State judge dismisses constitutional challenge to anti-vaping law

Kentucky State Capitol Building

By Sarah Ladd
Kentucky Lantern

Franklin Circuit Judge Thomas Wingate has dismissed a lawsuit challenging the constitutionality of a 2024 law banning the sale of some vaping products.

Wingate sided with the lawsuit’s defendants — Allyson Taylor, commissioner of the state Department of Alcoholic Beverage Control, and Secretary of State Michael Adams — who filed a motion to dismiss. The law designates the ABC as its enforcement agency.

The Kentucky Smoke Free Association, which represents vape retailers, had argued that the law was too broad and arbitrary to be constitutional because it is titled “An act relating to nicotine products” but also mentions “other substances.” The state constitution says a law cannot relate to more than one subject.

In his opinion, Wingate said the law doesn’t violate the state constitution.

The law’s title “more than furnishes a clue to its contents and provides a general idea of the bill’s contents,” he wrote.

The law’s “reference to ‘other substances’ is not used in a manner outside of the context of the bill, but rather to logically indicate what is unauthorized,” Wingate wrote.

The lawsuit centers on House Bill 11, which passed during the 2024 legislative session and is scheduled to take effect Jan. 1. Its backers said it will curb underage vaping by limiting sales to “authorized products” or those that have “a safe harbor certification” based on their status with the U.S. Food and Drug Administration.

Opponents have said it will hurt small businesses and favor big companies, and could drive youth to traditional cigarettes.

Altria, the parent company of tobacco giant Philip Morris, lobbied for the bill and is pushing similar bills in other states. Altria, which has moved aggressively into e-cigarette sales, markets multiple vaping products that have FDA approval.

“The sale of nicotine and vapor products are highly regulated in every state, and the court will not question the specific reasons for the General Assembly’s decision to regulate and limit the sale of nicotine and vapor products to only products approved by the FDA or granted a safe-harbor certification by the FDA,” Wingate wrote in a Monday opinion. “The regulation of these products directly relates to the health and safety of the commonwealth’s citizens, the power of which is vested by the Kentucky Constitution in the General Assembly.”

As part of resetting its relationship with rural hospitals, UK will not build a new hospital at interstate junction in southeast Lexington

By Al Cross

Kentucky Health News

FRANKFORT, Ky. -- The University of Kentucky will not build a hospital in southeast Lexington because it wants to do what its network of rural hospital partners want: focus on its mission as a top-level care facility for the sickest patients, a UK vice president told a legislative subcommittee Wednesday.

Mark D. Birdwhistell (UK photo)

The proposed Hamburg-area hospital "was perceived as us stepping outside of our swim lane" by the university's clinical affiliates out in the state, Senior Vice President for Health and Public Policy Mark Birdwhistell told the Budget Review Subcommittee on Health and Family Services.

"We heard loud and clear, 'We want UK HealthCare to focus on taking care of the sickest of the sick. We don't want UK out doing primary care and secondary care.' . . . That was very eye-opening."

Birdwhistell reiterated, "The message we received loud and clear from our clinical affiliates was, 'When our folks get that sick, we want them to come to UK. We want them on campus. We don't them in a community hospital.'"

UK was in the planning process for a new hospital at the southern junction of Interstates 75 and 64, and had bought the property and done some initial work. Baptist Health is in the process of opening a new hospital on an adjacent site.

Instead of a hospital, UK will build a clinic with specialty services like the one it has built in a former department store in the Turfland Center in southwest Lexington, but larger, Birdwhistell said after the meeting: "Turfland plus."

He told the legislative subcommittee that the university will also build other clinics to serve its employees in Lexington and the Bluegrass region, many of whom are "having to get health care outside the system. . . . We feel like that is our obligation."

Birdwhistell spoke to the subcommittee in a new role, which he said will include centralizing the university's "government-relations activities across campus," including "building a better partnership with the General Assembly. I felt I was uniquely positioned to do that."

 

Previously, Birdwhistell was UK HealthCare's vice president for health system administration and chief of staff. He was secretary of the state Cabinet for Health and Family Services under Republican Gov. Ernie Fletcher, and helped Republican Gov. Matt Bevin propose changes to the federal-state Medicaid program, which he had run before becoming cabinet secretary. He appeared with Angela Dearinger, executive vice dean of the UK College of Medicine, who was briefly health secretary at the end of Bevin's term.

The General Assembly is firmly controlled by Republicans. In the recent legislative session, Birdwhistell was the university's point man in changing legislation that helped Pikeville Medical Center and some other rural trauma hospitals but in its original form would have reduced some of the extra Medcaid payments that UK gets for being a "safety net" hospital.

That relates to UK's recent takeover of other hospitals in Ashland and Morehead, which Birdwhistell discussed at Wednesday's legislative subcommittee meeting. Speaking of UK's absorption of King's Daughters Medical Center in Ashland, he said "Where we failed . . . is when you put that UK brand in front of that name, that brings with it an expectation of service, not predator," which he said was the perception of some.

"And so, we're readjusting a lot of the narratives to say, 'When you have UK in front of your name, you go to a partner and say, 'What can we do to help you be successful?' It's not 'What do we do to crush you?' And this is community health care. This is not our forte, so we've learned that lesson. . . . We can grow the workforce for those providers and not have to do it ourselves."

Birdwhistell said UK can also serve as a backstop for its rural partners, noting that UK doctors rearranged their schedules one weekend to keep open the neonatal intensive-care unit at Pikeville, which would have had to close temporarily due to employee vacations. "That's what we do," he said. "That's where we excel and that's where we need to get back to."

UK's latest acquisition is St. Claire Medical Center in Morehead, where it has run a satellite medical-school program for several years. The College of Medicine also has satellites in Bowling Green and Northern Kentucky, and Dearinger said it has seven residency programs in Bowling Green, the state's third largest city, and is starting residency programs in Ashland and Pikeville.

"We are trying to grow the number of doctors to stay in our state," Dearinger said, calling UK's Rural Physician Leadership Program "one of our crown jewels." She said it has produced 120 doctors, most of whom are practicing in Kentucky, "the vast majority" in rural parts of the state. Later, she said 42 percent of all recent medical-school graduates from UK have stayed in Kentucky, far above the 24% of "a few years ago."

Two Democratic legislators from Louisville, Sen. Karen Berg and Rep. Lisa Willner, asked Dearinger if UK has had fewer applicants for medical school or residencies due to restrictions on medical education, by which they meant the recent state law that bans abortions except in cases of threat to the woman's life or permanent damage to a life-sustaining organ.

Dearinger said "To be honest, we have not seen a decrease." She said she has heard anecdotal reports of students or graduates interested in obstetrics and gynecology going elsewhere, but "We are still inundated with OB applicants to do a residency at the University of Kentucky."

Another Louisville Democrat, Rep. Sarah Stalker, noted a May 16 Kentucky Health News story, from Kentucky Public Radio, that said 15% fewer U.S. medical-school graduates applied to Kentucky residency programs in the 2023-24 academic year, and there was a 23% decline in those for obstetrics and gynecology, according to the Association of American Medical Schools., which blamed the decline on the state's near-total abortion ban.

Dearinger said UK is still getting hundreds of "very good applicants, and we don't have any problems filling our residency programs and fellowship programs with very high-quality young physicians. We are prioritizing as much as we can, Kentucky students, so that they will stay" in the state.

Roll call: Most members of the subcommittee did not attend the late-morning meeting. The chairman, Sen. Donald Douglas of Nicholasville, a physician, noted that at the start of the meeting and made an unusually pointed comment: "I expect my colleagues in the General Assembly to show up."

Cigarette tax collections in Ky. jumped, then dropped, after tax increases; state's smoking rate has also been on the decline

Kentucky Health News graph from state data

By Melissa Patrick

Kentucky Health News

Increasing state cigarette taxes has proven to be an effective policy to decrease smoking rates, and it appears that is also true in Kentucky.

Nearly 30 percent of Kentucky adults smoked in 2011, two years after the legislature had doubled the cigarette tax to 60 cents a pack. Following a 50-cent increase to $1.10 in 2018, the state's adult smoking rate fell to 17.4% in 2022, the last year for which a rate is available. 

Shannon Baker, the American Lung Association's advocacy director for Kentucky and Tennessee, said that while she could not point to something definitive to explain why Kentucky's smoking rate has been decreasing, as has also been the case in the nation, she could speak to the impact of raising cigarette taxes:

"When taxes increase, smoking rates decline. We should take advantage of that, for goodness sake, and increase the cigarette tax in Kentucky by at least $1 and then tax all other nicotine products at parity with the cigarette tax." 

After an initial boost in cigarette-tax revenue from the rate hikes in 2011 and 2018, revenue from the tax declined 24% from 2019 to 2024.

The legislature increased the tax to 30 cents from 3 cents in 2005, but smoking rates before 2011 should not be compared with those after that because of a change in survey methodology, says the Behavioral Risk Factior Surveillance System, a continuing federal-state poll of Americans' habits.

Baker stressed that its important to take advantage of all policies that are known to decrease smoking. Beyond raising taxes, she said it's important to fund the state tobacco-control program and enforce the law against underage sales, which she said would result in fewer youth becoming addicted to nicotine and growing up to be lifelong smokers, and all the health issues that come with that. 

The new report on state General Fund receipts for the fiscal year that ended June 30 showed a 1.5% increase in receipts from other tobacco products, such as electronic cigarettes or vapes.

Asked about the impact of vaping on decreasing smoking rates, Baker focused her comments on young people, who are more likely to vape than smoke.

"We really have to get a handle on this youth vaping problem," she said, noting that Kentucky is one of about 10 states that doesn't require tobacco retailers to be licensed. "We don't even know where all of these shops are in order to enforce the law against underage sales."

Baker added, "We really need a better method of enforcing the law against underage sales. And what that looks like is licensure and routine regular enforcement opportunities that result in significant penalties all the way up to license suspension and revocation, for scofflaws that routinely violate the law. We're not talking about any onerous policy on those who are compliant with the law. We're simply talking about those who violate the law and violate it routinely." 

The 2023 Youth Risk Behavior Survey found that 5.3% of Kentucky high-school students said they currently smoked cigarettes and 19.7% said they used electronic vapor products. Among middle schoolers, the 2.2% said they smoked cigarettes and 12.8% used a vapor product. "Current use" is considered having used a product on at least one day during the 30 days prior to the survey.

Asked if she thought the new law that bans retailers from selling unauthorized vapor products would be effective in decreasing youth vaping, as it has been touted to do, Baker said, "House Bill 11 turned into . . . an industry market-share grab and nothing more; it is not a protection for kids. What we saw was a bill passing that, in effect would, if it's upheld in court, remove certain products, primarily imported products, from the market shelves, which in and of itself is not a bad thing. But, it certainly doesn't protect kids who will just switch to the other products that remain on the shelves." 

The law has been challenged in court. If it holds up, it will go into effect January 2025.

Baker also wanted to make sure people know that the funds for the state's tobacco control program come from the Master Settlement Agreement with cigarette manufacturers, not from the cigarette tax.

"We need to increase funding for tobacco control because . . .  Kentucky has the highest lung-cancer incidence and mortality rates in the entire nation and most of that is due to our high smoking rate," Baler said. "So even though the smoking rate may be declining, it isn't gone. It isn't good, even."

Coleman reappoints two members to state opioid commission

By Melissa Patrick

Kentucky Health News

Attorney General Russell Coleman has reappointed two members to the state opioid commission, thus not changing the balance of votes on the issue of syringe-exchange programs, which he says he opposes.

Those members are Jason Roop, an assistant professor of business and theology at Campbellsville University, who represents victims of the opioid crisis, and Van Ingram, who works for Gov. Andy Beshear as executive director of the Kentucky Office of Drug Control Policy and fills a slot representing the drug treatment and prevention community. Each of their terms expires in 2026. 

The Kentucky Opioid Abatement Advisory Commission has nine voting and two non-voting members. The legislature created the commission in 2021 to distribute the state's portion of the $900 million in settlements with opioid manufacturers and distributors, with half of the money going to the state and the other half going to local governments. 

The money is provided in installments and so far, the state has awarded 110 grants worth more than $55 million for treatment, prevention and recovery.

Attorney General Russell Coleman

Coleman's opposition to syringe exchanges was revealed when Chris Evans, the commission's executive director and a Coleman employee, passed on a vote approving a grant for the Boyle County Agency for Substance Abuse Prevention because it included help for a syringe exchange. 

In passing, Evans said Coleman doesn't support the exchanges. Coleman, a Republican who was elected in November, later said that was especially the case for programs that are not limited to one-for-one exchanges. His spokesman said Coleman would not base commission appointments on the issue.

As of February, 41 Kentucky counties had syringe-exchange programs that operate under a one-to-one rule and 24 counties have needs-based exchanges, according to the state Department for Public Health. It estimates that the overall return rate of syringes is 85% to 90%. 

Syringe exchanges are supported by research. The Centers for Disease Control and Prevention says injection drug users who have access to exchanges are five times more likely to get treatment than those who don’t. Another study says the exchanges do not encourage drug use or increase the frequency of drug use among current users.

Exchanges were authorized by the state's 2015 anti-heroin law, in an effort to thwart the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. 

They also work to reduce overdose deaths by distributing naloxone; reduce medical harms such as skin, blood stream, and heart valve infections that severely injure substance users and incur large health care costs for society; and connect substance users to treatment and recovery supports in order to achieve sustained abstinence.

Patricia Freeman, a University of Kentucky pharmacy professor, has also been reappointed to the commission – by UK as a representative of the HEALing Communities study team, which is working on reducing drug-overdose deaths. Her term will expire in 2026. 

Two new non-voting members have also been appointed. State Rep. Chris Fugate, R-Chavies (Perry County), was appointed by House Speaker David Osborne to replace retiring Rep. Danny Bentley, R-Russell. Karen Kelly, chief of staff to U.S. Rep. Hal Rogers, R-5th District, was appointed by Senate President Robert Stivers to replace Carlos Cameron. 

Other members of the commission are Republican state Treasurer Mark Metcalf, who also passed on the Boyle County vote; Cabinet for Health and Family Services Secretary Eric Friedlander, who works for Beshear; Von Purdy, a vice president of Simmons College in Louisville, representing citizens at large; Darren "Foot" Allen, a retired state trooper, representing law enforcement; and Karen Butcher, representing citizens at large.

U.S. Supreme Court agrees to hear case challenging laws like Kentucky's that ban gender-affirming health care for minors

Photo illustration by Shutterstock Creative

By Mark Sherman

Associated Press

The U.S. Supreme Court on Monday jumped into the fight over transgender rights, agreeing to hear an appeal from the Biden administration seeking to block bans on gender-affirming care like the one in Kentucky.

The justices’ action comes as Republican-led states have enacted a variety of restrictions on health care for transgender people, school sports participation, bathroom usage and drag shows. The administration and Democratic-led states have extended protections for transgender people, including a new federal regulation that seeks to protect transgender students.

The case involves a Tennessee law that restricts puberty blockers and hormone therapy for transgender minors. The federal appeals court in Cincinnati allowed the law and a similar one in Kentucky to take effect after lower courts had blocked them. The high court took only the Tennessee case, but a ruling in it will control the Kentucky case, lawyers for the Kentucky plaintriffs told Alex Acquisto of the Lexington Herald-Leader.

In their appeal, lawyers for the transgender teens in Tennessee told the justices, “Without this Court’s prompt intervention, transgender youth and their families will remain in limbo, uncertain of whether and where they can access needed medical care.” Arguments will take place in the fall.

Last month, South Carolina became the 25th state to adopt a law restricting or banning gender-affirming medical care for transgender minors, even though such treatments have been available in the United States for more than a decade and are endorsed by major medical associations.

Most of the state bans face lawsuits. The justices had previously allowed Idaho to generally enforce its restrictions, after they had been blocked by lower courts.

Kentucky and at least 23 other states ban transgender women and girls from competing in certain female sports competitions. At least 11 states have adopted laws barring transgender girls and women from girls’ and women’s bathrooms at public schools, and in some cases other government facilities.

The nation’s highest court has only rarely taken up transgender issues. In 2020, the justices ruled that a landmark civil-rights law protects gay, lesbian and transgender people from discrimination in employment.

Gender-affirming care includes a range of medical and mental health services to support a person’s gender identity, including when it’s different from the sex they were assigned at birth.

The services are offered to treat gender dysphoria, the unease a person may have because their assigned gender and gender identity don’t match. The condition has been linked to depression and suicidal thoughts.

Gender-affirming care has counseling and treatment with medications that block puberty, and hormone therapy to produce physical changes. Those for transgender men stop periods, increase facial and body hair and deepen voices, among other things. The hormones used by transgender women can slow growth of body and facial hair and increase breast growth.

Gender-affirming care can also include surgery, including operations to transform genitals and chests. These surgeries are rarely offered to minors.

Every major U.S. medical group, including the American Academy of Pediatrics and the American Medical Association, has opposed the bans and said that gender-affirming treatments can be medically necessary and are supported by evidence.

But around the world, medical experts and government health officials are not in lockstep. Some European countries in recent years have warned about overdiagnosis of gender dysphoria. England’s health service stopped prescribing puberty blockers to children with gender dysphoria outside of a research setting.

Contributing: Geoff Mulvihill and Carla K. Johnson, AP.

Dr. Bruce Scott, Louisville otolaryngoloist, becomes president of American Medical Association, says he's 'ready to fight' for docs

AMA President Bruce Scott, M.D.

Kentucky Health News

Dr. Bruce A. Scott, an ear, nose and throat specialist from Louisville, was sworn in Tuesday, June 11, as the 179th president of the American Medical Association, the nation’s largest organization of physicians.

“I became a physician to care for patients, and we all know that’s getting tougher every day,” Scott said in his inaugural address. “Our health-care system should help physicians provide good care, not get in the way!” He said “The AMA does for physicians and our patients what we as individual physicians cannot do.”

Scott said “two decades of spiraling Medicare payment cuts and ever-increasing administrative burdens” have increased burnout among doctors to the point that “almost two-thirds of physicians show signs of burnout. One-third plan to reduce their hours. One in five physicians are hoping to stop practicing or retire in the next two years.

“We can’t afford to lose even one more doctor! As a physician in an independent practice, I live these issues every day. I see my colleagues struggling. I feel the urgency of the moment. I will bring that urgency to my presidency. You better believe I’m ready to fight.” 

Scott has been president of his state and county medical associations and remains on their boards. "As a leader of these associations, he has fought for access to care for vulnerable populations, improvement in public health and reduction of administrative burdens in health care," an AMA news release said. He joined the AMA Board of Trustees in 2015 and was speaker of the AMA House of Delegates starting in 2019.

Board-certified in both otolaryngology and facial plastic surgery, Scott is president of Kentuckiana Ear, Nose & Throat, a six-physician independent private practice group, medical director of Premier Ambulatory Surgery Center, and holds a clinical appointment at the University of Louisville medical school.

Scott is a director of Health2047, the AMA’s Silicon Valley-based subsidiary that finds and funds tech-enabled commercial health-care enterprises. "In this role he is helping shape the future of medicine to empower patients and healthcare providers with meaningful and measurable impact," the release said.

He has written many articles for medical journals, as well as chapters in otolaryngology textbooks, He earned his undergraduate degree at Vanderbilt University, completed his education and residency at the University of Texas.

In his inaugural address, Scott told how he suffered a penetrating hand injury when he was 12 and a surgeon told his parents "that I was unlikely to ever regain normal use of my hand, and I would probably lose at least two fingers," but Dr. Joseph Kutz, Louisville's world-renowned hand surgeon, "saved my hand and spared my fingers, forever changing the course of my life -- and, although I didn’t know it at the time, putting me on the path that led to tonight. To this stage, to this incredible moment. I am a surgeon, using this very hand, because of a doctor."

Scott and his wife Christy have three adult children. He is the second Kentuckian in recent years to be AMA president; Dr. Steven Stack, the state public-health commissioner sicne January 2020, was president in 2016-17.

Bill to help Pikeville hospital turned into a law that will help other rural hospitals after UK saw it as a threat and rewrote the bill

State Sen. Phillip Wheeler discussed his SB 280
 on KET's "Kentucky Tonight." (Screenshot from KET)

By Melissa Patrick
Kentucky Health News

State Sen. Phillip Wheeler of Pikeville says one of the most consequential pieces of legislation passed by state lawmakers this year is a bill he sponsored to funnel more money to rural hospitals in Kentucky. 

Senate Bill 280 allows certain rural hospitals that get at least 35% of their revenue from Medicaid to get the same enhanced Medicaid reimbursement rate as the University of Kentucky or the University of Louisville. 

The hospitals are defined as those that have a trauma center and offer clinical rotations for doctors, nurses and other medical professionals who are in training.

"It kind of levels out that playing field," Wheeler told Kentucky Health News. "And it does this without placing any additional liability for matching funds on the General Fund by allowing local communities to assess a provider tax against the medical provider." Such taxes are applied to revenues of health-care facilities, typically to get more government matching money.

Asked if his bill will keep rural hospitals from closing, Wheeler said, "I wouldn't be so bold as to say that this is the only solution. I think you need to take a multifaceted approach and providing these hospitals with the ability to compete and the funding they need to develop this specialized care is one piece of the puzzle."

Wheeler, a Republican who represents Elliott, Johnson, Lawrence, Martin and Pike counties, said the higher reimbursements will allow rural hospitals to provide a higher level of care, especially when it comes to specialty services. And this, he said, will increase access to care for rural communities. 

"Not only does that make a huge difference to the patients being served, but it also will result in a much larger increase in investment in health care in those communities," he said. "And . . . especially in a lot of rural areas, including where I live in the 31st Senate District, health care has essentially become our largest industry. I mean, the largest employer in my district, by far, is Pikeville Medical Center with over 3,000 employees." 

Wheeler said he didn't think anyone would be harmed by this law, noting that he resolved concerns voiced by UK HealthCare, which has clinical rotations at King's Daughters Medical Center in Ashland, which it recently purchased.

Path to "good public policy" 

Mark Birdwhistell, UK HealthCare's vice president for health system administration and chief of staff, explained that UK and UofL receive enhanced Medicaid reimbursements because they are Level I trauma centers that agree to care for the "sickest of the sick" patients in the state and also house the state's primary educational programs for medicine and dentistry.

UK HealthCare VP Mark Birdwhistell

He said the impetus of SB 280 and its companion bill SB 281, which was not heard in committee, came about when UK bought King's Daughters, which allowed the Ashland hospital to get the higher Medicaid reimbursement. 

The original SB 280 would have given Level II trauma centers -- Pikeville has the only one in the state -- the same enhanced Medicaid rate as UK and UofL. SB 281 said UK and UofL could only take that enhanced Medicaid reimbursement in clinics or hospitals that operated in the county of the educational facility, limiting UK's enhancement to Lexington.

"Both of these had unintended consequences," Birdwhistell said, so UK could not support the bills in their original form. He said they would have left UK with lower Medicaid payments for services provided in any hospital that it has an agreement with to provide care, such as Hazard Appalachian Regional Healthcare. In addition, he said UK has practices in other counties, such as Bowling Green and Manchester, that get enhanced Medicaid payments.   

"That would have been devastating if that had come to fruition," said Birdwhistell, who was state health secretary in 2006-07. Later adding, "It would have significantly reduced funding and would have eventually compromised good patient care in the commonwealth."

That's because the state has to get ongoing approval from the federal government for the special Medicaid payment plans, one for public universities and another for private hospitals. And, he said, if these two pieces of legislation had passed in their original format, it would have triggered an amendment to the current plans, possibly putting them at risk. 

Driven by this concern, Birdwhistell said he suggested that the bill keep the existing enhanced Medicaid plans but have a different solution allowing a third way for hospitals to get the enhanced payments. 

"We moved it from a potential where we would not be able to get as much federal Medicaid money in the state to a new program that has the potential of pulling in additional reimbursement and an incentive to focus on access and improved outcomes, improved patient outcomes," he said. 

The revised bill that passed allows an opportunity for hospitals to get comparable reimbursement to what the universities get if they meet the criteria to do so, and Birdwhistell. And this, he said, accomplishes the goal of creating a more "level playing field."

Further, he said SB 280 allows the opportunity for additional Medicaid payments for care provided by other health-care workers, such as advance-practice registered nurses, dentists and social workers. It also says that pediatric teaching hospitals are able to get the additional Medicaid reimbursements for services to patients under 18. 

"So I think we ended up with good public policy that has the potential of improving access and  patient outcomes for the Medicaid population," Birdwhistell said.

He added later, "I think it is transformative because it has the potential of aligning people's incentives around an increased increased physician workforce, opening up additional access, appointment availability. And thirdly, aligning around access and quality." 

Birdwhistell said six or seven hospitals will likely qualify for the enhanced Medicaid payments in the first wave of hospitals. He said the goal is to get the plan submitted to the Centers for Medicaid and Medicare Services by Aug. 1 and for payments to be approved by January 2025. 

A news release from the governor's office said it estimates that 43 Kentucky hospitals meet the requirements of the new plan, dubbed the Kentucky Medicaid Assistance Program. The plan is contingent upon approval from CMS. Wheeler said they have "very good indicators" that it will be approved. 

Why SB 280 is important

Donavan Blackburn, president and chief executive officer of Pikeville Medical Center, said he'd been working on this bill for the last year and a half "to address the inequality and disparity between us and urban hospitals," which have a greater share of patients with commercial insurance, which pays higher rates. 

He pointed out that his Level II trauma hospital accepts patients from 48 other hospitals in the region who need a higher level of care and that 77% of them are either on Medicaid or Medicare. He said Pikeville Medical Center "serves the sickest of the sick and the most financially challenged in the nation." 

And while he said his hospital could be likened to UK or UofL when it comes to the services it provides, it is not a state-owned hospital or a teaching hospital. The hospital has an agreement with the University of Pikeville and four nursing schools to provide clinical rotations. 

In particular, he said it's his mix of payers that makes SB 280 so important because this extra money will allow the high level of care provided by the hospital to continue. 

"And what that extra payment means is, is that programs like our children's hospital, like our trauma center, like our specialties and subspecialties, endocrinology, rheumatology, all those different specialties that we're able to offer here in our community can stay in our community," he said. "Which means that not only people have access to care, but it prevents a diagnosis that if it goes untreated, becomes advanced, which costs actually the state and federal government even more."

Further, he said it will allow the hospital to retain jobs in health care, which is the top economic driver in the region. 

Blackburn said the success of SB 280 will be evident if they are able to "keep those service lines open and to keep making investments and advancements and to be able to keep up with all the other markets. . . . It's about advancement and sustainability." 

Ky. Hospital Association presents awards at annual convention

Nina Eisner, Lexington (KHA photos)

Kentucky Health News

The Kentucky Hospital Association honored several health-care leaders in the state at its annual convention in Lexington on May 21.

KHA’s highest honor, the Distinguished Service Award, was presented to Nina Eisner and Charles Lovell for untiring and exceptional service.

Eisner has served in clinical and administrative health-care positions for 45 years. In 2002, she became CEO of The Ridge Behavioral Health System in Lexington, She has been a strong advocate for Kentucky’s psychiatric hospitals and their patients and is a long-serving KHA trustee and has served in many other roles with KHA, the association said in a news release.

Charles Lovell, Barbourville

Lovell has been part of the Kentucky and Tennessee health-care landscape for the past 45 years. After serving as an emergency-room nurse in Memphis, he became CEO of several Tennessee and Kentucky hospitals, coming to Kentucky in 2003, to run Caldwell County Hospital in Princeton. He helped build a replacement hospital to serve Caldwell and Lyon counties.

In 2015, Lovell became community CEO at Barbourville ARH Hospital, which added many services and was the 2023 Knox County Chamber of Commerce Business of the Year. Lovell himself was the chamber's Man of the Year. Lovell has also held many roles with the KHA, chairing its Board of Trustees in 2013-14.

KHA’s Award of Excellence, given to individuals who have made significant contributions to health care in Kentucky, was presented to State Rep. Danny Bentley, R-Russell. 

Bentley, a pharmacist, has represented House District 98 (Greenup County and part of Boyd County) since 2017. He is known for helping his neighbors with health issues, and as a legislator helped pass measures that helped rural hospitals.

The KHA Health Care Governance Leadership Award, for individuals who have had a positive and sustainable impact on the quality of care in their communities through their work as hospital trustees, was presented to Gavin Roberts, chair of the Owensboro Health Board of Directors. The hospital is Owensboro’s largest employer, and Roberts has chaired the Owensboro Chamber of Commerce.

As new Covid-19 variants become dominant and boosters are needed, vaccine misinformation continues; here are the facts

Photo from Getty Images via Kentucky Lantern

By Sarah Ladd
Kentucky Lantern

In the last month, new Covid-19 variants emerged as the dominant strain in the United States.

Covid-19 vaccines are still recommended for protection against the virus, and everyone who is 65 and over, or had medical conditions that make them more vulnerable, is advised to get a Covid-19 booster this spring.

The Cabinet for Health and Family Services says the KP.2 variant has already been confirmed in the state. Kentucky does not have any KP1.1 cases, cabinet spokesman Brice Mitchell said. These variants are in a group called FLiRT, after letters in the names of the individual mutations.

“These variants are not thought to cause more severe disease but do have some mutations in the spike protein that may make them more resistant to immunity conferred by vaccines and prior infections,” Mitchell said.

Kentucky has low levels of emergency-department visits and hospitalizations for Covid-19, but Mitchell said the state Department for Public Health “continues to recommend that all Kentuckians six months of age and older remain up-to-date with their Covid-19 vaccinations.”

A spokesperson for the Centers for Disease Control and Prevention told the Lantern that the CDC “continues to encourage Americans to get vaccinated, as the Covid-19 vaccination continues to be the best way to protect against serious illness.”

Despite that advice, not everyone is convinced. In the fourth year of Covid-19 — and about three and a half years since the vaccines arrived — misinformation about them persists, even among elected officials.

During the 2024 legislative session, vaccine misinformation — specifically around the Covid-19 shots — found its way onto the Kentucky Senate floor and into committee meetings. The Lantern consulted the CDC, the Food and Drug Administration and other sources in response to several vaccine claims made by lawmakers this year:

 

Claim: “The deaths and adverse events recorded to the Vaccine Adverse Events Report System that are submitted to this (Covid) vaccine total more than all other vaccines combined, since the CDC implemented the reporting system in 1990.”

Response: This claim has been debunked multiple times by multiple sources.

After Covid-19 vaccines became available, adverse reactions reported to the Vaccine Adverse Event Reporting System did increase, the CDC says, in part because so many people — more than 80% of Americans — received the shot. The 675 million doses of Covid-19 vaccine that have been administered in the U.S. are more than other types of vaccines. Also, under the emergency authorization for the Covid-19 vaccine, the FDA required health-care providers to report any adverse reaction in a patient even if it’s unclear the vaccine was the cause.

The Vaccine Adverse Event Reporting System is a voluntary early-warning system. Anyone may enter information about side effects or other adverse reactions after a vaccine; the reports are not verified, but scientists use the data to spot worrisome patterns that merit investigation.

"Anti-vaccination fringe groups have attempted to spin false stories using VAERS data, adding to misinformation about the safety of Covid-19 vaccinations," says the Johns Hopkins Bloomberg School of Public Health.

A study published in the Journal of the American Medical Association in March found that the more likely a state was to vote Republican, the more likely its vaccine recipients or their clinicians reported adverse effects from Covid-19 vaccines. These results suggest that either the perception of vaccine effects or the motivation to report them was associated with political inclination.

Claim: “Covid-19 vaccines caused “unprecedented rise in sudden cardiac events, miscarriages and stillbirths, blood clots, myocarditis in youth, and sudden deaths among all ages.”

Response: Receiving the shot does not increase the risk of death from non-Covid causes. That conclusion is based on safety monitoring after more than 675 million doses of vaccine have been administered.

Covid-19 vaccination during pregnancy is safe and not linked to an increased risk of miscarriage or stillbirth, according to CDC safety monitoring and research. It has identified four rare but serious types of adverse events following Covid-19 vaccination. Two of them — thrombosis and Guillain-Barré Syndrome — were associated with vaccines that have been discontinued in the U.S. and are no longer available.

About 5 people per 1 million doses of vaccine have experienced anaphylaxis, a severe, potentially life-threatening allergic reaction that requires immediate emergency medical treatment. It can occur after any medication or vaccination.

Also, an increased risk of myocarditis – inflammation of the heart – is associated with the Pfizer and Moderna vaccines. Varying by age and sex, the rates of myocarditis after vaccination range from zero to 188 per 1 million doses. Research has found that the risk of myocarditis is higher following a Covid infection than after a Covid vaccine, according to the CDC.

CDC and FDA have detected no unusual or unexpected patterns indicating Covid-19 vaccines are causing or contributing to any other serious medical conditions.

Vaccination against Covid-19 reduces the risks of dying from Covid and suffering long Covid. The most common vaccine side effects are usually mild, such as soreness in the area where the shot was given.

Claim: “Pet vaccines are actually safer than people vaccines.”

Response: Animal and human vaccines undergo different approval processes. The U.S. Department of Agriculture’s Animal and Plant Health Inspection Service regulates veterinary vaccines and the Food and Drug Administration regulates human vaccines.

According to a 2014 paper in the National Library of Medicine, the two “differ markedly.” Vaccine effectiveness is more highly studied in human vaccines than in animal ones, that study found.

What the FDA says: The FDA “takes its responsibility for ensuring the safety, effectiveness and manufacturing quality of all vaccines approved or authorized for emergency use in the U.S. very seriously,” a spokesperson said.

All ingredients in new vaccines are looked at for safety and effectiveness. The “rigorous and extensive” approval process includes lab work, animal studies and human clinical trials.

“Highly trained FDA scientists and physicians thoroughly evaluate the information in a marketing application,” the FDA said, before ever approving shots for public distribution. Both pet and human vaccines are safe.

Does Ky. law protect in vitro fertilization? Depends on who's asked

State Rep. Lindsey Burke, D-Lexington, whose son was born through in
vitro fertilization, said state law doesn't protect the procedure. (LRC photo) 

By Sarah Ladd
Kentucky Lantern

None of the bills to explicitly protect in vitro fertilization in Kentucky got a hearing this legislative session, making them effectively dead on arrival.

With roughly eight months until the next session, some lawmakers and attorneys disagree on what protections exist for IVF under current Kentucky law.

Republican Sen. Whitney Westerfield — who has children thanks to IVF — believes there is an appetite in the General Assembly to pass specific IVF protections. The failure to do so, he said, was probably “a function of time.”

Westerfield filed a bill to protect the process on the filing deadline for Senate bills. His House and Senate colleagues who filed similar bills also did so right before or on the filing deadlines.

The issue, he noted, wasn’t on “anybody’s radar” until an Alabama Supreme Court decision — which came down right before the deadline to file Kentucky bills — seemingly complicated the treatment.

Westerfield, of Fruit Hill in Christian County, announced before the legislative session began that he would not seek re-electin this year.

 
‘They should always be preserved’

Westerfield and his wife, Amanda, are expecting triplets this summer. The three, as well as their 6-year-old son, were adopted as embryos — the result of someone going through IVF and donating eggs. The Westerfields also have a daughter who joined their family as a “traditional domestic adoption.” They have another embryo they are paying around $500 annually to preserve.

“I think they should always be preserved,” Westerfield said. “But I also understand not everybody holds that view. My son is one of those that was preserved, thankfully. These boys that are on the way were preserved.”

The Westerfields chose to have children this way because, had they gone through IVF themselves, “We were worried that we might have more than we could try to transfer on our own,” Westerfield said.

“We didn’t want to have so many left over that we couldn’t … bring to full-term birth ourselves and give a home to. And then you worry about making sure they end up in a home somewhere because we don’t want them destroyed. Not everybody wants to adopt an embryo and be pregnant. Some people do, thankfully.”

Even though the legislature didn’t pass the IVF-specific bills this year, it did pass House Bill 159, which Gov. Andy Beshear then signed into law. It gives health-care providers immunity from criminal charges for medical mistakes.

On the day HB 159 passed the Senate, Westerfield said he believed it would protect IVF by default because it broadly protects “providers.”

The law states: “A health-care provider providing health services shall be immune from criminal liability for any harm or damages alleged to arise from an act or omission relating to the provision of health services.”

Westerfield, who is also a lawyer, said this is “more comprehensive” than what he proposed to specifically protect IVF. “It covered everything mine covered and then some,” he said.

Ben Potash, a lawyer representing three Jewish women who are suing over Kentucky’s abortion law, believes HB 159 does not protect IVF since discarding extra eggs in the IVF process is a willful act.

HB 159 says “Nothing … limits any liability for gross negligence or wanton, willful, malicious, or intentional misconduct.”

 
‘No one really knows what the law is’

Potash believes the two topics — abortion and IVF — are too closely related to be separated. Going through IVF in Kentucky right now is “precarious,” he said. “No one really knows what the law is.”

Kentucky Attorney General Russell Coleman has called IVF “an incredible blessing for so many seeking to become parents,” and said “The plain language of Kentucky’s laws makes it clear that neither IVF nor the disposal of embryos created through IVF and not yet implanted are prohibited.”

But Potash says, “Making it civil, secular law that life begins at conception introduces all kinds of complications to IVF, to motherhood in general, to parenthood in general.”

Kentucky’s “Human Life Protection Act” — the trigger law that went into effect after the U.S. Supreme Court overturned Roe v. Wade in 2022 — states that an embryo is an “unborn human being” from egg fertilization to birth.

The 1973 Roe v. Wade decision established abortion as a constitutional right. Once that federal protection was gone, Kentucky’s law updated to all but ban abortion entirely, except in rare and life-threatening situations. 

Judith Daar, dean of Northern Kentucky University’s Chase College of Law and a legal expert on reproductive assistance, said that while “Many states have language in their statutes regarding abortion that declare life begins at conception or fertilization,” those laws also link abortion to pregnancy, which “is defined as an attachment of the embryo inside the mom.”

That is the case in Kentucky. The law states that “‘pregnant’ means the human female reproductive condition of having a living unborn human being within her body throughout the entire embryonic and fetal stages.”

“To the extent that all the abortion laws tether and condition the conduct on the existence of a pregnancy, then IVF really does escape application of the abortion laws, at least in the preimplantation stage when the embryos are still in the laboratory,” Daar explained. “That is not, per se, a pregnancy because it doesn’t meet the definition of the attachment of the embryo into the uterus.”

Because of this, Daar said, Kentucky doesn’t necessarily need to pass an explicit bill on IVF at this time: “There’s nothing that I’m aware of … that suggests that any aspect of IVF practice is illegal under Kentucky law.”

 
The IVF process

Dr. Sigal Klipstein, chair of the Ethics Committee of the American Society for Reproductive Medicine, said people need IVF for many reasons. Some seek it because of infertility — a man has little to no sperm or a woman does not ovulate, for example. Same-sex couples may undergo IVF as a way to have biological children, she said, or uncoupled people may seek that service for themselves.

“In a typical IVF cycle, a woman might take about 10 days of injections,” Klipstein explained. These are “little, under the skin injections, kind of like insulin needles.”

“They sort of bypass the system,” she said. “So instead of having enough hormone to release one egg, you might release five or 10 or 20 eggs.”

A final shot at the end of those 10 days triggers ovulation, Klipstein said. The patient then undergoes anesthesia and eggs are removed with a needle that enters through the vagina under ultrasound guidance.

Eggs are then mixed with sperm in a lab and grown for five to six days. The best one is then implanted into the uterus.

Usually, there are extra eggs leftover, Klipstein said. They can be donated, stored, discarded, or be placed in the uterus during a time that won’t result in pregnancy. This is called “compassionate transfer,” Klipstein explained. In this process, “you’re sort of more physiologically, more naturally, allowing the embryos to reabsorb into the body.”

Potash said the “routine” extra eggs make the process complicated if they are considered human beings by law. The Alabama Supreme Court set the precedent for that complication when it ruled in mid February that frozen embryos are children.

“It’s unrealistic and cost prohibitive, as well as I think a little cruel,” Potash said, “to make those mothers keep those fertilized ova on ice, essentially, forever.”

Klipstein agreed, and asked: What happens if someone stops paying or a storage facility closes? “Do you require them to have more babies than they want? I mean, I don’t think you can compel someone to get pregnant against their will to prevent them from discarding those embryos.”

“It would be nice if we had one embryo for one baby, and we could do it as a one to one ratio,” she added. “But, you know, medicine doesn’t work that way. And IVF doesn’t work that way.”

Westerfield has a different perspective. “It’s hard for me to imagine someone going into that process without an awareness of the cost,” he said.

IVF can cost between $15,000 and $30,000 per cycle, according to a 2023 article in Forbes. Storage can cost from $350 to $600 per year as well, the magazine reported.

“I don’t think anybody goes into that without knowing whether or not they either can afford it, or have insurance to cover it, or what have you,” Westerfield said.

He and his wife wouldn’t have adopted as many embryos as they did, he said, “if we thought we couldn’t afford to keep this one on ice, frozen.”

“We wouldn’t have done more than what we could transfer at a time,” he said. “We wouldn’t have adopted three; we would have adopted one or maybe two.”

Providers, parents in ‘limbo’

Sen. Cassie Chambers Armstrong, D-Louisville, filed one of several unsuccessful bills to protect IVF this session. She said she is “disappointed” that no specific protections passed.

It might be plausible, she said, that HB 159 “does provide protection to IVF.” But, she said: “I don’t think that it’s decisive.”

The new law deals with criminal and not civil prosecution. That makes it unlikely to be applied to IVF, NKU’s Daar said.

“Instances of physicians acting in a criminal manner in the IVF setting is virtually non-existent,” Daar said. “I’m not saying it never happens, but it’s very, very rare. So a bill that generalizes criminal immunity … would not have a tremendous impact, if any impact, on IVF because that conduct just doesn’t occur.”

For now, Chambers Armstrong is particularly worried about how providers view the law. She wants to spend the interim talking to those people ahead of the next session.

“If IVF providers feel as though they have protection and this bill gives that to them, they will continue to offer services,” she said. “If they are concerned that they’re going to be subject to criminal liability for just doing their jobs, I’m worried that we’re going to see a chilling of making those services available.”

Meanwhile, she does think the state should “repeal … language that people believe could give embryos rights,” she said. But: “I don’t believe this General Assembly is going to do that anytime soon. I hope that people are correct when they say that we can provide some level of protection to IVF with those statutes on the books.”

Rep. Daniel Grossberg, D-Louisville, said the legislature has left “women and medical professionals” in “limbo”. He filed one of the unsuccessful bills to protect the process, and the only one in the House.

“The message that (this) sends,” he said, “is that women in Kentucky don’t have control over their reproductive choices.”

 
‘Let’s be proactive’

Rep. Lindsey Burke, D-Lexington, has openly discussed her journey with assault, infertility, IVF, miscarriage and abortion. She told the Lantern she doesn’t believe IVF is truly protected under current law.

“As long as fetal personhood is enshrined in Kentucky law, IVF is at risk,” said Burke, who is an attorney and mother of a son whom she had after undergoing IVF.

She is also paying $100 per month to store an embryo, as she hopes for another child someday.

Burke would like to file legislation to get “better insurance coverage for reproductive care” next year. She went into debt around $60,000 to have her son, she said. And: “I don’t think that anybody should have to do that.”

Chambers Armstrong, who is also a lawyer, said “I’m not sure that we’re going to get an answer as to whether this bill provides the type of protection for IVF that we’re hoping (for) unless and until it is challenged in court and we get a decision from the court.” But she doesn’t want to wait on litigation.

“Let’s be proactive. Let’s go ahead and pass a law that is very clear that it’s protecting IVF services and make sure that folks know that they can continue to receive the care that they have been seeking,” Chambers Armstrong said.

That must wait until at least 2025.

Legislative lobbying reports for last session rank pharmacy-benefit managers fifth, hospitals sixth, Altria 11th, Anthem 17th, docs 18th

The legislature meets in the Kentucky State Capitol.

By Al Cross

Kentucky Health News

The trade association for pharmacy benefit managers, which act as middlemen between drug and health-insurance companies, was the fifth largest reported spender on lobbying the state legislature in the first three months of the year, according to a compilation by the Kentucky Legislative Ethics Commission. 

The Pharmaceutical Care Management Association reported spending $94,694 on lobbying the General Assembly from January through March. The session began Jan. 2 and was over for most purposes by the end of March.

On March 28, the legislature gave final passage to Senate Bill 188, which is intended to keep the state's independent pharmacies from closing. It sets 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 PBMs argued that the law will cause insurance premiums to increase and its mandates in the bill won't allow businesses to gain from savings PBMs offer.

Independent pharmacies say they are losing money because of low fees paid by PBMs. The bill sets a minimum dispensing fee of $10.64 per prescription for the state's independent pharmacies until a study of dispensing costs is completed by the state Department of Insurance. This "gap-fill payment floor" will not be available to chain pharmacies. The results of the study will eventually dictate what the dispensing fee should be going forward. The study is to be repeated every two years, with fee adjustments made accordingly.

The law, 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 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.

Several other major lobbying interests dealt with health-care issues. The biggest spender was the Kentucky Chamber of Commerce, at $151,010, followed by the American Civil Liberties Union of Kentucky, at $139,599. Among many other things, the ACLU wants the legislature to enact exceptions to the state's near-total abortion ban.

Ranking sixth, just behind the PBM lobby, was the Kentucky Hospital Association, at $85,835. In 11th place was Altria Client Services, a cigarette company, at $73,309; it supported the successful bill to limit legal sales of vaping products to those approved by the U.S. Food and Drug Administration.

Ranking 17th was Elevance Health and Affiliates doing business as Anthem Inc., at $59,946. The health-insurance firm was followed by the Kentucky Medical Association, the main lobby for physicians, at $54,051, and the Kentucky Primary Care Association, a trade group for health clinics, at $49,416.

Overall, spending on legislative lobbying for the first three months of 2024 was a record of $9.719 million, the Ethics Commission reported Tuesday: "The previous record for the same period was $9.343 million, set last year; 933 businesses and organizations registered to lobby in Kentucky, spending $9.427 million; 727 lobbyists were paid $8.289 million in compensation, and also reported $291,942 in expenses."

Vape retailers and hemp association file suit to block new law that limits sale of vape products to those approved by the FDA

Only vaping products authorized or pending approval by
the FDA can be sold in Kentucky as of Jan. 1. (Getty Images photo)

By Sarah Ladd
Kentucky Lantern

Four vape shops, the Kentucky Vaping Retailers Association and the Kentucky Hemp Association have filed suit in Franklin Circuit Court seeking to strike down a new state law outlawing the sale of some of their products.

Greg Troutman, a lawyer for the Kentucky Smoke Free Association, which represents vape retailers, said he’s “hoping that we can get a resolution to this well before” the law is scheduled to take effect Jan. 1.

The lawsuit, which was filed Friday, argues that House Bill 11’s definitions of “vapor products” and “other substances” lump electronic cigarettes and vapable hemp and marijuana products together, making it too broad and arbitrary to satisfy the state constitution.

It also violates due process by requiring retailers to comply with a nonexistent regulatory process for hemp and other non-nicotine products, Troutman said.

Retailers will be subject to fines and penalties for selling vapable hemp-derived products once the law takes effect, the lawsuit says.

HB 11’s backers tout the bill as a way to curb underage vaping by limiting sales to “authorized products” or those that have “a safe harbor certification” based on their status with the U.S. Food and Drug Administration.

The bill was backed by Altria, the country’s largest manufacturer of cigarettes, which also markets FDA-approved vape products. Altria has spent more than $500,000 lobbying the legislature since January 2022, according to records filed with the Legislative Ethics Commission.

The suit alleges that the new law requires FDA approval for products that cannot possibly win FDA approval because the FDA has no regulatory process for them, such as those containing amanita muscaria (a mushroom) and hemp-derived products. The law would also apply to vapable marijuana products set to become available in Kentucky 2025 under a law the legislature passed last year, the lawsuit says.

“Unless the manufacturers are making a therapeutic claim — that is, they’re intended to cure, treat, mitigate disease — they’re not subject to an FDA regulatory process,” Troutman said. “So how can you condition market approval in Kentucky upon complying with a nonexistent process? That is absolutely Kafkaesque.”

In 2009, Congress required the FDA to regulate tobacco products to “protect the public health of the U.S. population and create a healthier future.” The FDA began regulating “electronic nicotine delivery systems” — e-cigarettes — under that authority in 2016.

The suit also alleges the new law violates a provision in the state constitution limiting laws to one subject. HB 11 is titled an “Act relating to nicotine products” but applies to non-nicotine vaping products such as those derived from hemp, the lawsuit says.

The defendants are Allyson Taylor, in her capacity as commissioner of the Kentucky Department of Alcoholic Beverage Control, and Secretary of State Michael Adams.

In the final days of the session, lawmakers merged HB 11 with Senate Bill 344, which created an e-cigarette registry. Gov. Andy Beshear signed the combined bill  into law April 5. Some advocates fear it could force more people back to traditional cigarettes, which are worse for bodily health than vaping.

Vape-store owners also testified the law could create a monopoly for big retailers and hurt small businesses.

A spokeswoman for House Republicans said Tuesday that she could not comment on pending litigation, but believes “the legislature’s efforts to keep potentially dangerous e-cigarettes out of the hands of our children will stand the test.”

Tobacco use can lead to all sorts of health problems, according to the Centers for Disease Control and Prevention. They include cancer, diabetes, heart disease and more. Nicotine is the addictive chemical in tobacco and can harm the developing brain, the CDC says.

Kentucky is No. 4 in smoking, down from No. 2, but at 17.4% of adults, experts say the state's smoking rate is still way too high

By Melissa Patrick
Kentucky Health News

Kentucky still has one of the nation's highest adult smoking rates, but has fallen to fourth among the states, after many years of either ranking first or second. The rate for 2022, the last year for which a rate has been calculated, is 17.4%.

Asked why Kentucky might have seen a drop in its ranking, Amanda Fallin-Bennett, director of the Kentucky Center for Smokefree Policy, said it could be because Kentuckians have good access to treatment programs. 

"Compared to other states, it does have pretty good access to tobacco-treatment services for most all Kentuckians," she said, adding later, "The majority of people who smoke cigarettes would like to quit. So we know that making cessation services available and accessible is a big help."

Kentucky passed a law in 2017 to require all insurance policies sold in Kentucky to cover all smoking-cessation medications and counseling approved by the U.S. Food and Drug Administration. This also includes Medicaid, which covers one in three Kentuckians. The law also removed many of the barriers to such treatment, such as co-payments and limits on length of treatment.

Kentucky offers a program called Quit Now Kentucky. The quit line can be reached at 1-800-QUIT-NOW(784-8669); through text QUITKY to 797979; or online at www.quitnowkentucky.org. The services are free and confidential. 

Fallin-Bennett added that it's important to consider that another reason that Kentucky's smoking rate has dropped could be because of increases in the uses of alternative tobacco products, like vapes. or heat-not-burn devices.

1 in 4 in Ky. smoked five years ago; now 1 in 6

With 17.4% of Kentucky adults reporting they smoke every day or some days, Kentucky ties with Mississippi for the fourth highest smoking rate in the nation, behind West Virginia (21%); Arkansas (18.7%); and Tennessee (18.5%). The figures are from the Behavioral Risk Factor Surveillance System, a continuing national survey by the Centers for Disease Control and Prevention.

Kentucky's smoking rate has been on a steady decline since 2011, even though it was nearly 20% in 2021 and nearly 25% just five years ago, according to America's Health Rankings, using CDC data.

This means that instead of more than one in four people smoking in Kentucky just five years ago and one in five in 2021, now just over one in six Kentucky adults are considered "current smokers."

Fallin-Bennett said any decrease in smoking is to be celebrated: "Smoking is the leading cause of preventable death and disease and so anytime someone stops smoking, they are dramatically reducing their risk for cancer, heart disease, stroke, preterm birth, just a myriad of adverse health outcomes that are associated with smoking."

Shannon Baker, advocacy director for the American Lung Association for Kentucky and Tennessee, said she had no data to analyze why Kentucky now ranks fourth among states instead of second, and cautioned that the focus should remain on the fact that Kentucky's smoking rate is still among the worst in the nation.

"I can tell you that 17.4% of Kentucky adults smoke compared to the national average rate of 14%. So still, it's still a terrible statistic, right? . . .  So I guess I would caution us to look at that, instead of how we rank," she said. 

Baker said any drop in the state's smoking rate is great news, but noted that Kentucky continues to have the nation's highest rates of lung cancer and lung-cancer deaths: "We still have miles to go." 

What next? 

Asked what needs to happen to bring this rate down further, Fallin-Bennett said increasing tobacco taxes would help, as would more Kentucky counties and cities passing  comprehensive smoke-free policies.

"So only 38% of Kentuckians are covered by comprehensive smoke-free policies where smoking is not allowed in restaurants, bars and workplaces," she said. "So that is an area that Kentucky continues to struggle with and that would likely further reduce smoking rates." 

Baker praised the efforts of the state's Lung Cancer Screening Advisory Committee, but said more Kentuckians and providers need to be educated about the availability of low-dose CT screening for smokers and former smokers who qualify for it.

She said she thinks the committee is the first in the nation "that's really focusing on what we can do to increase the number of eligible individuals actually getting the low-dose CT scan done, and making making it more accessible and affordable statewide," she said. "That's a huge opportunity for us."

A missed opportunity, she said, was in the recent legislative session, when legislators removed strict enforcement measures from House Bill 11, aimed at decreasing youth vaping. She said that the current laws that prohibit retailers from selling nicotine products to youth is "not effectively enforced." 

Baker added, "We need three things: We need licensing, and we need regular compliance checks, and we need penalties for violations that escalate for repeat violations all the way up to the point of suspension and revocation of your license for the worst actors, the scofflaw, and we know that they're out there. And those things together represent a tremendous opportunity to address youth e-cigarette use and nicotine addiction, and we missed the boat."

Gov. Andy Beshear signed HB 11 into law on April 5. It limits legal sale of vape products to those approved by the FDA. It will create a database of retailers that sell the products and set fines for retailers, manufacturers and wholesalers who violate the law, but penalties for retailers are much less than in the bill's original version.