Bill to keep dirty needles out of landfills hijacked with amendment to require needle-exchange programs to be one-for-one

By Melissa Patrick
Kentucky Health News

A House bill to educate the public about how to safely dispose of hypodermic needles easily passed was hit with a surprise amendment that would require a one-for-one needle exchange at needle exchange programs.

Rep. Mike Denham

The amended bill, which passed at the March 9 Senate Health and Welfare Committee meeting and now goes to the Senate floor, didn't set well with its sponsor, who said the amendment took him by surprise.

"At first blush, I have real problems with it," Rep. Mike Denham, D-Maysville, said in an interview. He said the amended bill would likely not pass in the House, but said he would review it and then decide whether to concur or not. He said he had already received emails and texts from his constituents telling him they did not support the committee substitute.

The original bill, House Bill 160, would require the state Department for Public Health to establish guidelines for disposal of hypodermic syringes, needles and other sharps used for home medical purposes and disseminate educational materials to pharmacies and the public. It was written to increase the safety of landfill workers who are at constant risk of being stuck by improperly disposed of needles.

Sen. Denise Harper Angel, D-Louisville, while supporting the original bill, voted no on the substitute and told the committee that the Louisville needle exchange program does not have a one-to-one requirement and is working well. "The effort here is to diminish disease," she said.

Sen. Ralph Alvarado

Needle exchanges were approved as part of an anti-heroin bill in 2015. Republican Sen. Ralph Alvarado, a Winchester physician, who voted for the substitute, said in an interview that the intent of the law was to only allow a one-to-one needle exchange. He said many senators would have voted against that measure if they had known exchanges did not have to be one-for-one.

The Office of the Attorney General released a formal opinion Dec. 18 that said needle-exchange programs in the state do not have to have a one-for-one exchange. The opinion was requested by state Senate President Robert Stivers of Manchester, who along with other Republicans, also say that the intent of the law was a one-for-one exchange.

Alvarado criticized then-Attorney General Jack Conway's opinion: "That wasn't how it was presented originally to the state." He added, "The one-for-one encourages more interaction, more opportunity for involvement for the provider to provide treatment for their disorders, to test them for communicable diseases and that sort of thing."

Dr. Sarah Moyer, the interim director of the Louisville Metro Department of Public Health and Wellness, said in an e-mail that not requiring a one-to-one exchange has been proven to reduce the spread of HIV and hepatitis C, which is the intent of the program. Kentucky leads the nation in hepatitis C and suffers more than 1,000 drug overdose deaths a year.

“A one-to-one syringe exchange implies that no needle sharing is occurring," Moyer wrote. "We know that is not the case. The ‘needs-based negation model’ is a best practice across the country. Our goals are to prevent the spread of HIV and hepatitis C in our community and to stop intravenous drug users from sharing and reusing needles. The program is working! Participants continue to return used and potentially infected syringes for sterile ones."

She added, "Our latest figures indicate that one syringe is being returned for every 1.3 syringes distributed among returning clients. Overall the rate is 1 to 1.7. We have more than 2,000 participants and the number continues to grow. We’ve tested approximately 500 for hepatitis C and HIV and referred those who test positive to medical treatment. We’ve also referred 143 individuals to drug treatment."

Alvarado said, "Even if the health departments want to do it this way now, that is not how the law was intentionally meant to be passed."

Needle-exchange programs operating or approved in the state are in Jefferson, Fayette, Grant, Pendleton, Carter, Elliott, Franklin and Jessamine counties.

Low-income workers say to keep Kynect and Medicaid expansion; advocates wonder how new insurance exchange will work

By Melissa Patrick
Kentucky Health News

As Republican Gov. Matt Bevin's administration moves forward with plans to dismantle Kynect, the state's health insurance exchange, several working Kentuckians shared stories at a news conference March 8 about how having affordable health insurance through Kynect and expansion of Medicaid has changed their lives, and asked the governor to reconsider his decision.

Jesus Gonzalez and Troy May

"For working Kentuckians in particular, Kynect is much more than just a website. It is a one-stop-shop for coverage that allows workers, students and caregivers an easy and seamless way to not only enroll in coverage, but to move easily between Medicaid and private insurance as their incomes fluctuate," said Emily Beauregard, executive director of Kentucky Voices for Health, an umbrella group of health-care lobbying organizations.

Beauregard said that contrary to popular belief, most newly insured Kentuckians are low-income workers who didn't have health benefits.

One of the part-time workers from Covington, Troy May, who is also a full-time graduate student at Cincinnati Christian University, explained how getting insurance through a qualified health plan on Kynect has allowed him to pursue a new career, work part-time and also care for his 90-year-old grandmother. He said federally subsidized insurance from Kynect "fills in the gap" between his life now and when he will eventually work full time and get work benefits.

"Every time that Gov. Bevin talks about dismantling Kynect," May said, "it's like a punch in the stomach." He said the same coverage he gets on Kynect will be $200 more a month, with higher deductibles and co-payments on the federal exchange, which he says is not affordable.

"So this idea that we can easily move to a federal exchange and it not impact Kentuckians negatively is just flat out wrong," he said, adding later, "I beg Governor Bevin and the Republicans in the state not to dismantle Kynect."

May said he is a Democrat who comes from a family of Republicans, many of whom have signed up for health insurance through Kynect and have asked him, on their behalf, to ask Bevin to reverse his decision.

Another worker, Jesus Gonzalez, a single father and a food server in a Lexington restaurant, signed up on Kynect for the Medicaid expansion, which allows those with incomes up to 138 percent of the federal poverty line to enroll. He said that he had not had health insurance for the past 10 years because he couldn't afford it and shared stories about the "peace of mind" he now has because he can go to the doctor and the dentist. He said this has "made a huge difference in my life."

"It is really important that we do what we can to save and keep Kynect and Mediciad expansion in Kentucky," Gonzalez said. Bevin has said the expansion won't be sustainable once the state has to start paying a small part of the cost next year, and is negotiating changes in the program with the federal government.

The conference was sponsored by Keep Kentucky Covered, a coalition that is focused on sustaining access to affordable health coverage in Kentucky through Medicaid expansion and Kynect.

Pleas to save Kynect are likely falling on deaf ears. Bevin campaigned on closing Kynect, and has said it is redundant because there is a federal exchange that does the same things.

Advocates argue that Kynect provides one website to sign up for subsidized insurance and Medicaid, while Bevin's new model will require two websites, one called Benefind for Medicaid and other public-assistance programs, and the HealthCare.gov for federally subsidized insurance.

Health Secretary Vickie Yates Brown Glisson told a House budget subcommittee last week that the state would move to a "supported state-based marketplace" that will allow it to keep some control over review of insurance plans and handle insurance-company grievances, but the actual enrollment and any consumers' eligibility appeals will be handled by the federal exchange. Consumer grievances will be handled by a state-federal partnership.

Glisson said she didn't know how many Kynectors, or health-insurance navigators, will remain. Beauregard and Rep. Joni Jenkins, D-Louisville, chair of the House Budget Review Subcommittee on Human Services, voiced concerns about the abilities of local offices of the Department of Community Based Services to handle the 1.3 million Kentuckians on Medicaid.

"They are already overburdened and overwhelmed with the amount of work that they are doing and facing budget cuts," Beauregard said. "I worry that people are going to have a harder time getting enrolled in coverage and keeping their coverage, and getting the assistance they need when they run into an application problem or need to ask a question."

Wait times at DCBS offices average 2 hours and 44 minutes, while wait times at the Kynect call center are 2.15 minutes, according to the education and outreach director at Kynect, Beauregard said.

Jenkins voiced the same concerns in a separate interview, also noting the importance of Kynectors who not only help people sign up for health insurance, but also help them access health care after they sign up.

"I would hope that our state's goal was to not only get people signed up, but (to also) connect them with health care," Jenkins said. Later adding, "I find it so interesting that we are going to do away with a Kentucky-made product that is working so well, that pays for itself, and that was paid for by federal dollars and it's like letting big brother come down and -- so, that is very interesting,"

Glisson told the subcommittee that she believed there would be some funding for Kynectors. She also said the county-based employees of her cabinet could help people get to the federal exchange if they don't qualify for Medicaid.

But even if some Kynectors are included in this new model, the number of them will be determined by the number of people on the federally subsidized plans, and not include funding for Kynectors to help those on Medicaid, Beauregard said, "so you will also see a difference in the level of service you get if you enroll in Medicaid verses enrolling in a private plan," she said.

"What is really important right now is to ensure that we have an enrollment system that works as well or better than Kynect moving forward for all of the Medicaid recipients in Kentucky," Beauregard said. "And what that means is that we have to make sure that we have the capacity, whether that be at the Kynect call centers or in DCBS, to help these individuals enroll in coverage and to make sure that we are not creating barriers that translate into our uninsured rates going higher again or people loosing access to the care that they critically need,"

About 60% of Ky. schools give all students free breakfast and lunch; federal program for those with mainly low-income students

photo: Kentucky Department of Education

During the 2014-15 school year, 104 of the 173 public school districts in Kentucky provided free breakfast and lunch to all students, with 610 schools and 279,263 children benefiting in the program, according to the U.S. Department of Agriculture website.

They were able to do this through the Community Eligibility Provision program, which allows school districts with predominantly low-income children to serve all students free lunch and breakfast. Kentucky was one of the first three states chosen to participate in the pilot program in 2011-12, which is now available nationwide. CEP is part of the Healthy, Hunger-Free Kids Act of 2010.

"Schools implementing CEP have reported great success, citing eased administrative burden, more efficient meal service operations, and increased program participation," Angela Kline, director of USDA policy and program development, said in an online letter to the regional and state directors of the program. "Most importantly, students attending CEP schools can count on two nutritious meals every school day, helping low-income families to stretch limited food budgets while reducing hunger among our nation’s children."

This is the first year the East Bernstadt Independent school district in Laurel County has participated in the program. Marcella Hensley, the food service director, called the program a success and said they plan to apply for the program again next year, Mike Moore reports for The Sentinel-Echo in London.

The northern Laurel County district has 462 students in K-8, plus 55 preschool students, Moore reports. Since the program began at the start of the school year, Hensley told Moore that she has seen a 2-percent increase of breakfasts and lunches being served, adding that the cafeteria staff prepares 980 breakfasts and 2,064 lunches per week. She said this amounts to about 70 to 80 more students at lunch each day and 80 to 90 more students at breakfast, compared to previous years.

 “I feel that if a child eats a breakfast, they function better in class,” Hensley told Moore. “They’re more alert and ready for what they’ve got coming at them academically-wise. To me, breakfast is more important because they function better during the day. If we see their faces more at breakfast, I feel like they’re going to do better in class.”

Poll: Most Kentucky adults, especially the poor, say time, money and motivation make it hard to improve their health status

By Melissa Patrick
Kentucky Health News

Regardless of how Kentucky adults describe their health status, almost two-thirds of them said it would be difficult or very difficult to make positive changes in their health, citing time, money and motivation as their main barriers, according to the latest Kentucky Health Issues Poll.

The survey, conducted Sept. 17 through Oct. 7, found that 43 percent of Kentucky adults said they were in excellent or very good health, 26 percent said they were in good health and 31 percent said they were in fair or poor health. The poll's error margin is plus or minus 2.4 percentage points.

Kentucky ranks 46th in the percentage of adults reporting excellent or very good health. Self-perception of health makes a difference. Research has found a "powerful link" between people's self-reported health status and the predicted length and quality of their lives, says the Institute for Policy Research at the University of Cincinnati, which took the poll.

When asked to name the "most important" thing they could do to improve their health status by one level, the answers varied by the respondents' current health status.

For example, those who reported excellent, very good or good health said they needed to exercise more and improve their diet to improve their health by one status. But those who reported fair or poor health most commonly cited taking care of current health problems and a need for better access to health care as the best ways to improve their health by one status.

"Kentucky adults understand that more exercise and a healthier diet can help them get healthier," stated Susan Zepeda, CEO of the Foundation for a Healthy Kentucky, said in a news release. "We can support better health for all Kentuckians by making changes in our built environment to make exercise easier, supporting access to fruits and vegetables, and continuing to offer all Kentuckians health insurance."

Adults with lower incomes were more likely to report difficulty in making a positive health change, according to the report.

While 65 percent of Kentucky adults said it would be difficult or very difficult to make the health change they had identified, this rate was a bit higher (71 percent) among those who made 200 percent or less of the federal poverty level. Among those who made more than 200 percent of the FPL, 61 percent said so. Only about one-third (32 percent) of Kentucky adults said it would be easy or very easy to make these changes.

The poll is funded by the foundation and Interact for Health, formerly the Health Foundation of Greater Cincinnati. It surveyed a random sample of 1,608 Kentucky adults by both landlines and cell phones.

Bevin administration will still have state health-insurance exchange but use federal exchange for enrollment; cost debated

By Melissa Patrick and Al Cross
Kentucky Health News

Republican Gov. Matt Bevin appears to have found a way to abolish the Kynect health-insurance exchange without chasing away insurance companies or causing them to limit their offerings – and at just over 1 percent of the cost estimate used by his Democratic predecessor. But he isn't eliminating the insurance fee that funds Kynect.

Bevin and Health Secretary Vickie Yates Brown Glisson emphasized the much lower costs – which they said would be a net $240,000 for information-technology changes, compared to the $23 million estimated last summer by Deloitte Consulting, the state contractor who built the exchange.

Democrats voiced skepticism about the numbers. But regardless of the cost, the greater impact for Kentuckians who buy federally subsidized health insurance is likely to be greater choice of coverage.

Since federal health reform was fully implemented in 2014, more insurance companies have joined the exchange and offered policies across wider areas. Kynect Director Carrie Banahan warned last summer that if the exchange were closed, some of its insurers might not use the HealthCare.gov federal exchange.

Glisson told a legislative committee that the federal exchange will be used for insurance enrollment, but as part of a "supported state-based marketplace," which will still be run by the state. That will please insurance companies, which are state-regulated and have always wanted a state-based exchange.

"It's kind of like the best of both worlds. I think our issuers are going to like this; I think our consumers are going to like this," Glisson told the House Budget Review Subcommittee on Human Resources.

For the new marketplace, the federal government will handle consumers' eligibility appeals but the state will handle insurance-company grievances and still review insurance plans. Certification of the plans will move to the federal government, but it will "strongly rely" on state recommendations, Glisson told the panel. Consumer grievances will be handled by a state-federal partnership.

The fee for using the federal exchange will be 1.5 percent, plus a proposed 0.5 percent state fee to cover outreach and plan-management functions. The state will have a "hotline" to provide basic information to consumers, and a call center for people on the federal-state Medicaid program.

Kynect advocates argue that one of its benefits is that Kentuckians can sign up for both Medicaid and subsidized private insurance on one system, instead of the two that will be required with the changes Bevin is making. Glisson said the new marketplace will be linked with Benefind, the new portal for enrolling in Medicaid and other public assistance.

Kynect has been funded by a 1 percent fee on all health-insurance policies sold in the state. Bevin has said it isn't fair for all insurance customers to pay for an exchange that fewer than 100,000 people use.

However. his office said the fee will remain in place to help pay transition costs, fund the Kentucky Health Information Exchange and fund "legacy costs" of Kentucky Access, the high-risk insurance pool for which the fee was established – and transformed into Kynect funding by an executive order from then-Gov. Steve Beshear.

Bevin spokeswoman Jessica Ditto told Kentucky Health News in an email that the administration will ask for language in the state budget bill to allow the fee to be reduced for insurers offering federally subsidized plans on the exchange.

Beshear, who recently started a lobbying campaign to fight Bevin's plan to close Kynect and scale back Medicaid expansion, said in a press release, "His math doesn't add up."

Glisson told the budget subcommittee, “For less than $250,000 to decommission Kynect, the commonwealth will be able to save at least $20 million. I would actually maintain somewhere between $20 million and $40 million this year.”

Ditto said the state would save the taxpayers $15 million to $25 million less under Bevin's plan.

Beshear said all those claims are false because Kynect has never used any state tax dollars. "There are no savings to use elsewhere," he said.

Beshear also said that the changeover will have additional costs that Bevin is not outlining. He called the governor's numbers "illusionary."

Glisson told the subcommittee, "We believe there will be additional cost-saving opportunities," including a "significant savings" on the Kynect call center, which has cost $23 million a year.

Rep. Joni Jenkins, D-Shively, told Ronnie Ellis of CNHI News Service that she is trying to identify an independent source who can lend credence to one set of numbers or the other. House Speaker Greg Stumbo agreed, saying, "Surely to goodness, someone somewhere can verify what those costs are."

Glisson told the budget subcommittee that the new marketplace would cost $5.3 million, but the state would only be responsible for $1.6 million of that amount. She said $4.1 million would pay for the cost of transferring data from the state exchange to the federal exchange and tying the data to Benefind. But she said this is likely eligible for a 90 percent match from the federal government, reducing taxpayer costs to $413,000.

Glisson said the rest of the cost comes from the $1.2 million to dismantle Kynect's information technology, but once it was shut down the state would save $1.3 million in maintenance and operations costs. Subtracting the estimated savings from the state's share of the costs equals $236,000, she said.

One unanswered question is how many Kynectors, or health-insurance navigators, that the state will have under the new system. Glisson said she believed there would be funding for some, and for some advertising, but she wasn't specific. She said county-based employees of her Cabinet for Health and Family Services could help people get to the federal exchange if they don't qualify for Medicaid. Here's a video of her presentation, via Kentucky Educational Television:

Whistleblower lawsuit accuses Humana of billing fraud in Florida, says misleading data in medical records put patients at risk

By Fred Schulte

Center for Public Integrity

Louisville-based Humana Inc., which operates some of the nation’s largest private Medicare health plans, knew for years of billing fraud at some South Florida clinics, but did little to curb the practice even though it could harm patients, a doctor alleges in a newly unsealed whistleblower lawsuit.

The suit was filed by South Florida physician Mario M. Baez. It accuses Humana and his former business partner, Dr. Isaac K. Thompson, of engaging in a lucrative billing fraud scheme that lasted years. The suit also names three other Palm Beach County doctors, two medical clinics and a doctors’ practice group as defendants. The suit was filed in October 2012, but remained under a federal court seal until Feb. 26.

Humana had no comment. “As a matter of long-standing company policy, Humana does not comment on pending litigation,” said company spokesman Tom Noland.

Thompson, a Delray Beach doctor, was indicted early last year on health care fraud charges stemming from similar allegations. He had pleaded not guilty, but last week indicated he would change his plea, and was to appear in federal court in Fort Lauderdale on Friday, March 4.

The Baez case is likely to bring fresh scrutiny to Humana, which has more than 3 million elderly patients in its Medicare Advantage plans nationwide. That business was a major incentive for Aetna Inc. to buy Humana, a purchase still pending regulatory approval. Aetna says the merged company's government-related business will be based in Louisville.

The Baez suit targets a billing formula called a risk score, which is designed to pay Medicare health plans higher rates for sicker patients and less for people in good health. But overspending tied to inflated risk scores has cost taxpayers tens of billions of dollars in recent years, as the Center for Public Integrity reported in a series of articles published in 2014.

Federal officials have struggled for years to stamp out these overcharges, known in health-care circles as “upcoding,” while at least a half-dozen whistleblowers have filed lawsuits accusing Medicare Advantage plans of ripping off the government.

Baez’s case adds a new wrinkle because it alleges that inflating risks scores not only wastes taxpayer dollars, but can also cause a patient to be harmed by improper medical treatment.

Baez said in a letter to the judge in the case, U.S. District Judge Kenneth A. Marra, that treating elderly patients with “multiple ailments” is difficult when you have accurate data, but “when medical records are poisoned with misleading data [from inflated risk scores] it becomes Russian roulette.” Patients aren’t told their risk score and aren’t likely to know if a doctor has exaggerated how sick they are or added bogus medical conditions to their medical records to boost profits, Baez said.

Doctors use a series of billing codes to document patients’ health, including any diseases they have and how severe they are. Medicare Advantage plans report these codes to the government, which calculates a patient risk score and sends off a payment to the health plan.

In Thompson’s case, Humana paid 80 percent of the money it received to the doctor and kept the rest. Prosecutors charged that fraudulent diagnoses submitted by Thompson between January 2006 and June 2013 generated overpayments of $4.8 million.

Baez alleges that Humana encouraged overbilling by providing affiliated doctors with forms that highlighted “more profitable” diagnosis codes they could use for patients. Many were statistically impossible to support, according to the suit, which cited allegedly inflated risk scores in more than three dozen patients.

Humana has acknowledged being the target of investigations into its billing practices, including some involving whistleblowers. So has another large Medicare Advantage plan operated by UnitedHealth Group. Last month, UnitedHealth said it was cooperating with a Department of Justice review of its billing practices, according to a Securities and Exchange Commission filing.

Court filings unsealed in the Baez case confirm that the company faces several similar whistleblower suits, including at least one that remains under court seal. The court records also suggest that the criminal fraud investigation that snared Thompson is not over.


“There are some components of the criminal investigation which remain active,” Assistant U.S. Attorney Mark A. Lavine wrote in a December 2015 court filing. Lavine added that the investigation “continues to move forward aggressively.” Lavine also indicated that two other whistleblower cases have been filed against Humana “in connection with similar allegations at other clinics.”

This story is co-published with NPR. It is part of a series, Medicare Advantage Money Grab.

Bills to preserve Kynect and Medicaid expansion are going nowhere, put prompt a lively debate among legislators on KET

Democratic state Rep. Darryl Owens of Louisville has filed bills to keep Gov. Matt Bevin from keepimng his campaign promises to dismantle the Kynect health-insurance exchange and scale back the expansion of Medicaid under federal health reform.

Owens acknowledged that House Bill 5 and House Bill 6 would likely get nowhere in the Senate, which is controlled by Republicans who support Bevin's approaches. However, but the filing of the bills prompted a lively discussion among four legislators on Bill Goodman's "Kentucky Tonight" program on KET Feb. 29.

Sen. Gerald Neal, D-Louisville, said that when voters elected Bevin in November, "They were not aware they were voting against their own interests and they're very upset about that."

Sen. Jimmy Higdon, R-Lebanon, said Democrats are misleading the public: "Those people who have expanded Medicaid think we're taking their coverage away." He said Bevin's moves are intended to save costs: "A lot of this is not sustainable."

House Democratic Caucus Chair and state Party Chair Sannie Overly said many Kentuckians got health insurance for the first time under federal health reform, and "We have a chance here in Kentucky to have a healthier future."

Rep. Stan Lee, R-Lexington, said "The commonwealth is not healthy if over one-quarter of our citizens are on Medicaid." Neal said he couldn't follow that argument.

Lee said the legislature should "do what we can to encourage a business climate that would encourage better jobs to come to this state."

Neal said the two goals are not in conflict because the state needs to have a healthy workforce.

Overly said the Medicaid expansion serves the working poor who were going to emergency rooms, "and we were paying for that." Now those people "get well checkups and visits" at no charge.

Lee said, "That's just another tired play from the Obama playbook. He said it would reduce costs."

Higdon said the Medicaid managed-care organizations "were supposed to work with people and get them healthy but are instead making money by shortchanging our providers."

Study of preventive health status finds Kentucky is in the middle of the pack generally, but has several good and bad aspects

A study that looked at preventive health services among states in three categories found that Kentucky fell near the middle of the pack for most of the measures, but was in the top 10 for adult flu vaccinations and top five for prevention of high blood pressure, but in the bottom 10 for human papilloma virus vaccinations for males.

The America's Health Rankings' Spotlight: Prevention study, released in partnership with the American College of Preventive Medicine, took an in-depth look at three categories of preventive services: access to health care, immunizations and chronic disease prevention, to "drive awareness and understanding" of the importance of preventive services and interventions.

The report notes that prevention is a "meaningful part of the solution" as the American healthcare system "sharpens its focus on quality, affordability and overall value." (Chart: Each state is a green dot, national average is a gray diamond and Kentucky is a blue diamond; click on image for larger version)

Access to health care was examined by looking at health care coverage, dedicated health care providers and annual dental visits.

"Access to health care is a key part of disease prevention," says the report. "Individuals without health insurance often have more difficulty accessing the health care system, are less likely to participate in preventive care programs, and have more unmet health needs than those with health insurance."

The report found that 90 percent of Kentuckians reported they have some kind of health insurance, above the national average of 87.6 percent.

Since the implementation of the Patient Protection and Affordable Care Act and the expansion of Medicaid to those whose incomes are up to 138 percent of the federal poverty level, the uninsured rate for Kentuckians aged 18 to 64 has dropped from 25 percent in 2013 to 13 percent in 2015, according to a recent Kentucky Health Issues Poll. Another Foundation for a Healthy Kentucky study reports that thousands of newly insured Kentuckians have used their preventive health services, including dental services, which are free under health reform.

Overall, 79.4 percent of Kentuckians said they had a regular health care provider. The national average is 76.7 percent. Hispanics (47.5 percent) fell below this rate as did Kentuckians between the ages of 18 and 44 years of age (66.5 percent).

Only 61 percent of Kentuckians said they had had a dental visit in the past year, which is lower than the national average of 65.3 percent. Income and education were the greatest barriers to getting dental care in the state, with only 41.2 percent of those who made $25,000 or less seeing a dentist and only 35.7 percent of Kentuckians with less than a high school education seeing a dentist.

A recent study on oral health found that 100,000 more Medicaid-eligible Kentuckians got an oral health service in 2014 than in 2013, prompting the project director for the study to say in an interview, "Kentucky's support for an adult dental benefit is huge."

Immunizations were examined through four different immunization measures that included children, teens and adults.

Overall, 72.3 percent of Kentucky's children had the recommended series of childhood immunizations, 85.5 percent of adolescents had the recommended Tdap (tetanus, diphtheria and pertussis) immunization, and 78.2 percent of adolescents got the recommended meningitis vaccine. All of these were close to the national averages of 71.6 percent, 87.6 percent and 79.3 percent respectively.

However, while 37.4 percent of Kentucky's adolescent females got the recommended HPV vaccine only 13.3 percent of the state's adolescent boys did, placing the state in the bottom 10 states for this measure. National averages were 39.7 percent and 21.6 percent respectively.

Kentucky, with 43.9 percent of its adults vaccinated for the flu, was in the top 10 states for this measure; and 67.7 percent of Kentuckians older than 65 reported being vaccinated for pneumonia. National rates were 40.4 percent and 68.5 percent respectively.

"Vaccines are among the most cost-effective clinical preventive services and one of the best tools for preventing infectious diseases," says the report. "Vaccinations have led to a 95 percent decrease in vaccine-preventable diseases over the last 50 years, and yet VPDs remain a major cause of U.S. morbidity and mortality with thousands of cases of illness and deaths each year."

The chronic disease prevention category was examined through three measures: adult awareness of high blood pressure, cholesterol check and colorectal cancer screening.

"Heart disease and cancer are the top two causes of deaths in the United States, accounting for 46 percent of all deaths in 2013, "says the report. "Routine screening can lead to early detection and treatment of chronic disease risk factors, including high cholesterol and high blood pressure, reducing heart disease and cancer mortality."

The report found that 39.1 percent of Kentuckians have been told they have high blood pressure, which places Kentucky in the bottom five states for this condition. Nationally, 31.4 percent of adults have high blood pressure, although many have it, but aren't aware of their condition, says the report.

Overall, the report found that 77 percent of Kentuckians have been tested for cholesterol in the past five years and 67 percent of Kentuckians aged 50 to 74 have had a colorectal cancer screening. Nationally 76.4 have had a cholesterol check and 66.4 percent have had a colorectal cancer screening.

"According to the Centers for Disease Control and Prevention, Americans use clinical preventive services at half the recommended rate, leading to tens of millions of individuals missing out on basic preventive care. Past research from the Institute of Medicine has also estimated that in one year, the United States spent $55 billion due to missed preventive opportunities," says the report.

Poll shows 13% of Kentucky adults 18-64 said they were not covered by health insurance last fall; employer coverage drops

By Al Cross
Kentucky Health News

Fewer Kentuckians reported having employer-provided insurance last year while the percentage on public insurance such as Medicaid continued to increase, according to the latest Kentucky Health Issues Poll.

The poll, taken Sept. 17 through Oct. 7, found that 41 percent of Kentuckians aged 18 to 64 said they had health insurance through their employer, down from 50 percent in 2014. Those saying they had public insurance rose to 35 percent, from 29 percent the year before.

The percentage on public insurance began to rise in 2014, when the state expanded eligibility for the federal-state Medicaid program to people in households with incomes up to 138 percent of the income level that the federal government considers the upper limit of poverty.

That also caused the share of Kentuckians without insurance to fall sharply. In the Kentucky Health Issues Poll in 2013 it was 25 percent; in 2014, it was only 12 percent. In 2015, it stayed stable at 13 percent. Another 8 percent in the latest poll indicated they were insured but had been without health insurance at some point in the past 12 months. The poll's margin of error is plus or minus 2.4 percentage points.

The uninsured figure is almost twice as high as that found in polling by The Gallup Organization, which includes people 65 and over, who automatically qualify for Medicare. Gallup found that in the second half of 2015, only 7.5 percent of Kentucky respondents said they did not have health coverage.

The Kentucky Health Issues Poll focuses on adults 18-64 because 98 percent of Kentuckians 65 and over have health coverage. The poll is conducted by the Institute for Policy Research at the University of Cincinnati for the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati.

Since 2013, the share of adults 18-64 who earn less than 200 percent of the federal poverty level and are uninsured has fallen from more than 3 out of 10 to only 1 in 10. “Uninsurance rates are now about the same for all Kentucky adults regardless of income, reducing one potential barrier to receiving needed health care,” says Jennifer Chubinski, Interact for Health's vice president for innovation and learning.

E-cigarette conference to be held in Laurel County March 24

"Project e-Prevent," a conference to understand e-cigarettes and their effects on Kentucky's youth, will be held at the London Community Center in Laurel County on March 24.

The program will look at evidence based information regarding e-cigarettes, analyze the association between e-cigarettes and nicotine addiction, discuss policy recommendations from medical and scientific authorities, discuss e-cigarette laws and enforcement and clarify 100 percent tobacco free school policy. Click here to see the full agenda.

The program is free and offers continuing education credits, but registration is required by March 11 at www.soahec.org/project-e-prevent/. Call 606-864-1432 for additional information.

The conference is supported through educational grants from the Southern Kentucky Area Health Education Center, Rockcastle Regional Hospital Respiratory Care Center and Rockcastle Kentucky Agency for Substance Abuse Policy.

Kentucky leads the nation in colon cancer, but it's 90% preventable through screening, which is easier than ever

All too often Kentuckians don't get screened for colon cancer because of fear, embarrassment, lack of access and cost concerns, but with March being National Colorectal Awareness Month it is a good time to reconsider these concerns, know that preventive screenings are covered by most health plans, and recognize that a decision to get screened could save your life.

“Fear is one of the biggest barriers to colon cancer screening,” Patty Francis, program director for the Colon Cancer Prevention Project, a nonprofit advocacy organization in Louisville, said in an interview. “But don't let these fears get in the way of getting screened. Talk to your doctor about screening options, because colon cancer is very treatable—very beatable—if found at an early stage.”

In fact, it is up to 90 percent curable if detected early, says the CCPP website.

And while Kentucky has made great strides in its age-eligible colon cancer screening rates, going from 35 percent in 1999 to 66 percent in 2012, there is still great room for improvement; more than one-third of age-eligible Kentuckians have still not been screened.

As of 2013, the latest year data are available, Kentucky led the nation in colon cancer and is ranked fourth for deaths caused by it, according to the CCPP website. The state has nearly 2,000 new cases of colon cancer each year and more than 850 Kentuckians die from it each year, according to the American Cancer Society.

Colon cancer screening options

The colonoscopy is considered the best way to detect or prevent colon cancer because it finds cancer in its early states, when there are no symptoms, and can also find and remove pre-cancerous polyps. Other tests include a flexible sigmoidoscopy or virtual colonoscopy, but these don't allow the doctor to check inside the entire colon and remove polyps.

Colonoscopies, which involves the use of a thin, flexible tube to examine part of or all of the colon, have come a long way over the years. The once-dreaded "bowel prep," which is taken the night before the procedure, has become more palatable and takes less time to work. And contrary to popular belief, the procedure is painless. Patients are given medication to help them relax before the procedure and it is performed under mild anesthesia. The procedure typically takes 20 to 30 minutes, unless there are polyps that have to be removed, which makes it go a bit longer.

Also, there are several non-invasive screening tests that check for blood in your stool, which can be a sign of precancerous polyps or colon cancer. A positive stool-based test typically requires a follow-up colonoscopy. These tests should be done once a year.

When should I get screened?

By the age of 40, everyone should talk to their physician about their risk of colon cancer and make a plan for screening. Those with inflammatory bowel disease, a family history of colon cancer or colorectal polyps, certain lifestyle factors or genetic predispositions are at higher risk of colon cancer, according to the federal Centers for Disease Control and Prevention.

Those with average risk should start screening by age 50. African Americans, who are at risk of getting colon cancer at an earlier age, should start at 45.

It is estimated that six out of 10 deaths from colon cancer could be prevented if everyone were screened at age 50, but you need to discuss your screening needs with your doctor at age 40, Andrea Shepherd, executive director of CCPP, said in an interview

“One of the biggest myths is that colon cancer is an old man's disease, but one in 10 people who are diagnosed with colon cancer are under the age of 50,” Shepherd said. “Colon cancer does not see race; does not see age; it affects everybody.”

The American Cancer Society lists these symptoms: a change in bowel habits that lasts for more than a few days; a feeling that you need to have a bowel movement that is not relieved by doing so; rectal bleeding; blood in the stool, which may make the stool look dark; cramping or abdominal pain; weakness and fatigue; and unintended weight loss.

But remember, the most common symptoms are no symptoms.

Screening colonoscopies for those who have insurance, or not

Last year, a new state law made clear that screening colonoscopies had to be paid for by insurance, effective Jan. 1. This includes colonoscopies performed as a result of a positive fecal-blood test as well as polyps that are found and removed during the screening colonoscopy. Some physicians are still not aware of this clarification, so it is important to discuss costs before any procedure is performed. And note that there is an appeals process if you are charged, Laura Ungar reports for The Courier-Journal.

The CCPP website says that this is not the case for Medicare patients, but their founder, Dr. Whitney Jones, is lobbying for this change in Washington, D.C.

Those who don't have health insurance should contact the state's Kentucky Colon Cancer Screening Program, which offers free screenings for qualified residents of Kentucky.

This year, Rep. Tom Burch, D-Louisville, has sponsored House Bill 115, which would expand KCCSP services to those who are "underinsured" as funds are available. This bill has passed the House and now resides in the Senate Health and Welfare Committee.

Those without insurance and also don't qualify for the KCCSP program, but who are at high risk and have had a positive fecal-blood test, should have their primary care provider contact the Surgery on Sunday program, which provides outpatient surgical procedures to income-eligible individuals and operates out of Lexington and Louisville, for possible help on getting screened.

Series on suicide as a public-health issue in Ohio is one of five finalists for national journalism ethics award

A newspaper series on suicide as a public issue in Ohio is among the five finalists for the Anthony Shadid Award for Journalism Ethics, which is given for aggressive reporting on important issues with care for the consequences of that reporting.

Reporters from The Columbus Dispatch dealt with privacy and public-safety issues issues in reporting on suicides as a public-health issue while considering the probability that reporting on suicides might lead to copycat attempts. The title of the series, "Silent Suffering," reflected the taboo that still attaches to suicide and discourages reporting about it, as noted here in January.

"The Dispatch spent nine months examining the effects of a public-health crisis spawned in part by a broken mental-health-care system," the paper says in a headnote for the series. One story was headlined "Most people who commit suicide have mental illness, don’t receive care needed."

Other finalists are a McClatchy Newspapers team that preserved medical privacy of victims of nuclear-energy programs; ProPublica and NPR, which protected the privacy and dignity of sick and injured employees in revealing how states are curtailing workers' compensation programs; Milwaukee Journal Sentinel reporter Gina Barton, who faced ethical challenges reopening a 40-year-old unsolved murder; and a team from The Associated Press that protected its sources from retaliation, including death, in reporting on the use of slave labor in supplying fish to the U.S.

The award is named for the late Anthony Shadid, a Pulitzer Prize-winning foreign correspondent for The New York Times and The Washington Post and a journalism graduate of the University of Wisconsin. The university's Center for Journalism Ethics oversees the award and will present it at its annual conference April 29.