Statewide smoking ban dead for this year, as House Democrats worry about political ramifications in fall elections

The sponsor of a bill for a statewide ban on smoking in enclosed public places said it is dead for this year, Tom Loftus reports for The Courier-Journal.

Westrom

"It's dead," Rep. Susan Westrom, D-Lexington, told Loftus. "I've been told that there aren't enough votes and we're just going to have to wait until next year. That came from the governor's office."

Westrom said that after she met last week with Gov. Steve Beshear, who supports a ban, he called House members to get more votes for the bill, but "now the governor is saying that it might be risky for some people if they had to vote on it."

Last week, Westrom said House Speaker Greg Stumbo and other leaders of the House's tenuous Democratic majority were not calling the bill for a floor vote because some members who had told her they would vote for it had told the leaders that they didn't want a vote for fear of political repercussions. Control of the House is up for grabs in this fall's elections.

Stumbo denied that, saying he still supported House Bill 173, but acknowledged, "Others in leadership have problems." But when the bill died, he told The Courier-Journal, "A lot of members that we spoke with — both Democrats and Republicans — didn’t really want to address the issue in an election year. . . . A lot of our members, most of whom live in rural areas, were intimidated by it."

Westrom told Ryan Alessi of cn|2's "Pure Politics" that Beshear told her that Republican votes were contingent on GOP representatives seeing that Democrats were taking the lead to pass the bill as the House voted. “Nobody seemed comfortable with how many Democratic votes would light up the board which would entice the Republicans,” Westrom said.

Rural health advocate pleads with legislature to 'end the tobacco epidemic in rural Kentucky'

Sen. Julian Carroll, D-Frankfort, looks at a Smoke Free Kentucky
display in the state Capitol. The group added black wreaths after the
smoking-ban bill died. (Courier-Journal photo by Jonathan Palmer)

The day that the bill for a statewide smoking ban died, the Kentucky Rural Health Association published a column in KyForward calling on legislators to "step up to the plate to help us save future generations from the scourge of tobacco use, disease and early death."

Tina McCormick of Henderson, the group's executive director, began her piece this way: "We have an epidemic right here at home and rural Kentuckians are the hardest hit." She added later, "The General Assembly must act now to fix the tobacco epidemic in rural Kentucky. Those of us who live in rural areas start using tobacco at a younger age, we use it more heavily, and we are more likely to breathe secondhand smoke at work and at home than those who live in the cities and suburbs in the commonwealth."

McCormick concluded, "This is a cry for help from rural Kentucky. We are tired of waiting for clean air. The facts are there. We need and want smoke-free air. Let’s make the tobacco epidemic history in rural Kentucky so that our children can expect a long, prosperous and healthy future. Please help us clear the air and end the tobacco epidemic in rural Kentucky." For the full column, click here.

Senate OKs bill to regulate e-cigarettes just like tobacco products

A bill to limit the sale of electronic cigarettes in the same way as sales of tobacco products passed the state Senate on Thursday, March 6. Senate Bill 109, sponsored by Sen. Paul Hornback, R-Shelbyville, would prohibit the sale of e-cigarettes and vaporized nicotine to minors. The vote was 36-2.

The bill now goes to the House. House Bill 309, which would regulate e-cigarettes as tobacco products, was approved by a House committee last month but has been awaiting action on the floor for several weeks.

House passes bill creating new type of order for end-of-life care, to be signed by patient and physician

An end-of-life order known as “medical order for scope of treatment” would be allowed in Kentucky under a bill that passed the Kentucky House on an 86-7 vote Thursday, March 6.

Unlike advance directives, such orders spell out a patient’s wishes for end-of-life care are also signed by the patient’s physician. A standard form for the orders would be developed by the Kentucky Board of Medical Licensure for use statewide.

“As a physician, I want to help people live and have a quality of life as long as they can,” said Rep. David Watkins, D-Henderson, the sponsor of House Bill 145. “But I sure don’t want to prolong suffering and agony … It’s our duty to make sure we keep our people in the final hours and final days of their life as comfortable as possible, and also to follow their wishes as close to the letter of the law as we can.”

The House defeated, 18-69, an amendment by Rep. Joe Fischer, R-Fort Thomas, that would have prohibited such orders from allowing food and water to be withheld from a patient unless death was “inevitable and imminent.” The bill now goes to the Senate.

Primary care, a big focus of health reform, faces challenges as Kentucky doctors deal with change

Craig Dooley, newly covered by Medicaid under health
reform, got an X-ray in Dr. Sven Jonsson's Baptist Health
office. (Photo by Luke Sharrett for The New York Times)

Primary-care doctors are key to the nation's health by providing preventive care to people who haven't been getting it but are now under federal health reform. However, some independent physicians in Kentucky and other states are struggling to run their businesses due to "flat or dropping reimbursement rates and new federal rules," many related to reform, Abby Goodnough writes for The New York Times. Goodnough's story is the latest in a series lookine at health reform through Kentucky examples.

Dr. Sven Jonsson joined Kentucky's Baptist Health System two years ago after leaving private practice in Louisville, fearing the law's often-expensive requirements. Now he is treating more patients, in the rural exurb of Taylorsville, and Baptist is handling all the details of the transition into the new health-care system.  "This is just a much saner place for me right now," he said. Primary care is more in demand because many states used it to expand Medicaid to people earning up to 138 percent of the poverty line.

Conversely, Dr. Tracy Ragland owns a small private practice in the wealthy suburb of Crestwood, and is concerned about the rules and payments associated with the new system. "The possibility of not being able to survive in a private practice, especially primary care, is very real," she said.

According to the American Medical Association, 40 percent of family doctors and pediatricians are independent. Ragland supports the idea of providing health coverage to more Americans, but says Medicaid and some private plans offered through Kentucky's health-insurance exchange don't pay enough, so she does not treat those patients. She says she values the flexibility of her private practice and the ability to spend as much time with patients as they need.

However, Ragland did join an "accountable care organization," a group of independent physicians who arrange care for a number of patients. "These networks, encouraged by the new law, reap financial rewards if they improve patients' health and spend less doing it," Goodnough notes. Ragland and her associates know that primary-care doctors can receive higher, Medicare-level reimbursements for seeing Medicaid patients, but this only lasts through 2014 and they didn't take the bait.

Doctors who have joined hospitals, like Jonsson, receive a baseline salary with bonuses for extra productivity, but that will probably change because the reform law will base payments on results. When Jonsson owned his own practice, he didn't accept Medicaid. At his new workplace at Baptist Medical Associates, he can treat Medicaid patients because the practice has space to grow, said Donna Ghobadi, an assistant vice president at the hospital.

Recently Kentucky passed a bill that will "give experienced nurse practitioners more leeway to practice independently," Goodnough reports. Ragland went to the state Capitol to ask legislators to give scholarships to medical and nursing students who will practice in under-served areas. "I don't get the emphasis on primary care is so important, but primary care physicians aren't," she said. Lawmakers said they will consider her ideas next year. (Read more)

Here's a video version of Goodnough's story:

Wear blue on Friday, March 7 to mark Colorectal Cancer Awareness Month and encourage screening and colonoscopies

Friday, March 7 will be "Dress in Blue Day" to mark National Colorectal Cancer Awareness Month and to help raise awareness about colon cancer in Kentucky, according to Madeline Abramson, wife of Lt. Gov. Jerry Abramson.

“Kentucky has one the highest mortality rates of colorectal cancer in the nation,” she said in a news release.  “The good news is that through preventative screenings, this deadly disease can be detected early and treated successfully. I ask Kentuckians to join me in wearing blue on March 7 to help spread the word about the risks of colon cancer and the importance of getting screened.”

The American Cancer Society estimates that about 2,200 Kentuckians will be newly diagnosed with colon cancer this year and nearly 900 of them will die from it.  Those over 50, or who have a family history of colon cancer, are at the greatest risk and should get regular colonoscopies, doctors say.

To help raise awareness in Frankfort, the State Capitol dome will be lit blue until March 7. Hospitals, businesses, churches, schools, banks, health departments and other organizations are planning and hosting special activities to commemorate the month and promote screening.  

For more information on Colorectal Cancer Month and Dress in Blue Day, visit Madeline Abramson’s website at http://1.usa.gov/NrsMri and the Colon Cancer Prevention Project site at http://bit.ly/1i3q98G. The Kentucky Cancer Program website at www.kycancerprogram.org has information about cancer prevention, awareness and treatment.

Kentucky Health Cooperative, a new kind of insurer, claims most of the business on the state insurance exchange

This story was updated Tuesday, March 4.
The Kentucky Health Cooperative, a non-profit, consumer-governed health plan, says it has captured 61 75 percent of the business on Kentucky's health-insurance exchange, according to the latest figures from the exchange.

The co-op competes on Louisville-based Humana's home turf and came out ahead of the insurance company that has $41 billion in annual revenues, CEO Janie Miller reminded Jay Hancock of Kaiser Health News as she told him how the co-op had beaten Humana and Anthem.

Unlike Humana, Anthem is offering exchange policies statewide -- but through a relatively narrow network of health-care providers, which may discourage enrollment. Anthem has sold 13 percent of exchange policies, and Humana is close behind at 12 percent despite not selling statewide.

Janie Miller (AP photo)

“They have a few more employees than I do,” Miller said of Humana. “We believe we're the health insurance plan of the people.” Hancock interviewed the former state Cabinet for Health and Family Services secretary at the recent National Alliance of State Health Co-ops meeting in Washington, D.C.

The Kentucky co-op is planning to expand into West Virginia next year. The co-op in Maine did even better than Kentucky, getting 80 percent of the exchange market in competition with Anthem, Hancock reports.

John Morrison, former president of the co-op alliance, estimated that co-ops have between 15 and 20 percent of the national enrollment through exchanges, Hancock reports. Open enrollment for 2014 ends March 31.

Morrison also told Hancock that co-ops will save billions for the consumers and taxpayers paying for insurance because of the added competition and lower prices. Premiums are 8.5 percent lower on average in states with co-ops than in states without them. He acknowledged that cause and effect hasn't been proven, but said “Nobody's offered another explanation for why that might be true.”

The 23 co-ops were created under federal health reform as non-profit, consumer-governed health plans. They must use any extra revenue to lower premiums and improve benefits, or refund the federal loans that funded them. They are designed to give for-profit companies more competition and hold down rates.

The co-ops have signed up nearly 300,000 members this year and two others are set to expand into new states next year, Montana Health Co-op to Idaho and Minuteman Health in Massachusetts to New Hampshire, officials said at the Washington meeting.

The reform law prohibits co-ops from using federal funds for marketing and advertising, but still requires them to do education and outreach. This creates "big challenge as they try to build their businesses from the ground up while expanding access to care and caring for the chronically ill, Hancock reports.

Sponsor of statewide smoking ban says House leaders are blocking a vote to protect some members from political fallout

By Al Cross
Kentucky Health News

The bill for a statewide smoking ban has stalled, with the prime sponsor saying House leaders are blocking a vote to protect members who have told the sponsor they would vote for it, but have told the leaders they don't want a vote because they don't want it to be used against them in their re-election bids.

The prime sponsor, Rep. Susan Westrom, D-Lexington, told Kentucky Health News on Thursday, Feb. 27 that she thinks the bill would pass if Speaker Greg Stumbo would let it be called up for a vote, but he is protecting members who fear how the issue will play politically.

"Wrong," Stumbo replied in an email to KHN Sunday night. "Others in leadership have problems." In another message Monday morning, he said "I'm for [the] bill; may be the only member of leadership supporting it; so you figure out why it's not being called. I told her in all my years as majority floor leader, I never refused to call a bill unless a majority of leadership opposed doing it."

The other leaders of the House Democratic majority are Floor Leader Rocky Adkins of Morehead, who calls bills up for votes; Speaker Pro Tem Larry Clark of Louisville; Majority Whip Tommy Thompson of Owensboro; Democratic Caucus Chair Sannie Overly of Paris.

Westrom told Ryan Alessi of cn|2 that the leaders are divided on the issue. "It depends on what member of leadership you talk to," she said. "It's just a little bit schizophrenic right now."

Adkins said in a prepared statement, "This bill is being handled like other bills that are high profile. It has been House leadership's long-standing position to vet these kinds of bills to our members through a vote count before they are brought to the House floor. As of Friday the votes for passage were not there. We will continue to monitor the count as we move forward in the session."

Stumbo, who has said he supports House Bill 173, said Feb. 26 that he wasn't counting votes but sensed that the bill wasn’t “quite there yet” but was within “striking distance” of passage.

The leaders kept the bill in the House Rules Committee for the maximum five days allowed by House rules, then posted it for passage on Feb. 14.

On Feb. 18, Westrom and the bill's main Republican sponsor, Rep. Julie Raque Adams of Louisville, filed a floor amendment to exempt electronic cigarettes, private clubs and cigar bars. Adams told Alessi that has helped get Republican votes and allay some legislators' concerns about over-regulation of private property.

"When you open up that private property for public purpose, government always involves itself," she said. "This does not cost a business owner any money."

Adams said the larger issue is Kentucky's poor health and what it costs the state. "This is the only proposal that's before lawmakers right now that actually addresses the cost of health care," she said. "The cost to our budget is so dramatic, and it's really on an unsustainable course right now, that if we don't make some significant changes relative to health care and how we deliver it in this state, we're not gonna be able to afford anything else."

Adams acknowledged that the bill might be easier to pass in 2015 because this is an election year. "It absolutely is a factor in people's re-elections," she said. But she and Westrom said that issue cuts both ways, because most Kentuckians don't smoke. However, about 28 percent do, more than in any other state.

Some House members may be reluctant to vote for the bill because its prospects are poor in the Senate, where President Robert Stivers, R-Manchester, opposes it. Some House Democrats say privately that Westrom didn't help her cause by being the only Democrat not to vote for the bill Stumbo has called his top priority, to raise the minimum wage. She passed.

Westrom's harder push for a vote in recent days coincided with a Feb. 26 tweet from the Kentucky Chamber of Commerce, which favors the bill. The message on Twitter read, "The only way to know the vote count is to take a vote. Kentuckians deserve a vote on HB 173, the Smoke-free Kentucky Act."

Highly addictive, crushable pain killer to be released this month; political leaders beg FDA to reconsider its decision

A new narcotic pain pill is set to be released to the market this month, and critics are begging the Food and Drug Administration to reverse its decision, fearing its addictive qualities and overdose potential, Laura Ungar reports for The Courier-Journal.

Zohydro ER is an extended-release hydrocodone medication made by Zogenix. It is a highly addictive drug only meant for patients with pain severe enough to require daily, round-the-clock, long-term treatment, for whom other treatments are inadequate.

"It’s a capsule of pure hydrocodone so powerful that one accidental dose can kill," Ungar writes. Doctors, lawmakers, drug-control officials and others are voicing their concerns that Zohydro ER will bring a new wave of prescription drug abuse to Kentucky just as Kentucky has been making "great strides" against this already existing problem.

Zohydro ER, unlike recent formulations of the popular painkillers OxyContin and Opana, is not crush-resistant, making it easier for abuse by crushing and then snorting or injecting it, Ungar reports.

Kentucky ranks third in the nation for overdose deaths, with more than 1,000 Kentuckians dying each year from prescription drug overdoses. The number has leveled off following passage of laws that target pill-pushing clinics and doctors, and put stricter regulations on painkillers.

“We could see the OxyContin days come back, just in a new form,” Dan Smoot, president and chief executive officer of the Eastern Kentucky anti-drug organization Operation UNITE, told Ungar.He was referring to the drug that first sparked Appalachia’s prescription abuse problem in the late 1990s.

The FDA approved Zohydro ER last fall, even though its own scientific advisory panel cited concerns about misuse and abuse and voted 11-2 against approving it. It’s set to hit the market early this month, Ungar reports. Last week a coalition of more than 40 health, consumer and other organizations urged the FDA to revoke its approval.

Attorney General Jack Conway was among 28 attorneys general who sent the FDA a letter asking it to reconsider, noting that it is reportedly "five to 10 times more potent than traditional hydrocodone products, and has no abuse-deterrent properties."

“We do not want to see the great strides we have made in Kentucky combating prescription drug abuse reversed,” Conway said in a statement after signing the letter. “For decades, we have fought the disastrous effects of the illegal marketing of the drug OxyContin. Zohydro ER has the potential to exacerbate the prescription-pill epidemic. ... The FDA’s decision to approve the drug doesn't make sense.”

U.S. Rep. Hal Rogers, R-5th District, and Senate Republican Leader Mitch McConnell, as well as two other senators, have expressed their disapproval, but the FDA says the drug meets its safety requirements and the benefits outweigh the risks for patients who qualify for the drug, Ungar reports.

Zogenix officials told Ungar they are committed to going “above and beyond FDA requirements” to make sure the drug is used appropriately, will monitor for misuse, and will allow an outside group to monitor and analyze their data. They said they are also working on an abuse-resistant pill.

They also pointed out that Zohydro ER will be regulated as a Schedule II controlled substance, which means it can only be dispensed through a physician’s written prescription, with no refills.

“Opioids are important pain-relieving medications that can provide significant benefits for patients when used properly for their approved indications,” Zogenix wrote Ungar.

Another benefit cited by Zogenix officials is that unlike many other hydrocodone painkillers, Zohydro ER does not contain acetaminophen, which can cause liver failure when used over a long period. They said more than half of liver transplants are caused by acetaminophen overdoses from overusing these sorts of combination drugs.

Young people are more likely to be diagnosed with advanced cancer if they are uninsured, national study finds

By Melissa Patrick
Kentucky Health News

Adolescents and young adults who don't have insurance are more likely to be diagnosed with advanced cancer than their peers who have health insurance, says the American Cancer Society, in what sounds like a warning to an age group that is key to the success of health reform.

Anthony Robbins, the society's director of health services research, and other researchers found that uninsured females were twice as likely, and males half again as likely, as insured people of the same age to be diagnosed with advanced cancer.

An advanced cancer diagnosis means that the cancer has spread to multiple parts of the body or is considered not curable, the society said in a press release. It is more difficult and expensive to treat and more deadly. The study, published in the March issue of Cancer, sampled data from nearly 260,000 cancer patients ages 15 to 39 in the National Cancer Database between 2004 through 2010.

Uninsured patients tended to be younger and male, and were more likely to be black or Hispanic, and more likely to reside in the South. They were also more likely to have lower income and education levels.

Young adults have experienced the least benefit from recent progress in the fight against cancer, but federal health reform could mitigate that, the study's authors said.

"The findings suggest that policies such as the Affordable Care Act that increase the number of people in America with health coverage will result in fewer late-stage cancer diagnoses and save lives," the authors said. "However, the success of these efforts may be directly tied to the fate of the Medicaid expansion component."

Kentucky is among the states that have expanded Medicaid's eligibility to people with incomes up to 138 percent of the federal poverty threshold. About 48 percent of the enrollees in Kynect, the state online marketplace for health insurance, are under the age of 35, according to a press release from Gov. Steve Beshear's office.

Substantial enrollment of people under 35, who often go without insurance because they think they are in good health and will remain that way, is considered essential for the success of  health reform, because premiums from healthy people subsidize care for the less healthy, many of whom were unable to get affordable insurance before reform.

Tobacco is top target in Beshear's health plans, but he still praises expansion of plant that makes smokeless tobacco

Gov. Steve Beshear says tobacco is the main cause of Kentuckians' relatively poor health, which he is pushing to improve, but on Feb. 27 "his tone shifted as he praised the economic benefits from a tobacco company's plans to expand its Western Kentucky processing operations for smokeless tobacco products," reports Bruce Schreiner of The Associated Press.

U.S. Smokeless Tobacco Co., an Altria Group subsidary that makes Copenhagen and Skoal from local tobacco, says it will spend $118 million and create 42 jobs as it expands its 90-employee plant in Hopkinsville. Beshear called that "proof that Kentucky is a great place to grow a business." If the company creates the predicted number of jobs, it could get $4.5 million and $1.4 million, respectively, in state and local tax breaks.

Tobacco farming is a smaller part of Kentucky's economy today than it was for most of the 20th Century, but Schreiner notes the state has the nation's highest percentage of smokers and "has the worst or near-worst rates for smoking, cancer deaths, heart disease and high blood pressure." Smokeless tobacco is linked to cancer of the mouth, throat and esophagus.

Those are among the reasons Beshear's tax-reform plan would raise levies on cigarettes and smokeless tobacco. "He also touts legislation calling for a statewide smoking ban at workplaces and in public buildings," Schreiner notes. "Altria opposes any tobacco tax increases."

The American Cancer Society says smokeless tobacco can cause nicotine addiction, which can lead to smoking, and can also lead to gum disease and tooth decay. Oral health is one of the seven main points in Beshear's recently announced plan to improve the state's health, Schreiner notes.

KentuckyOne Health lays off 500 of 15,000 employees, says it won't fill 200 vacancies; cites Obamacare and merger

KentuckyOne Health, which dominates the Louisville hospital market and has scores of locations across the state, says it has laid off 500 of its 15,000 employees and identified 200 vacancies that it won't fill, as it adjusts to federal health reform and the mergers that created it.

The company says it is trying to eliminate $218 million in expenses  by the middle of 2015. It is part of Denver-based Catholic Health Initiatives, and its CHI region "had the largest operating loss in the fiscal year that ended in June 2013, according to an October report by Standard & Poors, one of the firms that rates CHI's creditworthiness for investors who buy its debt," Chris Otts reported for WDRB.

KentuckyOne officials declined to give the number of layoffs by location. CEO Ruth Brinkley "attributed the changes in her company largely to a trend away from sick care, which revolves around hospitals, to a greater focus on wellness and disease prevention," Laura Ungar reports for The Courier-Journal. "She said this trend preceded the Affordable Care Act, but it was reinforced by the federal law. She also said hospitals are facing declining reimbursements from Medicare and Medicaid, and a payment model built around keeping people well rather than providing incentives for more hospitalizations and procedures. . .. . Brinkley also cited staffing and other changes prompted by the merging of hospitals that created KentuckyOne. She said mergers always bring redundancies in services and staffing, often leading to consolidations."

The company was formed in 2012 by the merger of the Lexington-based St. Joseph Health System and Jewish Hospital & St. Mary’s HealthCare of Louisville. The University of Louisville hospital was supposed to be part of the merger, but Gov. Steve Beshear blocked it on grounds that religious organizations should not control public facilities. A deal was negotiated, "turning over management of most of the hospital to KentuckyOne while keeping the facilities under public control," Ungar reports. "Brinkley said despite financial difficulties, KentuckyOne will continue to meet its financial and legal obligations to U of L Hospital."