A one-hour webinar, "Covering Health Care Reform: How to Inform Your Readers," is being offered from 2 to 3 p.m. ET Thursday at a cost of $45. (The earlybird fee of $35 has expired.) The sponsors are the Kentucky Press Association, the
Tuesday, December 3, 2013
Monday, December 2, 2013
A byproduct of cholesterol that acts like estrogen explains the link between high cholesterol and breast cancer
The link between high cholesterol and breast cancer can now be explained.
It is not the cholesterol itself, but a "byproduct of cholesterol (that) functions like the hormone estrogen to fuel the growth and spread of the most common types of breast cancer," researchers at the Duke University Cancer Institute report, according to Newswise.
Estrogen is known to "feed an estimated 75 percent of all breast cancers," Newswise reports. So basically, cholesterol creates a "byproduct" that acts like estrogen and "feeds" the breast cancer, the researches concluded.
This is the first time a link between high cholesterol and breast cancer has been explained, especially in post-menopausal women, according to the study, which also suggests that changes in diet or taking statins and other medication to reduce cholesterol may offer "simple ways to reduce breast cancer risk," Newswise reports.
Although studies have shown a connection between obesity and breast cancer, as well as high cholesterol and breast cancer, the reason for these connections had not been explained, said senior author Donald McDonnell, chair of the Department of Pharmacology and Cancer Biology at Duke: “What we have now found is a molecule – not cholesterol itself, but an abundant metabolite of cholesterol, called 27HC – that mimics the hormone estrogen and can independently drive the growth of breast cancer.”
The researchers also found that the more enzyme that makes the cholesterol byproduct that is present, the more aggressive the tumor.
It is not the cholesterol itself, but a "byproduct of cholesterol (that) functions like the hormone estrogen to fuel the growth and spread of the most common types of breast cancer," researchers at the Duke University Cancer Institute report, according to Newswise.
Estrogen is known to "feed an estimated 75 percent of all breast cancers," Newswise reports. So basically, cholesterol creates a "byproduct" that acts like estrogen and "feeds" the breast cancer, the researches concluded.
This is the first time a link between high cholesterol and breast cancer has been explained, especially in post-menopausal women, according to the study, which also suggests that changes in diet or taking statins and other medication to reduce cholesterol may offer "simple ways to reduce breast cancer risk," Newswise reports.
Although studies have shown a connection between obesity and breast cancer, as well as high cholesterol and breast cancer, the reason for these connections had not been explained, said senior author Donald McDonnell, chair of the Department of Pharmacology and Cancer Biology at Duke: “What we have now found is a molecule – not cholesterol itself, but an abundant metabolite of cholesterol, called 27HC – that mimics the hormone estrogen and can independently drive the growth of breast cancer.”
The researchers also found that the more enzyme that makes the cholesterol byproduct that is present, the more aggressive the tumor.
When test animals took anti-estrogen drugs such as tamoxifen, or when they quit receiving the cholesterol byproduct, the cancer was inhibited, according to Newswise.
Nelson said in the article that there was also a potential association between the cholesterol byproduct and the development of resistance to the anti-estrogen tamoxifen. Data also suggest the cholesterol byproduct may reduce the effectiveness of commonly used breast cancer therapies.
These findings suggest that women who have breast cancer and high cholesterol who take statins will have increased benefit, Newswise reports, because it will decrease their resistance to commonly used breast cancer therapies.
Further research will "include clinical studies to verify the suggested potential outcomes and to determine if this cholesterol byproduct plays a role in other cancers," McDonnel said.
Night lingers in Appalachia, but there are rays of sunlight
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| Harry Caudill talked with U.S. Sen. Robert F. Kennedy during his visit to Eastern Kentucky in February 1968. |
From 2000 to 2010, the number of drug-overdose deaths in Kentucky rose a staggering 296 percent, highlighting the state's drug abuse epidemic that now kills more than 1,000 Kentuckians a year. But communities have started to rise up and fight back against this lethal weapon, and for the first time in 10 years, deaths from prescription-drug abuse in Kentucky declined last year.
Still, the state's highest rates of overdose deaths are consistently found in Eastern Kentucky, where chronic poverty and economic hardships remain and numerous factors make it one of the worst areas in the nation for prescription drug abuse, experts say. Poverty is at the top of the list, reports Estep.
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| Click here for an interactive version of this map, with individual county data. |
Another factor was the region's chronic health problems, reports Estep. It is well documented that Appalachians suffer from disproportionately poor health and have increased risks of adverse health outcomes, compared to the rest of the nation and the rest of the state; many people addressed these problems with drugs, which unintentionally led to drug addiction.
Public assistance also played a role in the developing drug abuse problem. "Medicaid recipients can get prescription drugs at little cost, and some people then resell them for cash," Estep writes. For example, in Clay County, which has the third highest rate of drug overdoses per 100,000 people, 42 percent of residents were eligible for Medicaid in fiscal 2012, compared with 18.8 percent statewide.
Eastern Kentucky's ongoing battle against pills started well before a decade ago as the area suffered economic devastation of the Great Depression and doctors handed out pills to mask pain for injured coal miners and the sick poor, Caudill wrote, adding that the drudgery of coal-camp life also drove the use of pills.
Fifty years later, Estep writes, "Rising drug abuse added misery to the economic malaise, and corruption among public officials inflamed the drug problem. Drug dealers helped power brokers buy votes, then benefited as some local police and other officials turned a blind eye to their illicit sales."
A story of heartbreak and hope in Manchester
The story of one recovering addict, Melanda Adams, embodies these forces. Her home Clay County was at the center of the prescription-drug explosion, and her father, the county school superintendent, was convicted in a vote-buying scheme that he said he joined to help oust officials who were protecting drug dealers.
Social use of alcohol and drugs led Adams to start abusing drugs, but by the time she was 23, she was snorting as much as $800 worth of OxyContin pills and methamphetamine a day, she told Estep, adding that people start abusing drugs for a variety of reasons, and the shame of their addiction then becomes part of the reason to keep abusing them. "Your soul is tormented, really," she said.
The story of one recovering addict, Melanda Adams, embodies these forces. Her home Clay County was at the center of the prescription-drug explosion, and her father, the county school superintendent, was convicted in a vote-buying scheme that he said he joined to help oust officials who were protecting drug dealers.
Social use of alcohol and drugs led Adams to start abusing drugs, but by the time she was 23, she was snorting as much as $800 worth of OxyContin pills and methamphetamine a day, she told Estep, adding that people start abusing drugs for a variety of reasons, and the shame of their addiction then becomes part of the reason to keep abusing them. "Your soul is tormented, really," she said.
Her craving for drugs led Adams to steal the ingredients that a drug dealer had provided her boyfriend to make a batch of meth, for which she suffered an almost fatal beating that still didn't curb her addiction. After stints in jail and in rehab, police found her agitated and bleeding in her home. She remained in jail for three months, where she suffered from the sharp pain of detoxification and withdrawal. Then she started on the road to recovery, reports Estep.
Fueling problems of addiction faced by thousands, Eastern Kentucky counties used corrupt relationships with local police and political officials in their illegal businesses, which included selling drugs.
Jurors convicted Adams' father, school Supt. Douglas Adams of vote fraud in a number of elections. As part of his defense, Adams said his motivation for getting involved in the most notorious election at issue in the trial, the 2002 primary for county clerk, was that the incumbent, Jennings B. White, had been protecting drug dealers, reports Estep. Adams said he was fighting against White to save his daughter and others who had fallen victim to drugs.
In the late 1990's, Congress designated Eastern Kentucky as a High Intensity Drug Trafficking Area, which led to efforts that helped dry up the county's drug rings. The FBI led investigations, "leveraging charges against drug dealers to pursue investigations of local officials," reports Estep. In the end, more than a dozen public officials or election offers in Clay County had been convicted. This shook up the local political structure, which was necessary for the community to take a stand against drugs, Estep reports.
Now, as a result of greater community awareness, activism against drugs, and targeted law enforcement, drug overdose deaths in Clay County have fallen from 43 in 2011 to 27 in 2012. Coroner Danny Finley also credits this reduction to better practices by many doctors, and new state laws that have cracked down on pain clinics and over-prescribing doctors, reports Estep.
While the fight against drugs is never over, Melanda Adams is proof that there's hope in Manchester and hope for Clay County. "She has clear eyes, a big laugh and a feisty 6-year-old daughter," reports Estep. She runs her own convenience store and says its important for drug addicts who feel trapped to know that they are more than just addicts. "There is a chance," she told Estep. "Give 'em that hope."
Beshear's office says he is considering 'various ideas' for financing Ky. insurance exchange, not just a 1% fee on policies
"Gov. Steve Beshear’s administration is reconsidering how to pay for the
Kentucky Health Benefit Exchange amid increased criticism from some
Republicans in the legislature and a court case challenging a fee
Beshear created through executive order," Ryan Alessi reports for cn|2's "Pure Politics," a service of Time Warner Cable.
“Various ideas for a sustainability plan for the exchange are being discussed, and such a plan will be finalized for implementation before current funding expires in 2015,” the governor's office told Alessi. Current funding comes from the federal government.
Beshear's plans have called for the exchange to be financed with a 1 percent fee on policies bought through the exchange, to be paid by insurance companies using it. "But in a statement in response to questions from Pure Politics, the governor’s office said it’s suddenly considering other ways to pay for the exchange," Alessi reports, adding that the office didn't respond to his follow-up question about whether legislative approval would be needed for whatever plan was adopted.
House Speaker Greg Stumbo, a Democrat from Prestonsburg, said during a Kentucky Hospital Association panel last month that the fee does not require approval of the General Assembly. Senate Health and Welfare Committee Chair Julie Denton, R-Louisville, told Alessi that it does. Here's a video clip:
“Various ideas for a sustainability plan for the exchange are being discussed, and such a plan will be finalized for implementation before current funding expires in 2015,” the governor's office told Alessi. Current funding comes from the federal government.
Beshear's plans have called for the exchange to be financed with a 1 percent fee on policies bought through the exchange, to be paid by insurance companies using it. "But in a statement in response to questions from Pure Politics, the governor’s office said it’s suddenly considering other ways to pay for the exchange," Alessi reports, adding that the office didn't respond to his follow-up question about whether legislative approval would be needed for whatever plan was adopted.
House Speaker Greg Stumbo, a Democrat from Prestonsburg, said during a Kentucky Hospital Association panel last month that the fee does not require approval of the General Assembly. Senate Health and Welfare Committee Chair Julie Denton, R-Louisville, told Alessi that it does. Here's a video clip:
Stanton Elementary School, closed almost three weeks because of bat infestation, is scheduled to reopen Wednesday
By Melissa Patrick
Kentucky Health News
Stanton Elementary in Powell County will reopen this week after being closed for almost three weeks because of a bat infestation, school officials said Monday.
"They are moving everything back into the building today," Arliss Crowe, secretary to the district's director of pupil personnel, told Kentucky Health News on Monday. "Students will be back in the school on Wednesday." Schools in the county were dismissed Monday and Tuesday while crews moved furniture serving students who were moved to alternate facilities.
The state Department for Public Health closed the school Nov. 14 after bats were reported frequently entering the building, county School Supt. Mike Tate told The Clay City Times. An animal-removal company found three to five bats initially and did not see any more after they began their work, he said.
The company completed its work last week and told the school system to monitor the building for a week and if no bats are sighted it "could be safe to move back in," Tate told the weekly newspaper.
Tate told the weekly newspaper that he met with state health officials Friday, Nov. 29, to determine what needed to happen next. "We want to be careful and not act too quickly," he said then. "We want to get back, but we want to make sure the school is safe." (Read more)
Kentucky Health News
Stanton Elementary in Powell County will reopen this week after being closed for almost three weeks because of a bat infestation, school officials said Monday.
"They are moving everything back into the building today," Arliss Crowe, secretary to the district's director of pupil personnel, told Kentucky Health News on Monday. "Students will be back in the school on Wednesday." Schools in the county were dismissed Monday and Tuesday while crews moved furniture serving students who were moved to alternate facilities.
The state Department for Public Health closed the school Nov. 14 after bats were reported frequently entering the building, county School Supt. Mike Tate told The Clay City Times. An animal-removal company found three to five bats initially and did not see any more after they began their work, he said.
The company completed its work last week and told the school system to monitor the building for a week and if no bats are sighted it "could be safe to move back in," Tate told the weekly newspaper.
Tate told the weekly newspaper that he met with state health officials Friday, Nov. 29, to determine what needed to happen next. "We want to be careful and not act too quickly," he said then. "We want to get back, but we want to make sure the school is safe." (Read more)
Sunday, December 1, 2013
Beshear says Medicaid plan will transform Ky. in a generation; acknowledges it was easier because he wouldn't face voters
In a generation, Kentucky will be a very different state because the federal health-reform law and expansion of Medicaid has made health insurance available to all residents of the state, Gov. Steve Beshear told Los Angeles Times political reporter Mark Z. Barabak for a story the paper published on Thanksgiving Day. And he acknowledged that his Medicaid decision was easier because he can't seek re-election.
"I knew if I was going to make a huge difference in the health status of Kentucky, it was going to take some kind of transformational tool to do that, and that's what the Affordable Care Act is for me," Beshear told Barabak. "I think we've started something here that a generation from now you'll see a very different Kentucky than what you see today."
Beshear "conceded, with a small smile, that it was easier knowing he would never face voters again," Barabak writes. "Embracing Obamacare is not without political risk. Undaunted by the early success in Kentucky, Republicans plan to make the controversial program a major issue in 2014, when the GOP will be vying to take control of the state House for the first time in close to a century."
Politics aside, "The need for care in this pretty but hard-pressed state is unarguable," Barabak writes. "Kentucky leads the nation in cancer deaths and preventable
hospitalizations and suffers some of the highest rates of diabetes,
cardiovascular illness and premature death." But he says "Kentuckians may feel understandably whiplashed" because the state's Republican U.S. senators firmly oppose "Obamacare." (Read more)
"I knew if I was going to make a huge difference in the health status of Kentucky, it was going to take some kind of transformational tool to do that, and that's what the Affordable Care Act is for me," Beshear told Barabak. "I think we've started something here that a generation from now you'll see a very different Kentucky than what you see today."
Beshear "conceded, with a small smile, that it was easier knowing he would never face voters again," Barabak writes. "Embracing Obamacare is not without political risk. Undaunted by the early success in Kentucky, Republicans plan to make the controversial program a major issue in 2014, when the GOP will be vying to take control of the state House for the first time in close to a century."
Wednesday, November 27, 2013
Feds say reform law has saved Kentuckians on Medicare an average of $928 this year on prescription drugs
The federal health reform law has saved seniors and the disabled millions of dollars on their Medicare prescription-drug coverage, says the Centers
for Medicare & Medicaid Services.
CMS said 65,040 Kentuckians have saved a total of $60.4 million in the first 10 months of 2013, an average of $928 per person in Medicare. CMS said Kentucky seniors have saved $180.9 million on the coverage, known as Part D, since the passage of the reform law.
Seniors will also be free to use more of their Social Security cost-of-living adjustment as they choose, because the Medicare Part B premium will not increase in 2014 as a result of the law’s cost restrictions, CMS noted. The deductible for standard Part D plans will decline by $15 in 2014, to $310.
The data also show that since the Patient Protection and Affordable Care Act took effect, more than 7.3 million seniors and people with disabilities who reached the prescription coverage gap, commonly known as the "donut hole," have saved $8.9 billion on their prescription drugs, an average of $1,209 per person.
The "donut hole" is the gap in coverage after the basic coverage and before the catastrophic coverage takes effect. Without rebates authorized by the law, Medicare beneficiaries would have to pay out-of-pocket for the entire cost of prescription drugs once they hit the hole, until they incur enough expense to reach catastrophic coverage.
Next year, Medicare Part D participants in the donut hole will save about 53 percent on the cost of brand name drugs and 28 percent on the cost of generic drugs, CMS says. These savings and Medicare coverage are to gradually increase until 2020, when the donut hole will be closed.
CMS said 65,040 Kentuckians have saved a total of $60.4 million in the first 10 months of 2013, an average of $928 per person in Medicare. CMS said Kentucky seniors have saved $180.9 million on the coverage, known as Part D, since the passage of the reform law.
Seniors will also be free to use more of their Social Security cost-of-living adjustment as they choose, because the Medicare Part B premium will not increase in 2014 as a result of the law’s cost restrictions, CMS noted. The deductible for standard Part D plans will decline by $15 in 2014, to $310.
The data also show that since the Patient Protection and Affordable Care Act took effect, more than 7.3 million seniors and people with disabilities who reached the prescription coverage gap, commonly known as the "donut hole," have saved $8.9 billion on their prescription drugs, an average of $1,209 per person.
The "donut hole" is the gap in coverage after the basic coverage and before the catastrophic coverage takes effect. Without rebates authorized by the law, Medicare beneficiaries would have to pay out-of-pocket for the entire cost of prescription drugs once they hit the hole, until they incur enough expense to reach catastrophic coverage.
Next year, Medicare Part D participants in the donut hole will save about 53 percent on the cost of brand name drugs and 28 percent on the cost of generic drugs, CMS says. These savings and Medicare coverage are to gradually increase until 2020, when the donut hole will be closed.
Irvine hospital's Susan Starling wins American Hospital Association's award for leadership in small or rural hospitals
The award recognizes the accomplishments of small or rural hospital leaders who have improved health care delivery in their communities through innovative and progressive efforts. Starling was recognized "as a widely respected leader who fosters strong collaborative relationships that improve the health care of the rural community," says a press release from the American Hospital Association.
Serving a community of approximately 15,000 that covers several counties for the last 30 years, Starling has forged statewide partnerships, updated the Catholic Health Partners facility, provided leadership in initiatives such as Project HOME (Helpful Opportunities for Medical Care Enhancement), helped to connect uninsured and under-insured patients with preventive services, developed partnerships resulting in the first rural community lung-cancer screening and breast-cancer awareness and screening, and in 2010 provided "groundbreaking direction" for her hospital to be certified as the first Level IV trauma center in Kentucky, the release says.
Starling also received the Kentucky Rural Health Association’s Dan Martin Award for her dedication to rural health care in Kentucky in 2012, according to the release, and was recognized by the AHA's political action committee as its Most Valuable Player for her significant outreach and advocacy efforts. UPDATE, 2/23/14: Becker's Hospital Review included Starling in its initial list of "50 Rural Hospital CEOs to Know."
Humana, United and Assurant allow non-compliant policies to be extended; Anthem and Bluegrass offer sort of half a loaf
Some health-insurance companies won't give Kentucky customers the opportunity to renew polices that don't comply with the federal health-reform law, under the conditional extension granted by President Obama, state Insurance Commissioner Sharon Clark told a legislative committee yesterday.
"Humana, United Healthcare and Assurant Health say they will go along with President Barack Obama’s healthcare fix and let thousands of their customers renew their canceled insurance policies for another year," The Courier-Journal reports. "Insurers such as Bluegrass Family Health and Anthem are offering an alternative, providing some consumers an early renewal option that essentially could allow them to keep existing coverage partly into 2014."
"Melissa Metzger, an attorney for Anthem, said the company has spent more than $150 million to beef up operational systems and develop products that would meet the ACA requirements, often in markets that Anthem has served for decades," C-J reporters Mike Wynn and Chris Kenning write.
"About 280,000 Kentuckians — 130,000 in individual plans and 150,000 in group plans — have or will receive discontinuation notices from insurance companies saying their current health plans would not be offered under the federal health care law," Kevin Wheatley reports for The State Journal in Frankfort. "About a third of Anthem’s more than 100,000 individual plan members and half of its 100,000 group plan members have accepted" the company's offer, which expires Dec. 15, "to change the effective date of their current policies to Dec. 1, meaning they could carry that plan through Dec. 1, 2014."
"Humana, United Healthcare and Assurant Health say they will go along with President Barack Obama’s healthcare fix and let thousands of their customers renew their canceled insurance policies for another year," The Courier-Journal reports. "Insurers such as Bluegrass Family Health and Anthem are offering an alternative, providing some consumers an early renewal option that essentially could allow them to keep existing coverage partly into 2014."
"Melissa Metzger, an attorney for Anthem, said the company has spent more than $150 million to beef up operational systems and develop products that would meet the ACA requirements, often in markets that Anthem has served for decades," C-J reporters Mike Wynn and Chris Kenning write.
"About 280,000 Kentuckians — 130,000 in individual plans and 150,000 in group plans — have or will receive discontinuation notices from insurance companies saying their current health plans would not be offered under the federal health care law," Kevin Wheatley reports for The State Journal in Frankfort. "About a third of Anthem’s more than 100,000 individual plan members and half of its 100,000 group plan members have accepted" the company's offer, which expires Dec. 15, "to change the effective date of their current policies to Dec. 1, meaning they could carry that plan through Dec. 1, 2014."
Monday, November 25, 2013
Not only may you not get to keep your plan under Obamacare, you might not be able to keep your doctor; there are reasons
By Molly Burchett
Kentucky Health News
Part of the sales pitch for the federal health-care reform law was that people could keep their doctors, but many Americans and some Kentuckians won't because insurers are excluding some hospitals and doctors from policies in an effort to make the new, standardized plans on the insurance exchanges more affordable.
Eleven Kentucky hospitals have filed complaints with the state Department of Insurance, saying Anthem's policies on the state's exchange include only a narrow network of providers, excluding them. Limiting the number of providers on the exchanges is one seldom-mentioned way insurers are trying to reduce premiums for new policies.
The department upheld three of the complaints because the hospitals said they would be able to serve at least four of the state's eight Medicaid regions, a concern that led to their original exclusion. The department has since ordered Anthem to accept applications from those hospitals- UK Healthcare, Our Lady of Bellefonte in Ashland and Highlands Regional Medical Center in Prestonsburg, reports Mike Wynn of The Courier-Journal.
Insurance-company research shows that consumers’ highest priority when shopping for insurance is price. To compete on price, insurers contract with doctors and hospitals who charge them the lowest fees. Some prestigious and well-known academic medical schools that charge higher prices are being excluded from exchange plans, Forbes magazine reports.
These same market forces may also limit the ability for small hospitals and providers to provide care through exchange plans if their health systems lack economies of scale that enhance their negotiating power. UK has already negotiated a deal with Anthem, and the company's negotiations with Highlands and Bellefonte are ongoing.
Anthem is not the only insurance company with narrow networks. Stephen Miller, vice president of finance for the Kentucky Hospital Association, said other Kentucky insurers are also using network restrictions to "steer patients to hospitals with the best rates for the insurer," Wynn reports. Around the country, many plans have more narrow networks than previous plans in order to limit premiums, Politico reports.
This tactic lowers expenses for the insurers by bypassing higher-priced health systems but means that some patients may have to change doctors or hospitals, report Sandhya Somashekhar and Ariana Eunjung Cha in The Washington Post: "The result, some argue, is a two-tiered system of health care: Many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers."
Consumer advocates say tighter networks will disrupt care and limit access for middle-and lower-income consumers, who may be sicker than the average consumer, reports Kaiser Health News: "Narrow networks present the opportunity for lower costs via discounts from select hospitals and doctors in return for patient volume. But smaller networks can require members to travel farther for care or make it hard to get appointments."
Anthem says limiting networks helps insurers save money, which is passed on to patients through reduced premiums. Critics say healthy people must pay more than their fair share to help provide coverage for sicker people. Health-reform advocates say the law's trade-offs are acceptable costs in exchange for getting health coverage to more needy people, but some wonder about that if they have to drive 30 miles to get it.
What is a narrow network?
An insurance company's health-care network is a group of physicians, hospitals and other providers that agree to provide medical services at pre-negotiated rates. The wider the insurance company's network, the more doctors and hospitals from which you can choose without paying more to see an out-of-network provider.
Anthem spokesman Tony Felts said the smaller networks are an attempt to keep exchange plans affordable and that the company worked hard to design products that would attract consumers to them. Four other companies are offering policies on Kynect, the state exchange: Humana, United Healthcare, Bluegrass Family Health and the Kentucky Health Cooperative. Anthem and the cooperative are the only two insurers offering individual plans statewide.
"Many companies have selectively entered the exchanges because they are concerned that they will be dominated by risky, high-using populations who wanted insurance and couldn't afford it" before the law took effect, Gail Wilsensky, a UnitedHealth director, told U.S. News. "They are pressed to narrow their networks to stay within the premiums."
The reform law requires insurers to provide enough doctors and hospitals to ensure quality care, but the federal government offers little guidance on how this is defined. The Kentucky Heath Benefit Exchange says at least 20 percent of available essential community providers in an exchange service area must be in its network, and insurers must contract with at least one of these providers in each county in the service area. However, these regulations don't specify a penalty for not adhering to the recommendation, and there is no guarantee that the network includes your doctor.
Consider a plan's network, premiums and out-of-pocket amounts
Patients may not realize whether or not their doctor is in a plan's network until January, when the new policies take effect. Therefore, consumers should be careful to check the details about an exchange plan's network. Consumers should also be aware of the plan's out-of-pocket costs; the cheapest exchange plans have high deductibles.
On Kynect, insurance shoppers can filter plans to see if a specific provider is included. Insurance Department spokeswoman Gwenda Bond said the agency relies on insurance companies to provide network information to be posted on the exchange. She said the department has experienced some minor issues with this process due to insurers using different names for the same provider.
To address this problem, Kynect also provides a link to each issuer’s web site for their provider directory, said Bond. "The issuer’s provider directory web site should contain the most current list of providers available in the issuer’s network. We continue to work with insurance companies to improve the lists," she said.
"Under Obamacare’s exchanges, people who really want to keep their doctor, at any price, will often have to pay higher premiums for the privilege. And people who prefer lower premiums, above all, might need to choose a different doctor," writes Avik Roy of Forbes.
As Medicaid enrollment grows, fewer providers accept it
At the same time some providers are being excluded by insurance companies or are choosing to exclude themselves, some providers are opting out of the exchanges and are not accepting Medicaid patients. A recent survey by the Medical Group Management Association found that 40 percent of its members are still deciding if they are going to accept insurance offered on the Obamacare marketplaces, CNN reports.
About 56,000 Kentuckians have enrolled in Kynect plans as of Nov. 22, and 82 percent of those are Medicaid plans. According to the Centers for Medicare and Medicaid Services, which administers the Medicaid program, three times more doctors are refusing Medicare patients than three years ago.
Doctors cite Medicare's increasing rules and lowered payment rates as reasons for not accepting Medicaid, and those who will see some Medicaid patients are limiting the number, reports The Wall Street Journal. Doctors also say administrative hassles and delays in getting paid also discourage them from accepting Medicaid, says the Center for Studying Health System Change.
Hospitals across the state have expressed concern about delayed payments from Kentucky's managed care companies as a result of the state's quick transition to a managed care model, and state officials are working to address this problem. Still, Kentucky's Medicaid payment rates are about 72 percent of Medicare rates. The reform law raised Medicaid fees to match what Medicare pays primary-care doctors, but only for two years and after much administrative hassle.
Kentucky Health News
Part of the sales pitch for the federal health-care reform law was that people could keep their doctors, but many Americans and some Kentuckians won't because insurers are excluding some hospitals and doctors from policies in an effort to make the new, standardized plans on the insurance exchanges more affordable.
Eleven Kentucky hospitals have filed complaints with the state Department of Insurance, saying Anthem's policies on the state's exchange include only a narrow network of providers, excluding them. Limiting the number of providers on the exchanges is one seldom-mentioned way insurers are trying to reduce premiums for new policies.
The department upheld three of the complaints because the hospitals said they would be able to serve at least four of the state's eight Medicaid regions, a concern that led to their original exclusion. The department has since ordered Anthem to accept applications from those hospitals- UK Healthcare, Our Lady of Bellefonte in Ashland and Highlands Regional Medical Center in Prestonsburg, reports Mike Wynn of The Courier-Journal.
Insurance-company research shows that consumers’ highest priority when shopping for insurance is price. To compete on price, insurers contract with doctors and hospitals who charge them the lowest fees. Some prestigious and well-known academic medical schools that charge higher prices are being excluded from exchange plans, Forbes magazine reports.
These same market forces may also limit the ability for small hospitals and providers to provide care through exchange plans if their health systems lack economies of scale that enhance their negotiating power. UK has already negotiated a deal with Anthem, and the company's negotiations with Highlands and Bellefonte are ongoing.
Anthem is not the only insurance company with narrow networks. Stephen Miller, vice president of finance for the Kentucky Hospital Association, said other Kentucky insurers are also using network restrictions to "steer patients to hospitals with the best rates for the insurer," Wynn reports. Around the country, many plans have more narrow networks than previous plans in order to limit premiums, Politico reports.
This tactic lowers expenses for the insurers by bypassing higher-priced health systems but means that some patients may have to change doctors or hospitals, report Sandhya Somashekhar and Ariana Eunjung Cha in The Washington Post: "The result, some argue, is a two-tiered system of health care: Many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers."
Consumer advocates say tighter networks will disrupt care and limit access for middle-and lower-income consumers, who may be sicker than the average consumer, reports Kaiser Health News: "Narrow networks present the opportunity for lower costs via discounts from select hospitals and doctors in return for patient volume. But smaller networks can require members to travel farther for care or make it hard to get appointments."
Anthem says limiting networks helps insurers save money, which is passed on to patients through reduced premiums. Critics say healthy people must pay more than their fair share to help provide coverage for sicker people. Health-reform advocates say the law's trade-offs are acceptable costs in exchange for getting health coverage to more needy people, but some wonder about that if they have to drive 30 miles to get it.
An insurance company's health-care network is a group of physicians, hospitals and other providers that agree to provide medical services at pre-negotiated rates. The wider the insurance company's network, the more doctors and hospitals from which you can choose without paying more to see an out-of-network provider.
Anthem spokesman Tony Felts said the smaller networks are an attempt to keep exchange plans affordable and that the company worked hard to design products that would attract consumers to them. Four other companies are offering policies on Kynect, the state exchange: Humana, United Healthcare, Bluegrass Family Health and the Kentucky Health Cooperative. Anthem and the cooperative are the only two insurers offering individual plans statewide.
"Many companies have selectively entered the exchanges because they are concerned that they will be dominated by risky, high-using populations who wanted insurance and couldn't afford it" before the law took effect, Gail Wilsensky, a UnitedHealth director, told U.S. News. "They are pressed to narrow their networks to stay within the premiums."
The reform law requires insurers to provide enough doctors and hospitals to ensure quality care, but the federal government offers little guidance on how this is defined. The Kentucky Heath Benefit Exchange says at least 20 percent of available essential community providers in an exchange service area must be in its network, and insurers must contract with at least one of these providers in each county in the service area. However, these regulations don't specify a penalty for not adhering to the recommendation, and there is no guarantee that the network includes your doctor.
Consider a plan's network, premiums and out-of-pocket amounts
Patients may not realize whether or not their doctor is in a plan's network until January, when the new policies take effect. Therefore, consumers should be careful to check the details about an exchange plan's network. Consumers should also be aware of the plan's out-of-pocket costs; the cheapest exchange plans have high deductibles.
On Kynect, insurance shoppers can filter plans to see if a specific provider is included. Insurance Department spokeswoman Gwenda Bond said the agency relies on insurance companies to provide network information to be posted on the exchange. She said the department has experienced some minor issues with this process due to insurers using different names for the same provider.
To address this problem, Kynect also provides a link to each issuer’s web site for their provider directory, said Bond. "The issuer’s provider directory web site should contain the most current list of providers available in the issuer’s network. We continue to work with insurance companies to improve the lists," she said.
"Under Obamacare’s exchanges, people who really want to keep their doctor, at any price, will often have to pay higher premiums for the privilege. And people who prefer lower premiums, above all, might need to choose a different doctor," writes Avik Roy of Forbes.
As Medicaid enrollment grows, fewer providers accept it
At the same time some providers are being excluded by insurance companies or are choosing to exclude themselves, some providers are opting out of the exchanges and are not accepting Medicaid patients. A recent survey by the Medical Group Management Association found that 40 percent of its members are still deciding if they are going to accept insurance offered on the Obamacare marketplaces, CNN reports.
About 56,000 Kentuckians have enrolled in Kynect plans as of Nov. 22, and 82 percent of those are Medicaid plans. According to the Centers for Medicare and Medicaid Services, which administers the Medicaid program, three times more doctors are refusing Medicare patients than three years ago.
Doctors cite Medicare's increasing rules and lowered payment rates as reasons for not accepting Medicaid, and those who will see some Medicaid patients are limiting the number, reports The Wall Street Journal. Doctors also say administrative hassles and delays in getting paid also discourage them from accepting Medicaid, says the Center for Studying Health System Change.
Hospitals across the state have expressed concern about delayed payments from Kentucky's managed care companies as a result of the state's quick transition to a managed care model, and state officials are working to address this problem. Still, Kentucky's Medicaid payment rates are about 72 percent of Medicare rates. The reform law raised Medicaid fees to match what Medicare pays primary-care doctors, but only for two years and after much administrative hassle.
Humana allows policyholders to keep old plans without paying more; Anthem is still deciding
Humana, one of the three insurance companies offering individual health policies on the state's insurance exchange, will allow Kentuckians to keep their insurance coverage for another year without charging them more for it.
The other two companies on the individual market are Anthem and the Kentucky Health Cooperative. Anthem hasn't responded to recent inquiries about the old policies; it said last week that it was still deciding whether or not it would extend policies that don't comply with federal health reform. Since the non-profit cooperative is a new insurance organization, it is only offering policies that comply with the law.
A Humana spokeswoman told Kentucky Health News Monday that the company communicated premium amounts to individual policyholders in October when presenting policy owners with coverage options for 2014, including the option to continue their current plan. Those premium amounts for individual policies have not changed since the most recent changes to the Affordable Care Act, she said.
Some insurance experts have warned that consumers renewing noncompliant plans will be predominantly younger and healthier, while older and sicker people will migrate to the subsidized marketplaces, which could drive up costs for plans. Some states aren't allowing insurers to renew policies. For example, Washington Insurance Commissioner Mike Kreidler said he would not allow insurers to extend the policies “in the interest of keeping the consumer protections we have enacted,” reports Kaiser Health News.
In Kentucky, at least for Humana policyholders, this is not the case. President Obama said people whose policies were being canceled because they didn't comply with the law could renew them for another year if state regulators allow it. Gov. Steve Beshear gave insurers the green light to decide whether or not to renew these policies. Humana has decided to do so without charging additional premiums short-term.
Meanwhile, Anthem is deciding what to do and some existing policy owners in other states face as much as a 24 percent increase in their premiums. Obama's extension allows non-compliant policies to stay in place only for a year. This time next year, the transition must be made to plans that are qualified under the law.
The other two companies on the individual market are Anthem and the Kentucky Health Cooperative. Anthem hasn't responded to recent inquiries about the old policies; it said last week that it was still deciding whether or not it would extend policies that don't comply with federal health reform. Since the non-profit cooperative is a new insurance organization, it is only offering policies that comply with the law.
A Humana spokeswoman told Kentucky Health News Monday that the company communicated premium amounts to individual policyholders in October when presenting policy owners with coverage options for 2014, including the option to continue their current plan. Those premium amounts for individual policies have not changed since the most recent changes to the Affordable Care Act, she said.
Some insurance experts have warned that consumers renewing noncompliant plans will be predominantly younger and healthier, while older and sicker people will migrate to the subsidized marketplaces, which could drive up costs for plans. Some states aren't allowing insurers to renew policies. For example, Washington Insurance Commissioner Mike Kreidler said he would not allow insurers to extend the policies “in the interest of keeping the consumer protections we have enacted,” reports Kaiser Health News.
In Kentucky, at least for Humana policyholders, this is not the case. President Obama said people whose policies were being canceled because they didn't comply with the law could renew them for another year if state regulators allow it. Gov. Steve Beshear gave insurers the green light to decide whether or not to renew these policies. Humana has decided to do so without charging additional premiums short-term.
Meanwhile, Anthem is deciding what to do and some existing policy owners in other states face as much as a 24 percent increase in their premiums. Obama's extension allows non-compliant policies to stay in place only for a year. This time next year, the transition must be made to plans that are qualified under the law.
Beshear to study nursing-home staffing minimums, suggests homes' high liability costs are related to poorly ranked care
Responding to a letter from Kentuckians for Nursing Home Reform, which cited a low ranking for the state's nursing homes, Gov. Steve Beshear said he is "committed to taking steps toward improving the quality of care in Kentucky nursing homes," Valarie Honeycutt Spears reports for the Lexington Herald-Leader.
Beshear said he would call for forums across the state to allow the public and nursing-home residents to discuss their ideas for improvement, and would research the impacts of increased staffing in nursing homes. The reform group wants minimum staffing requirements, which the nursing-home industry opposes.
"I take this challenge very seriously and will be working with my staff and the state's Elder Abuse Committee over the coming months to explore ways in which we can improve the quality of care," the governor said in a Nov. 5 letter to Bernie Vonderheide, founder of the nursing-home reform group.
Vonderheide wrote Beshear in August after Kentucky was ranked 40th in nursing-home care by Families for Better Care, a Florida-based advocacy group for nursing-home residents. On a grade scale of A to F, the group gave Kentucky a D. The grade was determined by analyzing eight federal measures of nursing home quality, according to the group's release.
Beshear suggested in his letter that the low ranking of Kentucky's nursing homes might be related to another of their lobbying concerns — liability costs that are well above national norms. The homes want to limit those costs by subjecting lawsuits against them to medical review panels, which couldn't block the suits but would give the homes leverage in settlement negotiations.
The governor said "a trend emerges" when the low ranking is matched with an actuarial report showing that a typical 100-bed nursing home in Kentucky has annual liability costs of $535,000, while the national average is $154,000. Kentucky was among the states with high liability costs that received a below average or failing grade on the Families for Better Care report, Beshear noted.
Vonderheide said the letter marked "the first time . . . that a Kentucky governor has embraced nursing home staffing standards." Actually, as Spears reports, Beshear "said he would ask program leaders from the Cabinet for Health and Family Services to research the impact that increasing nursing home staffing could have in Kentucky." (Read more)
The Herald-Leader said in an editorial on the issue, "Listening, exploring, collecting information and ideas must lead — quickly — to action."
Beshear said he would call for forums across the state to allow the public and nursing-home residents to discuss their ideas for improvement, and would research the impacts of increased staffing in nursing homes. The reform group wants minimum staffing requirements, which the nursing-home industry opposes.
"I take this challenge very seriously and will be working with my staff and the state's Elder Abuse Committee over the coming months to explore ways in which we can improve the quality of care," the governor said in a Nov. 5 letter to Bernie Vonderheide, founder of the nursing-home reform group.
Vonderheide wrote Beshear in August after Kentucky was ranked 40th in nursing-home care by Families for Better Care, a Florida-based advocacy group for nursing-home residents. On a grade scale of A to F, the group gave Kentucky a D. The grade was determined by analyzing eight federal measures of nursing home quality, according to the group's release.
Beshear suggested in his letter that the low ranking of Kentucky's nursing homes might be related to another of their lobbying concerns — liability costs that are well above national norms. The homes want to limit those costs by subjecting lawsuits against them to medical review panels, which couldn't block the suits but would give the homes leverage in settlement negotiations.
The governor said "a trend emerges" when the low ranking is matched with an actuarial report showing that a typical 100-bed nursing home in Kentucky has annual liability costs of $535,000, while the national average is $154,000. Kentucky was among the states with high liability costs that received a below average or failing grade on the Families for Better Care report, Beshear noted.
Vonderheide said the letter marked "the first time . . . that a Kentucky governor has embraced nursing home staffing standards." Actually, as Spears reports, Beshear "said he would ask program leaders from the Cabinet for Health and Family Services to research the impact that increasing nursing home staffing could have in Kentucky." (Read more)
The Herald-Leader said in an editorial on the issue, "Listening, exploring, collecting information and ideas must lead — quickly — to action."
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