Free workshop on health coverage in Louisville Sept. 21; free lodging available to registrants who need to come the night before

Journalists covering health issues in Kentucky, from drug abuse to health reform, have a chance to immerse themselves in the subject at a free one-day workshop in Louisville on Sept. 21.

The workshop is sponsored by the Foundation for a Healthy Kentucky, which is also offering free hotel lodging to registrants whose distance from Louisville would make it inconvenient for them to get there by 9 a.m. EDT, when the workshop will begin.

The workshop is designed to help journalists cover health in ways that your readers, viewers and listeners will appreciate. It will feature a collection of America’s and Kentucky’s top health experts and health journalists. The program should yield terrific stories at the same time it helps you see how to make health coverage a more central part of what your newsroom does every day. The speakers will be:

• Dr. Nora Volkow, head of the National Institute on Drug Abuse, to talk about the opiate epidemic nationwide, why it's even worse in Kentucky, and specific stories you could and should be doing but probably aren’t.
• Bill Wagner, head of Louisville's Family Health Centers, to discuss the state of health reform in Kentucky and obstacles that remain.
• A patient of Wagner's clinic who is newly insured, to talk about what works with the reforms and what needs further reform.
• Abby Goodnough, national health reporter for The New York Times, to talk about her award-winning series on health reform that focused on Kentucky and lessons it holds for you.
• Laura Ungar, health reporter for USA Today and The Courier-Journal, to talk about what stories she'd do based on that day's session, and how to sell editors on health stories and a health beat.
• Mary Meehan, health reporter at the Lexington Herald-Leader who just began a Nieman fellowship at Harvard University, will talk about how to bring new life to the medical beat at media outlets that increasingly are stretched thin.
• Al Cross, director of the Institute for Rural Journalism and Community Issues, to discuss where the reform law works, where it needs fixing, and what to ask gubernatorial candidates in the upcoming election.
• Larry Tye, author and former reporter at The C-J and The Boston Globe, will moderate the sessions to keep the focus on making these issues resonate with your readers and listeners. He runs a Boston-based health reporting fellowship that Mary and Laura did, and where Nora and Abby were speakers.

"Larry Tye assembled what we think is a first-rate line-up of health officials and medical journalists to help you think about how to make health stories resonate with your editors and your readers," Cross said. "If you agree, sign up now because there's limited space and a growing list of registrants. Our speakers are the stars, but you will be the focus of the day's program."

Register for the free workshop and lodging at www.regonline.com/healthcoverageworkshop. Questions can be directed to Angela Koch at akoch@healthy-ky.org.

Stanford doctor starts local 'Get Healthy Lincoln County' program, plans to take it statewide via Kentucky Medical Association

Part of the effort: A weekend workout group in Stanford

A Stanford physician who started a local movement for a healthier community plans to promote it statewide through the Kentucky Medical Association’s Commission on Public Health.

"Dr. Naren James said in the next year, under the Affordable Care Act, health insurance rates will be affected by the overall health of a community," Abigail Whitehouse reports for The Interior Journal. “Having a healthier community will actually have a tangible impact on people’s health insurance rate,” James told her.

James said he was motivated to start the program when he realized that that Kentucky ranks very high in childhood obesity, "which ultimately effects the future of a community," Whitehouse notes. Much of the program's focus is on increasing residents' physical activity.

“The reason why we did ‘Get Healthy Lincoln County’ was to make a model that could be used statewide,” James told her. She writes, "His goal is to promote the movement so that every community in Kentucky can find a coalition of people interested in health to create that 'get healthy' community."

“It has to be from the ground up, not from the top down,” James said. “When you deal with health, people have to make the choice. It has to be educational.”

In June, the program conducted several activities, "many of which were successful," Whitehouse reports. "Now that the 'Get Healthy Lincoln County' movement has been approved as an annual effort, James said a committee has already begun planning for next year by determining what did and didn’t work well this time around.

For example, a history walk around Stanford, Kentucky's second oldest town, "had a great turnout," James said. Also successful were "a Saturday morning of exercise" in a local park and "Dinner with a Doctor," Linda Carney of Texas, "who provided the crowd with a plant-based diet and spoke about the benefits of such diets," Whitehouse reports.

"What’s for Dinner Stanford?," a project of the local extension office, "invited the public to participate in a plant-based cooking class using local produce," Whitehouse writes. "James said that the cooking class has done well and will continue throughout the year, but it was realized that programs which require more commitment require more of a push."

For example, a program called "Eight Weeks to Wellness" needed "more events to sell it," James said. "Anything you’re going to do for several weeks, you have to sell it. . . . We need to sell it to people’s individual needs. They have to understand why health is impacting them personally."

"In a broader sense, James said people leading the 'get healthy' movement have to learn to speak the right language," Whitehouse reports. “The language about health is immediately negative,” he said. “It’s a cultural shift. Speaking about health positively is so important, which we tried to do with the Get Healthy program and I think overall it came across positively. Even the things that are negative can be turned into positive.”

Medicaid manager Passport gives $25,000 to Democratic group that has given heavily to committee backing Conway for governor

Passport Health Plan, which manages Medicaid care for hundreds of thousands of Kentuckians, gave $25,000 this year to the Democratic Governors Association, "which already this year has given $600,000 to a Democratic super PAC supporting the election of Attorney General Jack Conway as governor," Tom Loftus reports for The Courier-Journal.

"Beshear’s office and Passport Chief Executive Mark Carter both said the $25,000 was not a political contribution but a sponsorship for a one-day policy conference co-hosted by the DGA in Louisville last spring," Loftus reports. "But Senate Republican Leader Damon Thayer of Georgetown said, 'Of course the DGA wanted to do a, quote unquote, policy conference in Louisville because Kentucky is the site of the only competitive governor’s race in the country this year.'" Passport is based in Louisville.

Loftus notes that the money was requested by Democratic Gov. Steve Beshear, who objected in 2010 to Passport's "spending of Medicaid funds on things like lobbying, travel, public relations, donations and sponsorships." Beshear said it should “cease spending a single taxpayer dollar that is not absolutely necessary to provide quality health-care services to Medicaid-eligible recipients.”

Thayer said the donation was a political contribution because the DGA exists to elect Democratic governors, as it says on its website. "An agenda shows the conference involved three one-hour policy discussions on the morning of May 21 at the Galt House," Loftus reports. "Participants included Beshear, Conway and a few other Democratic governors and Democratic candidates for governor from other states." No attendance numbers were given.

In 2010, then-state Auditor Crit Luallen "questioned more than $423,000 in sponsorships and donations — many of which did not seem to advance Passport’s mission of improving the health care of Medicaid recipients. Luallen's report resulted in sweeping reforms," Loftus writes. "Carter said criticism of spending on sponsorships was valid in 2010 when Passport had an exclusive state contract to manage Medicaid in the Louisville region," but now it has to "compete with four other, very large, for-profit plans," Carter said. "Things that are inappropriate when you area sole-source contractor, like sponsorships, are almost necessities to be able to compete with Humana, Anthem and others."

Loftus reports, "Two of the big private insurance companies that hold managed care contracts in Kentucky — which unlike Passport function in many states and offer products other beyond Medicaid managed care — are listed in the report as giving more to the DGA during the first half of this year: Humana, of Louisville, is listed as having given $80,000; Anthem, of Cincinnati, gave $325,000."

Passport expanded its operations after Beshear used federal health-reform money to expand eligibility for Medicaid, increasing the program's rolls by half. Conway supports the expansion but Republican candidate Matt Bevin says it needs to be scaled back. The reform law calls for the state to start paying 5 percent of the expansion cost in 2017, rising to the law's limit of 10 percent in 2020. Beshear, citing a state-funded study; says the expansion will pay for itself; Bevin scoffs at that.

Bevin and Conway to speak, answer questions about health policy at rural-health group's meeting Sept. 18 in Bowling Green

The Kentucky Rural Health Association is hosting a "Candidates Forum on Health" Friday, Sept. 18 in Bowling Green, after the conclusion of its annual conference. All of the candidates running for all offices in November have been invited, KRHA said, but the focus will be on the two major-party candidates for governor, who will speak and answer questions in separate, back-to-back sessions.

"I hope this forum will help us have a better understanding of what the candidates' views are on health care and what their approach will be," KRHA President Dr. Brent Wright said in an interview.

Republican Matt Bevin is scheduled to speak and answer questions from 1:15 to 2 p.m., and Democratic Attorney General Jack Conway is scheduled to do likewise from 2:15 to 3 p.m. Bowling Green is on Central Time. Candidates for governor and other statewide offices will have a meet-and-greet session at 11:30 a.m., before lunch.

Wright said he was looking for candidates' views on the Patient Protection and Affordable Care Act and rural health care, "especially after the auditor put forth his report on hospitals that face financial challenges throughout the state."

Independent candidate Drew Curtis said he was not invited but would seek an invitation.

Wright said the forum offers a unique opportunity for KRHA stakeholders, who represent many different areas of health care around the state, to find out what the candidates are saying about health and get their questions answered.

"We are a group that is about advocacy and education for rural health care," Wright said. "We want to convey that rural health matters and that our membership has a voice and that our concerns need to be heard."

The public is invited to the forum. Lunch will be provided free of charge to attendees, but registration is required. Click here to register.

The forum is co-sponsored by the Foundation for a Healthy Kentucky, the Friedell Committee, the Kentucky Academy of Family Physicians, the Kentucky Coalition of Nurse Practitioners & Nurse Midwives, the Kentucky Hospital Association, the Kentucky Medical Association, the Kentucky Primary Care Association and Kentucky Voices for Health.

The Sept. 17-18 KRHA conference and the Sept. 18 forum will be held at Western Kentucky University's Knicely Center on Nashville Road, with lodging at the adjacent Staybridge Suites on Campbell Lane and the new Hyatt Place, next to the WKU campus on Center Street (with shuttle service). The registration fees until Sept. 3 are $125 for KRHA members, $200 for non-members and $45 for student members. For the draft agenda, registration form and hotel information, in a PDF, click here.

Ky. to share in $2.5 million anti-heroin grant that will pair law enforcement and public health to put more focus on treatment

Kentucky will be among several states to share a $2.5 million federal grant to help fight the heroin epidemic in its communities, according to press release from the office of Senate Majority Leader Mitch McConnell.

Heroin overdoses killed 233 Kentuckians in 2014 and 230 in 2013. Kentucky had only 22 deaths attributed to heroin in 2011, according to the state's 2014 Overdose Fatality Report.

The $2.5 million will fund the Heroin Response Strategy, a new initiative that creates a partnership among five regional "high intensity drug trafficking areas," which includes Appalachia, New England and the Washington/Baltimore; New York/New Jersey and Philadelphia metropolitan areas.

The focus of the new program is on treatment, rather than punishment, of addicts.

“It’s something different, pairing law enforcement and public health,” Van Ingram, Kentucky’s director of drug policy, told The Courier-Journal. “Just arresting and releasing people is not working real well.”

The grant will fund sharing of intelligence, analysis of trends, training of law enforcement and strengthening of partnerships between public-health and public-safety agencies. It will also support the expansion of a Drug Intelligence Officer Network in 15 states, education and training for public-safety first responders, and conferences related to public health and public safety.

In addition to the grant, the Appalachia HIDTA will receive nearly $400,000 to be used for programs to help prevent drug abuse in Kentucky, Tennessee, West Virginia, and Virginia, says the release.

New health chair of Appalachian Ky. economic group says he's a conductor, not a director; deflects query on mining's health effects

By Melissa Patrick
Kentucky Health News

Dr. William Hacker, a former state health commissioner, is the new chair of the Community Health Advisory Council for Shaping Our Appalachian Region, a non-profit organization created last year by Democratic Gov. Steve Beshear and Republican U.S. Rep. Harold "Hal" Rogers of the 5th District to improve Appalachian Kentucky's economy.

Dr. William Hacker

So, what does that mean for Hacker? And for a region with some of the worst health in the nation, so bad that it is a drag on the economy?

Hacker said in an interview with Kentucky Health News that he was still learning about his responsibilities, but felt that one of the most important skills he brings to this role is his ability to network.

"What I'm assuming my primary role will be is not so much (to be) the director as it is being the orchestra conductor," he said.

He added later, "If I can use my platform to bring people together so that they can share resources, share energy, share knowledge, share success stories. ... Even if we don't have any new dollars to spend, we may be able to have better outcomes if we know what works and make that translational across communities. ... As the old African saying goes: If you want to go fast, go alone. If you want to go far, go together."

Hacker, a native of Clay County, practiced as a pediatrician in Corbin for 18 years, spent six years with Appalachian Regional Healthcare and was the medical director for a health insurance plan.

"I have a lifelong interest in Kentucky in general, and Eastern Kentucky in particular," he said. "My roots are in Eastern Kentucky."

He began his career in public health in 2001 when he joined the state health department's Maternal and Child Health division. After 9/11/01, he established the state's first public-health disaster preparedness program. In 2004, Republican Gov. Ernie Fletcher named him commissioner, a position he kept under Beshear until he retired in 2011. Hacker holds a clinical professorship at the University of Kentucky Department of Pediatrics and is an associate professor at UK's College of Public Health.

As an active volunteer, he said that many of his current activities "deal with core issues that help address prosperity in terms of education, of economic development and of health."

With SOAR, Hacker succeeds Dr. Nikki Stone of Hazard, who left the position after the final report of her Health Working Group, which initially set two priorities: coordinated health program in schools and a study of the health effects of large-scale surface mining, which research has suggested could be significant.

When the recommendations of the health group and working groups addressing other issues were published last fall, the mining-study recommendation wasn’t included in the list, which was limited to shorter-term recommendations, but it was mentioned in the health group’s report. Some other working groups continued to meet over the winter, but the health group did not.

A representative from the federal Centers for Disease Control and Prevention, after spending three months at the SOAR Pikeville office evaluating the recommendations, announced at the May 11 "Strategy Summit" that SOAR's health focus should be on substance abuse, obesity and diabetes, with no mention of the top two recommendations made by the people in the region.

Asked if he agreed with the CDC recommendations, Hacker said, "Clearly those are three issues that need to be addressed," but he added, "I don't want to be a disease-focused program, I want to be a community-focused program that leverages all assets and resources available to deal with the social determinants of health, while also addressing those three issues."

The CDC defines social determinants of health as "the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness."

Hacker said, "The core issue of poor health, really, is not so much health, as education and economic opportunity. The tripod of prosperity is good education, good economic opportunity and good health. If you have these three components, then you can build within your community, you can recruit industry and you have an educated workforce that is healthy."

"So it is the chicken and egg thing: How do you get economic opportunity to prosper in a place that has poor health outcomes? Which comes first, and how do we do that?," he mused, while commending Rogers and Beshear on their efforts to maximize federal, state and local resources to address these core problems within Appalachia.

Hacker said that one such resource is the CDC's commitment to provide a person for one year to help bridge SOAR activities with federal resources, programs and activities. Lt. Cmdr. Jenna Meyer has already been assigned to this role and is working from SOAR's Pikeville headquarters. Meyer said she was unable to comment.

Hacker remains optimistic. "I have never seen the leadership being provided that is comparable to what Congressman Rogers and Gov. Beshear have brought to bear on the SOAR activity," he said. "I am very hopeful that SOAR will be perceived 20 years from now as a turning point in improving the prosperity of Eastern Kentucky."

Hacker said one of the Advisory Council's greatest challenges is the responsibility of "distilling down" an actionable program to improve the long-term prosperity of the region from a list of so many valid, scientifically based issues that need to be addressed.

Asked if determining the health effects of large-scale surface mining would be one of his priorities, Hacker didn't answer directly: "Any contamination of the environment is unhealthy and should be avoided when possible, whether we are talking about heavy metals or whether we are talking about second-hand cigarette smoke.

"Within the million people who live in the SOAR area, coal mining is a very important part of some communities, but not for others. So, I will certainly listen and receive input from all concerns of the communities."

He said later of SOAR, "We need to tackle issues that have the broadest reach and the greatest impact."

As for the recommendation for a coordinated children's health program, Hacker said he recognized its importance, but noted that improving health was more complex than simply changing behaviors, and emphasized the importance of getting families out of poverty as a means of improving children's health.

He also noted that "grass-roots engagement is critical to any long-term success," reflecting on a saying of Dr. Gil Friedell, founding chair of UK's Markey Cancer Center, " If the problem is in the community, then solution is in the community."

The Advisory Council decided at its first meeting Aug. 10 that each of the 11 SOAR issue groups should focus on how they could contribute to bringing more jobs to Kentucky's 54 Appalachian counties. It was also established that each of the issue groups would hold an annual roundtable to ensure community involvement.

'Snapshot' from continuing study of health reform in Ky. shows steep drop in amount of uncompensated care at hospitals

A continuing study of federal health reform's impact in Kentucky has found a big drop in uncompensated care at hospitals and broader insurance coverage than in adjoining states.

The Foundation for a Healthy Kentucky is paying the State Health Access Data Assistance Center at the University of Minnesota more than $280,000 to study how the Patient Protection and Affordable Care Act is affecting Kentuckians.

How to read this chart: While the urban and rural figures overlap,
perhaps suggesting that rural hospitals have most of the bad debts,
they are actually separate totals. So, the high of nearly $160 million
is only for the urban hospitals; the high for rural hospitals, in the same
quarter, was $130 million. The actual total that quarter: $288 million.

Under the reform law, Kentucky expanded eligibility for the federal-state Medicaid program to people in households with incomes up to 138 percent of the federal poverty level. Hospitals welcomed the expansion, because it brought more people who hadn't been getting care into the system, but say it has also been challenging because Medicaid pays about 82 percent of their cost of providing care.

State officials say, and hospitals acknowledge, that hospitals now have much less uncompensated care, or bad debts, because more people have coverage. The study's first "snapshot" of the law's impacts puts numbers on that, reporting that uncompensated care dropped preciptously when the expansion took effect in January 2014, falling to $83 million in the last quarter of the year from a high of $288 million about a year earlier.

Medicaid expansion has also helped reduce the percentage of people without health coverage more in Kentucky than in adjoining states. In December 2014, 9.8 percent of Kentuckians reported having no health coverage, well under the adjoining-state average of 12.5 percent and the national average of 12.9 percent. The figures come from The Gallup Organization, which reported last month that the Kentucky figure had fallen to 9 percent. The study did not mention the more recent figure; it was limited to impacts through the first quarter of 2015.

The study reported that during the quarter, Medicaid funded 9,314 breast cancer screenings, 4,586 hepatitis C screenings, and thousands of other preventive services," a foundation news release said. There were 5,675 cases of substance-abuse treatment, which is newly eligible for Medicaid, during the quarter.

The study also noted that Medicaid enrollment remains concentrated in Eastern Kentucky, with 32 percent of the total; greater Louisville has 19 percent. For the study presentation in graphics, click here.

Next spring, the researchers will conduct a telephone survey about the impacts of the law. “This multiyear study from a nationally known independent source will provide valuable data to inform health policy decisions,” Susan Zepeda, president and CEO of the foundation, said in the release. She told Deborah Yetter of The Courier-Journal, "We're really making a difference in the lives of Kentuckians. More people will have those health insurance cards and have access to timely health care, and that's quite a positive story."

Beshear writes reply to a Virginia newspaper, pushing Medicaid expansion like he implemented in Kentucky

Gov. Steve Beshear, trying to help a fellow Democratic governor who is trying to expand Medicaid, has written a response to an editorial in which a Virginia largest state-capital newspaper opposed the move.

"Our success undercuts your whole opposition," Beshear says in the Richmond Times-Dispatch. "Having proved from the beginning that health care reform is both the right thing and the smart thing do, Kentucky has become the poster child for why states should expand Medicaid."

The editorial cited larger-than-expected Medicaid enrollments in Kentucky and other states, but Beshear says the piece "fails to grasp both the moral and economic arguments for expansion. . . . The core tenet of health care reform is helping families and saving lives. Not vague political theory, but helping people. That’s what we’re doing in Kentucky. It’s a Christian thing."

The editorial quoted state Republican state Sen. Chris McDaniel of Northern Kentucky, chair of the Senate budget committee, as saying the costs have created "a monstrous hole" in the state budget, though the federal government is paying the entire cost through 2016. Beshear cited a state-funded study that predicted the expansion will pay for itself by creating jobs and tax revenue for four years after the state starts paying part of the cost: 5 percent in 2017, rising to the law's limit of 10 percent in 2020.

"And those numbers don’t even address the societal impact of improved health on quality of life or economic capacity, or tangible things, such as worker productivity, school attendance and public image," Beshear writes. "So, to those who claim states can’t afford expanded Medicaid, I say this: You’re entitled to your own opinion, but you’re not entitled to your own facts. The facts in Kentucky demonstrate that not only can states afford to expand Medicaid, but they also really can’t afford not to do it. Especially if they care about their people."

Democratic Gov. Terry McAuliffe, whose powers to expand Medicaid are much more limited than Beshear's has repeatedly tried to get an expansion through the Virginia legislature. At a recent National Governors Association meeting, McAuliffe told Beshear that he could use some help from him.

Researchers: Trans fats, not saturated fats, are linked to greater risk of heart disease; but no reason to eat more butter and meat

Researchers at McMaster University in Hamilton, Ont., found that trans fats are linked with greater risk of coronary heart disease and death, but saturated fats are not associated with increased risk of heart disease, stroke, death, or Type 2 diabetes. Kentucky ranked sixth in the nation for heart-disease deaths in 2012, according to the federal Centers for Disease Control and Prevention.

"For years everyone has been advised to cut out fats," said lead author Russell de Souza, an assistant professor in McMaster's Department of Clinical Epidemiology and Biostatistics. "Trans fats have no health benefits and pose a significant risk for heart disease, but the case for saturated fat is less clear." He also noted that the researchers are not recommending an increase in saturated fat intake, because evidence does not show that it would benefit health.

Currently, people are recommended to limit saturated fats to less than 10 percent and trans fats to less than one percent of energy. Saturated fats are found in animal products like butter, cows' milk, meat and egg yolks. Trans fats are mostly produced industrially from plant oils to make margarine, snack foods and packaged baked goods.

De Souza and his colleagues analyzed 50 observation studies examining the association between saturated and/or trans fats and health outcomes in adults. The researchers did not find an association between higher saturated fat consumption and death, coronary heart disease, cardiovascular disease, ischemic stroke or type 2 diabetes. Instead, they found that industrial trans fat consumption was associated with a 34 percent increase in death, a 28 percent increase in risk for CHD mortality and a 21 percent increase in risk for CHD.

"Ours and other studies suggest replacing foods high in these fats, such as high-fat or processed meats and donuts, with vegetables oils, nuts and whole grains," de Souza said.

Ky. Rural Health Association meets in Bowling Green Sept. 17-18; major candidates for governor will speak back to back

The Kentucky Rural Health Association's annual conference will be held Sept. 17-18 in Bowling Green, with "a broader range of topics than ever before," KRHA says: "Whether you are a health-care provider, hospital or clinic administrator, community member, rural advocate, student, or simply curious about the rural healthcare landscape, we’ve got you covered."

KRHA says that at the end of the day-and-a-half meeting, attendees will be able to "build an overview of the state of rural health in Kentucky" and "become more skilled advocates for rural health at the local, regional and state levels," as well as explore opportunties for partnerships and collaboration.

A forum for the party nominees for governor will be held after the conclusion of the conference on Friday afternoon. Republican Matt Bevin is scheduled to speak and answer questions from 1:15 to 2 p.m., and Democratic Attorney General Jack Conway is scheduled to do likewise from 2:15 to 3 p.m. Bowling Green is on Central Time. The forum is co-sponsored by the Foundation for a Healthy Kentucky, the Friedell Committee, the Kentucky Academy of Family Physicians, the Kentucky Coalition of Nurse Practitioners & Nurse Midwives, the Kentucky Hospital Association, the Kentucky Medical Association, the Kentucky Primary Care Association and Kentucky Voices for Health. Before lunch, candidates for governor and other statewide offices will have a meet-and-greet session.

The conference and the forum will be held at Western Kentucky University's Knicely Center on Nashville Road, with lodging at the adjacent Staybridge Suites on Campbell Lane and the new Hyatt Place, next to the WKU campus on Center Street (with shuttle service). The registration fees until Sept. 3 are $125 for KRHA members, $200 for non-members and $45 for student members. For the draft agenda, registration form and hotel information, in a PDF, click here.

Ohio Gov. John Kasich, defending his Medicaid expansion as he runs for president, can point to lower-than-expected costs

John Kasich campaigned in Derry, N.H.
(Associated Press photo by Jim Cole)

By Al Cross
Kentucky Health News

Expanded eligibility for Medicaid, an issue in the Kentucky governor's race, is one of the major topics that separate Ohio Gov. John Kasich from his competition in the race for the Republican nomination for president. Like Democratic Gov. Steve Beshear, Kasich used the federal health-reform law to give Medicaid to households with annual income up to 138 percent of the poverty level.

Both states' enrollment of the newly eligible was higher than expected, adding to critics' concern that the expansions are a ticking time bomb for state budgets. States have to start paying 5 percent of the expansion cost in 2017, rising gradually to the law's limit of 10 percent in 2020. Advocates say increased tax revenue from a larger health-care industry will cover the cost, at least for a while.

Last week, Kasich's administration reported that Ohio's total Medicaid spending in the fiscal year that ended June 30 was 7.6 percent less than expected, despite the higher-than-expected enrollment. "Medicaid Director John McCarthy said savings have been achieved through expanded home-based care for seniors, shorter nursing-home stays, expanded managed care, capitated reimbursement policies — pay per patient rather than per patient visit — and other cost-controlling efforts," Catherine Candisky reports for The Columbus Dispatch.

Kentucky officials have pointed to capitated managed care, adopted statewide in November 2011, as the main reason Kentucky's Medicaid expenses have been lower than projected. However, health-care providers complain of slow payment, no payment and unfair treatment by managed-care companies.

Ohio's expansion added more than 500,000 people to the Medicaid rolls, bringing total enrollment to near 3 million. That is about 25 percent of the state's population of 11.6 million. Kentucky's expansion added about 430,000, currently about 400,000. About 1.2 million Kentuckians are on Medicaid, representing about 27 percent of the state's population of 4.4 million.

While Kasich and a few other Republican governors have used the reform law to expand Medicaid, he says that if elected president he would move to replace the law with something better. "The 'repeal' position is essential for Kasich," writes Chrissie Thompson of The Cincinnati Enquirer. "Kasich had to defend his Medicaid move in his first question in the prime-time debate" among top-tier GOP candidates.

"Kasich has insisted he wouldn’t cut back on the expansion of Medicaid to more low-income Americans," Thompson reports. "Instead, he says, he’d want to send the federal money back to states, with more freedoms on how to implement the program." Also, "He’s all but said he’d scrap the controversial (and, thus, delayed) mandate that businesses with at least 50 employees provide coverage for their full-time employees. . . . From there, it gets a little vague, except for Kasich’s clear discomfort with the idea of mandating just about anything." (Read more)

Improving Kentuckians' health will require education, fighting poverty; poor and less educated have poorer health, study shows

By Melissa Patrick
Kentucky Health News

Increased access to insurance is just one part of the equation to improve the health of Kentuckians, improving poverty and increasing education levels are disparities that must also be addressed if Kentucky ever hopes to improve the health of its citizens.

"We believe that health disparities can be eliminated, and that they must be eliminated," say the authors of a recently released report, Money Matters: Health Disparities in the Commonwealth - a Report on Socioeconomic status and health in Kentucky. "The first step towards eliminating health disparities is to understand and monitor where they exist."

The report was released by the Foundation for a Healthy Kentucky and the University of Kentucky College of Public Health.

Using 2011-12 data from the Kentucky Behavioral Risk Factor Surveillance System (the most recent data available), this report looked at the relationship between health, income and education and found that poverty and lower education levels are consistently associated with poorer health.

The data show that people who live in poverty and those with less education are more likely to be smokers. Smoking is a known cause of cancer, heart disease, stroke and other chronic conditions.

In 2011-13, the smoking rate in Kentucky was 28.6 percent, with almost one in three adults smoking. Of this group, almost half of the smokers (45.4 percent) were below poverty, while 20.9 percent were above poverty; and more than four in 10 (44.6 percent) had less than a high school education and about one in 10 (11.9 percent) were college graduates.

Obesity, which contributes to heart disease, stroke, type 2 diabetes and cancer, was also found to be more prevalent among the poor and uneducated.

The report found that 30.8 percent of Kentuckians were obese. Of this group, 38 percent lived below poverty and 30.9 percent lived above poverty; and 33.6 percent of those with less than a high school degree were obese, compared to 25.5 percent of college graduates.

Two-thirds of Kentuckians were considered overweight in the survey, and this was consistent across socioeconomic and education groups.

Poor, less educated Kentuckians in the survey also reported that they were less physically active and that they had increased activity limitations than those who lived above poverty and with more education.

Another health indicator among poor, less educated Kentuckians was that they were more likely to describe their health as fair or poor. Of the 23.1 percent of Kentuckians who described their health as fair or poor, 44.6 percent were below poverty and 17.6 percent were above poverty; and 45.2 percent of them had less than a high school education, while 9.1 percent of them were college graduates.

This finding was also true for people reporting poor physical health and poor mental health.

Of the 16.8 percent of Kentuckians who said they had poor physical health, 36.5 percent lived below poverty and 12.3 percent lived above poverty; and 30.8 percent had less than a high school education, while 7.4 percent were college graduates.

Of the 15.9 percent of Kentuckians who said they had poor mental health, 33.9 percent lived below poverty and 11.1 percent lived above poverty; and 28.2 percent had less than a high school degree, while 7.8 percent were college graduates.

Poorer, less educated people in Kentucky were also found to have increased levels of asthma and diabetes.

While the study also found that poorer Kentuckians have less access to health care, often forgo medical care due to the cost, and are less likely to have health insurance, it must be noted that this data was collected prior to the implementation of the Patient Protection and Affordable Care Act, which has since provided health coverage to more than 500,000 Kentuckians. The percentage of uninsured in Kentucky has dropped to 9 percent, compared to 20.4 percent in 2013, prior to the law's implementation.

That being said, "one-quarter of consumers who buy insurance on their own still have problems being able to afford needed care," according to a Families USA report.

"Simply having health insurance is no guarantee that consumers can afford to pay for health care," the report said. "Health insurance involves different types of costs that consumers must pay out of pocket—ranging from a health plan’s deductible to co-payments at a doctor’s office. These expenses add up, and research has shown that even nominal cost-sharing can deter people from getting needed care."

"Economic opportunity is the cornerstone of getting people jobs and employment. That then requires good education. Those two combined set the stage for people to pay more attention to their own health and the health of their community," Dr. William Hacker, former state health commissioner and current health chair of Shaping Our Appalachian Region, said at a recent advisory council meeting. SOAR is a bipartisan, nonprofit effort to improving the economy of Appalachian Kentucky.

The importance of getting families out of poverty was also noted by Dr. Terry Brooks, executive director of Kentucky Youth Advocates, in response to the 2014 Kids Count report, which ranked Kentucky 32nd in economic well-being.

"Here’s the bottom line from this year’s report: If we as a commonwealth want to get serious about improving the lives of our children, there is one overriding and persistent challenge: poverty," Brooks said. "You can’t talk education or health without talking family economics. And we can begin to tackle persistent poverty only when economic well-being policy stops being political and starts being about the common good."