Kentuckians increasingly covered by high-deductible health plans

Six times as many Kentucky workers were enrolled in high-deductible health insurance plans in 2014 as in 2006, reflecting a national trend, says a report for the Foundation for a Healthy Kentucky. As a result, the average amount they had to pay before their insurance kicked in more than doubled, from $1,178 in 2006 to $2,738 in 2014.

Most of the 93,666 people enrolled in the Kynect health-insurance exchange, where premiums are federally subsidized, chose high-deductible plans for this year.

"Employers and consumers often choose high-deductible health plans in return for lower monthly premiums," said Susan Zepeda, president and CEO of the foundation. "Research shows that these plans lead to decreased health-care spending as consumers who have to pay up front for care become more conscious of costs. But consumers on high-deductible plans also tend to use fewer preventive services, such as vaccinations and cancer screenings, that save money -- and lives -- in the long run. And these plans can make it more difficult for Kentuckians with low incomes or chronic conditions to pay their medical bills, leading them to delay or skip essential health care."

In 2014, 38.6 percent of the 2.4 million Kentuckians who get health coverage at work were enrolled in plans considered "high deductible" by the Internal Revenue Service: $1,250 for single and $2,500 for family coverage in 2014. In 2006, high-deductible plans covered 6.6 percent of enrollees. Nationally, enrollment in high-deductible plans rose from 8.6 percent in 2006 to 35.2 percent in 2014.

Figures are for Open Enrollment Period 3, for this year.

In Kentucky, 60 percent of this year's Kynect enrollees chose the "Silver" plan, which has a median deductible of $3,500 for an individual and $7,000 for a family, with median monthly premiums of $255 and $585.

"While the percentage of U.S. employees on health insurance plans with deductibles at any level grew from 66.4 percent in 2006 to 83.9 percent in 2014, the percentage of such plans in Kentucky was much higher than in the country as a whole in 2006, but has remained relatively stable since then (90 percent in 2006, 90.3 percent in 2014)," the foundation said in a news release.

The report was created by the State Health Access Data Assistance Center at the University of Minnesota as part of a 34-month study of the impacts of federal health reform in Kentucky.

Democrats in Congress lose key round in bid for immediate anti-addiction funds; threaten filibuster that could kill the bill

Deaths from prescription overdose hit a record high in 2014

By Danielle Ray
Kentucky Health News

Democrats are threatening to filibuster the proposed Comprehensive Addiction and Recovery Act after a Democratic-led effort to secure nearly $1 billion in anti-opioid addiction funds failed in a congressional conference committee Wednesday.

The amendments by Rep. Frank Pallone of New Jersey and Sen. Patty Murray of Washington were defeated in straight party-line votes. Republicans argue there is no need for additional spending because anti-addiction funds have already been proposed as part of the House Appropriations Committee's fiscal 2017 budget.

GOP committee leaders released a draft of that bill on Wednesday, which allocates $581 million to the Substance Abuse and Mental Health Services Administration to combat opioid and heroin abuse.

Democrats contend the drug epidemic is so urgent that more money is needed immediately. Nearly 29,000 people died from opioid overdose in the U.S. in 2014, including almost 1,100 Kentuckians.

“We have an opportunity and the clear responsibility to take life-saving action on this issue today,” Murray said in a news release. “We have a choice between preventing more of the deaths we've all heard too much about and allowing the status quo to continue.”

Democrats sent a letter to conference committee chair Rep. Fred Upton (R-Mich.) on Tuesday threatening to oppose the CARA bill if "significant funding" is not included in the conference report. If Democrats keep their pledge, the bill could face defeat in the Senate.

Though the measure passed in conference and has enough Republican support to push a final version through the House, a partisan split in the Senate—which would require a Republican supermajority of 60 votes to overcome a filibuster—could effectively stall the legislation.

Republicans refuse to fund the provisions in the bill without offsets from other programs that would render it budget-neutral. The Congressional Budget Office estimates that the bill would cost about $1.2 billion over five years, but those numbers do not take into account possible "downstream" savings these programs could create, like decreased prison populations and fewer addicts relying on other government programs.

Without Democratic-backed funding, CARA puts just $181 million in new money toward prevention, treatment and recovery.

Senate Majority Leader Mitch McConnell of Kentucky said Democrats should support the report despite their failed attempt at additional funding.

"The conference report the Senate will soon consider can make a difference for the American people," he said in a news release. "It’s the product of years of hard work, and it’s very similar to the CARA bill that already passed the Senate with no Democrat opposition."

The debate comes one day after the Obama administration unveiled a list of actions to fight the opioid epidemic. It includes expanding the number of patients certified doctors can treat with buprenorphine from 100 to 275. The U.S. Department of Health and Human Services also wants to eliminate potential financial incentives for doctors who prescribe opioids out of fear that patients will give them low marks in patient-experience surveys if they have pain after procedures.

The House is expected to cast a final vote on CARA on Friday and the Senate early next week.

At third and final Medicaid hearing, Eastern Kentucky residents say plan doesn't match up with the realities of their region

By Al Cross
Kentucky Health News

In the county and region where the expansion of Medicaid has had the most impact, residents and health-care providers gave the harshest criticism yet of Gov. Matt Bevin's plan to change it.

"Poor people don't need more red tape and hoops to jump through," Elizabeth Hensley of Clay County told state officials near the end of the Wednesday hearing that drew about 150 people to Hazard Community and Technical College.

Hensley contended that the plan, which would impose premiums on Medicaid members and work-oriented rules on most able-bodied members, is designed to limit usage of the program -- a goal that will leave some people without the care they need.

"The Bevin administration is obviously out of touch with the poor and people who live in poverty," Hensley said. "Poor people pay taxes too," such as sales and payroll taxes. "We are already taxed to death. This waiver will just make that literal. We know this governor doesn't care about us."

Health and Family Services Secretary Vickie Glisson didn't reply to that charge but said all the comments would be considered as the state amends its plan for submission to federal officials, requesting a waiver from standard Medicaid rules.

Whitesburg dental hygenist Pam Cornett,
a member of the Kentucky Oral Health
Coalition, said dental benefits should be in
basic coverage. (Image from WYMT-TV)

Several speakers objected to the proposal to remove dental and vision benefits from basic Medicaid coverage. Those services could be earned through a rewards program, but Mary McKenzie, director of a Hazard-based mental-health clinic, said, "To say you must earn what is a basic right, what most of us take for granted, is very insulting."

Dr. Lisa Triplett Short, a Hindman dentist, said many people covered by the expansion got dental care that "allowed them to be more cofident, to go out and seek employment."

State Rep. Fitz Steele, a Democrat from Hazard, said in written comments read into the record that annual dental and vision exams are "inexpensive tests [that] provide vital front-line diagnostics," and said hearing aids should also be included: "If you can't hear, you can't learn or work."

State Sen. Brandon Smith, a Hazard Republican, took no public position on the plan but was among those who thanked Glisson for holding a hearing in Perry County, where 19.1 percent of the population is covered by then-Gov. Steve Beshear's 2014 expansion of Medicaid eligibility. That is the highest rate of any county.

Serena Owen of Northern Kentucky submitted a petition calling for hearings in that region, Louisville and Paducah "to give Kentuckians more of a voice." Earlier hearings were held in Bowling Green and Frankfort; federal rules require two hearings but don't prohibit more.

State Rep. Joni Jenkins, D-Shively, traveled from her Louisville-area district to suggest that Bevin involve House members and senators from both parties in discussions to draft a compromise plan that would not use children, seniors, veterans and other vunerable people "as pawns in a political chess game."

Hensley claimed that Bevin knows federal officials won't accept the plan. Others have said likewise, citing the proposal that able-bodied adults who aren't primary caregivers be required to have a job, look for one, take job training or do a certain amount of volunteer work.

"I'm concerned about the oxymoron, mandatory volunteerism," said Michael Wynn of Grace Health in Knox County.

Andrea Bush of Hazard said the rule would lead to "unintended consequences" for people who don't have checking accounts or stable addresses.

Jason Bailey of the Berea-based Kentucky Center for Economic Policy said the plan is "based on the assumption that poor behavior choices has led to a high percentage of people covered by Medicaid," which he said is incorrect.

Bailey said most people in the expansion work, but mostly at low-wage jobs that don't offer health benefits. He said only 56 percent of Kentucky workers get coverage at work, down from 70 percent in the 1980s, and only 28 of the 120 counties "have more people employed today than when the recession hit. . . . That's not because of a sudden unwillingness to work."

Bailey said he fears that the plan "will worsen many of our challenges. . . . "Medicaid is a safety net program that provides a lifeline. Reducing its reach will only make problems deeper."

Some speakers endorsed the proposal to have Medicaid pay for 30 days of inpatient treatment for substance abuse, and its retention of current behavioral-health benefits.

But behavioral-health advocate Sheila Schuster of Louisville said the mentally disabled and others deemed to me "medically frail" shouldn't be required to pay premiums. She said most don't have a checking account, don't open their mail and often don't have stable addresses or guardians. "I beg you, I beg you" to exempt them, she beseeched Glisson.

Schuster said the move on dental and vision benefits "makes absolutely no sense," and the plan to raise premiums on people above the federal poverty line is "simply a penalty imposed for being poor."

No Kentucky health-insurance plans eligible for federal subsidies offer comprehensive coverage of addiction treatment

Photo from drugabuse.com

More than two-thirds of state health-insurance plans eligible for federal subsidies violate federal treatment requirements for addiction disorders, says the National Center on Addiction and Substance Abuse.

The center surveyed addiction treatment benefits offered among 2017 Essential Health Benefits benchmark plans and found that none, including Kentucky, offered comprehensive addiction-treatment benefits.

Kentucky, which has a greater addiction problem than most states, otherwise fared well in the report. The report said it was one of only five states with a sufficient description of substance-abuse benefits in its approved plans, and one of only nine that did not violate the law that requires parity for behavioral-health coverage.

The report cites benchmark plans, which determine the minimum level of benefits available to those covered in state exchange plans, frequently “excluded or not explicitly covered benefits” related to residential treatment and the use of methadone as therapy.

“Addiction is a chronic disease that often goes untreated, and when patients can't access addiction treatment it can lead to disability and premature death,” Lindsey Vuolo, associate director of health law and policy at CASA, told Steven Ross Johnson of Modern Healthcare. “We're really calling on states to amend their plans to comply with the law.”

The Patient Protection and Affordable Care Act requires insurance providers to cover essential health benefits, which include providing behavioral-health services and substance-use-disorder treatment at parity with medical care. Despite regulations that require coverage of addiction treatment without restrictions, the law does not specify which substance-abuse-disorder benefits should be covered, leaving that decision up to the states.

The law requires policies to cover at least one addiction treatment medication in each of four classes: anti-craving, opioid reversal, opioid dependence treatments and tobacco cessation.

The report found that 45 percent of plans proposed for 2017 are in violation by not providing coverage for an addiction treatment medication in each of the classes. Half of the plans also violated requirements by not covering anti-smoking services, which include screenings, up to eight counseling sessions per year and one 90-day treatment of any anti-smoking medication approved by the Food and Drug Administration.

Calls for more comprehensive coverage of addiction treatment services have increased over the past few years as the number of drug overdose deaths have reached record levels. More than 28,000 people died in 2014 from overdoses involving opioid drugs, including heroin, Johnson notes.

Last year, the federal government suggested including coverage of the full range of approved medication-assisted treatments as part of the essential health benefits to ensure greater access. The proposal faced opposition from insurers and pharmacy benefit managers and was ultimately struck down.

Feds ease access to most common drug against opioid addiction

Photo from thefix.com

By Danielle Ray and Al Cross
Kentucky Health News

Federal drug rules will soon loosen so that doctors can accommodate nearly triple the number of patients they can treat with the most common drug used to fight opioid addiction.

Under the regulation, which takes effect Aug. 5, doctors who are authorized to prescribe buprenorphine, commonly sold under the brand name Suboxone, can go from having a maximum of 100 patients on the drug to 275.

The Department of Health and Human Services estimates between 10,000 and 90,000 new patients will be able to get buprenorphine in the first year as a result. Another 2,000 to 15,000 new patients should be able to get the treatment in subsequent years, Jayne O'Donnell reports in USA Today.

HHS also wants to eliminate potential financial incentives for doctors who prescribe opioids out of fear that patients will give them low marks in patient-experience surveys if they have pain after procedures.

Federal regulators are pushing Congress for about $1 billion in funding to increase treatment options across the country for the drug epidemic. They say it would get more doctors trained in buprenorphine, particularly in rural areas short of physicians who can prescribe the drug, White House Drug Policy Director Michael Botticelli told reporters. HHS Secretary Sylvia Burwell said the money is needed to combat the epidemic.

House and Senate conferees are debating the Comprehensive Addiction and Recovery Act, which would improve treatment for addiction and overdoses and reform prescribe practices. The House version has no new money while the Senate version has $920 million and Democrats have vowed not to sign a report without significant funding, Botticelli said. The Senate version has bipartisan support and could be a re-election vehicle for some Republican senators and their leader, Mitch McConnell of Kentucky.

Kana Enomoto, principal deputy administrator of HHS's Substance Abuse and Mental Health Services Administration, said current drug law requires some limit on buprenorphine patuents. Many of those who commented on the proposed rule warned about the risk of the drug being diverted for illegal uses, she said.

Experts have cited this limit as a barrier to treatment for what is known as "opioid use disorder." Opioids are controlled substances used to treat pain. The rule aims to increase access to medication-assisted treatment and therapy for tens of thousands of people with opioid-use disorders, while preventing diversion, HHS says.

In another anti-opioid move, the Department of Veterans Affairs will require prescribers and pharmacists to check state prescription-drug monitoring databases before prescribing or dispensing opioids for pain. HHS is also launching more than a dozen new scientific studies on opioid misuse and pain treatment and seeking feedback to improve prescriber education programs.

Final hearing on Medicaid changes to be held Wed. in Hazard, hotbed of expansion, with live videostreaming from WYMT-TV

The final hearing on Gov. Matt Bevin's plan to change the Medicaid program will be held tomorrow at a different location than first planned, but with a video livestream.

The hearing will be held from 11 a.m. to 1 p.m. Wednesday in Room 123-E of the First Federal Center at Hazard Community and Technical College. It will be streamed on the website of Hazard's WYMT-TV.

Hazard is the seat of Perry County, which had the highest share of its population enrolled under the expansion of eligibility for Medicaid in 2014: 20 percent. The figures for adjoining counties were Breathitt, 17.6 percent; Knott, 15 percent; Letcher, 17.2 percent; Harlan, 18.8 percent; Leslie, 19.3 percent; and Owsley, 18.3 percent. For a interactive version of this map, with figures for every county, click here.

Judge rejects Bevin lawsuit against Louisville abortion clinic; administration says it will appeal

Republican Gov. Matt Bevin has lost the first round in his legal fight against the new but not formally licensed Planned Parenthood abortion clinic in downtown Louisville.

Circuit Judge Mitch Perry found that Planned Parenthood of Indiana and Kentucky "had, as it had claimed, been following directions of state officials when it began offering abortions in December as part of its effort to obtain a state license," Deborah Yetter reports for The Courier-Journal.

The directions came as Bevin's Democratic predecessor, Steve Beshear, was preparing to leave office. Bevin's lawsuit contends that any pre-license authorization was contrary to law, that the facility's patient-transfer agreements with other health-care facilities were a sham, that six abortions were performed before the authorization was given Dec. 7, and that Planned Parenthood was "attempting to accelerate the process" before Bevin took office in the first minutes of Dec. 8.

"Perry found no evidence Planned Parenthood had willfully violated the law during the licensing process," Yetter reports. "Rather, the judge found that cabinet officials, prior to the Bevin administration, had followed 20 years of consistent application of the law and state regulations involving abortion clinics. Perry said it 'defies reason' to conclude Planned Parenthood willfully violated the law."

Bevin spokeswoman Amanda Stamper said the state will appeal. The lawsuit seeks fines of $684,000, based on state law allowing a fine of up to $10,000 for each violation and $1,000 a day for continuing violations.

Perry's ruling doesn't mean Planned Parenthood "can resume offering abortions immediately," Yetter notes. "It must first obtain a license from the Bevin administration's Cabinet for Health and Family Services. And it suffered a setback in that effort in March when KentuckyOne Health backed out of an agreement required as part of a license to provide hospital care in the event of an emergency." Planned Parenthood said KentuckyOne CEO Ruth Brinkley cited "incredible" outside pressure as the reason. Planned Parenthood has submitted new transfer agreements to the cabinet, said its attorney, Thomas Clay.

Several Kentucky school districts are requiring students who drive to school to pass a drug test; Hardin County is the latest

Image: commons.wikimedia.org

By Melissa Patrick
Kentucky Health News

Hardin County has joined a growing number of Kentucky school districts that require student drivers, and those who participate in athletics, to submit to random drug testing, Anna Taylor reports for the News-Enterprise in Elizabethtown.

“We have traditionally done random drug testing with our athletes; however, it is a privilege to provide transportation services to our students,” Supt. Nan­nette Johnston told Taylor. “For the safety of our students that are driving and all students and everyone else on the road, we want to make sure they are safe as well. They will submit to the same random drug testing that happens with our athletes.”

The policy was recently adopted by the county school board and is slated to take affect in August at North Hardin, Central Hardin and John Hardin high schools. It says that if a student fails a urine test, driving privileges on school property will be suspended for 12 weeks and their parents will be notified. They will be tested again after the 12 weeks; they can regain their driving privileges, or, if they have a second offense, their privileges will be suspended for the rest of the school year. Refusal to cooperate results in suspension for the year.

“We want to make sure they haven’t been using and they don’t have anything in their vehicles that’s tempting them or other students,” Johnston said. “When they choose to be like an adult, they’re going to be treated like an adult.”

A quick internet search found that drug-testing student drivers, along with student athletes, seems to have become a trend across the state, with Whitley, Mercer, Hancock, and Bell counties all popping up with similar policies.

Private schools in Kentucky have also adopted the policy. Trinity High School in Louisville began its random drug and alcohol screening this year, but its policy includes all students, not just drivers Toni Konz reported for WDRB-TV. Covington Catholic High School will do random drug testing, including student drivers, next year, Desire Thompson reported for VIBE.

Last year, Andrew Wolfson of The Courier-Journal did an in-depth story about the legalities of random drug testing in schools, reporting that while the U.S. Supreme Court has never ruled on whether public schools could do random drug screenings on all students, it is not likely to approve such a rule.

In an updated statement in March 2015, the American Academy of Pediatrics said it did not support such policies. It said that while it supports the efforts to identify and address student substance abuse, tests can have false positive results, and such policies erode the student-school relationship and create issues about confidentiality of students' medical records.

Despite Bevin's take-it-or-leave it statements, officials say negotiations continue with feds on proposed Medicaid changes

Gov. Matt Bevin said when he announced his plan to change Medicaid that if the federal government didn't approve it, he would end the eligibility expansion that has added more than 440,000 people to the program. But his lieutenants say the proposed waiver of normal Medicaid rules is still being negotiated with federal officials.

"We're continuing to negotiate in good faith. We're pretty confident they'll approve our waiver or something pretty close to it," Adam Meier, Bevin's deputy chief of staff, said at a forum hosted by the Health Enterprises Network, a Louisville health-business group, Deborah Yetter reports for The Courier-Journal.

Mark D. Birdwhistell spoke as Gov. Matt Bevin listened June 22.

The architect of the plan, University of Kentucky health Vice President Mark D. Birdwhistell, said likewise. "It is not an all-or-nothing transaction,” Birdwhistell told Kentucky Health News Editor and Publisher Al Cross for his fortnightly C-J column.

"There’s negotiation on pieces and parts and components within the various waivers, and I expect that same negotiation to take place here as well."

Birdwhistell told Cross that the stickiest point is likely to be its requirement that able-bodied adults who aren’t the primary caregiver of a dependent have a job, look for one, take job training or do volunteer work. The Department for Health and Human Services has never approved a work requirement, and said in response to Bevin's June 22 announcement, “States may not limit access to coverage or benefits by conditioning Medicaid eligibility on work or other activities.”

Birdwhistell "wouldn’t speculate about how that might be negotiated, but the structure of the plan strongly suggests that one solution would be to make work-oriented activities part of the plan’s rewards system – in which Medicaid enrollees can earn better benefits (including vision and dental, which the plan would remove from the program’s basic benefits)," Cross writes. "Bevin could declare victory, and so could President Obama, who counts health reform as his main accomplishment."

Cross noted criticism from Democratic U.S. Rep. John Yarmuth of Louisville, in an interview with Nick Storm of cn|2’s “Pure Politics.”

“He just wants to blame the Obama administration for ‘forcing him’ to roll back the Medicaid expansion,” Yarmuth said of Bevin, a Republican. “This is a way to do it with less political pushback. I hope that people in Kentucky figure out what he’s doing and don’t let him get away with it ... a very cynical approach to doing business.”

Cross suggested that Bevin could avoid much of the pushback if he dragged out the negotiations "past the Nov. 8 election, in which Republicans have a good chance to gain control of the state House and thus full control of the General Assembly. That power struggle means a lot to Kentucky, but probably little to the White House. And it probably means little to the 400,000-plus Kentuckians whose health care is at risk. But they have the most at stake."

State honors three local groups for fighting abuse of elderly

Three community groups have received awards from the Kentucky Cabinet for Health and Family Services to help their efforts to stop elder abuse.

The Public Awareness Initiative awards, including $500 each, went to the Kentucky River Council Against the Maltreatment of Elders, the Northern Kentucky Elder Maltreatment Alliance and the Pulaski County Elder Abuse Council.

Such efforts make a difference for Kentucky’s seniors, said Judge Timothy Feeley, deputy secretary of the cabinet. “Elder abuse and neglect has risen to such a level of concern that these councils have become crucial resources for local education and prevention,” he said. “Through their resourcefulness and collaborations, their projects are teaching respect for elders and saving lives. I commend their community efforts over the past year.”

Kentucky River CAME operates in Breathitt, Knott, Lee, Leslie, Letcher, Owsley, Perry and Wolfe counties. In the past year, CAME has hosted a Senior Safety and Advocacy Day, sponsored a children’s poster contest and held its second Regional Elder Abuse Awareness Day, drawing about 300 people, dressed in elder abuse prevention T-shirts.

Another popular project was “Blowing Bubbles for Elder Abuse.” On May 4, CAME distributed small bottles of bubbles to elementary schools and senior centers in all eight counties. Students and seniors all blew bubbles to raise awareness of elder abuse prevention and encourage respect for elders.

Northern Kentucky EMA, serving Boone, Campbell, Gallatin, Kenton, Owen and Pendleton counties, presented workshops on insurance fraud and scams, reverse-mortgage myths and helping the rural elderly with utility bills; sponsored its annual children’s poster contest with the theme “Why I Love My Grandparents;” and circulated fliers and training materials about reporting procedures, types of abuse and how to avoid abuse.

In its nomination materials, the Pulaski County Elder Abuse Council called itself “small but mighty.” 

About 100 people attended its annual conference last August, which featured speakers on law enforcement, the legal system, hospice care, health care and the state’s adult safety program. The council raised awareness and more than $200 through its Pumpkins on Main decorating project and provided 12 needy seniors with clothes and food at Christmas.

Kentucky received more than 30,000 calls to report abuse, neglect and exploitation of people age 60 and older for state fiscal year 2015. State law requires reporting suspected abuse, neglect or exploitation is the law, and it’s confidential. The toll-free reporting hotline is 1-877-KYSAFE1 (1-877-597-2331).

Every county has a similar council. Membership is free and open to anyone interested in working to prevent elder abuse in his or her community. To become involved contact state liaison Stacy Carey at 502-564-7043. Get more information about the councils and recognizing the signs of elder abuse online at chfs.ky.gov/dcbs/dpp/eaa/.

Signs of Elder Abuse

If you believe there is imminent risk, immediately call 911 or local law enforcement.

Neglect

§  Obvious malnutrition, dehydration

§  Dirty and uncombed hair; dirty and torn or climate-inappropriate clothes; or offensive body odor

§  Hoarding

§  Lack of glasses, dentures or hearing aid, or lack of medical care

§  Bedsores

§  Recent suffering or loss of spouse, family members or close friends

Physical Abuse

§  Frequent injuries such as bruises, burns, broken bones; explanation of the injury seems unrealistic

§  Multiple bruises in various stages of healing, particularly bruises on inner arms or thighs

§  Experiences pain when touched

§  Loss of bowel and bladder control

§  Never leaves the house or allows visitors

§  Never mentions family or friends

Sexual Abuse

§  Evidence of sexually transmitted disease

§  Irritation or injuries to the mouth, genitals or anus

§  Upset when changed or bathed

§  Fearful of a particular person

§  Loss of bowel and bladder control

Emotional/Psychological Abuse

§  Isolated from family and friends

§  Sudden dramatic change in behavior, appearing withdrawn, depressed, hesitant to talk openly

§  Caregiver won’t let victim speak for herself or himself

§  Caregiver scolds, insults, threatens victim

§  Trembling, clinging

Financial Abuse

§  Unusual activity in bank account; sudden large withdrawals, expenditures that are not consistent with past financial history

§  Use of automated teller machines (ATM) when the person has no history of using ATMs or cannot walk

§  A recent will, when the person seems incapable of writing a will

§  Rights signed away on legal papers without understanding what the papers mean

§  Unpaid bills, such as house payment, rent, taxes or utilities

Congress goes home for July 4 after another Zika impasse

Congress took a break for the July 4 holiday after reaching another impasse on funding to combat the Zika virus that has caused birth defects in Mexico and the Caribbean.

"Senate Democrats on Tuesday shot down a House-passed bill that would have provided $1.1 billion to fight the mosquito-borne virus, citing opposition to the measure's changes in pesticide regulations and restrictions on money for birth control," Fox News reports. The bill would also "rob Obamacare of funding, impose new restrictions on Planned Parenthood and provide some $800 million less than the Obama administration is seeking," Politico reports, and "allow the Confederate flag to fly at veterans' cemeteries."

"In the short term, Democrats are more open to criticism: After clamoring for new Zika funding for months, they are set to vote against a bill at funding levels they’ve already agreed to," Politico notes. "But given the history on legislative impasses, Democrats are betting that the majority party will be held responsible by voters."

Republicans remained firm. Senate Majority Leader Mitch McConnell of Kentucky "suggested that, barring a sudden deal, there may be no vote until the upper chamber returns in September."

Senate Democratic Leader Harry Reid of Nevada "pressed for negotiations to resume and bemoaned that both parties agreed in May to a $1.1 billion Zika bill, only for House Speaker Paul Ryan to make changes," Fox reports. "Reid argues those changes appeased the chamber’s conservative conference, but resulted in an unacceptable piece of legislation."

President Obama asked for $1.9 billion for Zika in February. "The Republicans controlling Congress instead forced the administration to redirect more than $500 million in unspent Ebola-fighting funds to combat Zika," Fox notes. After the House passed a bill with less than a third of the money Obama wanted, Republicans in the House and Senate agreed on a $1.1 billion plan with the added provisions and spending cuts to pay for it.

"Democrats particularly opposed a provision that restricts the use of $95 million worth of federal grants to provide services such as birth control to women in Puerto Rico threatened by the virus. Democrats charged that the restrictions were targeted at clinic on the island run by Planned Parenthood, a group loathed by many anti-abortion Republicans," Fox reports. "In addition to the limits on Planned Parenthood, the bill would temporarily lift Clean Water Act permitting requirements on pesticide spraying for municipalities and other large-scale users."

A lobbyist for the March of Dimes, which advocates for maternal and fetal health, told Politico that the Republican bill was “doomed from the start.” Cindy Pellegrini continued, “We have a hard time imagining an issue that could be more of an emergency than an infectious disease transmitted by mosquitoes that destroys babies’ brains in utero. The package looked like it was not designed to be successful and that was deeply troubling for us.”

Obama said Friday that a Zika vaccine could be developed in "fairly short order" once Congress enacts the funding. University of Kentucky researchers are among those working on that.

Ky. and Southeast lack statewide smoking bans; political climate here has shifted focus to local bans; Hazard just passed one

By Melissa Patrick
Kentucky Health News

Kentucky hasn't passed a comprehensive smoke-free law, but neither has any state in the Southeast, notes a recent Centers for Disease Control and Prevention report.

The CDC report says 28 states have comprehensive smoke-free laws, which are laws that prohibit smoking in all indoor areas of workplaces, restaurants and bars. These bans cover about 60 percent of Americans.

California was recently added to the list, but overall adoption of statewide smoking bans has slowed recently. All but two of the 28 states, including the District of Columbia, enacted their comprehensive smoke-free laws between 2000 and 2010, and only two states passed such laws between 2010 and 2016. (Seven states have laws that include electronic cigarettes.)

"We've made great progress in protecting many Americans from secondhand smoke exposure," CDC Director Tom Frieden told HealthDay. "But millions of Americans, especially those living in southeastern states, are still unprotected from this completely preventable health hazard."

The report marks the 10-year anniversary of the 2006 Surgeon General's report, The Health Consequences of Involuntary Exposure to Tobacco Smoke, that says there is no such thing as risk-free secondhand smoke and the only way to protect against it is by completely eliminating indoor smoking.

Exposure to second-hand smoke can cause stroke, lung cancer and heart disease in adults. Exposed children are at an increased risk for sudden infant death syndrome, acute respiratory infections, ear infections, asthma and slowed lung growth.

"Secondhand smoke exposure contributes to approximately 41,000 deaths among nonsmoking adults and 400 deaths in infants each year," says the report.

The most recent Kentucky Health Issues Poll found that 66 percent of Kentucky adults favor a statewide smoking ban and 31 percent opposed it. However, efforts for a ban have stalled because new Republican Gov. Matt Bevin opposes such legislation, saying ity should be a local decision.

About one-third of Kentucky's population is covered by comprehensive smoke-free policies, and another 10 percent or so live in places that have ordinances with varying exceptions. Kentucky has one of the nation's highest smoking rates, 26 percent.

Ellen Hahn, a University of Kentucky nursing professor and director of the smoke-free policy center, encouraged advocates at a recent smoke-free conference to shift their efforts to localities because of the current political climate.

Hazard just approved an indoor workplace smoking ban that goes into effect July 6, WYMT-TV reports. In Eastern Kentucky, smoking and lung cancer rates are double the national average, PBS NewsHour reports.

Of the 23 states without comprehensive smoke-free laws, 14 of them have some local comprehensive smoke-free laws and nine of them don't have any such laws at either the local or state level. Eight of those nine states without smoking bans have statutes that prohibit local bans, says the report. One, North Carolina, bans smoking in bars and restaurants.

"Smoke-free laws provide a low-cost, high-impact benefit to the public's health," Corinne Graffunder, director of the CDC's Office on Smoking and Health, told HealthDay. "These laws substantially improve indoor air quality, help smokers quit, prevent youth and young adults from starting to smoke, change social norms about the acceptability of smoking, and reduce heart attack and asthma hospitalizations among non-smokers."