Kentucky and apply for federal funding opportunities.

Colon cancer: SB 16, by Alvarado, addresses several issues related to the screening program, including adding "prevention" to its name and requiring the Department of Medicaid Services to compile and present annual statistics on services related to colorectal cancer. 

Beshear had already signed HB 108, sponsored by Melinda Gibbons Prunty, R-Belton (Muhlenberg County) into law. It codifies existing Medicaid coverage of colorectal cancer, which includes screenings starting at age 45 for most people and genetic cancer-risk testing for the disease, to ensure uniform coverage for Medicaid patients that lines up with commercial-plan requirements. 

Infants and new mothers: HB 155, sponsored by Rep. Nancy Tate, R-Brandenburg, would allow the use of a “newborn safety device” to aid the anonymous surrendering of a newborn infant at a participating hospital, police station or staffed fire station. 

HB 212, sponsored by Samara Heavrin, R-Leitchfield, would require data in an annual state report on fatalities among children and new mothers to include information on demographics, race, income and geography associated with the fatalities. 

Mental health: HB 50, by Moser, would make health-insurance plans comply with a 2008 federal law that requires them to treat mental-health conditions and substance-use disorders just like physical conditions and file annual reports to show how they are complying. Beshear signed this bill March 12. 

Several health bills could still pass

HB 556, sponsored by Bentley, would allocate $20 million to a rural hospital operations and facilities loan fund created but not funded in the 2020 session. The bill has received two of the required three readings in the Senate and is in the Appropriations and Revenue Committee.

SB 51, by Alvarado, would ban the requirement of prior authorization for any prescription drug that is used in the treatment of alcoholism or opioid-use disorder and that contains methadone, buprenorphine or Naltrexone, or that is approved by the U.S. Food and Drug Administration for the mitigation of opioid withdrawal symptoms. It awaits a House floor vote. 

HB 91, sponsored by Rep. Joseph Fischer, R-Fort Thomas, would add to the state constitution a statement that it does not secure or protect a right to abortion or funding of abortion. The bill has had two readings and is in the Senate Rules Committee awaiting a floor vote. If passed, it would go on the ballot for voters to consider in November 2022. Governors don't act on constitutional amendments.

Health bills that are dead

SB 81, sponsored by Republican Caucus Chair Julie Raque Adams of Louisville, and HB  147, by Moser, would have restored local government control over use, display, sale and distribution of tobacco or vapor products. Neither was assigned to a committee, though Moser is chair of the House Health and Family Services Committee. Advocates of the bill said it had the votes to pass. 

SB 78, sponsored by Adams and Sen. Paul Hornback, R-Shelbyville, would have permanently removed the required collaborative agreements for prescriptive authority of controlled substances between a physician and an advanced practice registered nurse, and upon approval of the Kentucky Board of Nursing. The bill got out of committee, but wasn't called for a floor vote. 

Rep. Jerry Miller, R-Eastwood, tried to add SB 78's language as a floor amendment to SB 166. He ended up withdrawing it because it was deemed to not be germane, but made a floor speech about the importance of getting this legislation passed in the next legislative session.

After noting that this is the fourth year the legislation has been filed, and that he knew 70 of the 100 House members would have voted for it, Miller said, "This is a bill that's time has come. . . . APRNs are the general practitioners of the 21st century and we need to give them greater authority." 

SB 83, sponsored by Meredith, would have let medical professionals refuse to perform procedures that violate their religious or moral beliefs. It got out of committee, but was never called up for a floor vote. Meredith filed a similar bill in the 2020 legislative session that did not pass.