Owensboro commissioners drop pre-existing bars from draft of smoking-ban ordinance

The Owensboro City Commission compromised to gain the support of all five members to vote for a smoking ban, which will come up for a vote on Sept. 2, Steve Vied reports for the Owensboro Messenger-Inquirer.

The original draft of the ordinance eliminated smoking in all public places in the city, and was favored narrowly. The compromise allows smoking to continue in establishments that are already in operation and don't allow entry to anyone under 18, thus exempting bars, as a county ordinance does.

"New bars that open after the ordinance goes into effect, whether they allow customers under 18 or not, will not be permitted to have smoking," Mayor Ron Payne said.

"Thank you so much," said Ashley Oberst, an employee of Rocky's Bar and Grill at Ninth and Crittenden streets. "It means more than you know."

"I'm not here to make choices for adults," Commissioner Jeff Sanford said, but if smoking "is around kids, I can't support it."

Payne told the audience at a meeting, "First and foremost, this commission wants to act in unison. We did not want a split vote. No. 2, we have listened to you. You made some good points that we have considered. We all have wrestled with this. This is a toughie. I have three younger brothers, all gone, two from lung cancer."

The new version also deleted regulation of electronic cigarettes. (Read more; this article is behind a paywall)

Grimes and McConnell lay out differences on health reform

By Al Cross and Megan Ingros
Kentucky Health News

U.S. Sen. Mitch McConnell kept attacking federal health-care reform and challenger Alison Lundergan Grimes gave her strongest defense of it yet as the candidates held the closest thing to a debate Wednesday, Aug. 20, at Kentucky Farm Bureau headquarters in Louisville.

Grimes was the most detailed she has been in a public discussion about health-care reform. Grimes indicated that she supports Kynect, the state health-insurance exchange, created by Gov. Steve Beshear and funded by Obamacare, where people sign up for Medicaid or buy insurance.

“For the first time ever, because of our governor, 500,000 Kentuckians are able to go to the doctor, their kids get checkups before school, and many of them are farm families in rural Kentucky,” she said. “The law isn’t perfect but we have to work to fix it. . . . We have to work to streamline the Affordable Care Act, to make sure there aren’t over-burdensome regulations on our businesses, especially our small businesses.”

Grimes endorsed President Obama’s delay in the law’s employer mandate and suggested that he should also live up to his promise that “If you like your doctor, you can keep it.”

She actually appeared to be referring to keeping old insurance policies, because her next words were, “We should be working to extend that grandfathering clause so we live up to that promise that Washington politicians made to Kentuckians. . . . It requires a senator, though, who doesn’t want to repeal root and branch the access to health care that Kentuckians just got for the first time.”

McConnell answered, “She won’t use the words, but she supports Obamacare, he single worst piece of legislation that’s been passed in the last half-century.”  He said Obamacare is going to cost jobs and it “ought to be pulled out root and branch and we ought to start over.”

McConnell said what should have been done is “truly national competition among health-insurance companies to keep prices down and quality up,” as well as “a national medical malpractice standard to bring some sanity to the litigation lottery that’s confronting every health-care provider in America; and thirdly, we need to allow small businesses to form groups for the purpose of more purchasing power on the open market.”

Citing a study by the Congressional Budget Office, McConnell said the law will only cover 10 million of the 40 million people who were uninsured, and will “cost 2.5 million jobs.” The study says the predicted reduction, through 2024, will come “almost entirely because workers will choose to provide less labor,” not because jobs will be eliminated.

McConnell said Kentucky will not be able to afford its expansion of the Medicaid program, which covers about three-fourths of the newly insured. “She applauds it,” he said. “It’s fine for the governor because the first three years the federal government will pick up 100 percent of the tab, but after that, the state’s going to be in serious financial problems.”

Beshear has cited studies showing that the Medicaid expansion will pay for itself by expanding the health-care industry and creating jobs, but Republicans say they are skeptical of that.

A video of the debate is available on the Farm Bureau website, www.kyfb.com, until Sept 20. The specific site is http://new.livestream.com/accounts/7542430/events/3309694.

Hopkinsville paper gives detailed description of federally mandated changes in Christian County school lunches

Five years ago Christian County Public Schools served a dessert with every meal, white rolls, and vegetables with plenty of salt, Margarita Cambest reports for the Kentucky New Era in Hopkinsville.

Shift to 2014: Dessert is considered an occasional treat, fruit is a staple, the rolls are whole grain and there are vegetables galore, with a lot less salt.  Students are adjusting to these changes as school meal programs shift to comply with new federal guidelines, Cambest reports.

“They want to be healthy, but they don’t always want to eat healthy,” Sandra McIntosh, the schools' food service coordinator, told Cambest. “This makes it easier.”

The Healthy, Hunger-free Kids Act, which passed in 2010, initially required schools in the federal meal program to decrease fat and sodium and increase whole grains. This year, strict sodium and calorie limits have taken effect. McIntosh told Cambest that this was the first major change in the program's law in 30 years.

Specifically, fruits and vegetables must be offered, with a choice between two meats, two vegetables and two fruits at each meal, Cambest writes. Whole grains have replaced white bread, and only fat-free or low-fat milk may be served, including chocolate milk. Calorie limits vary between grades, but all students must take at least one serving of fruit or vegetable at breakfast and one of each at lunch.

So what does a typical meal look like?  The New Era sampled lunch at Hopkinsville Middle School and reported a menu of breaded and baked chicken (with or without barbecue sauce), a cheeseburger on a whole-grain bun, or a chef's salad. Green beans, mashed potatoes with gravy, or veggies with low-fat ranch dressing were served on the side, and a choice of a banana or mandarin orange slices rounded out the meal.

“A lot of times, kids aren’t offered this kind of variety at home,” schools spokeswoman Heather Lancaster told Cambest.

This year, all Christian County public-school students are eligible for free meals under the federal Community Eligibility Program, which applies to schools that serve mostly low-income students. The middle school and the district's two high schools were the last in the district to be added to the program, Cambest reports. In the first 10 days of school, the three schools served 1,690 more breakfasts and 595 more lunches than in the same period last year. (Read more; this article is behind a paywall)

Doctors of osteopathy are an increasing answer to the doctor shortage, as more osteopathic medical schools open

Doctors of osteopathy could be part of the solution to Kentucky's well-documented primary care doctor shortage, Laurel Black reports for The Paducah Sun.

"The American Association of Medical Colleges predicts that a growing population of aging people, health insurance expansion, and a freeze on Medicare funding for residency training positions will lead to a physician shortage of more than 90,000 by 2020," Black reports.

Rural areas are expected to be most affected by the shortage of physicians, especially in the area of primary care, Black writes. Kentucky is already experiencing this problem. A presentation at the 2013 Kentucky Rural Medical Educators Conference said Kentucky had a 1,287:1 primary care physician-to-citizen ratio, 557 short of the national average.

Despite this "looming doctor shortage," little attention has been given to osteopathic medicine as a possible solution, Black writes. But enrollment in osteopathic medicine, "which puts a focus on primary care and works to place its doctors in under-served regions," is growing.

"There are a lot of osteopathic schools. It's definitely a growing field," Griffin Bicking, a doctor of osteopathy and a vascular surgeon at Baptist Health Paducah, told Black.

"Graduates in osteopathic medicine have increased by more than 250 percent between 1980 and 2005, according to a study by the medical colleges' association. In 1980, there were 14 schools with fewer than 5,000 students in America; there are now 30 schools with more than 30,000 students," Black reports. "It's estimated that today nearly 30 percent of all medical school graduates are estimated to be doctors of osteopathy," or D.O.s.

The University of Pikeville's Kentucky College of Osteopathic Medicine has graduated more than 800 physicians since its inception in 1997, with 60 percent of these graduates serving primarily in rural healthcare facilities in Eastern Kentucky and other regions of Appalachia, according to its website.

New or relatively new osteopathic medical schools near Kentucky are in Harrogate, Tenn.; Lewisburg, West Virginia; and Blacksburg, Va.  Other adjoining states with such schools include Ohio, Illinois, Indiana and Missouri.

Black reports that the stigma associated with D.O.s is fading as people seek a more holistic approach to their health. She also notes that the most notable difference between D.O.s and a doctor with traditional training is a required 300 to 500 hours of training in osteopathic manipulative treatment. This training, known as OMT, involves the movement of patient's bones and muscles to treat illness and injury and is part of the controversy surrounding D.O.s, Black reports.

However, more than half of D.O.s "used OMT on less than 5 percent of their patients," according to a study reported in Academic Medicine, the journal of the medical colleges' association, Black writes.

"Curriculum-wise, it's pretty much the same," Bradley Albertson, an internist and pediatrician at Mercy Primary Care in Benton, told Black of osteopathic medicine, which also requires four years of training followed by an internship and a residency. "The differences are more political and social."

Albertson opted for a non-osteopathic residency after attending a college of osteopathy for medical school, telling Black it "would add legitimacy to his practice."

And while osteopathic schools try to push primary care, D.O.s can go into any field a traditional doctor can, and it usually pays more to specialize, Black writes.

Albertson told Black that he is not sure that osteopathic schools will be the solution to the predicted patient-doctor gap and suggest it will take a "variety of solutions," including giving nurse practitioners more privileges.

Busy Woodford County girl is one of 20 youth ambassadors in national campaign against childhood obesity

Genna Ringler of Woodford County has been named to the youth advisory board of the Alliance for a Healthier Generation, a national anti-childhood obesity group, John McGary reports for The Woodford Sun.

Geena Ringler, Alliance for a Healthier Generation
youth ambassador (Woodford Sun photo)

"I  see a lot of kids at my school every day.  They want to be healthier, but they don't know how, so I'm hoping that when I serve on the board, and even after that, that I show them ways that they can lead a healthier lifestyle," Ringler told McGary.

The 12-year-old's life is already full.  She peer-tutors children with special needs, teaches special-needs children to swim, runs cross-country, is on the local swim team and enjoys bicycling, McGary reports.  She has also led a fundraiser that generated nearly $2,800 for the Muscular Dystrophy Association, to honor a friend and classmate who passed away.

She applied for the ambassador position in Febuary, was selected in May and was off in July for training in Utah, where she met the 19 other selected ambassadors, received media and interview training, and consulted with the adult ambassadors to develop goals for her project.

"I didn't know that it wasn't just playing video games," she told McGary, referring to the causes of childhood obesity. "It's so much more.  It's your economic background and how your parents raise you ... and all that kind of stuff."

Ringler told McGary that childhood obesity is an epidemic and that "it takes a lot of people to help change one person's lifestyle and I thought that one more person could help make a difference." (Read more) Kentucky ranks eighth nationally in child obesity.

Women leading Ky. Health: With less than 16 months left, Haynes tries to 'bake in' health reform, managed care, more

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

By Melissa Patrick
Kentucky Health News

How does a person create lasting change in an ever-changing political environment? “Bake it in,” says Audrey Tayse Haynes.

Secretary Audrey Haynes

As secretary for the Cabinet for Health and Family Services since 2012, Haynes has led the state's efforts to implement the federal health-reform law, dealt with the controlled chaos that was the transition to managed-care Medicaid and faced controversies in the social-services system. Now, with less than 16 months left in Gov. Steve Beshear's administration, she wants to make big improvements in the state’s behavioral-health system.

“We want to get as much (done) as we can get and we want to get it baked in,” Haynes said, “so hopefully the next person that comes will be as enthusiastic about building on the foundation that we have laid.”

Haynes brought more than 25 years of leadership experience to her job, including appointments under three earlier governors. From 1997 to 2001, she was deputy assistant to President Bill Clinton and director of the Office for Women’s Initiatives and Outreach, then special assistant to Vice President Al Gore and chief of staff for Tipper Gore. For the next decade, she was senior vice president and chief government affairs officer for the YMCA of the USA in Washington, D.C.

  

She says her personal style of leadership – “collaboration, inclusion and transparency” – took her staff a while to get used to, but is paying off with results.

“I’m all about forcing people to work together and trying to figure it out because you get a better product,” she said. “We don’t sign things around here unless it’s been vetted through the agency that it is going to impact. It took a while for people to get used to that.”

At her recommendation, Beshear named Carrie Banahan to run the state insurance exchange, Kynect, which has enrolled 521,000 people and become the nation’s model of how to run a successful exchange.

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“We all collaborate and all work together,” Banahan said in a separate interview. “Audrey has comprised a good team in the cabinet and we support her 100 percent.”

“I couldn’t get a better boss,” Public Health Commissioner Stephanie Mayfield said in a separate interview.  “She is genuinely concerned about not just her employees, but the health of the public.”

Haynes said the expanded access to coverage under health reform will improve the health of Kentuckians and the state's health statistics, something employers consider when choosing sites.

“Kentucky has worked so long and hard on building a better, more educated citizenry, so that we (can) recruit more industry and have a stronger economic development base. I believe that is important,” she said. “But equally as important is that we have healthy employees. … I do believe that our state will see many, many benefits from this.”

Health reform has been the most controversial domestic issue of the last few years, but for many people in the health-care industry, there has been more tooth-gnashing over the managed-care Medicaid system that began several months before Haynes became secretary.

Managed care, in which insurance-company subsidiaries get a certain sum per patient and increase their profits by controlling costs, “has not been a walk in the park to implement,” Haynes acknowledged. Providers have complained about slow payment and rejection of claims, and one managed-care firm left Kentucky, saying the state gave it misleading financial information.

She said all involved had to “stop, take a breath and stop screaming long enough to sit down and honestly work through the problems. . . . We have just forced people to the table month in and month out to work out these issues.”

Haynes began collaboration with providers and managed-care firms, and held public forums for all stakeholders to ask questions and get answers. It recently started a second round of forums, and she says things are much calmer now, almost three years after managed care began.

“Our first series of forums for health providers were so successful in opening the lines of communication and making connections that allow us to work better together,” she said in a press release. “We decided to not only repeat but expand the scope of the forums this year, bringing new topics to the forefront like behavioral health, which is particularly timely due to improved access allowed by the Affordable Care Act.”

The next big frontier in managed care is integrating behavioral health with physical health, she said. Noting that more behavioral-health providers are now eligible to receive Medicaid reimbursements, she said that increases accountability toward better outcomes for such patients.

Haynes has little more than a  year left to “bake it in,” because Beshear cannot seek re-election. She acknowledges that the changes in health care are “turning people’s worlds upside down.”

“There are a lot of changes going on, and they are not going to be able to just move on a dime,” she said. “So we have to be able to push, cajole, be patient, teach and then repeat all of that constantly.”

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

Health Commissioner Stephanie Mayfield Gibson

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

By Melissa Patrick

Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fort Thomas joins other wealthy school districts in U.S. that have dropped federal school-lunch program

The wealthy Fort Thomas school district in Northern Kentucky is dropping out of the federal school-lunch program because "Kids didn't like their healthful lunches," Jessica Brown reports for The Cincinnati Enquirer.

"The 2,800-student district joins a small but growing number of school districts across the country – mostly wealthy districts who can afford to forfeit the money – who have dropped out of the federal program in the wake of stricter nutritional standards," Brown writes. "Schools said students don't like the unsalted potatoes, low-fat cheese or the mandatory fruits and vegetables. They throw food away or decide not to eat at all."

Forsaking federal funding will cost the district an estimated $260,000 a year, Brown reports. "Children who get free or reduced-price lunches – about 17 percent of the student body – will still get them at that price." (Read more)

UPDATE, Aug. 25: About 150 school districts nationwide have withdrawn from the federal program, Bloomberg BusinessWeek reports.

Women Leading Kentucky Health: Insurance Commissioner Sharon Clark is key player in making health-reform law work

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

By Melissa Patrick
Kentucky Health News

The day after the Patient Protection and Affordable Care Act was signed into law, a reporter called the state Department of Insurance and asked what it all meant. The reply? People in the agency had to read it first – all 2,700 pages of it, Commissioner Sharon P. Clark recalled.

Commissioner Sharon P. Clark

“We hit the ground running on March 24, 2010 and have continued since then,” Clark said in an interview. “It has been a lot of strain on the resources here and people’s time just to get a grasp of it. I am not exaggerating when I say there have been thousands of hours involved with it.”

Clark’s department is not in the Cabinet for Health and Family Services, but she is chair of the 19-member advisory board for Kynect, the brand the state uses for the health-insurance exchange Gov. Steve Beshear created under the law.

That strategic appointment was made by Cabinet Secretary Audrey Haynes, who said she realized early on how important it was to have the Insurance Department “at the table.” Haynes said the committee has had a “united front” since the beginning.

Clark attributes the success of Kynect, which has enrolled 521,000 people in health coverage, to collaboration and communication. “Everybody has just had to roll up our sleeves,” she said. “It has been the governor’s expectation that we work together and we get the job done. I don’t think any of us ever had any hesitancy with it.”

Clark, who was the Insurance Department’s director of consumer protection and education from 1998 to 2003, has seen the disruption and disasters that can happen to people without health insurance.

“I can’t tell you how much financial devastation there has been for people that did not have insurance coverage,” she said. They “have had, due to medical conditions, had to file for bankruptcy. … . I think anything that gives people the opportunity to get insurance has a significant impact on their lives.”

But the reform law and its implementation have been controversial, and Clark said, “The times continue to be challenging.”

One of the early challenges was making sure everyone was on board. Clark said it was important to the committee to make sure all stakeholders, such as hospitals, insurance agents and companies, doctors and the Kentucky Chamber of Commerce, were able to offer input and be involved in the process.

“The first collective voice was that Kentucky needed its own exchange” for people to sign up for health insurance or Medicaid, Clark said. She laughed and said, “I have been involved in government for over 20 years and it is rare that you get everybody saying the same thing.”

A more recent challenge has been President Obama’s decisions to allow states to extend existing health-insurance policies that don’t meet the requirements of the law for two more years, or policy years beginning on or before Oct. 1, 2016. Beshear allowed insurance companies to make such extensions.

Clark said the extensions created confusion in the marketplace. She said it is difficult for insurance companies to make such changes in mid-stream, because policy and technology systems have already been put in place toward compliance with the law.

The department’s major role in the new system is approving insurance companies’ rates, policies and forms. “We must approve the product or there is nothing out there to be sold,” Clark said.

Clark, like Beshear a longtime Democratic Party activist, says insuring Kentuckians will not only improve their health, but to also make a difference in their lives. “Health care is for all of us,” she said. “It is for all of us, society as a whole.”

Poll: Kynect considered a success, but voters haven't embraced it, and they still disapprove of the Affordable Care Act

By Al Cross
Kentucky Health News

A new poll again indicates that Kentuckians marginally approve of the state health-insurance exchange created under the federal health-reform law, but clearly disapprove of the law itself.

The poll, taken Aug. 7-10, surveyed Kentuckians who said they were likely to vote in the Nov. 4 election for the U.S. Senate. After questions about the Senate race, President Obama and the 2015 governor's race, would-be voters were asked, "Do you approve or disapprove of the Affordable Care Act?" then "Do you approve or disapprove of Kynect?" The terms were not defined; the Patient Protection and Affordable Care Act is widely known as Obamacare, so opinion of the president influences opinion of the law.

Fifty-one percent said they disapproved of the law, while 34 percent said they approved and 14 percent said they were not sure. But regarding Kynect, the brand for the insurance exchange, 34 percent said they approved, 27 percent said they disapproved and 40 percent said they weren't sure. The poll's error margin, which applies to each figure, was plus or minus 3.1 percentage points.

The more liberal voters were, the more likely they were to approve of the reform law and the insurance exchange. Among moderate voters, 47 percent approved of both, while 36 percent disapproved of the law and only 17 percent disapproved of Kynect. The remainders were undecided.

Women and Democrats were more likely to approve of both measures. Independents disapproved of the reform law more strongly than Republicans did, and were evenly divided about Kynect, but they were only 10 percent of the total, so the error margin for their results is almost 10 percentage points.

When asked about "implementation of the Affordable Care Act," 41 percent of self-described likely voters said it has been very successful or somewhat successful, while 54 percent said it had been very or somewhat unsuccessful. Six percent were undecided. The detailed percentages were: very successful, 15 percent; somewhat successful, 26 percent; somewhat unsuccessful, 20 percent; and very unsuccessful, 34 percent.

Asked about "implementation of Kynect," 21 percent said it has been very successful and 24 percent said it has been somewhat succcessful, for a total of 45 percent. Sixteen percent said it has been somewhat unsuccessful and 13 percent said it has been very successful, for a total of 29 percent. The other 26 percent said they were not sure.

The survey was taken by Public Policy Polling, a North Carolina firm that usually polls for Democrats but produces results that have leaned only slightly Democratic. Eighty percent of the respondents were contacted by an automated telephone call and 20 percent were contacted through the Internet. The online respondents were more likely to approve of the law and Kynect. The main poll results are at http://www.publicpolicypolling.com/main/2014/08/mcconnell-leading-in-re-election-bid.html#more and the details are at http://www.publicpolicypolling.com/pdf/2014/PPP_Release_KY_8121205.pdf.

Nationally, opinions about the reform law "have been locked in partisan stasis, occasionally moving slightly up and down," since it was enacted in March 2010, Kaiser Family Foundation President Drew Altman writes for The Wall Street Journal., citing the foundation's polling. Altman adds that opinions of the law "are stuck in neutral because the law is a proxy for people’s feelings about the president and the direction of the country, which are similarly divided along partisan lines. For many voters, it is almost impossible to tell where opinion on Obamacare ends and opinion on its namesake begins." Obama is unpopular in Kentucky, getting a 32 percent job-approval rating in the latest public, statewide poll.

Fayette County Board of Health wants to regulate electronic cigarettes, raising some questions

The Lexington-Fayette County Board of Health is discussing ways to restrict the use of electronic cigarettes in public places and strategies to inform people about their potential dangers, Mary Meehan writes for the Lexington Herald-Leader. This continues not only the debate about whether or not e-cigarettes should be regulated the same way as traditional tobacco products but also how much power health boards may have in such matters.

E-cigarettes are battery-powered, and the liquid nicotine turns to vapor that can be inhaled. Though they don't contain tobacco, nicotine is sometimes used as a pesticide and can be harmful to humans as well. The General Assembly recently passed a law regulating e-cigarette sales, making them illegal to minors. The Danville City Commission has already banned the indoor use of e-cigarettes. “The state now classifies them as a tobacco product. What makes them different? By our ordinance, there is no distinction,” City Manager Ron Scott said.

Sometimes advertisements make it seem as though e-cigarettes are a safe alternative to traditional smoking, Meehan writes. Fayette Health Board Chairman Scott White, an attorney, noted that some e-cigarette flavors, such as bubble gum, target children. "If marketing a deadly product to children isn't evil, I don't know what is," he said. "We have enough history with the tobacco industry to know we need to get ahead of this."

Some think e-cigarettes can help people quit smoking, but that hasn't been proven. More research is still needed. Also, even if e-cigarettes help some people quit smoking, they may be a "gateway drug" to others.

The board may change "Lexington's current smoking ban to include e-cigarettes" and create "a public education campaign," Meehan reports. It's unclear how the board would do that, since the ban was passed by the Urban County Council. Also, the state Supreme Court recently ruled that health boards couldn't pass smoking bans, and it's unclear whether that decision would come into play.

Ellen Hahn, director of Kentucky Center for Smoke-Free Policy, told Meehan it would be best to "include electronic cigarettes in smoke-free laws because they are a tobacco product, and they pollute the air," Meehan writes. "E-cigarettes give off tiny particles that can lodge in the lungs and cause disease."

Though public health departments are helping reduce smoking rates in Kentucky, the "rates remain high, with about 29 percent of adults smoking and approximately 18 percent of people younger than 18," Meehan reports. "The state has also reported a leap in nicotine poisonings, and that leap has been tied to e-cigarettes." (Read more)

UK researchers find surprising differences in teens' concussion symptoms and physical and emotional effects

University of Kentucky researchers have discovered surprising differences in symptoms student athletes experience following a concussion, a particular concern as high-school football season nears.

Lisa Koehl, a doctoral candidate in the university's Department of Psychology, and Dan Han, director of the Multidisciplinary Concussion Program at UK HealthCare, drew from a UK database of patients with brain injury and drew a sample of 37 athletes aged 12 to 17.

Koehl said in a press release that 22 of the 37 participants had emotional symptoms after suffering concussions. Among those with such symptoms, 23 percent also had sensitivity to light, while 14 percent had sensitivity to noise. Of the teens who did not have emotional symptoms, 13 percent had light sensitivity, but none of them had noise sensitivity.

Han said said participants who reported anxiety were 55 percent more inclined to have attention difficulties than those who didn't report anxiety. Teens who were irritable or aggressive were 35 percent more likely to report issues with attention those those who were not irritable.

The two groups did not show differences in how many experienced "loss of consciousness, amnesia, nausea and/or headaches, indicating that the groups were likely comparable in the level of the severity of concussion," the press release says.

Koehl said the research helped them understand how physical and emotional symptoms in concussion patients interact, with each causing the other in different cases. "Identifying factors that affect a teen's experience after concussion may help in planning for the appropriate treatment and in making decisions about when to return to play and what accommodations are needed at school during recovery," Han said. (Read more)