Health cabinet offers no budget-cut details at committee meeting; legislators say they need this information to draft budget

Democrats on the state House Budget Subcommittee on Human Services pressed the Cabinet for Health and Family Services for more details on how it planned to implement Republican Gov. Matt Bevin's proposed budget cuts of 4.5 percent in the fiscal year that ends June 30 and 9 percent in the upcoming biennium, Kevin Wheatley reports for cn|2's "Pure Politics."

"The CHFS budget includes proposals to raise wages for social workers, assist community mental health centers and local health departments with rising retirement cost and increase funding for child advocacy centers, among others," Wheatley notes.

The budget will not cut Medicaid funding, Bevin said at his Jan. 26 budget speech, although his administration is negotiating with federal officials for changes to the program to make it less costly. In the same speech, he also promised to end the Medicaid expansion if this is not accomplished.

Former Gov. Steve Beshear, under federal health reform, expanded Medicaid to include those with incomes up to 138 percent of the federal poverty level to join the program. Since then, Medicaid has added about 425,000 Kentuckians to its rolls.

Secretary Vickie Yates Brown Glisson

CHFS Secretary Vickie Yates Brown Glisson told the committee Feb. 3 that her staff was "still considering what to cut within social services, public health, aging services, mental health and other key areas that fall within her cabinet," Deborah Yetter reports for The Courier-Journal.

Glisson said it would be early March before she would have more answers about the cuts, although she believed they would not impact the cabinet's essential services, Wheatley reported.

The lack of detail didn't set well with the lawmakers, Wheatley noted. Committee member Rep. Jim Wayne, D-Louisville, told Glisson that they needed this information sooner than that so the House, which originates the budget legislation, could have time to get it drafted and sent to the Senate for action.

“The process here is that we need to review this budget and we need to know its impact as soon as possible because we’ve started this process now, and essentially you’re saying, ‘I don’t have the information to give you to do the work that you as the committee members need to do,’” Wayne said. “So two weeks is really, in this process, I think is long.”

Rep. George Brown, D-Lexington, asked exactly how much it was going to cost the state to dismantle Kynect, the health-insurance exchange Beshear created, and move to the federal exchange. Beshear’s administration said moving to the federal exchange would cost the state $23 million, but Bevin has disputed that amount, apparently expecting the federal government to pay most of the bill.

Andrew McNeill, a senior adviser to Bevin, told the committee the administration had some "preliminary quotes" that weren't "anywhere close" to the previously cited $23 million, but couldn't share them because they weren't final. He also said the 1 percent assessment on insurers to pay for Kynect would be used to dismantle it.

Rep. David Watkins, a Henderson Democrat and retired physician, expressed his disappointment in losing Kynect, saying the exchange helped Kentuckians get coverage and often helped people discover they were eligible for Medicaid: "It is going to be much harder for them to sign up for the programs available to them."

Wheatley reports, "Glisson said the cabinet will have a new computer system available at its local offices for residents to enroll in health coverage through the federal exchange or in Medicaid. She also suggested that some 'Kynectors', or workers hired to help residents navigate the state exchange, could remain during the transition."

Rep. Addia Wuchner from Burlington was the only Republican lawmaker who spoke during Wednesday’s meeting, "praising Bevin’s budget proposal and saying that access to health care doesn’t necessarily improve health outcomes," Wheatley reports.

Republican senators won't block Medicaid expansion funding

Republican leaders of the state Senate say they will not block the estimated $250 million in spending needed to pay the state's forthcoming share of the Medicaid expansion in the two-year state budget that begins July 1, Adam Beam reports for The Associated Press.

Under the Patient Protection and Affordable Care Act, outgoing Democratic Gov. Steve Beshear expanded the federal-state Medicaid program to include those with household incomes up to 138 percent of the federal poverty line. Republicans were skeptical of the move but could not block it; state law gave Beshear the authority to act without legislative involvement.

The federal government is paying the full cost of the expansion through next year. In 2017 and 2018, Kentucky will be responsible for 5 and 6 percent of the cost, respectively. This cost will eventually rise to the federal health-reform law's cap of 10 percent in 2020.

A state-funded study by Deloitte Consulting said the expansion will pay for itself through 2020 by creating health-care jobs and generating tax revenue, but Republicans and Republican Gov.-elect Matt Bevin scoff at it. The actual jobs created appear impossible to track, but the total gain in health-care jobs since the expansion began appears to be about two-thirds of the number of expansion-related jobs predicted by the study.

Bevin, who won the governorship by almost 9 percentage points and takes office Dec. 8, campaigned on scaling back the Medicaid expansion and had called his victory a mandate to enact his policies, Beam notes.

However, revising the program will require time and the approval of federal officials, and Senate President Robert Stivers told reporters at the start of a two-day Republican caucus retreat in Maysville that the Senate does not plan to block the $250 million budget request, Beam reports.

"Just as Gov. Beshear implemented by executive order, Gov. Bevin can deal by executive order. It's appropriate to see what direction he wants to go," Stivers said. "I think you saw this from Gov. Bevin during the campaign as he became more familiar with the issues saying, 'We want to transition, not to just totally stop it'."

Bevin has appointed Louisville health lawyer Vickie Yates Brown Glisson to oversee the Cabinet for Health and Family Services, which includes the Medicaid program.

New research building at UK will focus on state's health disparities

Artist's rendering of new research center

A new research facility that will focus on addressing the health challenges and disparities in Kentucky is being built on the University of Kentucky's campus and is scheduled to be completed in spring 2018, said to a UK news release.

“This project represents the potential to improve the lives of so many, both within Kentucky where our health outcomes are so poor, and beyond,” Gov. Steve Beshear said. “Our entrenched health problems won’t improve without major investment like this project, which will complement the lifesaving efforts at the Markey Cancer Center and its designation as a National Cancer Institute.”

The $265 million building gets half of its funding from the state and the other half from university resources, including private gifts, according to the release. The facility is considered unique because it focuses on Kentucky’s health disparities, specifically in Appalachia, and fosters multidisciplinary research across numerous fields to develop solutions to these complex problems.

We know that so much of discovery today, whether at the cellular or community level, happens at the intersection of disciplines," Lisa Cassis, UK's vice president for research, said in the release. "This facility is being designed to foster discovery and collaboration so that what happens in labs and in the course of basic research can be translated to answers and solutions at the community level."

Women leading Kentucky health: State health commissioner sees 'stars aligned' for Kentucky to finally get healthier

Health Commissioner Stephanie Mayfield Gibson

This is the third in a series of stories about four high-ranking female state officials who have guided the state's embrace of the Patient Protection and Affordable Care Act.

By Melissa Patrick

Kentucky Health News

“The stars have aligned” and Kentucky has at last “created an infrastructure” to make the state healthier, says Dr. Stephanie Mayfield Gibson, commissioner of the state Department for Public Health.

“What a great time to be in my position,” Mayfield said in an interview, in which she enthusiastically ticked off a list of aligned stars:

• Her bosses, including the governor and lieutenant governor, who are “extraordinarily supportive of health care;”
• The expansion of the federal-state Medicaid program to households with incomes up to 138 percent of the federal poverty level;
• The Kentucky Health Benefits Exchange, branded as Kynect, where Kentuckians sign up for Medicaid or subsidized private insurance;
• The Kentucky Health Information Exchange, an electronic network that makes a wide range of health information easily available; and
• Programs that enhance the quality of care to get better outcomes and decrease costs, such as the programs to stop over-use of emergency rooms.

Mayfield says her top priority is to decrease exposure to tobacco, because so many of Kentucky’s health issues are related to its most famous crop. About 28 percent of Kentuckians smoke, and “The single most important factor that negatively impacts the health of the commonwealth . . . is exposure to tobacco smoke,” Mayfield said. “I want people well.”

She said Kentucky must also address the epidemic of painkiller abuse, which has made it one of the top three states in deaths related to abuse of opioids; and obesity, which is connected to cancer, diabetes and cardiovascular disease. Kentucky ranks in the top five in each of those diseases, and is in the top 10 for child and adult obesity.  

“Who wants the reputation for being number one in cancer deaths?” Mayfield asked. “We know we can do better. These are winnable battles.”

These and other issues are included in Kentucky Health Now, a plan Gov. Steve Beshear has set forth to improve the health of Kentuckians, with specific goals to be reached by 2019, the end of the next gubernatorial term. Beshear’s term ends in December 2015.

Mayfield is vice-chair of the team overseeing the effort, led by Lt. Gov. Jerry Abramson.  She seems to have the full confidence of Audrey Haynes, the secretary of the Cabinet for Health and Family Services, who lit up when asked about her, but Haynes said she had to make sure that Mayfield, a pathologist who ran the state health lab for seven years, was cut out to be the state’s top doctor.

“It’s a job where … you have to kind of have a better understanding of politics,” Haynes said.  “But I wanted her to rise above all that because she is the public health commissioner. Hers is more about the science.  I need her to be honest and tell the truth.”

Haynes said she told Mayfield, “You are going to tell people what they don’t want to hear sometimes, but always stick with science.  You have to rise above the rhetoric, no matter what.”

“And so I recommended her to the governor and they also fell in love with her.” She became commissioner on Oct. 1, 2012.

Kentucky’s health problems have mounted for decades, but Mayfield is optimistic that they can be overcome because of the Medicaid expansion and increased access to health insurance under the federal health-reform law. Thousands of people have sought care for problems that went untreated because they had little or no money or no insurance.

The federal government is paying the entire cost of those newly eligible for Medicaid until 2017, when the state will begin paying 3 percent, rising to the law’s cap of 20 percent in 2020.  Republican legislators and candidates for governor have voiced concern about the state’s ability to pay its Medicaid bills.

Mayfield said the state is working on controlling costs, through the managed-care system that began in 2011.  One target of cost control is the “super-utilizers” of emergency rooms, or those who come to hospital emergency departments 10 or more times per month.

Mayfield, who was put in charge of finding a way to reduce super-utilizers, said 80 percent of them have mental-health issues, so she is working on the problem with Medicare, the state Department of Behavioral Health and Kentucky’s three medical schools. Kentucky is one of six states accepted into the National Governors Association Policy Academy to address super-utilization.

Dr. William Hacker, who preceded Mayfield as commissioner, said her broad training and deep experience in the department uniquely qualified her to succeed Dr. Steve Davis, who was interim commissioner after Hacker retired.

“She is multidisciplinary and thinks beyond the public-health world,” Hacker said. “She has done an excellent job.”

Mayfield, who has been nationally recognized for her contributions to the state’s electronic health information exchange, also stresses the importance of using technology to improve the health of Kentuckians – especially those who live in rural areas, far from specialists.

Mayfield describes her style of leadership as one of action.  “If we say we are going to do something, then let’s build that infrastructure and let’s get it done,” she said.

Hacker said, “Dr. Mayfield is a thoroughbred.  She is on the go at 90 miles per hour.  She is focused on accomplishing goals.”

Haynes said Mayfield “led massive change at the lab” and knows “how to cajole and support and lead” – and when to be firm. “There are times you have to stick to your guns. You have to choose sort of your poison and you have to say ‘I’ll give you this, but I’m not giving this.’ I needed somebody that didn’t feel the political pressure to give in, and that would stick with it. And really just be a great public face of public health.  And she is all of that.”