Study finds people with high deductibles skimp on doctor visits

In theory, higher deductibles on health-insurance plans should force down health-care costs because patients will become smarter shoppers, but a study has found that patients shifted to a higher-deductible plan did not shop for a better deal, but simply used "way less" health care, Sarah Kliff reports for Vox.

In 2006, Kliff reports, about one in 10 employees had a health insurance deductible over $1,000, but today about half do. Health economists consider that "good news," long theorizing that "higher deductibles would force down health-care costs" because if patients had to pay more of the cost, they would shop for the best price, ultimately forcing expensive physicians to lower their price.

But a "massive new study" by economists that "studied a firm that, in 2013, shifted tens of thousands of workers into high-deductible insurance plans" has found this to not be the case, Kliff reports.

"The new paper shows that when faced with a higher deductible, patients did not price-shop for a better deal. Instead, both healthy and sick patients simply used way less health care," Kliff writes.
"This raises a scary possibility: Perhaps higher deductibles don't lead to smarter shoppers but rather, in the long run, sicker patients."

For two years, the study looked at a company that shifted more than 75,000 workers and their dependents from a plan with no deductible to one with a $3,750 deductible. Along with the shift, employees received a $3,750 subsidy to a health savings account, which they could use for their health care cost, and they were also given online tools to look up prices for doctor visits, tests and other services.

Researchers found that while workers health spending dropped by 15 percent in a single year for all types of health services, they also found that the reason for it was not because of smarter shopping, but instead, they just went to the doctor less for both "potentially wasteful" diagnostic test and "potentially valuable care," like preventive visits.

"I am a little bit surprised at just how poorly patients were able to do when looking at very similar products, like MRI scans, and with a shopping tool," Jonathan Kolstad, an economist at University of California Berkeley and one of the study's co-author, told Kliff. "Two years in, and there's still no evidence they're price shopping."

This finding was also found true for the sickest workers, but once this population exceeded their deductible, use of medical services rebounded, Kliff writes.

Kolstad couldn't definitively answer why sick patients forgo care even though they had $3,750 to spend in their health savings account, "but he thinks it might have a lot to do with the difficulty all of us have, as patients, guessing how much we'll spend on health care in a certain year."

"This is a difficult task for consumers to take on, and we now have very detailed data to show that's the case," he says. "When we've thought about the economics, we've generally thought this type of price change wouldn't be problematic, that sicker people would just spend their deductible and get the care they need. This research suggests that's not the case."

"Americans aren't used to shopping for health care, and maybe we don't want to start," Kliff writes.

One challenge is that most people don't have access to enough information to comparison shop, like you can for a dishwasher on Amazon, she writes.

But still, this reality doesn't hold true for the workers in this study because they were provided with cost comparison tools as well as financial incentives to choose the less expensive option. But it didn't seem to matter, "Instead of looking for a lower-cost option, workers simply decided not to go to the doctor at all," Kliff writes.

Kolstad told Kliff that the findings from this study "makes him skeptical of "demand-side" interventions in health care — those that rely on consumer demands for lower health prices to ultimately lead to less medical spending" and that "interventions that reduce demand could have the unintended consequence of actually raising long-term health-care costs." But he also said that there needs to be further data and evaluation to determine the long-term effects.

New outpatient psychiatric clinic in Louisville will accepts most insurance, including some Medicaid, which is not the norm

A new mental health clinic is opening in Louisville that will accept most forms of health insurance, including some Medicaid patients, which most smaller, outpatient psychiatric providers don't accept, Joe Sonka reports for Insider Louisville.

Ren Scheuerman, a psychiatric nurse practitioner and Louisville native who worked with PsychBC in Cleveland, is moving back to open up a PsychBC clinic at 10200 Forest Green Blvd. in the Hurstbourne area. He told Sonka that most smaller outpatient psychiatric providers operate on a cash-only basis.

“It’s going to be great for the patients in Louisville, because most people have mental-health coverage on their health insurance,” Scheuerman told Sonka. “We now technically have parity in mental health, but because so many providers don’t take insurance, it really creates a financial hardship for a lot of patients. Twenty-dollar co-pays are affordable, but going every month or two weeks for $150 is just not affordable for most people … and most primary-care providers don’t do psychotropics anymore, just because of legal liability.”

Alex D’Auria, PsychBC’s community relations director in Cleveland, told Sonka that the Louisville clinic will accept a wide variety of private insurers, in addition to Medicaid managed care organizations CareSource and CoventryCares.

Sonka spoke to experts who said smaller psychiatric clinics and private-practice psychiatrists don't accept insurance because they don't have the staff to manage all of the "red tape on claims" required by insurance companies and their managed-care subsidiaries, and because "reimbursement rates are too low." He also found that private psychiatrists "are not taking the really difficult cases either."

Dave Langdon, spokesman for the Louisville Metro Department of Public Health and Wellness, told Sonka that this lack of private providers is especially noteworthy for the considerable number of individuals who gained coverage through the expansion of Medicaid under the Affordable Care Act.

The “ACA aims to give parity between medical health and behavioral health services, but there are few psychiatrists or psychologists who take Medicaid,” Langdon told Sonka.

New test developed by top expert at UK will lead to earlier diagnosis of COPD, in which Kentucky leads the nation

A University of Kentucky professor helped develop a new tool to diagnose chronic obstructive pulmonary disease, which is often diagnosed late and is more prevalent in Kentucky than anywhere else in the nation, Laura Joszt reports for The American Journal of Managed Care.

“Undiagnosed and untreated COPD can lead to detriments in quality of life, and basically people start doing less because they have difficulty breathing,” said Dr. David Mannino, professor of medicine at UK's College of Public Health. “Many people attribute this difficulty of breathing to just getting older when, in fact, they may have a disease that is potentially treatable.” Mannino is recognized as the top U.S. expert on COPD, according to a UK news release.

COPD is a chronic inflammatory lung disease that causes obstructed airflow from the lungs. It includes diseases like emphysema, chronic bronchitis and asthma. It is the third leading cause of death in the U.S., according to the federal Centers for Disease Control and Prevention. Kentucky has the highest COPD rate in the nation, 9.3 percent of its population.

Likely causes of that are Kentucky's high smoking rate (26.5 percent); its high level of poverty, which often limits access to medical care; and its high rate of agriculture and mining jobs, which expose workers to dust and other irritants that can lead to COPD, Maren Auxier writes for the Lung Institute.

“Smoking is the number-one risk factor for COPD. If you look at a map of cigarette smoking, it will match very tightly with a map of COPD," Mannino writes. Several studies, including one by UK researchers, have found that there are fewer COPD hospitalizations in places with comprehensive bans on smoking in workplaces.

On top of all that, at least one-third of Americans get a late-stage diagnosis, which decreases the possibility of an intervention," Joszt reports.

The new five-step diagnostic tool developed by Mannino at UK combines a five-question "yes" or "no" questionnaire that asks about the patient's lifestyle with two common non-invasive methods for diagnosing COPD: a peak-flow examination and spirometry. Previous screening methods to diagnose COPD relied on the patient's smoking history, cough and sputum.

Mannino said at a recent European Respiratory Society meeting that a study has found that his new tool to be the most effective diagnostic approach, and UK will now test the effectiveness of the tool among different populations.

"Not only could the tool help health providers diagnose COPD in mere seconds, but it could help patients find out if they suffer from COPD symptoms before a visit with the doctor," Joszt writes.

Ky. nursing homes say number of citations alleging 'immediate jeopardy' to residents show 'excessive regulation' by state

Kentucky's nursing home industry says it is under "excessive regulation," but The Courier-Journal reviewed more than 100 reports of state inspections of Kentucky nursing homes over the past three years and found "multiple instances" where residents had been "threatened, ridiculed, slapped, injured or sexually abused" or "lived in squalid conditions amid urine, feces, mice and insect infestations," with several cases of residents dying because of "poor or neglectful care," Deborah Yetter reports for the Louisville newspaper.

Kentucky nursing home representatives note that Kentucky nursing-home inspectors are more likely to cite violations that place residents in "immediate jeopardy" than inspectors in other states, "even though Kentucky nursing homes compare favorably in other categories, such as staffing or quality measures," Yetter writes.

An immediate-jeopardy violation is one that causes harm, serious injury or death, or is likely to do so. It carries fines of up to $10,000 a day, and "Some of Kentucky's 289 nursing homes have been fined nearly $16 million in the past three years for violations," Yetter reports.

Betsy Johnson, former state Medicaid commissioner and executive director of the Kentucky Association of Health Care Facilities, the main nursing-home lobby, said at a legislative committee meeting Sept. 16 that Kentucky has a "broken regulatory environment" and that the rules to ensure the safety of residents are "overly strict," Yetter reports.

"We firmly believe that the current regulatory environment only exacerbates the toxic litigation environment in Kentucky," Johnson said in a follow-up letter to the state's joint Health and Welfare Committee. The nursing home industry has lobbied for years for a state law to limit lawsuits.

Advocates counter that state oversight must not be weakened.

Brian Lee, executive director of Families for Better Care, a Florida-based nonprofit that advocates for quality nursing home care, said "lawmakers should consider details of violations before accepting the industry's claim of too much regulation," Yetter writes.

"If you look at these inspections, all of them, all of them ... this is serious stuff," Lee said. "It's not dust bunnies in the air vents."

Maryellen Mynear, inspector general for the Cabinet for Health and Family Services, told the committee in a letter, "The fact that an industry believes it is over-regulated does not make it so."

Mynear explained at the hearing that Kentucky inspects nursing homes on behalf of the federal government, and the U.S. Centers for Medicare and Medicaid Services determines the severity of a violation and how much to fine the facility, not Kentucky inspectors. She noted that the federal government provides most of the funding for nursing-home care, receiving nearly $1 billion from Medicaid in 2015.

Mynear listed the number of violations that were serious enough for fines over the past few years: 47 in fiscal year 2013; 53 in 2014; and 40 in 2015. She noted that only 36, or 12 percent, of Kentucky's nursing homes got the top five stars in the CMS rating system; and 42 percent of them rank below average, the largest percentage among the eight states in CMS's Southeast region.

Mynear acknowledged to the committee that "Kentucky's seemingly high number of immediate jeopardy violations may be skewed by the fact that some troubled homes rack up multiple or repeated citations," Yetter reports. But Mynear disputed Johnson's claim that citations lead to lawsuits and litigation costs for nursing homes, saying that "in several recent Kentucky lawsuits involving egregious abuse or wrongful death cases, no violations had been cited or fines imposed."

Some Republican lawmakers on the committee were sympathetic to the nursing homes' complaint. Sen. Ralph Alvarado of Winchester, a physician who has directed several nursing facilities, said, "Maybe we can reduce the cost to our residents and facilities just by decreasing the regulatory burden we have in long-term care."

Rep. Tim Moore of Elizabethtown suggested that regulators might be a bit over-zealous like Deputy Barney Fife in the "Andy Griffith Show." Moore said, "There were times when Barney applied the law in such a way that it really wasn't helping anybody and it was just a burden to everybody and Andy had to rein him in."

The meeting ended with an agreement for the nursing home industry and state officials to discuss areas of concern and possible resolution of disputes. "Mynear said that  she's willing to talk, but that doesn't mean her agency is willing to back down when it finds problems," Yetter writes.

The Courier-Journal offers these tips on how to check out a nursing home:

• Go to http://chfs.ky.gov/os/oig/  for inspection reports.
• Go to Medicare.gov/nursinghomecompare for a Medicare facility rating.
• Ask the nursing home for its most recent survey, or inspection. They are required to provide it upon request. 

Kentucky Health Cooperative, burdened by unhealthy policyholders and Congress's cuts in a subsidy, is closing

By Al Cross
Kentucky Health News

The Kentucky Health Cooperative, which sold 75 percent of the policies bought through the state health-insurance exchange, is going out of business because it lost so much money and Congress cut subsidies for insurers who would up with a costlier group of policyholders under the federal health-reform law.

Co-op officials said they were expecting $77 million from the federal government to cover past and expected losses, but got only $9.7 million. The co-op lost $50 million last year, the most of any of the 22 co-ops created with subsidies from the reform law.

Less money was available from the federal government because of a restriction that Republicans added to the omnibus spending bill last December.

That didn't keep Senate Majority Leader Mitch McConnell, R-Ky., from saying in a news release, “Barely a week goes by that we don’t see another harmful consequence of this poorly conceived, badly executed law. Despite repeated Obama administration bailout attempts, this is the latest in a string of broken promises with real consequences for the people of Kentucky who may now be losing the health insurance they had and liked, twice within the past three years because of Obamacare’s failures.”

The co-op said in a news release that it had reduced its losses to $4 million by the end of June. "We were on track to reverse direction and begin operating in the black, and we expected this to come about in 2016," said Glenn Jennings, who took over as CEO in June after Janie Miller resigned.

To cover losses, the co-op asked for and received an average rate increase of 20 percent for this year and 25 percent for the enrollment period that begins Nov. 1. But when the federal subsidy fell far short, the co-op had little choice but to close, said Joe Smith, its board chairman.

The press release from McConnell's office said the co-op had been "ordered" to close, but Smith said in an interview, "We did it voluntarily."

Spokeswoman Susan Dunlap said the co-op consulted with the state Department of Insurance and the federal Centers for Medicare and Medicaid Services about its future, "but I have never heard the word 'ordered' used." She said "Herculean and unrelenting efforts were made" to save the co-op.

State officials were largely mum on the matter. A call to Insurance Commissioner Sharon Clark was returned by an email from spokeswoman Ronda Sloan, who was asked if the department had advised the cooperative to shut down. She declined to comment further.

The cooperative said it will meet its financial obligations to the 52,000 people it insures. Smith said it was required to have a reserve five times its premium income to cover losses.

Co-op policyholders will have to find new insurers by Dec. 31, when their policies will expire. The enrollment period ends Jan. 31.

The co-op's demise was relegated to the eighth paragraph of a 19-paragraph press release from the state Cabinet for Health and Family Services, which touted the fact that more insurers than ever will be offering plans through Kynect, the state health insurance exchange.

Co-op officials blamed its troubles on the fact that it attracted too many unhealthy people and thus had to pay out much more than expected in claims.

"Many of our members had never had health insurance before," Jennings said in the release. "What happens when people don't have health insurance? They probably aren't looking after their health and well-being. They're probably not seeing providers. If they aren't seeing providers, they might not be aware that they have chronic conditions. Or, they might be dealing with something that's acute, but they didn't have the out-of-pocket funds to get treatment. All this adds up to a lot of people with pent-up medical needs."

Smith noted that the co-op was the only insurer to offer a "platinum" plan, the top level of coverage. He said that was ideal for people who had been in the state's high-risk pool, funded by a fee on all health-insurance policies, which is now used to fund Kynect. However, he said they were in the pool for a reason: they were high-risk. 
 
Smith said the co-op achieved its mission of promoting "community health and well-being by engaging its members and providers," insuring more than 50,000 people who hadn't had insurance, and hopefully offering competition that made other insurers' premiums lower. "We have kept the financial and health well-being of our members at the forefront," he said.

Proposed Medicare premium hike could cost Kentucky a lot, because some on Medicare are also on Medicaid

UPDATE, Nov.2: a two-year budget was passed  by Congress Oct. 29 and awaits the signature of the president. The agreement will reduce the increase in Medicare premiums for Part B, which pays for physicians services, next year to 15 percent  from the  unprecedented 52 percent increase that would have occurred if this law had not been passed. However, the author writes, "Consider the can kicked down the road" as this law only holds through 2017, according to the U.S. News and World Report. 

UPDATE, Oct. 28: the budget deal agreed to by the president and Congress eliminates the Medicare premium increase.

By Melissa Patrick
Kentucky Health News

If a proposed increase in Medicare premiums is approved later this month, Kentucky will have to find a way to cover as much as an extra $100 million a year for Medicare beneficiaries whose premiums are paid by the federal-state Medicaid program.

"The state is concerned about the budget implications surrounding this issue," the Kentucky Cabinet for Health and Family Services said in a statement. "Since Medicaid is funded in great part with federal dollars, the Department for Medicaid Services must comply with all federal mandates. . . . All states are following this issue closely, since the decision by the (U.S. Department of) Health and Human Services to increase Medicare Part B premiums could have significant budget implications for state Medicaid agencies."

HHS has not yet finalized its projections, but is expected to announce the final 2016 Medicare monthly premiums later this month.

Premium increases could affect about 15 million of the 51 million people enrolled in Medicare Part B, which covers doctors’ services, outpatient hospital services, some home-health care and other items. Those who are in both programs are expected to have an increased premium of $55 a month.

If the $55 hike goes through, "Kentucky taxpayers will be hit with another $100 million a year Medicaid bill in 2016," writes David Adams, a strong critic of the federal health-reform law who sued unsuccessfully to stop Gov. Steve Beshear's embrace of the law.

On his Kentucky Progress blog, Adams said some 200,000 Kentucky Medicare recipients are also on Medicaid. The Cabinet for Health and Family Services did not immediately respond to a request to confirm that number.

"This is a huge issue for states," Matt D. Salo, executive director of the National Association of Medicaid directors, told The New York Times. "To finance Medicare, the federal government would shift billions of dollars in costs to state Medicaid programs."

It's also an issue for the federal government, which pays most Medicaid costs. Congress and the Obama administration are looking for ways to stop these Medicare premium hikes, including using administrative action, noting that premiums "could rise by roughly 50 percent for some beneficiaries next year," Robert Pear reports for the Times.

But Pear also reports that Republicans, who are looking at "the cost of avoiding such big premium increases, $77.5 billion by some estimates," may see this as a problem, with aides to Speaker John Boehner telling the Democratic leadership that the "cost would have to be offset by savings elsewhere in the federal budget."

Why are some people in both programs? "Medicare enrollees who have limited income and resources may get help paying for their premiums and out-of-pocket medical expenses from Medicaid," the National Conference of State Legislatures explains. "Often referred to as 'dual eligibles,' these individuals are among the disabled, most chronically ill, and costly in either program. It’s been estimated that on average the dual eligible population costs 60 percent more than non-dual eligible individuals. Medicare covers their acute and post-acute care services, while Medicaid covers Medicare premiums and cost sharing, and—for those below certain income and asset thresholds—long-term care and social supportive services and, until 2006, prescription drugs, among other services. Approximately half initially qualify for Medicare because of disability rather than age and nearly one-fifth have three or more chronic conditions."

Most on Medicare won't pay more, so rest have to make it up

Gail Buckner of Fox Business explains why some Medicare recipients may see a 50 percent increase in their premiums, while most will not.

Medicare, the federal health insurance program for those 65 and older, is comprised of Medicare Part A, which covers hospital stays, and Part B, which covers doctor visits and out-patient services.

Part A is paid for by a 2.9 percent tax on employers and employees. The cost of Part B is shared by the federal government, which typically pays 75 percent, and premiums.

A "hold harmless" rule set by Congress years ago that says if a senior's Part B premium goes up more than their Social Security benefit, their premium can remain the same.

Because inflation has been so low, many Social Security beneficiaries will not get a cost-of-living adjustment next year, which means their Medicare premiums won't change. This year, 70 percent of retirees fall into this category,

But that also means that the remaining 30 percent will have to bear the entire increase in the premiums.

The New York Times reports that Medicare actuaries predict an increase of $159 a month for most standard premiums as well as an increase in the annual deductibles, estimating a rise to $233 next year, from $147 in 2015.

Those who will have to pay the higher premiums are: dual eligibles; new retirees; individuals who are enrolled in Medicare, but do not receive Social Security, such as retired teachers; and wealthy retirees, who make up 6 percent of seniors.

Ky. pharmacists can now fill orders for a lifesaving anti-overdose drug without a doctor's order, but at greater expense

By Melissa Patrick
Kentucky Health News

Pharmacists across Kentucky can now fill orders for naloxone, including the nasal-spray Kentucky-developed version, used to treat opioid and heroin overdoses, without a prescription. Training to help them do that is in progress.

But even if this life-saving drug, often known by the brand name Narcan, is more readily available, that doesn't mean it is affordable; its cost has recently doubled, NPR reports.

That has caused concern not only for individuals, but also for government agencies on tight budgets like first responders, police departments and health departments.

At the Aug. 25 Woodford County Fiscal Court meeting, the ambulance director Hunter Shewmaker said the Bluegrass county has 10 to 15 drug overdoses a month, and “Our Narcan use is going through the roof,” at $40 a dose. “We may give two or three doses to one patient” to counteract an overdose, he said.

Lt. David Bahler of the Cincinnati Fire Department told WXIX-TV that his agency was well on its way to over 200 uses of naloxone for the month of October, having already administered 50 doses as of Oct. 7. Covington reported using naloxone 40 to 50 times a month, the station's Michael Baldwin reports.

The cost of one dose of naloxone is between $35 and $39, up from under $2 a dose many years ago, Covington ambulance director David Geiger told Baldwin, predicting that the cost of naloxone "will take 17 percent of our supply budget."

Amphastar Pharmaceuticals is the only company that makes naloxone in the dosage that can be delivered nasally, the method most agencies prefer because it doesn't require the use of a needle.

Amphastar has said that it raised the prices because of "increased manufacturing costs, including a rise in the prices of raw materials, energy and labor," NPR reports.

Other experts say that "heightened demand, a limited number of producers and an expensive new product are a recipe for price increases," Kristina Fiore writes for MedPage Today.

Daniel Raymond, policy director for the Harm Reduction Coalition, told NPR, "They can have a narrow market at higher prices, or a much broader market at lower prices. Either way, they're going to be making money. The latter way, they're saving more lives."

Kentucky training

Kentucky pharmacists can now fill naloxone orders, working with physician protocols, because of recent legislation meant to tackle the heroin-overdose epidemic in Kentucky. Last year, more than 1,000 Kentuckians died from an overdose.

The naloxone training programs for pharmacists, which will run through October and November, were developed by the Advancing Pharmacy Practice in Kentucky Coalition and are expected to reach more than 500 pharmacists, according to a University of Kentucky news release.

“This is game-changing legislation for public health in Kentucky,” Trish Freeman, director of the UK College of Pharmacy’s Center for the Advancement of Pharmacy Practice, said in the release. “The coalition recognized that and worked hard to bring the necessary resources together to ensure Kentucky pharmacists had the proper training to make sure they could fill this important need in our communities.”

The nasal spray version of naloxone was developed by UK pharmacy professor Dan Wermeling through his startup company AntiOp Inc.

“This project is a great example of pharmacists putting patients first,” said Wermeling, a College of Pharmacy alumnus and native Kentuckian. “This college began its work in naloxone because we saw how opioid overdose was wreaking havoc on Kentucky communities. We approached this as a public-health problem, and we sought to leverage the resources and capacity we have at the college to help save lives right here in the commonwealth. I am proud that our work is starting to pay dividends, and I am proud that Kentucky pharmacists are leading the way.”

Remaining dates on the coalition's training tour are: Oct. 27 in Owensboro; Oct. 29 in Lexington; Nov. 3 in Pikeville; Nov. 12 in London/Corbin; and Nov. 19 in Louisville. The coalition will also offer training  Oct. 11 at the Jefferson County Academy of Pharmacy's fall seminar at Sullivan University in Louisville; Oct. 23 at the UK College of Pharmacy and Sullivan University College of Pharmacy preceptors meeting, at the pharmacy college in Lexington; and Nov. 14 at the Kentucky Pharmacists Association Legislative Conference at the Hyatt Regency Hotel in Lexington.

Health-reform law has been substantively changed at least 14 times, most recently by Kentucky's Rep. Brett Guthrie

While the debate over repealing "Obamacare" has polarized Washington and the country, Congress occasionally passes amendments to the Patient Protection and Affordable Care Act. The latest, signed by President Obama Oct. 7, was sponsored by Republican Rep. Brett Guthrie of Kentucky's Second District.

Rep. Brett Guthrie, R-Ky.

"There are a lot of things in the bill that need fixing. I'm for repeal and replace," Guthrie told Gregory Korte of USA Today. "But here's the situation: You have people being negatively affected, and so can we find a way to work together to fix it?"

Guthrie's Protecting Affordable Coverage for Employees Act will "maintain the current definition of the small group market for health insurance as employers with one to 50 employees," a release from Guthrie's office said. "That definition was set to expand under the Affordable Care Act to employers with one to 100 employees on Jan. 1," notes Stephanie Salmons of The Messenger-Inquirer in Owensboro.

Guthrie's release said, "The small group insurance market has increased mandates and restrictions under Obamacare,so those workers who would have been forced into the small group market would have seen disruption in their coverage and increased cost."

The bill was "passed by both chambers without a single 'no' vote and signed by the president with no controversy or fanfare," USA Today reports. "Obama has signed at least 14 bills making substantive changes in his signature legislation," eight of them Republican bills, according to the Congressional Research Service.

Obamacare critic Grace-Marie Turner of the Galen Institute "said the congressional action comes just under the wire, as insurance companies finish pricing contracts for 2016 coverage," USA Today reports. "And the quick, businesslike way in which the bill was passed just shows that neither side saw any benefit in politicizing the issue, she said."

"I think here the White House certainly doesn’t want to announce with big fanfare that the Republican Congress has led on making changes on the president's health law," Turner said. "And the Republicans don't want to say that they’re fixing it, because they want to repeal it entirely."

Guthrie said his bill affects every congressional district in the nation. "Not everybody has a Fortune 10 or 15 business in their district, but everyone has small to medium-sized businesses," he told Salmons.

For example, Sterett Crane and Rigging in Owensboro will avoid a 14 percent premium increase "just based on the demographics of our workforce," human resource manager Dee Dee Jackson told Salmons. If the law had not been changed, Sterett would have been pooled with larger employers "who might have higher claims, possibly leading to premium increases because of those larger claims, she said." The company has 96 employees, about 64 of whom are eligible for benefits.

"Unbeknownst to the public, there is actually some governing going on," Larry Levitt, a senior vice president at the Kaiser Family Foundation, told USA Today. But he added, "I'm not sure this relatively modest measure will pave the way for a raft of bipartisan consensus around the health law. None of the changes strike at the heart of the law or change it in any substantial way. So maybe it's a little overstated to say it’s actual governing."

Another rural Ky. hospital will become part of a new group to stay afloat; Glasgow's hospital is buying Columbia's bankrupt one

ColumbiaMagazine.com  

Another rural Kentucky hospital is merging with a larger hospital system in order to keep its doors open.

T.J. Regional Health, the parent company of T.J. Samson Community Hospital in Glasgow, just announced its plan to buy Westlake Regional Hospital in Columbia and its clinics, according to a news release.

“Westlake has been an important part of the healthcare infrastructure of Columbia and Adair County for 35 years," T.J. Regional Health President and CEO Bud Wethington said in the release. "We see great opportunities to collaborate with the physicians and employees to grow the health care services and continue its efforts to advance the health status across the region.”

Westlake is owned and operated by Adair County Public Hospital Corp. and the Adair County Hospital District, both of which are in bankruptcy.

The Glasgow hospital has recently cut and adjusted salaries and offered early retirement to reduce costs, and was surprised when The Medical Center at Bowling Green bought Caverna Memorial Hospital in Horse Cave, which referred many patients to Glasgow. Now the Glasgow hospital looks to rebuild its network by buying the one in Columbia.

(Base map from Google maps)

Metcalfe County, between Glasgow and Columbia, has no hospital. The Columbia hospital is close to the tax-supported Russell County Hospital in Russell Springs, a critical-access hospital that was managed by Baptist Health Lexington until about a year and a half ago.

The proposed acquisition is contingent upon multiple factors, including reaching certain agreements with creditors, confirmation of a Chapter 9 bankruptcy plan by a federal bankruptcy judge and of approvals from state and federal regulators. 

More consolidations are expected. Fleming County Hospital in Flemingsburg recently merged with a larger hospital system to stay afloat. Rural hospitals in Nicholas and Fulton counties have closed in the last year.

Residents of Bourbon County and the Central Appalachian Coalfield are some of the nation's most sleep-deprived

Bourbon County residents are some of the nation's most sleep-deprived, according to county-level data from a study by the federal Centers for Disease Control and Prevention. The study is based on a 2009 survey that asked 432,000 people how many times over the past 30 days they didn't get enough sleep or rest. Respondents were separated into two categories: people who reported poor sleep on fewer than 15 days, and those who reported it on more than 15 days, Christopher Ingraham reports for The Washington Post.

Among Bourbon County respondents, 54 percent said they don't get enough sleep, the seventh highest total in the nation. Many Central Appalachian Coalifield counties also had high rates; those in Kentucky were led by Harlan County, 49 percent; Floyd County, 44%; Breathitt County, 44%; Knox County, 43%; Knott County, 41%; Pike County, 41%; and Morgan County, 40%. 

For an interactive version of the map, click here.

"Researchers looked at a number of social and demographic factors to see whether anything correlated—obesity, income, education, drinking rates, overall physical and mental health," Ingraham writes. "They found, interestingly, that 'relatively younger individuals of lower socioeconomic status and poorer health were more likely to live in hotspot counties.' People who were generally younger, poorer and in worse health were more likely to live in places with high rates of bad sleep."

Cooking classes in E. Ky. help residents, researchers find ways to overcome barriers that hinder healthy eating in rural areas

Almost 180 cooks in six Eastern Kentucky counties are learning about heart-healthy cooking at their local Cooperative Extension office, while also helping with dietary research, according to a University of Kentucky news release.

Mary Stevens of Jackson County attends heart-healthy
cooking classes with her mother Betty. (UK photo)

The program, Rural Eating and Healthy Cooking, allows REACH participants to plan and prepare heart-healthy meals and then take them home to their families for sampling. Recipes for the meals are made from the American Heart Association's official heart-healthy cookbook, of which each participant gets a free copy, are budget-friendly and are made with easily obtained ingredients.

The program is a collaboration between the UK's College of Nursing and Department of Family and Consumer Sciences, which works with Extension agents. UK nursing professor Frances Hardin-Fanning, the principal investigator on the study, said she "hopes to gather valuable information about overcoming the various environmental barriers that hinder healthy eating in rural populations."

“There are a lot of things beyond your ability to change,” Hardin-Fanning said of the difficulties people in rural communities can have with eating healthy diets. “But cooking healthy food at home is not one of them.”

West Liberty resident and program participant Bonnie Burton, whose husband is a cancer survivor and pre-diabetic, said she had already begun cutting sodium from their diet and reading nutrition labels, but since participating in the program has learned how to incorporate fresh herbs to boost the flavor of heart-healthy meals and said that she was surprised that her "meat-and-potatoes" husband liked the meatless, three-bean chili that they made in class. 

 “I know how to cook, but there’s always room for improvement,” Burton, 66, said.

The study will last 12 months. Trained interventionists provide health coaching for those in the experimental group, including: trying to identify barriers to healthy eating, regularly reviewing the participants' healthy eating goals; regularly evaluating progress toward these goals; and offering motivation for improving eating habits. The participants are asked to provide their grocery receipts each month for measuring changes in their intake of fruits, vegetables and saturated fat.

Australian filmmaker gained 22 pounds eating foods that most parents think are healthy; visited Ky. to see 'Mountain Dew mouth'

An Australian filmmaker, while maintaining his normal caloric intake and eating standard grocery store items, ate the equivalent of 40 teaspoons of sugar a day for two months and gained 22 pounds, expanded his weight size and developed pre-diabetes, reports The Orange County Register, in a story republished in the Lexington Herald-Leader.

Damon Gameau visited rural Kentucky to observe rotten teeth caused by "Mountain Dew Mouth" for the documentary, "That Sugar Film," which is available on videostreaming services.

image: www.npr.org

"I wasn't eating any junk food," Gameau told the Register in a phone interview from Melbourne, Australia. "I was eating these perceived health foods that most parents would give their kids."

The Register notes that hidden sugar, in products like high-fructose corn syrup, has been added to most products since food companies started lowering the fat content in their products.

"Even if you're taking beverages out of the equation, there's more and more sugar creeping into more and more different foods," Michael Goran, director of the University of Southern California's Childhood Obesity Research Center, told the Register.

The Food and Drug Administration has proposed changing food labels to include the amount of added sugars, separate from natural sugars, that occur in foods. "Added sugars provide no additional nutrient value, and are often referred to as 'empty calories,'" the agency said in an explanation of the proposal.