Bipartisan 'momnibus' bill aims to improve health of mothers, kids

State Rep. Kim Moser, a Republican from Taylor Mill in Northern Kentucky, spoke with other female legislators at a press conference Wednesday to announce their "Momnibus" bill. (Legislative photo)

Kentucky Health News

Legislators are accustomed to seeing "omnibus" bills that deal with many subjects, sometimes related, sometimes not. Now the Kentucky General Assembly has a "momnibus" bill intended to improve the health of children and mothers, including expectant ones.

House Bill 10 was developed by an informal, bipartisan group of female legislators concerned about the state's poor maternal health, said its main sponsor, Rep. Kim Moser, R-Taylor Mill.

"Addressing Kentucky's high maternal mortality rate and saving mothers and babies is obviously a priority for all of us," Moser said at a Wednesday press conference. Kentucky had the nation's sixth highest maternal death rate, 38.4 deaths per 100,000 live births, from 2018 through 2021. The national rate for that period was 23.5 per 100,000.

More than 90% of the state’s maternal deaths are preventable, Dr. Jeffrey M. Goldberg, legislative advocacy chair of the Kentucky chapter of the American College of Obstetricians and Gynecologists, told a state Senate committee last year. Just over 14 percent of Kentuckians lack access to adequate prenatal care, according to the March of Dimes.

Moser, a mother of five who was a neonatal intensive-care nurse, spoke from her own experiences: “I’ve really worked with mothers and babies and sick newborns, in their newborn phase, oftentimes through their first year, and I was able to really see some of the reasons for poor health disparities, especially in our poor areas of our state.”

Citing the advocacy group Every Mother Counts, Moser said “The leading causes of maternal death in the U.S. [are] lack of access to health care, including a shortage of caregivers, a lack of insurance, inadequate postpartum supports and certainly socioeconomic disparities, including the stress of racism and discrimination.” In Kentucky, she added, the risks are greater because of the prevalence of heart disease and diabetes.

HB 10 would:

• Add pregnancy to the list of "qualifying life events" that allow people to get health-insurance coverage outside normal enrolment, which could encourage more prenatal care.
• Create the Lifeline for Moms Psychiatry Access Program, for which Kentucky has received a $750,000 grant. Moser said she will also ask for an appropriation in the state budget “to make sure that’s a sustainable program.” It would be required to operate a hotline from 8 a.m. to 5 p.m. Mondays through Fridays.
• Expand the HANDS (Health Access Nurturing Development Services) home-visitation program for new and expectant parents to include breastfeeding counseling and assistance, education on safe sleep, as well as expanding the program to include telehealth, which Moser said she believes will help “reach moms in underserved areas or areas where she may have a transportation issue.”
• Require the Cabinet for Health and Family Services to study and make recommendations about the role of doulas, who provide assistance with the birth experience. 
• Strengthen an advisory council that provides policy guidance to increase collaboration, improve data collection, and suggest additional improvements.

Some Kentucky Republican legislators began paying more attention to such issues after the U.S. Supreme Court eliminated the federal right to abortion, activating a state "trigger law" that bans abortion except to save the mother's life or prevent permnent damage to a life-sustaining organ. 

"The wide gulf between abortion-rights and anti-abortion lawmakers was felt when Moser invited Addia Wuchner, executive director of the Kentucky Right to Life Association, to speak at the end of the press conference," reports Rebecca Grapevine of the Courier Journal. "That prompted most of the assembled Democratic lawmakers . . . to quietly walk out of the room."

State Rep. Sarah Stalker

One Democrat who remained, Rep. Sarah Stalker of Louisville, told the Courier Journal, "If we're going to force people to have children when they are not prepared to, when they are not ready to, when they are not interested in the family, it is critical that we give them the access to the health insurance . . . It doesn't help me and it doesn't help Kentucky, you know, Kentuckians at large and particularly women, to dig in my heels."

The second listed sponsor of the bill is Rep. Nancy Tate, R-Brandenburg, a leading anti-abortion legislator. Other Republican sponsors are Reps. Danny Bentkey of Russell, Emily Callaway of Louisville, Stephanie Dietz of Edgewood, Robert Duvall of Bowling Green, Ken Fleming of Louisville, Mark Hart of Falmouth, Kiom KIng of Harrodsburg, Amy Neighbors of Edmonton, Rebecca Raymer of Morgantown, Tom Smith of Corbin, Nick Wilson of Williamsburg and Susan Witten of Louisville.

Besides Stalker, the bill's Democratic sponsors are Reps. Lindsey Burke and Cherlynn Stevenson of Lexington. Democratic Reps. Lisa Willner of Louisivlle and Rachel Roberts of Newport initially attended the press conference but left and are not listed as sponsors.

Information for this story was also provided by the Kentucky Lantern.

UK has $3 million grant to study impact of mothers' opioid use on babies; Ky. 3rd in rate of babies with opioid-withdrawal syndrome

Photo: healthychildren.org

By Lindsay Travis
University of Kentucky

A team of researchers at the University of Kentucky is working to better understand the impact of opioid-use disorder on mothers and babies.

Every 24 minutes in the United States, a baby is born with neonatal opioid withdrawal syndrome (NOWS) after being exposed via  a mother with opioid-use disorder.

In Kentucky, about 2 percent of babies born in 2020 had symptoms of NOWS — the third-highest rate in the U.S. In Appalachia Kentucky, that frequency increases to 7.7 percent — 77 of every 1,000 babies.

Early delivery can complicate pregnancies with opioid-use disorder and give children an increased risk of impaired neural development, including cognitive, motor, social and emotional abilities.

UK’s research team wants to understand how inflammation and dysregulation in the placenta caused by opioid use are linked to negative cognitive consequences in the baby.

The study titled “POPI: Placenta, Opioids and Perinatal Implications” is funded by a $3 million grant from the National Institute on Drug Abuse, part of the National Institutes of Health. Additional funding is possible, pending progress with the research.

Part of the research team, led by Ilhem Messaoudi, left
center (University of Kentucky photo by Jorge Castorena)

“This study is going to have a tremendous impact on Kentuckians, many of whom know first-hand the profound devastation opioid use has on the overall health of the commonwealth,” said Ilhem Messaoudi, chair of the Department of Microbiology, Immunology and Molecular Genetics in the College of Medicine and a principal investigator on the grant.

“NIDA specifically called for research on the placenta-brain axis — the idea that what happens during pregnancy and the placenta’s health will have long-term ramifications on the offspring, including brain development,” said Messaoudi. “The team assembled to find answers for our smallest Kentuckians all bring a variety of expertise to this study including to maternal-fetal medicine, pathology, neuroscience and neonatology.”

Pregnant women who seek care at UK HealthCare’s Perinatal Assistance and Treatment Home (PATHways) program will be eligible to enroll in the study. PATHways, a comprehensive treatment program, is designed to help pregnant and postpartum mothers who are living with substance use disorders.

“Kentucky has one of the highest maternal mortality rates in the country combined with a high rate of opioid use disorder. PATHways provides us a unique opportunity to support pregnant mothers and invest in those lives through this kind of project that blends a variety of scientific specializations,” said Dr. John O’Brien, chief of the Division of Maternal-Fetal Medicine at UK HealthCare, a professor in the Department of Obstetrics and Gynecology in the College of Medicine and co-principal investigator on the grant.

As part of the study, researchers will collect ultrasound data, blood samples, the placenta and umbilical cord blood and conduct neurodevelopment assessment on babies for one year after birth. The data will help them determine the impact of maternal opioid use disorder on both the health of the placenta and the baby’s brain.

“In previous studies, using a rat model, we’ve learned maternal opioid use disorder increases inflammation in the brain and alters microglia — cells that are like the housekeepers of the brain,” Messaoudi said. “The alteration can affect the way the brain continues to develop.”

Investigators can measure that change in the brain through another type of immune cells found in the blood, called monocytes. The team will track neurobehavioral outcomes through a series of assessments in the newborn period and at age 3, 6 and 12 months.

O'Brien said, “Our hope is this research project will provide health-care professionals the knowledge and evidence necessary to improve the care of pregnant mothers with opioid use disorder, reduce risks and optimize neonatal outcomes.”

The study also includes researchers in the College of Medicine’s departments of Pediatrics and Pathology and Laboratory Medicine, as well as the Spinal Cord and Brain Injury Research Center and the Dr. Bing Zhang Department of Statistics in the College of Arts and Sciences.

If you or someone you know is pregnant and dealing with substance-use disorder, contact UK's Polk-Dalton Clinic at 859-218-6165 to make an appointment for prenatal care.

Kentucky health insurers give $750,000 to Louisville public-benefit firm to improve care for opioid-exposed infants in rural Kentucky

NAS stands for neonatal abstinence syndrome.

By Melissa Patrick
Kentucky Health News

The Kentucky Association of Health Plans, the trade group for companies selling health insurance in Kentucky, has given $750,000 to Nascend, a Louisvile-based public-benefit corporation that works to help infants with neonatal abstinence syndrome, caused by mothers using opioids during pregnancy. 

The KAHP grant will allow Nascend to extend its certification program to rural hospitals in Kentucky, to help standardize and improve care for opioid-exposed infants across the state, a news release said.

“Kentucky’s Medicaid managed-care organizations are proud to partner with Nascend . . . to show demonstrable results by eliminating care gaps and improving health outcomes for mothers and babies,” KAHP Vice President of External Affairs Katherine Kington North said in the release.

The NAS certification program is designed to help health-care providers treat substance-exposed infants more effectively and efficiently, which ultimately leads to better outcomes for the children and families as well as savings to the health care system, the release said. 

Dr. K. Dawn Forbes, founder and CEO of Nascend, said her team of neonatologists is excited about the impact that this grant will have across the state, particularly in rural areas. 

“We are going to be able to address a lack of standardized care guidelines, outdated and ineffective infant assessment tools, overused medication treatment, poor parental engagement, and insufficient nutrition," Forbes said in the release. "This is a game-changer, and we appreciate Kentucky health plans for being laser-focused on improving the social determinants of health.”

Kentucky has been particularly affected by the opioid epidemic, with NAS rates reaching 19.4 per 1,000 infants, with a peak rate of 77 per 1,000 infants in the state's Appalachian region. The national average is only 7 per 1,000.

The release says the KAHP grant will "help decrease the need to transfer infants to facilities in urban areas, better maintain patient-provider relationships, reduce family stress, and retain care and resources locally while also contributing to an estimated cost savings of at least $2.83 million annually by serving a minimum of 500 infants per year at full implementation." 

Nascend says it has trained more than 7,000 health-care providers in 38 states and improved the lives of more than 1.6 million infants. The company was recognized this year as a "Top 10 Health Education Services Provider" by Healthcare Business Review, and received the "Top Social Impact Company Award" at the 2023 Canopy Annual Good Business Summit for "aligning purpose and value with community impact," a news release said. 

'Toddler formulas' for infants and young children offer little nutritional benefit, writes a UK specialist in pediatric digestion

Photo by tun723, iStock/Getty Images Plus via UK

By George J. Fuchs III, M.D.

University of Kentucky

A recent report from the American Academy of Pediatrics as part of my work on the AAP Committee of Nutrition addresses the claims made by the manufacturers of so-called “toddler formulas," purporting to bolster the immune system and improve brain development. Simply put, a nutritionally complete super formula that gives your child a brain boost and protects them from diseases is too good to be true.

Nutrition is integral to a child’s cognitive and physical development, especially in the first years of their life. Additionally, these years represent a narrow window of time during which nutritional status and the right nutrients at the right time are primary determinants of health and risk of obesity, diabetes and other diseases in childhood and through adulthood.

While the benefits of breastfeeding in the first six months of life are well-documented, there are numerous reasons why some infants must subsist on iron-fortified formulas. The composition of infant formulas is standardized and regulated by the Food and Drug Administration per the Infant Formula Act of 1980 and the manufacturing facilities are regularly inspected.

Recently, liquid nutritional products referred to as “formulas” have been developed for the older infant and toddler and increasingly promoted by manufacturers. Older infant-young child formulas (OIYCF) are marketed under identities such as “transition formulas,” “toddler formulas” or “growing-up milks." These formulas are not to be confused with medical or therapeutic formulas for conditions such as chronic gastrointestinal diseases, metabolic disorders or food allergy, the use of which are prescribed and monitored by pediatric specialists.

Unlike infant formulas, there are no standard criteria for the composition of OIYCFs. Some of these formulas have been criticized as having elements considered to be unnecessary or potentially detrimental, including high or low protein, and higher sodium content relative to cow milk and added sweeteners. OIYCFs are considered by some to be “sugar-sweetened drinks” and have been associated with greater intakes of sweetened beverages as well as sweetened dairy products, such as fruit yogurts and cream cheese desserts.

Advertisement practices for OIYCFs often convey them as a necessary “next stage” or “next step” for optimal nutritional intake. Manufacturers of OIYCF make claims that are not required to be based on scientific evidence or be reviewed or approved by the FDA. Claims of improved brain development or immune function have incorrectly shown to influence parents’ belief that OIYCFs are healthier than breast milk or cow milk. OIYCFs are not nutritionally complete and are marketed to parents of healthy children as a replacement or substitute for cow’s milk.

The diets of young children are generally adequate for most micronutrients, although possible gaps exist, especially for vitamins D and E and fiber. Nearly all store-purchased cow milk in the United States is fortified with vitamin D, thus eliminating the need for a supplemental formula. Additionally, OIYCFs are considerably more expensive than cow milk and can represent a significant cost burden to families, especially when consumed daily. Parents and caregivers are advised to provide nutritionally balanced diets that include fortified foods; children consuming a diet of solid foods that provide sufficient iron and vitamin content have no need for supplemental formulas.

If you are concerned about your child’s nutritional intake, ask their pediatrician for recommendations for a balanced, nutrient-rich diet to help ensure proper cognitive and physical development during formative early years.

Dr. George Fuchs is a pediatric gastroenterologist at Kentucky Children’s Hospital and a professor in the UK Colleges of Medicine and Public Health.

Baby death rate fell 6% in Kentucky in 2022 while it increased nationally and in most states that border Kentucky, CDC reports

By Al Cross

Kentucky Health News

For the first time in 20 years, the rate of infant mortality in the U.S. showed a statistically significant increase in 2022, according to preliminary data from the Centers for Disease Control and Prevention. The national baby-death rate rose 3 percent from 2021, but in Kentucky it dropped 6 percent.

The rate measures the percentage of babies who died before their first birthday. The national rate rose from 5.44 deaths per 1,000 births in 2021 to 5.6 per 1,000 in 2022. Kentucky's rate fell from 6.15 in 2021 to 5.77 in 2022 and now ranks 28th among the states. In 2021, the state ranked 17th.

Cabinet for Health and Family Services graph; click to enlarge

Kentucky's infant-mortality rate has usually been higher than the nation's, reflecting its status as a poor state with lower-than-average health, but in 2019 its rate was 4.9 deaths per 1,000 births and the national rate was 5.6 per 1,000.

The state has fared worse in maternal mortality, the rate of women who die while pregnant or within six weeks of givign birth. It led the nation in 2021. Last year, when it ranked sixth nationally, state officials extended postpartum Medicaid coverage to one year after birth; it had lasted for only 60 days.

Infant mortality declined in Kentucky and 17 other states in 2022, led by Nevada at 22 percent, followed by Alabama, New Hampshire, Arkansas, Alaska, Colorado, Connecticut, Rhode Island, Minnesota, South Carolina and Kentucky.

Following Kentucky on the list of states with decreases were Mississippi, which still had the nation's highest rate, 9.11 per 1,000; North Carolina, 6.49; Oklahoma, 6.89 (all down about 3%); and Illinois, 5.59 (down 1%).

Most bordering states showed an increase in rates: Ohio, 7.11 (up 1%); Virginia, 6.21 (up 4%), Indiana, 7.16 (up 6%); Tennessee, 6.61 (up 7%); West Virginia, 7.32 (up 8%); and Missouri, 6.77 (up 16%). Arkansas continued to have one of the higher rates, 7.67 per 1,000, but had one of the bigger decreases, 11%.

Experts were uncertain of the reasons for the national increase. They noted increases in maternal complications and cases of bacterial meningitis, influenza and respiratory syncitial virus (RSV), both of which "rebounded last fall after two years of pandemic precautions, filling pediatric emergency rooms across the country," Mike Stobbe of The Associated Press reports.

"The U.S. infant mortality rate has been worse than other high-income countries, which experts have attributed to poverty, inadequate prenatal care and other possibilities," Stobbe notes. "But even so, the U.S. rate generally gradually improved because of medical advances and public-health efforts."

UK hospital, celebrating 60th anniversary of its opening, recalls the governor for whom it was named: A.B. 'Happy' Chandler

A.B. Chandler breaks ground for the hospital. (UK photo)

As the University of Kentucky celebrates the 60th anniversary of the opening of its medical center, it asked the grandson of the governor who campaigned for it, and for whom it is named, to reflect on what it means to the state.

Ben Chandler, who had his own political career and now runs the Foundation for a Healthy Kentucky, said in a video interview with UK that A.B. "Happy" Chandler "felt like an institution was needed, which not only educated health care providers who would then fan out across the eastern part of the state, but also a place where people from Eastern Kentucky could come to get health care. . . . Eastern Kentucky had a high rate of infant mortality, they had several counties that had no physician at all, and almost no health care whatsoever."

The Albert B. Chandler Hospital has done "incalculable" good, Chandler said. "There's just no way you can describe it. Not only do you have the medical benefits that accrue as a result of the establishment of this institution, but the economic advantages that are connected with it. UK HealthCare is one of the largest employers in Lexington and Central Kentucky. And if you can think about the importance of this from an economic standpoint for the city of Lexington, it really just boggles the mind. There are very few things that have happened economically in Lexington that have been as important as the establishment of this medical facility."

Albert Benjamin Chandler III said his grandfather "would be really astonished at the growth and at the stewardship that has taken place throughout these years. He would be very, very proud of the people who were instrumental in building this institution. And he would just be incredibly proud of their stewardship of it over the years, and probably pretty surprised at just how dramatic its effect has been."

Kentucky's intensive-care units will give new parents insurer-funded kits so new parents can learn how to give CPR to infants

Training kit for giving infants cardiopulmonary resuscitation

The Kentuckiana American Heart Association and the Kentucky Association of Health Plans, the association for companies selling and managing health insurance in the state, and have introduced a new initiative to equip thousands of new Kentucky parents with kits to teach them how to give cardiopulmonary resuscitation to an infant. 

The initiative is funded by a $95,000 grant from KAHP. The AHA will distribute 3,000 Infant CPR Anytime Training® Kits to newborn intensive-care units throughout the state. The kits include an inflatable manikin along with a video course designed to provide infant choking and CPR training in about 20 minutes. 

 “We’re excited to provide funding for this partnership with the American Heart Association. This is an extremely effective tool that will increase the chances of survival in the face of an emergency and equip new parents with the confidence to administer lifesaving techniques," Katherine Kington North, director of external affairs for KAHP, said in a news release.

 

The release notes that the at-home kits will fill voids created by staffing problems related to the Covid-19 pandemic. They will be available in English and Spanish. The AHA began deliveries of the kits in mid-May, with 1,900 distributed to date, says the release. The KAHP gift capped off National CPR Awareness Week, which ran from June 1-7 this year.

“With preterm infants, there are twice as many cardiovascular malformations as those born at full term, so the kits are especially important to those families,” Dr. Sandra Guerra, chief medical director for KAHP member WellCare of Kentucky and board chair of the Kentuckiana AHA, said in the release. 

She added, “Premature infants may also have breathing difficulties due to an underdeveloped respiratory system, and should it be necessary, parents will have the know-how to administer aid before an ambulance arrives. The physical practice that these kits provide is tremendous.”

In 2020, there were 5,705 preterm births in Kentucky, representing 11% of live births, according to the March of Dimes.

Beshear signs executive order to activate price-gouging laws for baby formula, which remains in short supply

Beshear signs executive order (Photo via Facebook)

By Melissa Patrick
Kentucky Health News

Gov. Andy Beshear signed an executive order Thursday declaring a state of emergency in order to apply state price-gouging laws for baby formula. 

“By implementing our price-gouging laws, we can make sure that families are not being charged more than they should to obtain a critical supply of formula to feed their baby,” Beshear said at his weekly news conference.

Beshear said Attorney General Daniel Cameron has not reported any claims of price gouging, or requested that the price gouging laws be activated, but other states have reported such claims and have taken steps to address them. 

Beshear encouraged any families who have experienced price gouging to contact Cameron's office. That can be done by calling 502-695-5485 or by filling out a price-gouging complaint form. 

Cameron encouraged those who use the form to report as many details as possible about the suspected gouging, including the name and address of the seller or retailer, the item purchased, the price of the item after the emergency declaration and the price of the item before the emergency declaration, if known. And if consumers are seeking a refund, he said they should keep receipts to show proof of purchase. 

“As parents, Makenze and I recognize the incredible stress and fear that the shortage is causing Kentucky families, and our office will use the full force of the law to ensure that the price charged for essential products like baby formula is no more than the law allows," Cameron said in a news release. 

Beshear acted a week after Kentucky lawmakers met to discuss the baby formula shortage, and Rep. Kim Moser, R-Taylor Mill, called in an opinion article for him to address price-gouging issues. 

State Health Commissioner Steven Stack encouraged families who are struggling to find baby formula to seek support from a number of agencies.  

“The infant formula shortage has caused worry and frustration for Kentucky’s families as they have sought to provide nutrition to our most precious citizens,” Stack said in a news release.  “We encourage families to reach out to all available resources in their community, including local health departments, pediatricians, food pantries, community action councils and other supporting agencies to meet the nutritional needs of their infants and to ensure they thrive. We also encourage all eligible families to enroll in WIC or SNAP to help during this shortage.”

Women, Infants and Children nutrition benefits are available to Kentucky residents who are pregnant, breastfeeding or have a child 5 or younger and have household income of no more than 185% of the federal poverty level, with rules governing what counts as income. Anyone who receives Medicaid or is part of the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) automatically meets income requirements for WIC. Click here for a WIC pre-screening Tool to see if you are eligible.

Cameron warned families to guard against baby formula scams and encouraged Kentuckians to only purchase baby formula from known, reputable sources; to use a credit card to make the purchase if possible; to avoid paying for formula up front if purchasing from an unknown source; and to be suspicious of sources advertising formula at prices that are too good to be true. Any suspected scams can be reported to ag.ky.gov/scams.

The shortage is largely the result of of violations at Abbott Nutrition's Michigan factory that caused the U.S. Food and Drug Administration to shut it down in February. The investigation was prompted by four bacterial infections in infants who had consumed formula from the plant. Abbot has up to 40% of the formula market in the U.S.

Abbott announced June 4 that it had resumed production at the factory after meeting initial requirements agreed to with the FDA in a consent decree May 16.

But that doesn't mean an immediate end to the shortage. Abbott says its priority is production of EleCare, a special formula for children with multiple allergies, before it ramps up production of its other products. The initial EleCare product is expected to be released "on or about June 20," Abbott's release said.

Some relief is also expected from oversea shipments of non-specialty baby formula. On June 6, President Biden announced that his administration had sourced a flight through the Operation Fly Formula initiative. His administration says the delivery will include Nestlé NAN SupremePro Stage 1 infant formula and that additional deliveries will be announced soon.

FDA Administrator Robert Califf told lawmakers on May 26 that the baby formula shortage in the U.S. will likely not be resolved until late July.

The latest dataset from Datasembly, a retail data firm, for the week ending May 29th shows a 73% out-of-stock rate for baby formula nationally and a 76% out-of-stock rate for Kentucky. 

Mothers on WIC program who need formula should call health department; others should call pediatrician, health secretary says

Photo from nbcnews.com

By Melissa Patrick
Kentucky Health News

As Kentucky families struggle to find baby formula for their infants and no immediate end in sight, Kentucky lawmakers discussed ways to improve the situation at the June 2 meeting of the Interim Joint Committee on Health, Welfare and Family Services. 

The shortage is largely the result of a U.S. Food and Drug Administration investigation of Abbott Nutrition's Michigan factory that resulted in it shutting down in February. The investigation was prompted by four bacterial infections in infants who had consumed formula from the company's Michigan plant. Abbot makes up to 40% of the formula market in the United States.  

Abbott announced Saturday that it had resumed production at the factory after meeting initial requirements agreed to with the FDA as part of a consent decree the company entered into on May 16. 

But that doesn't mean an immediate end to the shortage. Abbott says its priority is production of EleCare, a special formula for children with multiple allergies, before it ramps up production of its other products. The initial EleCare product is expected to be released "on or about June 20," Abbott's release said. 

Last week, FDA Administrator Robert Califf  told lawmakers that the baby formula shortage in the U.S. will likely not be resolved until late July. 

On June 2, Datasembly, a retail data firm, reported that the nationwide out-of-stock rate for formula in the week ending May 28 was 74%, up from 70% the week before and 45% the week before, according to Bloomberg. Kentucky's latest out-of-stock rate is 76.7%, a slight increase from 75% the week before. 

President Joe Biden has done several things to increase access to formula, including invoking the Defense Production Act to mandate increased production and importing formula manufactured overseas. 

Legislators and Beshear

The day before the health committee meeting, Rep. Kim Moser, R-Taylor Mill, a co-chair, published an opinion article that urged Democratic Gov. Andy Beshear to issue a plan for how to deal with the shortage, saying "We have heard nothing from Gov. Beshear on what families are to do." 

Moser took several jabs at Beshear's handling of the shortage and said he should issue executive orders to increase the production of formula and address price gouging, as governors in other states have done. 

"I am calling on him to make a statement and do what he can to address this shortage because Kentucky families struggle every day to find the necessary supplies for their children," Moser wrote.

At the committee meeting, Eric Friedlander, secretary of the Cabinet for Health and Family Services, said there are already anti-price gouging statutes on the books that should continue to be enforced. 

Moser said the state attorney general's office told her that any anti-price gouging policies specific to formula need to be tailored specifically to this food product. "I think it's worth looking into, just to provide some protections," she said. 

She also noted that Agriculture Commissioner Ryan Quarles (whom she is supporting for governor) is calling for donations of formula through his Kentucky Hunger Initiative. 

Beshear answered several questions on the topic at his regular weekly news conference, in Frankfort just after the committee meeting in Northern Kentucky. "It's certainly something that I'm concerned about," he said, adding that the FDA should have seen the ramifications of shutting down the Abbott plant. 

"I'm going to push to ensure that every time the FDA makes one of these decisions, and I get they're making it in terms of immediate health, but they need to be providing a long-term analysis of the ramifications, how this impacts our economy, and different supply chains so in the very least, the president, governors, Congress is made immediately aware of what could happen," Beshear said. 

Beshear was not asked about price gouging or ways to increase formula production or price gouging, He encouraged people on Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, to call their local health department or their community WIC agency and all others to reach out to their pediatrician. 

Friedlander did likewise at the committee meeting, adding that those who are not part of the WIC program should reach out to their pediatrician.

He said the state is looking at ways to take back formula from families who have excess supplies and redistribute it, but the rules governing that are pretty stringent. He also encouraged families to check out online resources to locate formula such as the U.S. Department of Health and Human Services website at hhs.gov/formula.

Health departments, WIC and retailers

Kentucky has taken advantage of federal waivers that allow the WIC program to cover more types and sizes of formula since February. Click here to see the list of approved formulas available to WIC participants.

"We're doing pretty much everything we can to try to help families find the formula they need," Cathy Winston, nutrition manager at the Northern Kentucky Health Department, told the committee. "And it's been a real challenge." 

Moser commended the department for its efforts, but suggested more needs to be done for families not on WIC, by providing information to them about what substitutes are acceptable if they can't find the baby formula they normally use. "We have some desperate families out there," she said.

Shannon Stiglitz, a lobbyist for the Kentucky Retail Federation, walked the legislators through challenges that retailers face in the formula shortage, including supply-chain issues that started during the pandemic, the need to limit on purchases to minimize panic buying, and efforts to minimize theft. 

Stiglitz said four baby-formula manufacturers in the country is "too few," and said Abbott has contracts with 30 of the 31 states that use a single provider, exacerbating the shortage for WIC families.  

Breastfeeding as an option

Sen. Ralph Alvarado, R-Winchester, encouraged new and expectant mothers to consider breastfeeding and consult their doctors about it. 

"You won't have to worry about any of this., and you can provide your child with the nutrition that it needs, probably the best nutrition that your baby could have," said Alvarado, a physician. "So I would encourage moms to think about that. That's really the the answer for this moving forward."

Some new mothers don't want to breastfeed, or have to rely on formula for several reasons; they may have an illness, incompatibility with work schedules, or issues with lactation or their baby's latching to a breast.

FDA chief says baby formula supply is expected to remain short through late July; meanwhile, shortage gets worse in Kentucky

Photo from The Associated Press

By Melissa Patrick
Kentucky Health News

The baby formula shortage continues to worsen in Kentucky, with the state's out-of-stock rate increasing by 20 percentage points since May 8, according to the retail data firm Datasembly. 

Datasembly reports that in the week starting May 15,  the latest data available, Kentucky's out-of-stock rate for baby formula increased to 75%, up from 55% the prior week. That placed Kentucky 26th among the states, with out-of-stock rates ranging from a high of nearly 89% in Utah to a low of 45% in Illinois. The nationwide out-of-stock rate is 70%. 

Gov. Andy Beshear said at his May 26 news conference that he could not confirm the data, but said, "Certainly there is a nationwide shortage, which is real concerning." 

Kelly Potts, a spokeswoman for Datasembly, said in an e-mail that their data comes from more than 230 retailers with over 130,000 stores across the U.S., Canada and Mexico, and the out-of-stock (OOS) index only includes U.S. stores. 

"Datasembly’s proprietary data collection platform collects OOS information for each designated product based on OOS indicators . . . We collect the in-stock and out-of-stock information at the product level for each of the stores," Potts said. "For example, if a retailer offers 10 unique formula products on the shelf and the indicators point to 5 of the 10 products being out of stock, this would generate a 50% out-of-stock status." 

Beshear encouraged Kentuckians who are part of the Special Supplemental Nutrition Program for Women, Infants and Children, or WIC, to reach out to their WIC provider, which is usually the local health department, if they are struggling to get enough formula. He said those who are not part of the WIC program should reach out to their pediatrician.

WIC is available to Kentucky residents who are pregnant, breastfeeding or have a child 5 or younger and have household income of no more than 185% of the federal poverty level, with rules governing what counts as income. Anyone who receives Medicaid or is part of the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) automatically meets the income requirements for WIC. Click here for a WIC PreScreening Tool to see if you are eligible for WIC benefits. 

According to the state Department for Public Health, Kentucky has about 19,500 infants on WIC who are fully formula-fed in any given month. 

The health department said it connects WIC participants with about 350,000 containers of formula per month, accounting for about $2.2 million in WIC benefits per month, just over a third of the total benefits. 

The department said redemption of formula since the February recall by major manufacturer Abbott Laboratories has declined by about one-third, from an average utilization rate of about 82% six months before the recall to about 69% in the first quarter of the year.

The agency said it took several actions in response to the recall. 

"The Kentucky WIC Program quickly requested and began to execute all waivers available to the states as soon as the U.S. Department of Agriculture provided for them," Susan Dunlap, spokeswoman for the department, said in an e-mail. "However, that has only been a small part of their response." 

Louisville's WFPL reports that Kentucky made its first policy change to expand the types of formula covered by WIC in February, and has since updated this policy several times to add more types of formula to the list. Click here to see the list of approved formulas available to WIC participants. 

Dunlap said the state has worked to keep local health departments updated as the situation has unfolded; is pushing important updates to WIC families via the WIC Shopper smartphone app; and are in "constant contact" with Abbott about reports of regional supply deficiencies. 

In a story about the baby formula shortage that opened with the state's May 8 out-of-stock rate, Norge Garcia told the Louisville Courier Journal about his struggles to find the specific formula for 4-month-old, who was born premature and can only have one type of formula, Nutramigen, because of his weight.

"I walked the day before yesterday more than six hours looking for milk, and of the 10 cans that WIC gives us . . . we only got one," Garcia told the newspaper in Spanish.

"I went to seven Walmarts — all the Walmarts that are here in Louisville, I went to all of them," he said. "I went to Target and none of them have any. There is only milk for babies 9 months and older."

Abbott and the U.S. Food and Drug Administration recently agreed how to reopen the Michigan plant where formula is made, but it will take several weeks to affect supplies. Beshear said Thursday, "We believe that we're going to see a significant boost in the coming weeks, but we've got to get to that point." 

The baby formula shortage in the U.S. will likely not be resolved until late July, FDA Administrator Robert Califf said Thursday at a Senate Health Committee hearing, The Hill reports.

"My expectation is that within two months we should be beyond normal, and with a plethora,” Califf said. “It’s going to be gradual improvement up to probably somewhere around two months until the shelves are replete again.”

Beshear and Senate president discuss medical marijuana, hero pay; Stivers says PBM bill stuck in Senate over cost concerns

By Melissa Patrick
Kentucky Health News

FRANKFORT — State Senate President Robert Stivers said he favors funding more research on medical marijuana before making it legal in Kentucky, but Gov. Andy Beshear says medical cannabis has overwhelming support in the state and should pass when the legislature returns to reconsider vetoed bills. 

At separate press conferences in Frankfort Thursday, the two leaders also discussed the Republican legislature's rejection of the Democratic governor's plan to give Kentuckians who worked throughout the pandemic a "hero bonus;" and Stivers said a House bill to rein in pharmacy benefit managers died in the Senate for fear it would raise consumers' and employers' costs.

Medical marijuana: Stivers said the House-passed cannabis bill "would be difficult" to pass the Senate next week, but he supports a bill by Rep. Kim Moser, R-Taylor Mill, to create a cannabis research center at the University of Kentucky and expects it to pass. "I think it not only would be good locally but nationally and internationally to understand the medicinal and therapeutic values of marijuana," he said.

Senate President Robert Stivers

Stivers acknowledged that studies show cannabis helps with certain medical conditions, "but every study I've read said the sample sizes have been too small, the duration is too long and therefore more study is needed."

Moser's House Bill 604 has had two of its three required readings, so it could clear the Senate Appropriations and Revenue Committee and the full Senate quickly on April 13 and/or 14.

Beshear urged the legislature to pass the medical-cannabis bill in those two remaining days, which would require suspension of the three-readings rule. "Its time has certainly come."  

He added, "Kentuckians deserve the passage of a medical-marijuana bill. They overwhelmingly support it. When 70-plus percent of a state is in favor of something, it's time for the General Assembly to step up and do something about it. Represent the people." 

Asked later if he could do anything by executive order to make it easier for people with certain conditions to have access to medical cannabis, Behsear said, "We're going to explore that. . . . I am for medical marijuana and I will continue to push it until we make it a reality." 

The House passed its cannabis bill, HB 136, by a vote of 59-35, with just over half of the Republicans who voted on the bill favoring it. A similar bill passed the House in 2020 but died in the Senate. 

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

Asked why the bill didn't gain any traction in the Senate after such overwhelming support in the House, Stivers said, "When it got here, we started getting, from business sector and provider sector, various questions and comments about what the overall cost would be to various plans." 

The bill was opposed by one of the session's heaviest lobbying campaigns. The Pharmaceutical Care Management Association, the PBM trade group, spent $38,369 to get its message to lawmakers before March, when it ran television commercials urging voters to ask their legislators to defeat it.  

Stivers said it had been assigned to the Appropriations and Revenue Committee "because it has potential fiscal impact -- local, individual, personal and state fiscal impact." He indicated that the bill would not pass, since that would require suspension of the three-readings rule, and more education would be needed among Republican senators about what it would do. 

Hero bonuses: Stivers said the General Assembly took a different approach to hero bonuses that he said would benefit everybody, mainly because it was too hard to determine just who would qualify for bonuses. He said the legislature is giving income-tax reductions and workforce incentives, and investing in  infrastructure and higher education. 

Gov. Andy Beshear

Beshear disagreed, reflecting on how scary it was early in the pandemic when the mortality rate from the virus was 10 percent in some places and essential workers were asked to show up at work every day.

"I believe this legislature needs to spend some of the last two days including hero bonuses. They deserve those hero bonuses. . . . I think it's really disappointing."

Health bills become law: Beshear signed three more health-related bills into law Thursday.

House Bill 525, sponsored by Moser, would allow Medicaid to pay certified community health workers. CHWs aren't trained medically, but are trained as patient advocates who come from the communities they serve. They help clients coordinate care, provide access to medical, social and environmental services, work to improve health literacy, and deliver education on prevention and disease self-management.

Senate Bill 10, sponsored by Sen. Robby Mills, R-Henderson, addresses the nursing shortage with both short-term and long-term solutions, including streamlining the process for out-of-state and foreign trained nurses to practice in Kentucky without compromising the standards of care; improving access to nursing education by removing "arbitrary" enrollment limits without compromising the quality of the programs; and adding term limits and geographic requirements for the Board of Nursing.

Senate Bill 105, sponsored by Sen. Max Wise, R-Campbellsville, will increase awareness and screenings for the cytomegalovirus (CMV), a virus that can cause childhood deafness and other health conditions. Most CMV infections are not diagnosed without newborn screening, resulting in missed opportunities for needed care. It is titled Bella Dawn Streeval’s Law, after a woman who died two years ago Thursday after suffering from CMV.

Opinion: Legislature is moving bill that would restrict abortion rights while ignoring several filed to help babies and mothers

This opinion was originally published in the Lexington Herald-Leader.

By Linda Blackford

Herald-Leader Opinion Editor

Why bother writing about abortion access in Kentucky? The die is cast, as it were, with superdupermajorities in the state House and Senate who can legislate however they want. It’s very possible that in the near future, the Supreme Court will strike down the constitutional right to an abortion, and Kentucky will become once again home to back alleys and wire hangers. We already have a trigger law in place outlawing the practice in Kentucky as soon as the Supreme Court rules.

On Tuesday, March 1, the House Veterans, Military Affairs and Public Protection Committee, which for some strange reason now hears abortion bills instead of the Health and Family Services Committee (because Health members might be too touchy-feely?), approved House Bill 3, the new omnibus bill that does all kinds of things to make it even harder to get an abortion here. The bill takes special aim at MAB, medication that can cause an abortion very early on in a pregnancy, and is so safe and effective that it accounts for half of all abortions in Kentucky and was recently approved by the Food and Drug Administration to be sent through the mail directly to people’s homes.

Photo illustration from Deamstime

So why shout into the wind (again)? Well, I think it’s worth pointing out that Republicans are not the only ones who care about mothers and babies. The Kentucky House Democratic Women’s Caucus (again) has crafted a slate of maternal health bills, not one of which has been even assigned to committee.

They range from a sales tax exemption for breast pumps to bereavement leave in the case of a child’s death to Medicaid coverage for doulas. House Bill 37 would try to stem Kentucky’s horrific maternal mortality rates, including the fact that Black women die at more than double the rate of white women. According to the 2020 Maternal Mortality Report for Kentucky, in 2017, roughly 76 percent of all maternal deaths were preventable.

One exception is House Bill 174, which would extend Medicaid to new mothers for up to a year, which passed the House, and of course there are some Republicans, like Sen. Julie Raque Adams of Louisville, who have worked hard on issues affecting families.

But 16 bills from House Democrats would also address getting new mothers on Medicaid, postpartum depression, parental leave, and new rights for pregnant inmates. In other words, they are all trying to help the lives of mothers and babies in this state — actual people who are already here — in humane and holistic ways.

And let me say this again: None of these bills has been assigned to committee, which tells us that the majority party is not really that interested in doing anything but score political points.

There are two more bills that sit ignored in the Committee on Committees: House Bills 299 and 300 would require health-care plans to cover birth control before and immediately after a pregnancy. If I were worried about unwanted pregnancies, I’d be very interested in getting birth control to more people, but that is both logical and consistent, two words that don’t abound in Frankfort.

Despite what Republicans tell you, no one thinks abortion is grand or wonderful, but as many doctors will tell you, it can be an important part of women’s healthcare that should be between those women and their doctors. The fundamental hypocrisy of the GOP caring only about the unborn is alive and well. Sadly, it will probably be even more on display in the years to come. 

Linda Blackford writes columns and commentary for the Lexington Herald-Leader. She has covered K-12, higher education and other topics for the newspaper for the last 20 years.

Virus that was suppressed by pandemic measures resurges in Ky. and the South; main threat is to younger kids, vulnerable adults

The Centers for Disease Control and Prevention is advising people in Kentucky and states to the south to look out for a respiratory illness that is spreading in the region.

The disease is inter-seasonal respiratory syncytial virus.  RSV cases have been reported in Kentucky, Tennessee, Arkansas, Oklahoma, New Mexico, Texas, Louisiana, Alabama, Florida, Georgia, Mississippi and the Carolinas.

"Infants, young children, and older adults with chronic medical conditions are at risk of severe disease from RSV infection," the CDC said in an official health advisory Thursday. "Each year in the United States, RSV leads to on average approximately 58,000 hospitalizations with 100 to 500 deaths among children younger than 5 years old and 177,000 hospitalizations with 14,000 deaths among adults aged 65 years or older."

RSV was suppressed last winter, due to precautions taken to thwart the coronavirus, so "older infants and toddlers might now be at increased risk of severe RSV-associated illness since they have likely not had typical levels of exposure to RSV during the past 15 months," the CDC warns. "In infants younger than six months, RSV infection may result in symptoms of irritability, poor feeding, lethargy, and/or apnea with or without fever."

Older children may have runny nose and decreased appetite, followed by cough, often followed by sneezing, fever, and sometimes wheezing, CDC says. Symptoms in adults are much like those caused by common cold viruses, and there is no specific treatment other than management of symptoms.

Volunteers of America gets grant for drug treatment and recovery services for pregnant and postpartum women in southeastern Ky.

Volunteers of America Mid-States received a $2.6 million federal grant, one of three in the nation, for treatment and recovery services for pregnant and postpartum women and their children in southeastern Kentucky. VOA says it and the University of Kentucky's Human Development Institute will use the money "to serve an estimated 1,250 individuals and their families over a five year period," said a news release from Senate Majority Leader Mitch McConnell and 5th District U.S. Rep. Hal Rogers. 

The release said the two Republicans contacted the Substance Abuse and Mental Health Services Administration "in support of their constituents’ grant application and inspirational work to help mothers and families maintain long-term recovery." The program will be based in Manchester.

“This federal investment into southeastern Kentucky is welcome news as we continue facing the crisis of addiction,” said state Senate President Robert Stivers, R-Manchester. “For years, Senator McConnell has brought national attention and federal resources to support the life-saving efforts such as those of Jennifer Hancock and VOA. It’s been my privilege to work with them both on behalf of Manchester and those in need. I’m grateful they are constantly delivering for Kentucky, and I look forward to the many families who will benefit from this grant.” 

Video to prevent shaken baby syndrome, being seen at birthing centers, wins a state public-health award

A video aimed at preventing shaken baby syndrome, by educating parents about it, has won an award from the Kentucky Public Health Association.

“Many of us remember taking a baby home from the hospital and thinking, ‘Where’s the instruction book?’” said Bill Jones, CEO of WellCare of Kentucky, which so-sponsored the video. “This video doesn’t provide answers for all of parenthood’s challenges, but it will give parents vital information to help keep children safe. As the largest Medicaid provider in Kentucky, we believe strongly in the importance of prevention practices. Often, information is prevention.”

WellCare, a managed-care company, developed the video with Prevent Child Abuse Kentucky and the Kentucky Hospital Association, which shared in the award. They distributed the video to birthing centers throughout Kentucky last year.

The hospital group said the video could be viewed by 50,000 new parents a year, at the state's 46 birthing centers. “Becoming a new parent can be both overwhelming and joyous,” CEO Nancy Galvagni said. “Our birthing hospitals are in a unique position to provide immediate support to new parents, and through this ground-breaking educational video, we can protect thousands of infant lives.”

Shaken baby syndrome is the common name for pediatric abusive head trauma. "Serious traumatic brain injury in young children is largely the result of abuse and results in significant morbidity and mortality," says the Centers for Disease Control and Prevention.

The video focuses on the story of Liz Renner, and her son Colton, Now 4, Colton suffered trauma at the hands of a caregiver as an infant. “My hope is our personal story can be shared with as many new parents as possible so others can prevent this type of trauma from happening to their babies,” Renner said.

Children need 14 doctor visits before age 6, but preschoolers are increasingly not covered by insurance, especially in Kentucky

Kentucky Health News

In 2018, the number of Kentucky pre-schoolers without health insurance was about half again as large as the number had been in 2016, and that was one of the largest increases in the country over that time.

Researchers at Georgetown University in Washington, D.C., found that 4 percent of Kentucky children under 6 lacked insurance in 2018. In 2016, it was 2.7%. In percentage points, Kentucky's increase was the nation's fifth largest.

Chart by Stateline, Pew Research Center

Kentucky's percentage stayed under than the national average, but got much closer to it. The U.S. figure rose to 4.3% from 3.8%.

Ten other states — Alabama, Florida, Georgia, Illinois, Kentucky, Missouri, Ohio, Tennessee, Texas, Washington and West Virginia — also had significant increases, alarming health officials and experts.

Kentucky was one of seven states where the uninsured rate for children under 6 was higher than the rate for those 6 to 18.

"The first years of life play an outsize role in human health. They are foundational to the development of the brain and the cardiovascular, immune and metabolic systems. Early childhood is when medical interventions to correct problems in any of those areas are most likely to succeed," Michael Ollove writes for Stateline, a publication of the Pew Charitable Trusts.

"The American Academy of Pediatrics recommends that children visit the doctor at least 14 times before they turn 6 years old. During those visits, they should receive speech, hearing and vision tests, as well as screenings for genetic disorders and the possible effects of trauma or toxic exposure. The U.S. Centers for Disease Control and Prevention recommends that children under 6 receive numerous vaccinations, including for hepatitis A and B, diphtheria, whooping cough, polio, chicken pox, and measles, mumps and rubella."

Experts say children need 14 medical checkups before age 6.
(Photo by Amber Arnold, Wisconsin State Journal, via Stateline)

Al Race, deputy director at the Center on the Developing Child at Harvard University, told Ollove that a lack of health-insurance coverage often leads to a lack of health care, and can allow health problems to persist into adulthood instead of being corrected: “The earlier you can catch them, the easier it is and the better results you’ll have to put things back on track.”

After Kentucky expanded Medicaid under the Patient Protection and Affordable Care Act in 2014, the percentage of children in the state with health insurance rose to 96.2%, from 93.6%. Children are covered by the Children's Health Insurance Program, a program similar to Medicaid in which the federal government pays most of the cost, but the Medicaid expansion encouraged more enrollment. As the economy improved, adult Medicaid enrollment declined.

Supporters of the ACA said the reduction in the adult uninsured rate stalled because of the Trump administration's attempts to repeal and "sabotage" the law, through a shorter window to sign up for subsidized health insurance, huge cuts to the advertising budget and the number of "navigators" who help people find an insurance plan and the removal of the individual mandate to have insurance. Critics of the ACA blamed the stalled progress on rising premiums in the individual market.

Kentucky had nation's third largest increase in 2016-18 in percentage of children under 6 without health insurance

By Melissa Patrick
Kentucky Health News

Over the past two years, Kentucky saw the third largest increase in the nation for the percentage of children under 6 years of age with no health insurance, says a Georgetown University study.

The university's Center for Children and Families' analysis of the most recent census data found the rate of uninsured children under 6 in Kentucky rose from 2.7 percent to 4 percent between 2016 and 2018. That was a bigger jump than the increase in the national rate during the period, from 3.8% to 4.3%.

The state's rate had been trending down since 2014, when the state fully implemented the 2010 Patient Protection and Affordable Care Act.

The rate was 5.2% in 2013, 4.1% in 2014, 3.5% in 2015 and 2.7% in 2016, before increasing in 2017 to 3.5% and to 4% in 2018.

The estimated number of uninsured Kentucky children under 6 rose from 8,608 in 2016 to 12,973 in 2018, meaning that 4,365 more didn't have coverage, a 50.7% increase.

Chart from Georgetown report; click on it for larger version

Kentucky was one of 11 states that showed a significant increase in both the rate and number of uninsured young children, says the report. It doesn't say whether the increase is specific to any one type of coverage.

In a blog post about the report, the liberal-leaning Kentucky Center for Economic Policy reports that the Georgetown finding is in line with the broader coverage losses seen in Kentucky from 2016 to 2018. "But the increase in the number of uninsured young children (50.7%) far outpaced the increase in the number of uninsured Kentuckians as a whole (10.9%)," writes KCEP policy analyst Dustin Pugel.

Pugel told Kentucky Health News in an email that the increase could be partly a result of "practices in Kentucky that enforced stricter paperwork requirements, which led to 97,438 Kentuckians losing Medicaid coverage in state fiscal year 2019." He provided a month-by-month list of discontinuances due to paperwork, based on state data. "Although it’s not clear how many of these would not have been eligible had they presented the paperwork in time, how many were children, or how many may have regained coverage since," he wrote, "an enrollment loss of that magnitude must have contributed to the increase in uninsured to some degree."

A spokesperson for the state Cabinet for Health and Family Services said Friday that it would need time to review the report before commenting.

The Georgetown report says it is critical for children under 6 to have health insurance, not only for medical care during a time that includes rapid brain development and physical growth, but also because it protects families from financial risk that can come from an unexpected injury or illness. Further, it points to research that shows health insurance for children is linked to better health, educational, and economic outcomes well into adulthood.

The American Academy of Pediatrics recommends that children get 15 checkups before age 6. These early visits include not only vaccinations and preventive care, but screenings that can detect developmental delays to allow for early intervention.

The Georgetown report notes that the increases occurred during a time of economic growth, "when children should be gaining health care coverage," not losing it. The report says a number of factors could have contributed to this coverage reversal, including declines in Medicaid and in the Children's Health Insurance Program.

It adds that these declines have likely been influenced by the Trump administration's "policies and rhetoric targeting immigrant families," which has reportedly deterred many parents from signing up eligible-citizen children in available Medicaid and CHIP coverage. It also points to ongoing national policy debates and decisions that it says have "undoubtedly sowed confusion among parents and caregivers about whether coverage would be available to their children."

Specifically, the report points to 2017 efforts in Congress to repeal the ACA and cut Medicaid, along with a months-long delay in funding the children's insurance program, as well as cuts to outreach grants designed to boost enrollment.

Adding to Kentuckians' confusion, Pugel notes, they also had to keep up with the status of the Medicaid program, which then-Gov. Matt Bevin was trying to change with, among other things, work requirements. The proposal has been blocked by a federal judge, and new Gov. Andy Beshear has said he plans to rescind the proposal.

Kentucky's numbers would likely be higher if Beshear's father, then-Gov. Steve Beshear, had not expanded Medicaid to adults with incomes up to 138 percent of the poverty line, because the report shows that young children were more likely to be uninsured in states that did not expand Medicaid.

"Research shows that when adults have access to coverage, they are more likely to enroll their eligible children," says the report. This is often called the "welcome mat."

The report adds that young children tend to be uninsured at lower rates than their school-aged peers. However, Kentucky and six other states have shown an opposite trend; in Kentucky, 4% of its young children are uninsured, compared to 3.7% of school-aged children.

"For these states," the report says, "the inversion serves as a potential warning sign that more could be done to reach uninsured young children."

March of Dimes gives Ky. D-minus for high rate of pre-term births; maternal deaths spike; new collaborative will work on such issues

By Melissa Patrick
Kentucky Health News

Childbirth, which should be one of life's most joyous occasions, has become more deadly for Kentucky mothers, and remains problematic for many Kentucky babies because it comes too early.

One in nine Kentucky babies are born prematurely, so many that the March of Dimes gave the state a D-minus on its 2019 Premature Birth Report Card. And the rate of Kentucky women who died as a result of pregnancy complications nearly doubled from 2017 to 2018.

A baby is premature if born before 37 completed weeks of pregnancy, which is four weeks short of full term. In 2018, Kentucky had 6,109 pre-term births, 11.3 percent of live births. The national average is 10%, a rate that has risen four years in a row.

Because important growth and development happens in the last weeks of pregnancy, pre-term babies are at an increased risk of neurological disorders, intellectual disabilities, and respiratory and digestive problems. They are also more likely to have vision and hearing problems. Complications from being born early is the main overall cause of newborn death, the March of Dimes says.

Pre-term babies are also more at risk for long-term challenges, including chronic diseases such as heart disease, high blood pressure and diabetes, says University of Kentucky HealthCare.

November is Prematurity Awareness Month. The cause of about half of premature births is unknown, but the March of Dimes says there are common risk factors, the strongest being a history of pre-term birth, multiple pregnancy and certain uterine or cervical conditions.

Other factors in the mother that can increase risk include being underweight or overweight, diabetic or older than average for a mother; smoking or using drugs during pregnancy; or having preeclampsia, a type of high blood pressure that some women get during or right after pregnancy.

Kentucky has one of  the highest rates of smoking during pregnancy in the nation, with nearly 18% of pregnant women in the state smoking cigarettes at some time during their pregnancy. The national rate is 6.9%, according to the United Health Foundation's health rankings.

This year's March of Dimes report also looks at several factors that are linked to adverse maternal and infant health outcomes, such as whether a mother has health insurance or prenatal care or if they live in poverty. It also looks at racial disparities in pre-term birth, beyond the aforementioned factors.

In Kentucky, 7% of women between 15 and 44 were uninsured, and 18.6% of them lived in poverty. Among those who were pregnant, 14% received inadequate prenatal care. The pre-term birth rate among African American women in Kentucky is 30% higher than the overall state rate.

In addition to the increasing rates of pre-term birth, the report notes that more than 22,000 babies a year in the U.S. die before their first birthday. That's about two babies every hour.

Number of maternal deaths nearly doubles

The report also says that a woman in the U.S. dies from pregnancy complications about every 12 hours, and more than 60% of those deaths are preventable.

Kentucky's maternal mortality rate nearly doubled in 2018, said Dr. Connie White, deputy commissioner for clinical affairs in the state Department for Public Health. In 2017, the state had 39 maternal deaths, with substance abuse a factor in 62% of them; in 2018, that number increased to 76, with at least half related to substance abuse, according to death certificates.

White said the state is still reviewing patients' medical records for 2018, but the numbers are evidence that "We are failing as a system" of delivery hospitals and providers, which should prompt all to ask where that failure exists.

To tackle these problems, the state recently launched the Kentucky Perinatal Quality Collaborative. It will work toward reducing premature births, maternal mortality and neonatal abstinence syndrome, and improving maternal and infant health outcomes. "Perinatal" refers to care given before and after the birth of a child.

White said the collaborative will ask key questions: "Are we not getting people into treatment? Are we not connecting them?" she asked. "Are we not following up afterwards? Are we working with women who have had their children taken away from them? What are we doing to really wrap our arms around these women?"

White said the collaborative will also look at data and recommendations from a new Maternal Mortality Review Committee to create evidence-based interventions that all providers and delivery hospitals can implement.

"This quality collaborative can now take those recommendations and we hope start making inroads into decreasing Kentucky's maternal death rate," she said, adding later, "There are evidence-based things that we can do, but we need to all be rowing in the same direction."

The collaborative is funded by a three-year grant from the federal Centers for Disease Control and Prevention. White said there was a great "pent-up" need for this collaborative, shown by 78% of the state's 46 birthing hospitals being represented at the collaborative's Oct. 22 launch in Louisville. Those hospitals represented 91% of the state's births.

White said the state is applying to become part of the Alliance for Innovation on Maternal Health program, which has created "bundles" of evidence-based protocols and training modules to address many of the problems that contribute to poor maternal and child outcomes, such as hypertension, hemorrhage, and maternal opioid use. After the state becomes part of the program, these bundles would be available to all of the state's providers and delivery hospitals.

She noted that six counties in Kentucky offer the Sobriety Treatment and Recovery Teams program to help parents with addictions to keep their children out of foster care while keeping the child safe. The counties with START are Kenton, Jefferson, Boyd, Martin, Daviess and Fayette.