Studies show that comprehensive smoke-free laws and tobacco taxes are associated with lower rates of youth smoking

Kentucky Health News

Tobacco-control policies such as taxes and comprehensive smoke-free laws are associated with lower rates of youth smoking, according to recent studies. 

The purpose of the first study, published in Sage Journals, was to determine whether the presence and strength of local smoke-free ordinances was associated with cigarette and smokeless tobacco use among high school students in Kentucky, and whether use varied by urban/rural location.

The researchers used data from more than 353,000 10th and 12th graders in the 2004-2018 biennial Kentucky Incentives for Prevention Survey. The smoke-free ordinance data came from the Kentucky Center for Smoke-Free Policy at the University of Kentucky.

The center said in a news release that UK researchers "found that high-school students living in Kentucky counties with a comprehensive smoke-free law are 23% less likely to smoke cigarettes and 16% less likely to use smokeless tobacco compared to those living in counties with a partial smoke-free law or no law." 

Also, "Students in counties with moderate/weak laws did not differ in likelihood of use for either product, compared to those in counties without a law." 

Comprehensive smoke-free laws prohibit smoking inside all workplaces and public places.

The study also found that rural youth may be more likely to smoke. 

"Students in urban counties were 14% less likely to smoke, but there was no difference in likelihood of smokeless use by urban/rural location," says the report.

In conclusion, the researchers write, "Given that nearly half of U.S. youth are not protected by smoke-free laws, advocacy for comprehensive smoke-free workplace laws in all states and municipalities may be an important component in reducing the prospect of youth cigarette and smokeless tobacco use." 

In Kentucky, nearly 5% of high-school students smoke cigarettes and nearly 22% of them use electronic cigarettes, according to data from the Campaign for Tobacco-Free Kids. 

A separate study, published in the American Journal of Preventive Medicine, that looked at how changes in state tobacco-control policies impacted youth e-cigarette use in 2013-19. It found that adolescents were 55% less likely to use e-cigarettes following the enactment of a statewide comprehensive smoke-free law than before the state had a law.

 

The researchers then compared this to the impact of age-of-purchase laws and e-cigarette excise taxes and found that comprehensive smoke-free laws had the biggest impact on youth vaping. 

"Youth were 21% less likely to use e-cigarettes when their state had a minimum age-of-purchase law than when they did not," says the release. 

In addition, the study found that "while changes in tobacco excise taxes did not have a statistically significant impact, adolescents who lived in states with higher average cigarette excise taxes were more likely to use e-cigarettes." 

"This suggests that states need to consider parity and tax all tobacco products including e-cigarettes at the same rate," says the release. "These findings indicate that comprehensive smoke-free laws, tightening restrictions on youth access, and enforcing existing age-of-purchase laws can reduce the likelihood of e-cigarette use among youth."

Ky. children 10-17 have nation's 2nd highest obesity rate, 19.6%; adult rate of 37.7% is 9th highest, a slight improvement from 2021

Map from Trust for America's Health State of Obesity report

Kentucky Health News graph from state data

By Melissa Patrick

Kentucky Health News

Kentucky ties with Wisconsin for the nation's ninth-highest adult obesity rate, an improvement from second-highest last year, but Kentucky children aged 10-17 still have one of the nation's highest rates, No. 2, after ranking first last year.

The 20th annual State of Obesity report from Trust for America's Health says 37.7% of Kentucky adults are obese and nearly 72% of the state's adults are either obese or overweight, tied for sixth place with Delaware. Among the state's high-school students, 19.6% of them are obese and 16.2% are overweight.

Nationally, the report says the number of obese adults continues to rise, noting that 22 states had an 2022 adult obesity rate at or above 35%, up from 19 states in 2021. A a decade ago no state had an adult obesity rate at or above 35%, the report says.

"Since TFAH’s initial report, published in 2004, the national adult obesity rate has increased by 37 percent and the national youth obesity rate increased by 42 percent," says the report. 

The national adult obesity rate is 42% and the national rate for children ages 2 to 19 is nearly 20%, according to the report.  

The good news is that from 2021 to 2022, Kentucky's adult obesity rate declined 6.4%, or 2.6 percentage points, to 37.7% from 40.3%. But that was still above the levels of 2018, 2019 and 2020.

West Virginia (41%), Louisiana (40.1%), Oklahoma (40.0%), and Mississippi (39.5%) have the highest rates of adult obesity. The District of Columbia (24.3%), Colorado (25.0%), and Hawaii (25.9%) have the lowest adult obesity rates.

“It’s critical to recognize that obesity is a multifactored disease involving much more than individual behavior,” Dr. J. Nadine Gracia, president and CEO of Trust for America's Health, said in a news release. “In order to stem the decades-long trend of increasing obesity rates we have to acknowledge that the obesity crisis is rooted in economic, health, and environmental inequities. Ensuring all people and communities have equitable opportunity and access to healthy food and physical activity is fundamental to addressing this crisis.”

Kentucky continues to struggle with all of these conditions. It ranks fifth worst for the percentage of adults with diabetes (15%) and hypertension (40.3%), and nearly 27% of its adults are physically inactive, ninth worst. 

The report shows that more adult men than adult women are obese in Kentucky: 38.7% of men and 36.7% of women, a switch from last year's report. Kentucky's adult men have the second highest obesity rate in the nation; its women rank 18th, tied with Texas.

By age, Kentucky adults between 45 and 64 have the highest obesity rate, 42%. That's followed by those 25-44 (41.2%), 65 and older (33.7%) and 18 to 24 (24.1%). 

"Solving the nation’s obesity crisis will require addressing the economic and structural factors that impact where people live and their access to employment, transportation, healthcare, affordable and healthy food, and places to be physically active," says the report, which includes policy steps to address the crisis that they say should be taken by federal, state and local officials and stakeholders. They include: 

• Fully fund the Centers for Disease Control and Prevention's proven chronic disease and obesity prevention programs so they reach every state.
• Make healthy school meals available for all students and increase access to Supplemental Nutrition Assistance Program (SNAP) and other nutrition support programs.
• Implement a mandatory front-of-package labeling system on food packaging to help consumers make informed choices.
• Close tax loopholes and eliminate business-cost deductions for advertising unhealthy food to children.
• Make physical activity and the built environment safer and more accessible for everyone, including by increasing federal education funding for health and physical education and investing in active transportation projects like pedestrian and bike paths.

Spending reports by health-care lobbying interests reflect their success at having their way in the Kentucky General Assembly

The legislature meets in the Capitol. (State photo)

Kentucky Health News

Seven of the top eight spenders on lobbying the General Assembly last year had health-care issues in play. Most of the seven were mainly focused on health issues, and most of them were successful.

Lobbying reports to the Kentucky Legislative Ethics Commission showed the Kentucky Chamber of Commerce, which lobbies on some health issues, ranked first by spending $408,301, mainly for the 16 lobbyists it employs. The Kentucky Hospital Association was second at $304,707.

"Included in the hospital advocacy group's spending was $23,000 on digital advertising for its priority legislation that passed into law after stops and starts, loosening requirements on ambulance services to improve slow response times," notes Joe Sonka of the Louisville Courier Journal. "KHA also successfully lobbied for two bills providing incentives to attract and retain nurses and health care workers and one to expand hospitals' remote access to pharmacy databases."

The third-place spender, at $269,685, was tobacco company Altria, parent of Philip Morris USA. Altria "successfully lobbied to block a bill raising taxes on cigarettes and vaping products and another that would give local governments the ability to add extra regulations on the display of tobacco and vaping products," Sonka reports.

The fourth-ranking spender was the ACLU of Kentucky, at $195,489. Among other things, it lobbied unsuccessfully against bills to restrict abortion.

The main lobbying group for doctors, the Kentucky Medical Association, ranked fifth at $157,416. KMA spent $30,000 "for polling it commissioned late in the year to craft messaging for one of its top legislative priorities" in the session that begam Jan. 3 and will resume Feb. 5. "The KMA has a website promoting a "physician-led, team-based care model," urging people to contact legislators and oppose legislation to lift limits on services that can be provided by nurse practitioners," Sonka rpeorts.

Hospital firm HCA Healthcare, which has hospitals in Bowling Green and Frankfort, was seventh in lobbying spending at $146,548. LifePoint Health, which has hospitals in Flemingsburg, Georgetown, Lebanon, Mayfield, Maysville, Paris, Somerset, Versailles and Winchester, reported spending $110,002, ranking it 17th. 

The Pharmaceutical Care Management Association ranked eighth, at $142,257. The group represents pharmacy benefit managers, who are middlemen between drug manufacturers and insurance companies; the managers have come under much legislative scrutiny in recent years. The group successfully oppposed a bill to rein in in pharmacy benefit managers; House Bill 457 "breezed through the House by an 88-3 vote but then ground to a halt in the Senate without any readings or committee hearings — all while the association spent more than $52,000 on advertisements urging legislators to defeat the bill," Sonka writes. "Senate President Robert Stivers said the bill stalled after his caucus began to hear concerns from the business sector about the measure increasing the costs of health plans, mirroring the association's messaging."

The other lobbying group in the top eight was the Kentucky League of Cities, which ranked sixth at $151,308. Its main legislative interest, a constitutional amendment to give cities more taxing options, including sales taxes, was defeated by the No. 9 group, the Kentucky Retail Federation, which reported spending $142,237. Overall lobbying expenses hit a record $24.3 million in 2022.

Senate passes bill to limit Medicare drug costs, keep Obamacare discounts; Ky. senators vote no, citing tax increases, inflation

Kentucky Health News

Senate Democrats passed a bill Sunday titled the Inflation Reduction Act, which would allow Medicare to negotiate with drug manufacturers to lower prices, as well as limiting out-of-pocket drug costs for Medicare beneficiaries and continuing pandemic-lowered rates for federally subsidized health insurance.

Mitch McConnell and Rand Paul of Kentucky joined all other Republican senators in voting against the bill, which would also pay for several measures to combat climate change. It passed the Senate on Vice President Kamala Harris's tie-breaking vote and is expected to pass the House this week.

The bill targets climate change mainly through tax credits for electric vehicles, and would be paid for with "substantial tax increases, mostly on large corporations, including establishing a 15 percent corporate minimum tax and imposing a new tax on company stock buybacks," The New York Times reports. It also aims to boost tax revenue by boosting the payroll of the Internal Revenue Service.

Republicans said the economy is in recession, so it is no time to raise taxes, and cited official estimates that the bill would have little economic impact. McConnell said in a press release that Democrats' "response to the runaway inflation they’ve created is a bill that experts say will not meaningfully cut inflation at all. The American people are clear about their priorities. Environmental regulation is a 3% issue. Americans want solutions for inflation, crime, and the border."

Florida Sen. Rick Scott said on CBS's "Face the Nation" that because drug companies will have less money for research, "there will be lifesaving drugs that seniors will not get." Told that the Congressional Budget Office estimates that only 1% of drugs would be so affected, Scott said a viewer's grandmother might be in the 1%.

Those provisions would not take effect until 2026 and would apply to only 10 drugs, but would include more drugs in later years.

The bill would put a $2,000 annual cap on seniors' out-of-pocket costs for prescription drugs, and would guarantee that they could get vaccines without charge. Medicare patients would pay no more than $35 a month for insulin; the bill would have set the same limit for private insurance plans, but Republicans forced removal of that, based on the parliamentary rules governing the bill.

People on federally subsidized health insurance, known as Obamacare, would get three more years of the discounts that Democrats pushed into law last year and that would otherwise expire this fall, just before the annual enrollment period for Obamacare policies, held by about 90,000 Kentuckians.

Financial troubles may make Letcher County Health Department vacate the multi-million-dollar building it opened 12 years ago

UPDATE, Oct. 13: The health department bought the former Dairy Queen for $280,000 and is renting parts of its building, the Mountain Eagle reports.

Letcher County Health Department (Mountain Eagle photo)

By Sam Adams
The Mountain Eagle

An unwillingness to raise tax rates, a declining tax base, reduction in federal and state funding, and Covid-19 closures and layoffs have created a perfect storm that has put the Letcher County Health Department in danger of losing the multi-million-dollar health center that opened just 12 years ago.

Discussions are underway for the department to purchase the old Dairy Queen building just across the river for storage of records, and possibly to move some services to the Letcher County Recreation Center, though officials would not talk about that possibility.

“At the last board meeting, what I can tell you, is the health department is exploring options because the amount of taxes the public health taxing district will take in is the lowest it has received in decades,” said Scott Lockard, director of public health for the Kentucky River District Health Department.

Lockard would not say what those options are, but he said the department has not defaulted on its loans. He said it was able to pay all its bills except its assessment to the district.

“We have no plans to move out of it at this time, but I don’t know what the future holds,” Lockard said. The department is “actively seeking renters” for space in the 32,000-square-foot building, he said.

Letcher County (Wikipedia map)

Minutes of the Letcher County Board of Health meetings, which occur only one time a year, show the district has been struggling since at least 2019, when Lockard informed the board it was facing a $183,000 deficit and recommended a tax increase. Judge/Executive Terry Adams, who sits on the board, suggested renting unused space instead of raising taxes. Adams made a motion during the same meeting to set the tax rate at 8 cents per $100 assessed value, the same as the prior year, and the board voted to accept that rate. The board has set the same rate each year since then, turning down a 9.2 cent per $100 tax rate in June of this year.

During that meeting, Lockard suggested the board cash in certificates of deposit to buy the old Dairy Queen building, and the board voted unanimously to authorize Dr. Ricky Collins, chairman of the board, and board member Dr. Debbie Williams to sign a purchase contract.

Collins, who was elected chairman during the meeting, said Tuesday that discussions on the property purchase are still underway. He said he had heard talk of a move to the recreation center also, but he has not been involved in anything about it and knew of nothing official. He referred questions to Judge Adams.

Adams said he could not comment on whether the department could move to the recreation center, which is just across the river from the Health Center. “There’s nothing affirmative about doing anything,” he said.

Tax removed from e-cig hardware sold separately from liquid

By Melissa Patrick

Kentucky Health News

The General Assembly has passed legislation to remove the 15 percent wholesale tax on the hardware used in electronic smoking devices when it is sold separately from the e-cigarette liquid. The e-cigarette liquid will continue to be taxed at 15%. 

Atlanta Journal-Constitution photo

That was the intent of the original tax bill, Republican Rep. Jason Petrie of Elkton, sponsor of House Bill 249, an omnibus revenue bill, said at a February committee meeting. He said legislators had been receiving lots of calls about it, and the bill more clearly defines how open "vaping" systems should be taxed. 

Last March, when the Senate Appropriations and Revenue Committee passed a trimmed down version of a House bill to tax e-cigarettes for the first time in Kentucky, Sen. Chris McDaniel, R-Taylor Mill, said the hardware should only be taxed at 6%. Ultimately, the 15% tax on open systems, including both hardware and solution, and a $1.50-per-pod tax on closed vapor cartridges were added to the revenue bill and became law.

A fiscal statement attached to this year's bill notes that Kentucky started taxing vaping products in August 2020 and has generated about $1.5 million per month from the levies. It says about $1.4 million per month comes from taxes on closed systems, like those sold by Juul Labs, and about $185,500 per month on the open systems, which are typically sold in "vape" shops. 

The report says removal of the 15% separate-hardware tax will cost $243,750 in revenue. That's a relatively small amount, but health advocates were not happy with the change. 

“Removing the tax on open vaping system devices reduces tax revenues at a time when Kentucky remains very uncertain about the long-term economic impact of the pandemic," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in an e-mail. "Moreover, these devices will become the sole tobacco product to escape a state excise tax." 

In contrast, Chandler said, "Only 19 of the state’s 61 local health departments will get funding for tobacco prevention and cessation beginning July 1. We urge the governor and lawmakers to work together to address Kentucky’s continuing tobacco and nicotine addiction problem, which appears to have grown during the pandemic." 

The American Cancer Society Cancer Action Network said it was "dismayed" with the removal of this tax and urged Gov. Andy Beshear to veto the bill.  

"Right now, over 26% of our Kentucky high-school students are using e-cigarettes. Eliminating taxes on some e-cigarette products will make them even more appealing to price-sensitive consumers, including youth," said Kristy Young, chief ACS-CAN lobbyist in Kentucky. "All tobacco products, including e-cigarettes, should be taxed at parallel rates to encourage people who use tobacco to quit rather than switching to lower-priced alternatives. As we face skyrocketing youth tobacco use, now is not the time to take steps backward."

Bill to tax electronic cigarettes at 15% goes to governor; health advocates say it will decrease young people's use of the products

By Melissa Patrick
Kentucky Health News

Kentucky lawmakers gave final approval Wednesday to a tax on electronic cigarettes, which is expected to decrease teen use of the products by increasing their price.

Centers for Disease Control and Prevention illustration; click for larger version 

The Senate added the 15 percent excise tax to the catch-all revenue bill, House Bill 351. It was a trimmed-down version of HB 32, which, among other things, would have put a 25% tax on e-cigarettes, generating about $50 million.

The reduced tax is expected to generate $25 million, but most of that will be negated by tax breaks for agriculture, coal and alcohol industries, the Lexington Herald-Leader reports.

HB 351 will reduce the taxes to 15% on open "vaping" systems, like those typically sold in "vape" shops, and added a $1.50-per-pod tax on closed vapor cartridges, like those sold by Juul Labs. Gov. Andy Beshear is expected to sign it.

Health advocates expect the tax to decrease teen use of the products. Following is a statement from the Foundation for a Healthy Kentucky, joined by the Kentucky Chamber of Commerce, the Kentucky Cancer Foundation, the Kentucky Equal Justice Center, the Kentucky Health Collaborative, the Kentucky Medical Association, the Northern Kentucky Chamber of Commerce and Kentucky Youth Advocates:

"This new tax is clearly a win for health in Kentucky, especially for our adolescents and teens, because it will result in a significant price increase that will deter many of our youth from using dangerous e-cigarette products," said Ben Chandler, president and CEO of the foundation. "E-cigarettes are the only tobacco product sold in Kentucky currently not subject to an excise tax. The relatively low cost has been a factor -- along with the kid-friendly flavors -- in luring up to 80,000 Kentucky kids to try these highly addictive products.

"We applaud the legislature for adopting a pod tax that will substantially increase the price of the products that are most popular among youth right now, including the Juul and knock-off reusable devices and the Puff Bar and Posh disposable e-cigarettes. In the midst of the coronavirus pandemic, inhaling toxins that are shown to damage the lungs puts these kids and every other smoker and vaper in the Commonwealth at greater risk for serious complications from covid-19. This is an important bill today and for the future, and a strong step in the right direction."

Rep. Jerry Miller, R-Louisville, the sponsor of HB 32, questioned why the Senate didn't include the section of his bill that would have raised the tax on snuff products as a way to generate more revenue. His bill would have doubled the tax on snuff, which includes Snus packets, and he alluded to the lobbying influence of Altria Group, the maker of Snus and the nation's largest tobacco-product manufacturer, with a smokeless-tobacco factory in Hopkinsville.

"Given that Altria had accepted the doubling of ad-valorem tax on snuff and Snus, and was therefore included in the governor's budget and the House budget, I cannot understand why the Senate would not accept that increase in revenue," Miller said in a statement read by House Republican Caucus Chair Suzanne Miles as most members voted and communicated remotely due to the threat of the coronavirus. But some thought the bill was still too much.

Sen. Robin Webb, D-Grayson, said she voted against it because she had not had time to read and digest it, and because she had filed several amendments, including one for a 10% tax. Sen. Tom Buford, R-Nicholasville, who also favored that rate and voted no, said "I am fearful that the vaping tax at 15 percent will drive many of our individuals trying to free themselves from the tobacco products back to them, not only that, but our youthful individuals."

Others voting no in the Senate were C.B. Embry of Morgantown, Jimmy Higdon of Lebanon, Albert Robinson of London, John Schickel of Union, Brandon Smith of Hazard and Whitney Westerfield of Hopkinsville, all Republicans. Five senators passed and five did not vote, for a roll call of 20-8-5. The House passed the bill 68-22.

Here are some resources to help quit smoking:

• Quit Now Kentucky offers nicotine replacement therapy and counseling , call 1-800-QUIT-NOW (800-784-8669) or text QUITKY to 797979.
• My Life, My Quit, a quit-vaping service for teens that provides coaching by text message, by phone, or by online chat; call 855-891-9989 or text START MY QUIT to 855-891-9989.
• This is Quitting, a free coaching service for those ages 13-24 to help them quit using e-cigarettes; text KENTUCKY to 88709.

State House passes 25% tax on electronic cigarettes

By Melissa Patrick

Kentucky Health News

FRANKFORT, Ky. -- A bill aimed at reducing teen use of electronic cigarettes by increasing their price passed the state House 75-17 and went to the Senate Feb. 26. The bill would place a 25 percent wholesale tax on the products.

State Rep. Jerry Miller

The bill's sponsor, Rep. Jerry Miler, R-Louisville, told the House that youth use of e-cigarettes is "creating a crisis" and "The most effective way to attack underage use is through raising the price."

The Kentucky Incentives Prevention Survey found that from 2016 to 2018, Kentucky teenagers nearly doubled their e-cigarette use, with more than one in four high-school seniors and one in seven eighth-graders reporting use in 2018.

House Bill 32 would also raise the wholesale tax for "other tobacco products," such as cigars, to 25% from the current 15%, and add e-cigarettes to that list. It would also double the per-unit tax on chewable and non-smokable products, but does not increase the tax on traditional cigarettes.

Gov. Andy Beshear proposed a 10-cent-per-pack hike in the cigarette tax, estimated to raise nearly $40 million for the next two-year state budget.

Miller said his bill is projected to bring in nearly $50 million. He said the amounts were increases "that a large manufacturer" said it could live with without opposing the bill.

The original bill called for a 27.5% wholesale tax on e-cigarettes, which are the only tobacco products in Kentucky that does not have an excise tax. That would be equivalent to the current tax in cigarettes.

Terry Brooks, executive director of Kentucky Youth Advocates, applauded the bill's passage, but asked that the Senate go to 27.5%, "to make a real impact for young people." 

"E-cigarettes put our young people at risk of nicotine addiction, serious lung injury or disease, and other harmful outcomes," Brooks said in a prepared statement. "A tax on e-cigarettes equivalent to that on cigarettes is a proven way to prevent usage among youth and can reduce future healthcare costs and provide additional revenue for the state budget."

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said the 25% tax was close enough to the cigarette tax to reduce youth use of the products. Chandler noted that after the state raised the cigarette tax 50 cents a pack, to $1.10, in 2018, annual sales dropped 36 million packs.

Miller is also the sponsor of House Bill 69, which would add a long list of regulations to e-cigarettes. It passed out of committee on Feb. 12, but has not yet been called up for a House vote.

Representatives from the Kentucky Smoke Free Association, which represents about 400 independent vape shops statewide, told lawmakers at the bill's committee hearing that while they support the added regulations in HB 69 because they address teen-access issues, they did not support the tax because it would hurt their businesses and would discourage adults from using their products as a smoking cessation device.

A recent U.S. Department of Health and Human Services report says more research is needed before it can be concluded that e-cigarettes help people stop smoking.

Democratic governor wants cigarette-tax hike, new tax on electronic cigarettes, not as much as one Republican's bill

By Melissa Patrick
Kentucky Health News

To pay for such things as a teacher-pay increase and 350 news social workers to fight child abuse and neglect, Gov. Andy Beshear wants to raise the tax on all tobacco products and add a new tax to electronic cigarettes, the only tobacco product in Kentucky that does not have an excise tax.

Gov. Andy Beshear makes his budget speech. (KET image)

The Democratic governor's taxes would have to be approved by the Republican-controlled legislature. Republicans often balk at new taxes, but comments from several leading GOP members suggest that some version of the e-cigarette tax will pass.

They are more skeptical of Beshear's proposed 10-cent tax increase on cigarettes, to $1.20 per pack from $1.10.

In his budget speech to the General Assembly, Beshear proposed a tax on e-cigarettes at 10 cents per fluid milliliter. His office said eight of the 19 states that tax so-called "vaping" products do so with a per-milliliter tax instead of a percentage of of the sales price.

The plan would also raise the tax on snuff and chewing tobacco to 38 cents per unit, from 19 cents,  and would raise the tax on other tobacco products, such as cigars, from 15 percent of the average wholesale price to 30%, which would make the tax rates on other tobacco products effectively the same as the proposed $1.20 cigarette-tax rate.

The higher tobacco taxes would raise $94.2 million for the two-year budget: $50.3 million in the fiscal year that begins July 1, and $43.9 million the following fiscal year, apparently presuming that the higher tax will decrease consumption.

If the cigarette tax were to pass, it would place Kentucky at the same rate as West Virginia, but would be noticeably higher than Indiana, Missouri, Tennessee and Virginia. The bordering states with the highest rates are Ohio, $1.60, and Illinois, $2.98. The national average is $1.81.

In 2018, Kentucky lawmakers increased the cigarette tax by 50 cents, to $1.10 per pack.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, praised the governor's proposals to raise tobacco taxes, noting the health savings that would result from them.

"In addition to raising revenue on one side of the budget, they reduce health-care and business costs and increase employee productivity on the other," Chandler said in a news release. "We know they're effective: the recent cigarette tax hike raised $140 million in new revenue its first year; at the same time, Kentuckians bought 36 million fewer packs of cigarettes."

Rep. Steve Rudy, chair of the House budget committee, said the most likely taxes to pass are those on electronic cigarettes, because “We’re trying to curtail this. . . . I’ve had a lot of school superintendents and teachers tell me it’s becoming an epidemic in the schools.”

Between 2017 and 2019, e-cigarette use more than quadrupled among the state's middle-school students and nearly doubled among its high-school students, with one in four high schoolers and one in five middle schoolers reporting monthly use; and one in 10 high school students reporting daily use.

Sen. Chris McDaniel, chair of the Senate budget committee, more cautiously said he needed to examine all of the components of Beshear's proposal before deciding how to proceed, but said he was open to looking at it.

"Any tax needs to be evaluated in the confines of its total impact," he said. "Since the last [cigarette] tax, we've seen a decline in smoking in the commonwealth. We know we've had a bit of an impact there. And we're going to take a look at it as part of the whole."

Senate Majority Floor Leader Damon Thayer said it's too soon to talk about the cigarette tax, but "I think a tax on vaping is something that needs to be considered. I don't think it should be as high as the tax on cigarettes, but I think it probably should be higher than the current 6 percent sales tax. So I think there is probably some momentum towards getting something done on that."

Thayer said he didn't think e-cigs should be taxed likewise because they are "not the same product" and added that while it's important to work toward decreasing the youth vaping epidemic, it's also important to recognize "there is evidence that vaping helps addicted adult smokers wean themselves off traditional cigarettes."

A 700 page U.S. Department of Health and Human Services report says more research is needed before we can conclude that e-cigs help people stop smoking.

"The evidence is inadequate to infer that e-cigarettes, in general, increase smoking cessation; factors contributing to the uncertainty include the changing characteristics of e-cigarettes, the many different contexts in which they are used, and the limited number of studies conducted to date," says the report, titled, "Smoking Cessation, A Report of the Surgeon General."

Rep. Jerry Miller

A bill to tax e-cigarettes in Kentucky has already been posted in the House Appropriations & Revenue Committee, chaired by Rudy.

House Bill 32, sponsored by Rep. Jerry Miller, R-Louisville, would place a 27.5% excise tax on e-cigarettes. It would apply the same rate to other tobacco products, which are now taxed at 15%, thus raising the levy by the same percentage that the cigarette tax was increased in 2018.

"I believe the tax bill will move out of the House, I feel pretty confident about that," Miller said. "We are working on modifying it to make sure it passes the Senate."

He said it was helpful that Beshear had proposed an e-cig tax, noting that the governor told him after his speech that he liked Miller's bill even better. He said that was likely because his proposal would generate more money than the governor's. "Whereas his is 20 million-ish, mine is in the 30 million range," he said.

Asked if he was willing to compromise the 27.5% rate, he said, "As I tell people, I don't pass perfect bills, I pass the best bills that can pass and I'm going to get the best bill I can pass through the Senate and onto the governor's desk."

Miller has also filed HB 69, which would further regulate e-cigarettes. Heunsuccessfully sponsored an e-cigarette tax bill in the 2019. In 2018, an e-cig tax was included in legislation that raised the tax on traditional cigarettes, but was removed in the Senate just before final passage and after lobbying by Altria Group, the largest tobacco company and 35% owner of Juul Labs, the largest e-cig company.

A recent Kentucky Health Issues Poll found that 75% of Kentucky adults support such a tax.

Organ donor's story spurs bill to give state employees paid time off for such donations, create tax deduction for related expenses

Beth Burbridge gave Jackson Alldaffer a kidney. (via CJ)

"A woman who donated an organ to a complete stranger, then mounted a campaign to give paid leave to people who do likewise, told her story Thursday and moved a legislative committee that approved a bill giving the benefit to state employees," Dalton Stokes reports for The State Journal in Frankfort.

Beth Burbridge of Louisville is an analyst for a health-care company (she won't name it, but says it's not involved in organ transplants). So, she knew the medical risks of donating a kidney, but she didn't know the financial risks, Bailey Loosemore reports for the Courier Journal.

"She could be denied health or life insurance because she'd had the surgery," Loosemore reports. "Other states have laws in place that alleviate the risks or offer protection to live organ donors . . . but in Kentucky, there are none."

Burbridge told the House State Government Committee that "When she asked her employer to schedule some time off for the operation and recovery, she was told all the time off would have to come from time she had saved and the rest would be unpaid," Stokes reports.

“I was speechless,” she told the committee. “The surgery was not elective to the young man who was dying.” She had learned of his plight from a post on her neighborhood's Facebook page.

"So, one Monday she had final testing at the hospital. Tuesday, she donated a kidney. Thursday, she returned home," Stokes writes. "On Friday she needed to be off painkillers to make sure she could handle eight hours without medication, because she had to go back to work on Monday."

She worked from home that day, but “anything complicated took me all day,” she told the committee, and she had to tell colleagues who asked her questions that they would have to wait for answers.

"Seeing the difficulties that face living organ donors," Stokes reports, "she wrote Rep. Jerry Miller, R-Louisville, asking for help.

“She knew exactly the best way to approach it,” Miller told the committee, which he chairs. It approved the bill without dissent. One member, Rep. Kevin Bratcher, R-Louisville, asked Burbridge, "Where do you keep your wings? That was an amazing story."

"Burbridge’s story began with a Facebook post," Stokes writes. "One morning before she got to work, she saw a plea for help from the family of Jackson, a dying boy who lived in her Louisville neighborhood. He needed a kidney, but it couldn’t come from family because the disease was genetic. She saw she was a match for the blood type they needed and asked herself, 'What if this was our family? . . . I kept thinking about my love for our sons; what would I do to save them?'

"Burbridge underwent myriad tests on two occasions before she could surprise Jackson’s family with the news that she was going to save their son, Stokes reports. Burbridge told the committee, “I will never forget this day or the way Mindy [Jackson’s mother] broke down crying and hugged me for the longest time. Derek [Jackson’s father] was in such disbelief that he kept me talking for hours just to hold on to the moment.”

The bill would give state employees who donate organs six weeks of paid leave, those who donate bone marrow a week’s paid leave, and create a tax deduction for expenses related to such donations. It now goes to the Rules Committee, which could send it to the full House or to another committee.

Miller got a similar bill passed on the third try in 2016, but then-Gov. Matt Bevin, on grounds that it created tax credits for employers. Miller said he scaled back the plan to tax deductions in light of the state’s fiscal difficulties.

Burbridge said she hopes the bill sets an example for other employers. Doctors told the committee that Kentucky had only 72 living organ donors last year, that 928 people in the state are waiting for organs who would be covered by the bill.

“We just don’t have enough donations from deceased donors,” said Dr. Tom Wade, medical director of kidney transplants at the University of Kentucky. “It’s very important that we encourage and protect” living donors; we owe them our gratitude and whatever protections we can give them.”

Health issues poll: 75% of Ky. adults support tax on e-cigarettes; highest rate of use is in younger adults; about half recognize harm

By Melissa Patrick
Kentucky Health News

The latest Kentucky Health Issues Poll shows that three out of four Kentucky adults support taxing electronic cigarettes, which is the only tobacco product in the state that isn't already taxed.

The poll, taken Oct. 16 to Dec. 6, found support for a tax on e-cigarettes, at a similar rate as a pack of cigarettes, was virtually the same among Democrats (78%)  as among Republicans (76%), with independents (72%) close behind.

Support for the tax has increased since 2014,  the last time the poll asked the question, when only 53% of Kentucky adults favored such a tax.

Rep. Jerry Miller, R-Louisville,  has filed House Bill 32 to impose a 27.5% excise tax on e-cigarettes and related devices, commonly known as "vapes" though they produce aerosols as well as vapors.

"We think parents and adults who work with kids understand that the most appalling problem with vapes right now is the youth epidemic," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll, said in a news release. "Taxing these products on par with cigarettes is one of the most effective steps we can take to reduce youth vaping, and we'll be advocating for that as a measure to protect kids during this year's General Assembly."

The Coalition for a Smoke-free Tomorrow, which comprises more than 225 Kentucky organizations, also supports the legislation. The coalition estimates that such a tax would generate $34 million in its first year. Chandler is the chair of the coalition.

Legislative leaders indicated in December at the Kentucky Chamber of Commerce's legislative preview that there is support for such a tax in the 2020 legislative session, which recently convened, although it is uncertain if it will be as high as the cigarette tax.

Miller unsuccessfully sponsored an e-cigarette tax bill in the 2019. In 2018, an e-cig tax was included in legislation that raised the tax on traditional cigarettes, but was removed in the Senate just before final passge and after lobbying by Altria Group, the largest tobacco company and 35% owner of Juul Labs, the largest e-cig company.

The poll also found that about one in four Kentucky adults, or 26%, had ever tried an e-cigarette, a rate that has remained about the same since the poll first started asking the question in 2016.

E-cigarettes continue to be more popular among youth and younger adults, with 42% of those 30 to 45 and 39% of those 18 to 29 saying they had ever tried them, compared to 20% of those 46 to 64 and 9% of those over 65.

Of the adults who had ever tried e-cigarettes, 9% of them said they used  them every day or some days. That rate was 7% in 2017, which statistically is essentially the same.

Teens use e-cigarettes at the highest rate. The Kentucky Youth Risk Behavior Survey found that the percentage of students who had ever tried an e-cigarette increased from 44% in 2015 to 53% in 2019.

The poll also asked Kentucky adults whether they believed e-cigarettes were just as harmful, more harmful or less harmful as traditional cigarettes for youth and for adults.

About half of those polled said they are just as harmful for both youth (45%) and adults (54%). Forty percent said they are more harmful to youth and 21% said they are more harmful for adults; 9% said they were less harmful than traditional cigarettes for youth, and 19% said they were less harmful than traditional cigarettes for adults.

A recent article in the American Journal of Public Health summarizes a growing body of research that shows the many dangers of e-cigarettes for both youth and adults. It also refutes the oft-made claim that e-cigs are 95% safer than traditional cigarettes, calling this estimate a factoid, or an unreliable piece of information that has been repeated so often it becomes accepted as fact.

The Kentucky Health Issues Poll is funded by the foundation and Interact for Health a Cincinnati-area foundation. It surveyed a random sample of 1,559 via landlines and cell phones. The margin of error is plus or minus 2.5 percentage points.

Kentucky legislators have filed four bills targeting teen use of e-cigarettes; Coalition for a Smoke-Free Tomorrow is supporting two

By Melissa Patrick
Kentucky Health News

As teen use of electronic cigarettes continues to surge, Kentucky lawmakers in both parties will be working to pass bills aimed at decreasing their use in the legislative session that starts Jan. 7.

Through Dec. 12, four such bills had been pre-filed, including one to raise the legal age to buy all tobacco products to 21; one to ban the sale of flavored e-cigarettes; one to impose registration and licensing requirements to sell e-cigs; and one to tax them at the same rate as traditional cigarettes.

Teen use of e-cigarettes increased to more than 5 million in 2019 from 3.6 million in 2018, a 39 percent jump, according to the latest annual National Youth Tobacco Survey.

The latest data for e-cigarette use by Kentucky teens, from 2018, shows e-cigarette use had nearly doubled since 2016, with more than one in four high-school seniors and one out of seven eighth-graders reporting they used e-cigs in 2018, the Kentucky Incentives for Prevention study found.

Sen. Ralph Alvarado

Sen. Ralph Alvarado, R-Winchester, most recently pre-filed Bill Request 967 to raise Kentucky's legal age for buying all tobacco products, including e-cigarettes, from 18 to 21. Alvarado chairs the Senate Committee on Health and Welfare and is a practicing physician.

"Youth tobacco use had been declining for decades, but it has suddenly skyrocketed since the introduction of e-cigarettes and vapes," Alvarado said in a news release. "The science is clear that adolescents and teens are particularly vulnerable to the health risks of nicotine and other toxins in tobacco products. This bill is a common-sense, widely supported measure to help keep tobacco out of the hands of kids."

A similar bill was introduced in the last legislative session, but tobacco-friendly senators blocked it. At the federal level, U.S. Senate Majority Leader Mitch McConnell, R-Kentucky, has proposed a bill to raise the legal age to buy tobacco products to 21.

Already, 19 states have raised the tobacco age to 21, along with Washington, DC and over 530 localities, although the strength of their laws vary substantially, according to the Campaign for Tobacco-free Kids. Some companies see the law as a way to limit other forms of regulation.

The latest Kentucky Health Issues Poll found that six in 10 Kentuckians would support increasing the minimum age to purchase tobacco products to 21, with majorities in each political party.

Most teens get tobacco from older friends who can buy the products legally, but youth under age 18 typically don't hang out with people who are 21 or older, so the bill helps cut off a major social source of tobacco for kids," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release. He noted that the bill would put more enforcement responsibility on retailers.

Rep. Buddy Wheatley

"We can't wait any longer to act," Chandler said. "Focus groups the foundation conducted in partnership with Kentucky Youth Advocates made clear that teens in the commonwealth who never would have touched cigarettes are using e-cigarettes, and they mistakenly believe they're safe. We have to raise the age from 18 to 21 in this legislative session," Chandler said.

Another bill to thwart teen e-cigarette use has been filed by Rep. Buddy Wheatley, a Democrat from Covington. He prefiled Bill Request 925 to ban the sale of flavored e-cigarettes and vapes. It also includes fines upwards of $2,500 to those who would continue to distribute them.

“My bill follows the similar model our country set a decade ago, when the FDA banned certain flavors in cigarettes because of their appeal to our children,” Wheatley said in a news release. “That was the right move then, and it’s the right move now." He added, "The hope is that the federal government will take similar steps regarding a ban of e-cigarette flavors, but until that happens, my bill will at least make sure this is in effect here in Kentucky.”

However, that doesn't seem likely to happen any time soon. President Donald Trump said in September that he would ban all e-cigarette flavors except tobacco and menthol, but has since backed off this decision in the face of protests from users, retailers and manufacturers.

The Foundation for a Healthy Kentucky also applauded Wheatley's bill and said it was time to take "bold steps" to reduce the youth vaping epidemic.

 ("Vaping" is a term used by manufacturers, sellers and users of electronic cigarettes, but many of the devices do not produce a vapor, which is liquid particles suspended in the air. They produce an aerosol, which has liquid and/or solid particles suspended in a gaseous medium.)

"Adolescents and teens are drawn to e-cigarettes because of the flavors and then get addicted to the nicotine," Chandler said in a separate news release. Rep. Wheatley's bill would cut off a primary reason kids use these dangerous products and keeps them from becoming the next generation addicted to nicotine. It's an addiction that will haunt them the rest of their lives."

Rep. Jerry Miller

Two other bills to combat the surge of youth e-cigarette use have been filed by Louisville Republican Rep. Jerry Miller.

Bill Request 468 would require all retailers or manufacturers of vapor/aerosol products that come with "enhanced cartridges" to register with the Department of Alcoholic Beverage Control and pay a $500 annual licensing fee per location annually.

It would also prohibit retailers and manufacturers from selling such products online, by catalog or by phone; prohibit home delivery by outside vendors; require real-time age verification for purchase through an electronic third-party source no later than Jan. 1, 2021; and call for fines on any person under the age of 18 who tries to purchase electronic cigarettes or related products. His other measure, Bill Request 32, would impose a 27.5 percent excise tax on e-cigarettes and related devices.

Miller told the Louisville Courier Journal in October that he recognized the lure of the flavored products to teens and doesn't banning them, but said any such ban needs to be on the federal level. "If Washington wants to ban it, fine, that's their deal," he said. "In terms of Kentucky, how we're going to reduce teen vaping, I see it as more effective to regulate it."

The Coalition for a Smoke-Free Tomorrow will hold a rally at 10 a.m. Tuesday, Jan. 14, in the Capitol rotunda to support of the excise tax and the higher age limit. It will also call for more funding for prevention and cessation programs. The rally is titled "Answers to Kentucky's Youth Vaping Epidemic: A rally for laws to protect youth from tobacco!"

Bonnie Hackbarth, vice-president for external affairs at the foundation, which staffs the coalition, said in an e-mail that the rally will support only the bills that have unanimous support of the coalition's steering committee, comprising representatives of 20 organizations. She said there is not unanimous support for Wheatley's bill or Miller's regulation and licensing bill, for various reasons.

"Some members believe the flavor ban should extend to all tobacco products, for example. Some would support the Wheatley bill but not the Miller bill. Others, including the foundation, support both," Hackbarth said. "The coalition – which now has more than 220 members and partners – is led by the steering committee of representatives from 20 organizations, and all steering committee members must agree for a measure to become a coalition priority."

Sunday, Dec. 15, is the deadline to sign up for federally subsidized health insurance, better known as Obamacare

By Melissa Patrick
Kentucky Health News

Time is running out to sign up for federally subsidized health insurance for 2020. The deadline for enrollment on Healthcare.gov is Sunday, Dec. 15, and fewer Kentuckians have enrolled than at this time last year.

Five weeks into to the six-week enrollment period, Kentucky enrollment on the federal exchange was

26,982. That was 3,190 fewer than the 30,172 who had enrolled by that time last year. Nationally, 321,165 fewer people had signed up.

The numbers for both years only reflect people who had signed up for a new plan or who had actively chosen a plan. Those who already have plans on Healthcare.gov and don't choose a new one will be automatically re-enrolled, and those numbers haven't yet been included in the enrollment reports.

Even if you have a plan on Healthcare.gov, experts say it's a good idea to look at all of your options each year to make sure you have the plan that best suits your needs or offers the best cost.

Josh Peck, the founder of Get America Covered, told Inside Health Policy that while it's concerning that the numbers are down, new enrollees are up nationally compared to last year, which "could bode well for final sign-up totals." Further, he noted that there is usually a surge of enrollment during the last weeks of sign-ups.

Don't assume you can't afford coverage, because most people using the marketplace qualify for financial help to lower their costs. In 2019, 79 percent of Kentuckians enrolled through the federal exchange qualified for tax credits and subsidies that reduced their premiums.

Update 12/10/19: A Kaiser Family Foundation report published Dec. 10 found that 31% of uninsured Kentuckians who could be shopping on the marketplace were eligible for premium subsidies large enough to cover the entire cost of a bronze plan, which is the minimum level of coverage available on Healthcare.gov.

"Rather than continuing to go without insurance, the 4.7 million uninsured people eligible for no-premium bronze plans would benefit from the financial protection health insurance offers. While bronze plans have high deductibles, they all cover preventive care with no out-of-pocket costs, and a number of bronze plans cover additional services, such as a few physician visits, before the deductible. If a low-income enrollee in a bronze plan needs a hospitalization, they will likely have difficulty affording the deductible, but the deductible will also likely be much less than the cost of a hospitalization without insurance," says the report. 

A person should qualify for a federal subsidy, or a tax credit, with an income between 100% and  400% of the federal poverty level. The federal government has an online calculator that indicates whether you fall into this bracket.

Consumers should also be wary of plans that appear to meet the Patient Protection and Affordable Care Act standards, but actually don't. That's because President Trump's administration, which has tried to weaken "Obamacare" after failing to repeal it, has loosened restrictions on plans that aren't compliant with the ACA, called "short-term plans," which are less expensive but offer less coverage.

The best way to make sure your plan is ACA-compliant is to shop on Healthcare.gov; if you are working through an insurance broker, say you want an ACA-compliant plan.

Where can I find help? 

The state-based call center is available at 855-459-6328 to help assist Kentuckians with where to go for coverage, answer questions and pre-screen for eligibility. The Healthcare.gov customer service center (800-318-2596) is also available 24 hours a day, seven days a week. Click here to find an application assister or an insurance agent near you.

Carol Adkins, coordinator of community engagement and outreach for the Kentucky Primary Association, encouraged Kentuckians who are signing up for health insurance on Healthcare.gov to talk to an application assister each year before they sign up because plans often change and premiums and options fluctuate.

"Always make plans to meet with a free, certified application assister to help you apply or re-certify," she said in an e-mail. "They are trained to help with the initial application, answer questions, explain options, assist with enrollments and more."

She stressed that  assisters are not agents and do not benefit in any way from your enrollment, but are simply there to help you with your application at no cost to you. She also noted that KPCA has assisters that specifically work on connecting children with coverage all over the state.

If you miss the deadline, the only way you'll be eligible to enroll in or change your health plan for 2020 is if you qualify for a special enrollment period. To qualify for special enrollment, you must have a qualifying life event such as a change in family status (for example, marriage, divorce, birth, or adoption of a child), change in residence, or loss of other health coverage (such as loss of employer-based coverage, or loss of eligibility for Medicare or Medicaid).

Health departments get another year before pension hikes kick in, but some are already raising taxes in anticipation

By Melissa Patrick
Kentucky Health News

While local health departments are more than grateful that legislation passed in the recent special legislative session gives them another year to manage their looming pension crisis, several counties have already asked for a tax increase as a way to help pay for it.

The Kentucky Department of Public Health said in an email last week that it had received 63 of this year's 113 county tax resolutions and so far 10 counties have asked for a higher rate. Of those, the department said board minutes show that Boone, Boyd, Campbell and Kenton discussed the increase in the Kentucky Retirement System cost prior to voting on the tax rate.

"However, the other six counties mentioned in their board minutes there was a discussion, but did not mention in the minutes details of the discussion," the email said. They are Leslie, Muhlenberg, Ohio, Union, Wayne and Webster counties.

The new law, written and signed by Gov. Matt Bevin, freezes the pension cost of health departments for another year, at 49 percent of payroll, avoiding an increase to 83 percent.

That gives them one more year to decide whether to stay in the state retirement system, with an increase in their pension contribution to 83% of payroll, or leave it -- and either pay a lump sum equal to their projected pension liabilities, or pay it off over the next 30 years in installments.

Allison Adams, director of the Buffalo Trace District Health Department, which includes Mason and Robertson counties, explained that the state has a cap of 10 cents per $100 property value for health taxing districts, and some counties have set this cap even lower through referenda.

Adams, who is also the president of the Kentucky Public Health Association, said it is a fallacy to believe that health departments can simply double their tax rate to pay for their pension obligations, as some legislators have suggested.

Using Robertson County as an example, she said the tax rate there is already set at 8 cents per $100 property value, which would allow it to request 2 more cents per $100 property value, which she said would bring in about $90,000.

But that's not enough to make any real difference, since the cost of one clerk and one nurse in that department, figuring 83% of payroll for their pension, is $175.207 -- an amount that does not include any other costs for required programs and services, Adams said.

"For those who have the tax base, it would help them," she said. "But for those who don't, it wouldn't help."

And for those counties that are levying the maximum tax rate and still don't have enough resources, even after whittling down their staff, to deliver only core and statutorily required services, Adams said, "The next thing to do is to cut services."

The Anderson County Health Department  increased its tax rate in June to help pay for the pension increase that was set to kick in on July 1, but has since been delayed until next year. But the county Board of Health rescinded a portion of the requested 75% increase, reducing it from 52.5 cents per $1,000 in assessed property value to 47.5 cents, which represents a 58% increase from the original rate of 30 cents per $1,000, Ben Carlson reported on June 19 for The Anderson News.

Public Health Director Tim Wright made the request to lower the rate at a specially called meeting after discovering he had made a mistake in his request, explaining that he was unaware that the spreadsheet he used to build his annual budget already included the increase for pension costs, so when he computed his figures the pension had been added in twice, Carlson reported.

The new rate will keep the department from tapping into its reserves to pay the looming pension costs. The new rate will generate about $230,000, and $140,000 of that will go into pension funding, according to documents provided by Wright, Carson reports. Wright said that this is the county's first rate increase in about 20 years.

J Smith, the public health director of Garrard County Health Department, told John Cheves at the Lexington Herald-Leader: “The only reason we came in under budget this year is because of all the cuts we made. But we can’t keep doing that, we’ve done all we can do there,” Smith said. “I told our Board of Health that if we want to keep the services we have left, we’re going to have to have a tax increase.

Chris Crum, public health director at Greenup Health Department, told Rachel Adkins of The Daily Independent in Ashland that because Greenup County raised its health tax last year, it was no longer at risk of closing because of the looming pension costs.

Another challenge is that some counties don't have a separate taxing district to finance their health departments, Melinda J. Overstreet reports for the Glasgow Daily Times.

Barren County Judge-Executive Micheal Hale told Overstreet that Barren is one of three counties in the eight-county Barren River District Health Department that does not have a separate taxing district for health, and without that the county is fiscally responsible for its funding. The county's health department is one that the state health department put on a list that were at risk of closing within 12 months if they didn't get a reprieve from the bigger pension obligation.

Hale told Overstreet that an overnight jump to an 83% contribution would require the county to contribute well over $1 million, which he said would be "catastrophic" for the county's budget. He added that after the final budget is decided, he would ask the committee to look into the possibility of a health taxing district.

Depending on local tax dollars to fund public health would result in huge inequities, said Scott Lockard, director of the Kentucky River District Health Department, which covers some of the state's poorest and unhealthiest counties.

"Communities that need public-health services the most, that have the highest poverty rate, that have the poorest health outcomes, also have the least ability to raise local revenue," Lockard told Kentucky Health News in June.

Adams pointed out  that counties with high property values could raise their tax by 0.5 cents and generate more revenue than a county with low property values that double their rates.

Health departments and their employees making tough choices now that the General Assembly has passed Bevin's pension bill

Bevin at bill signing (Lexington Herald-Leader photo by Alex Slitz)

Kentucky's health departments and their employees face some difficult decisions in the wake of the pension legislation passed in the recent special session of the General Assembly.

The law written and signed by Gov. Matt Bevin freezes the pension costs of health departments for another year, at 49 percent of payroll, avoiding an increase to 83 percent, which would have forced layoffs and program cuts, and could have put some of them out of business.

But now the health departments must choose whether to stay in the Kentucky Retirement System "at full cost, leave the retirement system by paying a lump sum equal to future projected benefits payments, or buy their way out in installment payments over 30 years," writes David Zoeller of The Paducah Sun.

Marshall County (Wikipedia map)

Zoeller notes that the Marshall County Health Department "has already been making tough decisions," such as ending its school-nurse program and cutting its staff by almost 30 percent.

John Cheves of the Lexington Herald-Leader notes, "Public employers that quit KRS will be encouraged through financial incentives to freeze their employees’ pensions so they accrue no further benefits. Instead of a pension, employees will be transferred into a riskier defined-contribution retirement plan, such as a 401(k), with a balance that rises and falls with the stock market, and that retirees can outlive if their money runs dry. . . . Some could lose hundreds of thousands of dollars in anticipated retirement benefits if their pensions are frozen."

Cheves's object example is the Garrard County Health Department, which has seven employees, some of whom are less than 10 years from retirement. "Under the state pension formula, the final decade on the job is crucial to maximizing their monthly retirement checks," he notes, and gives a specific example:

"Cathy Stapleton, a nurse at the health department, is 55 with plans to retire at 62. She doesn’t want her pension to be frozen and replaced with a 401(k) account that would have seven years — not the usual 30 to 40 — to build wealth through compound interest. One ill-timed market crash could sink her." She told Cheves, "It means a lot when you come into a pension. It means you have a retirement where you can count on having that income every month." Getting a new 401(k) plan at age 55 "would be a lot different."

Garrard County (Wikipedia map)

Department Director J Smith told Cheves he will recommend to the Garrard County Board of Health that it stick with KRS and pay the 83 percent. "Telling middle-aged people who devoted their lives to public service that they’re suddenly going to risk financial insecurity in their senior years is not a viable choice, he said," Cheves reports, quoting him directly: “We’re not going to opt out. If we opt out, to me, we’re screwing our employees here. Some of my people have got just a few years left. We expect to get what we were promised. We were promised a pension.”

The department has already eliminated family-planning services, cut health education, "laid off its emergency-preparedness coordinator and a front-desk clerk, and officially eliminated a third position, Smith’s old job, which he still does in addition to being director," Cheves reports. "That means he splits his time between inspecting schools, businesses, septic tanks and the like for safety and cleanliness, and managing the department."

“I’ll admit, our response time is slower now because of it,” Smith told Cheves. “When people used to call in for a site evaluation, we usually could get out there the same day. Now it might take us a week. It’s just — I’m sorry, we don’t have the people we used to. . . . I told our Board of Health that if we want to keep the services we have left, we’re going to have to have a tax increase.”

Kentucky River District Health Department
service area: Wolfe, Lee, Owsley, Leslie,
Perry, Knott and Letcher counties (KRDHD map)

Using local tax dollars to fund public health would result in huge inequities, said Scott Lockard, director of the Kentucky River District Health Department, which covers some of the state's poorest and unhealthiest counties. "Communities that need public-health services the most, that have the highest poverty rate, that have the poorest health outcomes, also have the least ability to raise local revenue," Lockard told Kentucky Health News in June.