Kentucky Health News reporter gets fellowship to report on rural health workforce issues, with a focus on nurses

Melissa Patrick

Melissa Patrick, reporter for Kentucky Health News, has been named 2016-2017 Nursing and Health Care Workforce Media Fellow for the Center for Health, Media & Policy.

Patrick, a former nurse, will focus on rural health issues that affect nurses and other health care providers within the evolving health care delivery system during her eight-month fellowship.

“We’re thrilled to welcome Melissa as this year’s media fellow. She is strongly committed to raising awareness about the role of nurses and other health care workers in the current and future health care system” Diana Mason, co-founder of CHMP, said in a news release.“This fellowship provides an opportunity to work with some of the top health journalists and nursing workforce experts, hone reporting and production skills, engage in cross-platform reporting, and contribute to the national conversation about health care delivery challenges in the years ahead.”

Patrick's main project will take a multi-part look into a shortage of school nurses throughout the state, a shortage of nurses to serve rural areas, the role of advance practice nurses in meeting some of Kentucky’s health needs and state policy issues impacting nurses.

The fellowship is supported by a grant from the Johnson & Johnson Foundation.

Dr. Michael Karpf to retire as head of UK hospital

Dr. Michael Karpf

Dr. Michael Karpf, who has led the University of Kentucky Medical Center during a decade of major growth, announced Wednesday that he would retire in 2017. At 71, his retirement was not unexpected.

"We have made considerable progress, and I feel that the original goals that we established have been achieved," Karpf said in a statement. "We have built a strong foundation for UK HealthCare," the medical center's brand. "Consequently, I think it is time for an organized transition to a new leader who has boundless energy to address the challenges of a rapidly evolving health care system."

During Karpf's 13 years at the helm, annual discharges from the hospital doubled to 37,789, and transfer of patients from other hospitals for sub-specialty care "astoundingly grew" from 1,000 to more than 18,000, annually, UK President Eli Capilouto said in a news release. "But numbers on tell part of the story."

Capilouto said Karpf, who is paid $882,000 a year, "grew partnerships with hospitals and physicians in 180 clinical locations across the state. . . . I am convinced that UK HealthCare is the greatest success story in modern academic health center history. This is not grandiosity. The numbers show it."

The greatest manifestation of Karpf's work is the new Albert B. Chandler Hospital Pavilion A, which he said will be more than 96 percent complete with projects authorized in June.

"Although Pavilion A is as technologically advanced as any hospital in the country, it is also an exceptionally empathetic facility – comfortable and comforting for our patients, their families, visitors, and, just as important, for our faculty and staff," Karpf said. "We will also have refurbished/repurposed four of the seven floors in Pavilion HA (Kentucky Children’s Hospital). Over the next 18 months we will finally have a state-of-the-art neonatal ICU that appropriately supports a superb NICU staff and faculty."

"Karpf’s emphasis on highly complex medical care, however, sometimes came at a price," reports Linda Blackford of the Lexington Herald-Leader. "In 2012, UK suspended its pediatric cardiology program after an uptick in mortality rates for babies, including at least two babies who died while in UK’s program. An internal review recommended better training for both doctors and nurses and a dedicated ICU. Earlier this year, Karpf announced a partnership where pediatric heart surgeries at UK would be performed by a heart surgeon with a primary appointment at Cincinnati Children’s Hospital."

Blackford adds, "Karpf also is part of a whistleblower lawsuit filed by UK surgeon Paul Kearney, who was stripped of his clinical privileges for using abusive language toward co-workers and one patient. Kearney alleges that Karpf targeted him after the surgeon started asking questions about the financial dealings of UK HealthCare and the Kentucky Medical Services Foundation," which UK contends is not a public agency.

Karpf came to Lexington from UCLA, where he ran that university's medical center. He said he and his wife Ellen will remain in the city, and he plans to "take a part-time faculty position working on health service and health policy issues."

KentuckyOne Health announces diabetes prevention program in Central Kentucky

KentuckyOne Health is launching a program to prevent Type 2 diabetes in Central Kentucky. The year-long program is modeled after a Centers for Disease Control and Prevention program "designed for individuals at high risk for Type 2 diabetes and is proven to help people lose weight and lower their risk of Type 2 diabetes by 58 percent," KentuckyOne said in a news release.

Nearly 30 million Americans have diabetes, and it is "estimated that more than 14 percent of Kentuckians suffer from this chronic condition, which can also lead to heart disease, stroke, amputation, end-stage kidney disease, blindness and death," the release said.

KentuckyOne recommends the program to those who meet any two of the following criteria:
• 18 years or older
• Elevated blood sugar
• Diagnosed with pre-diabetes or gestational diabetes
• Overweight

Informational sessions are being held to provide "details of the 16-week course and the following monthly meetings" to help interested people decide if the course is right for them. Trained lifestyle coaches are leading the group meetings, teaching how to make healthy lifestyle choices.

An introductory session will be held Thursday, Sept. 15, at 6 p.m. in the Medical Office Building at Saint Joseph East, located at 160 Eagle Creek Drive. One will be held in Berea Thursday, Sept. 22, at 5:30 p.m. at Saint Joseph Berea, 305 Estill Street, in the Education Suite on the fourth floor.

To enroll or get more information, call 859-31-2595 or visit KentuckyOneHealth.org/dpp. A physician referral is preferred, but not required to participate. Space is limited.

Kentucky's uninsured rate drops to 6 percent; states that expanded Medicaid, like Kentucky, saw the greatest drops

The share of Kentuckians without health insurance dropped by more than half from 2013 to 2015, bringing it down to only 6 percent of the state's population, from 14.3 percent, according to the U.S. Census Bureau. That was one of the largest decreases in the nation.

U.S. Census Bureau map, based on American Community Survey

The drop reflects a net gain of 355,000 people with insurance, according to the American Community Survey, a continuous poll of the U.S. population. The survey showed an even larger drop among Kentucky children, from 16.6 percent uninsured in 2013 to 4.2 percent in 2015.

Data from 2013 provide a benchmark for comparison because it was the last year before implementation of the Patient Protection and Affordable Care Act, including the expansion of Medicaid in Kentucky to those who earn up to 138 percent of the federal poverty level.

The report found that the 32 states that expanded Medicaid had the largest increases in insurance coverage. Kentucky's decrease in uninsured appeared to be larger than any other state but California.

Advocacy groups credited the expansion for the decrease, and asked Gov. Matt Bevin to consider that when it comes time to negotiate with the Centers for Medicare and Medicaid Services about the governor's new plan for Medicaid. The plan is designed to encourage higher levels of participant involvement through premiums and "community engagement" requirements, conditions that could be denied.

Bevin has said he would negotiate with the federal officials, but his plan says it constitutes the conditions under which Kentucky will continue the expansion. A failure of negotiations could take health insurance away from more than 430,000 Kentuckians who now have health insurance through the expansion.

Kentucky Center for Economic Policy

In its statement, The Kentucky Center for Economic Policy touted the many health and economic benefits that have resulted from the expansion, such as increased preventive care, fewer emergency room visits and reports of improved personal health, and said the current Medicaid proposal creates "barriers to coverage like premiums, lockouts and work requirements that would reduce the number of Kentuckians covered."

“Because Kentucky has seen the greatest gains, we also have the most to lose if harmful changes to Medicaid are approved,” KCEP Executive Director Jason Bailey said. “Our hope is that the Bevin administration will negotiate in earnest with the federal government to find a way to build on our successes and not move backward on our health progress.”

Kentucky Youth Advocates noted that eligibility for children in Medicaid and the Kentucky Children's Health Insurance Program did not change from 2013-15, "indicating that the increases in coverage for children were likely an indirect result of more parents gaining health insurance through Medicaid expansion."

"We know that when parents have health insurance, their children are more likely to have health insurance," Dr. Terry Brooks, executive director of KYA, said in a statement. "We encourage Gov. Bevin to negotiate with CMS on a Medicaid proposal that continues affordable coverage for families and does not result in people losing coverage."

Bevin spokeswoman Amanda Stamper also noted that most of the new enrollment came from the expansion of Medicaid, and painted a different picture of this reality. “This is a sad commentary on the economic state of Kentucky and is not sustainable,” Stamper told John Cheves of the Lexington Herald-Leader. “While some are focused solely on enrollment, Gov. Bevin is focused on driving better health and employment outcomes and the long-term fiscal sustainability of the Medicaid program.”

Bevin's proposal says it "is expected to save taxpayers $2.2 billion over the five-year waiver period," by reducing enrollment in the program by about 88,000 people in the next five years, but only $331 million of that would be state tax money, because the federal government covers the bulk of Medicaid costs.

Sipping on sugary drinks ruins teeth, perhaps more from the acid in them; it's almost as corrosive as battery acid, VA dentist says

Many of us constantly sip on a soft drink, especially in Kentucky, but the habit could be ruining our teeth.

Most soft drinks have sugar, acid or both and repeated exposure to this combination "wears down tooth enamel, which leads to decay and, eventually, tooth loss," Patrick Reed reports for Kentucky Educational Television.

"Mountain Dew mouth"
{Photo from healthline.com)

This "sugar-acid double punch" is especially dangerous for soda drinkers, and particularly to those who sip on them constantly - leading to what is often referred to as "Mountain Dew mouth," a phenomenon most common in Appalachian Kentucky.

As part of KET’s "Inside Oral Health Initiative," funded in part by the Foundation for a Healthy Kentucky, several Kentucky dentists offered tips on how to minimize the effects of sugar and acid on the teeth.

It's an important topic in Kentucky, because the state ranks fifth in daily consumption of soft drinks and fruit drinks, with 43.2 percent of people in the commonwealth, according to the federal Centers for Disease Control and Prevention.

Threats to Tooth Enamel

Tooth enamel, which covers the visible, outer portion of the tooth, "is the strongest material in the human body and can keep teeth healthy for a lifetime," Reed writes. However, repeated exposure to sugar and acid will cause it to erode, and once it's gone, it's gone.

“On a scale of 1 to 10, if battery acid is a 1, then most soft drinks are a 2. That’s how acidic they are,” Robert Henry, chief of dentistry at the Department of Veterans Affairs Medical Center in Lexington, told Reed. “If you add sugar on top of that, you’re just setting up an environment that’s acidic,” he adds. “And then the sugar moves in and basically does the rest. It’s literally like throwing kerosene on an open flame.”

Reed said the erosion is intensified by repeated exposure to not only soda, but also any sugary drinks such as fruit juice, sports drinks, and energy drinks. And while diet soda seems like a good idea because it lacks sugar, many brands contain acid.

"If you take one sip of soda, it’s going to take three to four hours for your mouth to go to a pH of neutral,” Pikeville dentist Bill Collins told Reed. “So, if you’re sipping every 15 to 20 minutes, your acidic level in your mouth is down to a pH of 1 or 2. And you’re keeping it there, and it basically dissolves the enamel on your teeth.” (The numerical figure for neutral is a pH of 7).

Practicing in Eastern Kentucky, Dr. Collins and Dr. Nikki Stone of the University of Kentucky told Reed that even very young children in the region have a habit of sipping soda.

“Drinking pop is our culture – we have an actual ‘pop culture’ in Eastern Kentucky,” said Stone, who has created a "Drink Pyramid" graphic to educate children about healthy habits. It says soda should only be consumed at parties or on weekends.

 Tips for reducing the impact of sugary drinks

• If you must drink soda, do it fast, and once a day at most. This leaves less time for the sugar and acid to wash over the teeth and cause decay.
• Never drink soda before bedtime, and clean your teeth thoroughly at night. Collins recommends that heavy soda drinkers should rinse as much residue as possible from their teeth, with water, before they brush to decrease the risk of scrubbing the acid into their teeth.
• Avoid added sugar in food, as this too can cause enamel erosion and tooth decay.
• Brush twice a day, two minutes per session, in the morning and always before bedtime.

Sept. 23 is deadline to apply for grants that can be used for syringe exchanges; 17 approved, but few in high-risk counties

By Melissa Patrick
Kentucky Health News

The state Office of Drug Control Policy is offering competitive grants to local boards of the Agency for Substance Abuse Policy for them to use toward harm-reduction programs for 2017. The deadline to apply is Sept. 23.

The grant money can be used for syringe exchanges (with some restrictions), Narcan (naloxone) programs, community education and other harm-reduction efforts. While local health, fire and police departments cannot apply directly for the grant, ASAP boards can apply on their behalf. Grant amounts will be considered up to $20,000, depending on the proposal, according to the Office of Drug Control Policy. Click here for a link to your local ASAP chairperson.

This is the second year the grants have been offered. Last year, all 37 ASAP boards that applied got some funds. Elliott and Harlan counties are the only two in the state without ASAP boards.

A 2015 federal Centers for Disease Control and Prevention analysis identified the 220 U.S. counties most vulnerable to an HIV or hepatitis C outbreak among intravenous drug users, and 54 of those counties are in Kentucky.

So far, 17 Kentucky counties have approved syringe exchange programs, according to the Cabinet for Health and Family Services. But only six (Knox, Pike, Grant, Carter, Boyd and Mercer) are in the most vulnerable group.

Stars locate syringe exchanges; green counties are deemed most at risk for HIV and hepatitis outbreaks

Syringe exchanges were authorized in Kentucky under a 2015 anti-heroin law and require local approval and funding. They are meant to slow the spread of HIV and hepatitis C, commonly spread by the sharing of syringes and needles.

"The key to needle exchange is that it is an opportunity to engage someone in treatment," Allen Brenzel, medical director of the state Department for Behavioral Health, Development and Intellectual Disabilities, said in an interview. "There is no evidence to support that they cause people to use more often or to use more drugs. What they do is they help people begin the process of engaging and trusting that people will help them. . . . They are very, very important."

Brenzel said the federal report alone is reason enough for counties to adopt syringe exchange programs. "An HIV epidemic would cost us, in addition to the human lives, millions and millions of dollars to treat and contain," he said.

Hepatitis treatment is also expensive. Dr. John Ward, director of the CDC's Division of Viral Hepatitis, said at a recent conference in Lexington that the cost of testing and treatment for hepatitis C is between $32,000 and $56,000 on most health plans.

Kerry Steinhofer of The Advocate-Messenger in Danville reports that Boyle County, which is considered the 35th most vulnerable by the CDC, is in the early stages of planning a syringe exchange. Its ASAP board plans to apply for one of the aforementioned grants and is hopeful they will be chosen.

Brent Blevins, the county health department, told Steinhofer that he did not expect any problems with the Danville City Commission or the Boyle County Fiscal Court in getting approval of a syringe exchange.

Lincoln County Judge-Executive Jim Adams told Abigail Whitehouse of The Interior Journal in Stanford that he expects some political pushback. The county is ranked 97th most vulnerable nationwide, and is in the early stages of learning about syringe exchange, Whitehouse reports.

Clark County started its exchange program about eight weeks ago and has already seen more clients than it anticipated seeing after six months, indicating a higher number of drug users in the community than expected, Health Director Scott Lockard said in a telephone interview. (On Sept. 2, the exchange saw 14 total clients, collected 199 needles and gave out 289.)

What's important is that disease is being prevented, Lockard said. "We are truly farther along and doing much better than I thought we would be at the six-month window," he said. "Obviously there is a need."

Lockard said Kentuckians are becoming more accepting of syringe exchange programs, and predicted that more counties will soon follow with their own. A Kentucky Health Department Association survey taken in December found that 75 health departments, out of 109 who answered the question, were in some phase of the education process or approval of syringe exchange programs.

"This is an example of public health at its finest," Lockard said. "I think we are going to see positive impacts on our hepatitis C rates in our communities, and hopefully prevention of any HIV outbreaks."

Feds reject Ohio's Medicaid proposal, which was a lot like Ky.'s; federal comment period for Kentucky plan runs through Oct. 8

By Melissa Patrick
Kentucky Health News

The Centers for Medicare and Medicaid Services rejected Ohio's new Medicaid plan Friday, saying it could lead to the state's low-income people losing health coverage -- a decision that should place Kentuckians on alert, since it has a lot of similarities to the one Gov. Matt Bevin has proposed.

Ohio's new plan would have required all non-disabled Medicaid beneficiaries, except pregnant women, to pay up to $8.25 per month, depending on income, into a health savings account, with a $99 annual limit. Beneficiaries who failed to make their payments within 60 days of the due date would have lost coverage and would have had to pay back all missed payments to re-enroll.

"CMS is concerned that these premiums would undermine access to coverage and the affordability of care, and do not support the objectives of the Medicaid program," acting CMS Administrator Andy Slavitt wrote in a letter to the state's Medicaid director.

Bevin's proposal would also require Medicaid members to pay premiums, between $1 and $15 per month, depending on income, except pregnant women, children and the medically frail. These amounts would be assessed on households, not individuals.

Kentucky's plan would also dis-enroll members for non-payment, but has different penalties for those above or below the federal poverty level. Non-payers under that line would be required to make co-payments and lose $25 from their health savings account, which would be suspended. Like Ohio, Kentucky would stop coverage for those above the poverty line.

Kentucky's plan, like Ohio's, would allow suspended individuals to re-enroll by making back payments. Kentucky's plan would also require them to participate in a financial or health literacy course.

Slavitt, of CMS, said Ohio's application indicated that more than 125,000 Ohioans would lose coverage each year because of these changes, and "We do not believe that this practice would support the objectives of the Medicaid program, because it could lead to a substantial population without access to affordable coverage."

Kentucky officials also forecast that their plan would decrease enrollment: by about 17,000 in the first years and by 85,000 in the fifth year.

Another challenge for approval that Kentucky's plan faces is its "community engagement" requirements, which requires all able-bodied adults who aren't primary caregivers to work or volunteer, eventually 20 hours a week. No plan has been approved so far with any work requirements.

Ohio had proposed to require that a workforce-development agency referral be offered to any of its members who worked fewer than 20 hours a week, while clearly stating that participation in any such program was not a condition of enrollment.

Why should Kentuckians care about what happens in Ohio?

While Bevin has said he would negotiate with federal officials, his plan says it constitutes the conditions under which Kentucky will continue the Medicaid expansion implemented by his Democratic predecessor, Steve Beshear. Thus, a failure of negotiations could take health insurance away from the more than 430,000 Kentuckians who qualified under the expansion of eligibility to households who earn up to 138 percent of the federal poverty level.

Ohio could not negotiate with CMS because its legislature wrote its plan into its two-year budget. Slavitt clearly stated in rejecting Ohio's plan that waivers allowing changes in Medicaid rules cannot be approved unless they "strengthen coverage of health outcomes for low-income individuals in the state, increase access to providers, or otherwise increase the efficiency and quality of care provided to Medicaid beneficiaries and other low-income populations in the state."

Kentucky's waiver comment period runs through 11 p.m Oct. 8. Click here to comment. Click here to see the proposal.

Sitting down? It could be killing you; how about a standup desk?

Increasing numbers of news reports about the dangers of sitting are prompting traditional offices to make their workstations healthier by ditching desk chairs. "The link between sitting jobs and deadly disease processes galvanized the rise of the adjustable desk and the decline of the cubicle world as we knew it," Steve Shaw reports for Insider Louisville.

Burger Boy owner Dan Borsch of Louisville at his standup desk
(Insider Louisville photo courtesy of Dan Borsch)

Louisville restaurateur Dan Borsch made the switch to a standup desk after suffering a back injury three years ago."It took about two weeks to get used to the standing aspect of it," Borsch told Shaw. "After that, I don't notice it all -- and I love it."

Borsch said he is pain-free, and attributes his back relief to the $1,000 desk, not his exercises. "I do believe that, because of the standing desk, my back has been better than it would have been otherwise -- without a doubt."

Prolonged or leisurely sitting contributes to metabolic syndrome, which the Mayo Clinic defines as "a cluster of conditions -- increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels -- that occur together, increasing your risk of heart disease, stroke and diabetes." The Mayo Clinic describes in more detail what happens:

"Red blood cells in your legs begin to clump together, thickening inside your vessels and slowing circulation. If, later, you notice a further drop in energy, it's because your body's insulin production is down. The sugars . . . linger in your bloodstream, rather than being ushered into your muscles for energy. Soon a key element responsible for vacuuming fat out of the blood deactivates. Small amounts of fat begin to accumulate in your blood; your body will store it in an easy-to-access central location — your gut."

Mayo adds, "You may also have hunger cravings, even though you haven’t moved. That’s because your appetite-regulating hormones leptin and ghrelin have gone off-kilter. Meanwhile . . . deep within your leg muscles, a gene critical for suppressing clotting and inflammation switches off. By the end of the day, even with a lunch break and trips to the water cooler, your good cholesterol and insulin sensitivity may have fallen 20 to 40 percent.”

Shaw writes, “Sitting disease may be even more concerning to women than men.” A study by Alpa Patel, an epidemiologist with the American Cancer Society, found that “men who spent six hours or more per day of their leisure time sitting had an overall death rate that was about 20 percent higher than men who sat for three hours or less. The death rate for women who sat more than six hours a day was about 40 percent higher.”

Patel writes that leisure-time sitting “has been associated with greater mortality, cardiovascular disease, type II diabetes mellitus, obesity, and some cancers . . . markers of chronic disease risk such as weight gain, high cholesterol, high fasting insulin levels, and other biomarkers.” She estimates that, on average, people who sit too much “shave years off their lives.”

Convinced that standing during his long workdays will improve his health, Borsch tells Shaw that it’s likely he’ll never sit at his desk again. “Once you make that two-week transition or maybe three weeks — or however long it takes somebody to make that initial adjustment — there’s no looking back.”

If buying a standup desk isn’t on your to-do-list, Bonnie Berkowitz and Patterson Clark from The Washington Post recommend “sitting on something wobbly, stretching the hip flexors, walking during breaks, alternating between sitting and stranding, and trying yoga poses.”

Open comment period begins today for Gov. Matt Bevin's Medicaid request to feds for Medicaid waiver; ends Oct. 8

By Melissa Patrick
Kentucky Health News

Kentuckians have 30 days to let the federal government know what it thinks about Gov. Matt Bevin's new Medicaid plan, starting today and ending at 11 p.m. Oct. 8.

Gov. Matt Bevin

“We look forward to the public input that will be received over the next 30 days,” the Republican governor said in a news release. He said the plan “will allow us to provide Medicaid coverage that ensures better health outcomes for Kentuckians in a fiscally responsible manner. Without it, there will be no expanded Medicaid in Kentucky, so we look forward to working with CMS to ensure this coverage continues.”

CMS is the Centers for Medicare and Medicaid Services. The plan is called Kentucky HEALTH, standing for Helping to Engage and Achieve Long-Term Health. It seeks a waiver from federal Medicaid rules, under a law allowing five-year demonstration programs.

Bevin continues to say that if this waiver is not approved, the state will no longer provide Medicaid coverage to the 430,000 Kentuckians who now qualify for the program under his Democratic predecessor's expansion of Medicaid under federal health reform to those who earn up to 138 percent of the federal poverty level.

But when Kentucky Health News asked him in August if he was willing to negotiate with Health and Human Services Secretary Sylvia Burwell, he said, "Absolutely. That's where we are in the process."

Burwell has indicated that the process could easily continue until after the November election, in which Republicans hope to take control of the state House and the White House. She told former Gov. Steve Beshear in a July 21 letter, "Medicaid waivers in other states have often taken between six to 12 months to negotiate."

The Bevin administration submitted the formal Medicaid plan to Burwell Aug. 24. In a statement, the Department of Health and Human Services said that opening the federal comment period only signifies the completeness of the application for an 1115 Medicaid expansion waiver.

“Application completeness is an early step in the waiver review process, and simply means that the waiver contains sufficient information to evaluate it," HHS Press Secretary Marjorie Connolly said in the statement. "After the comment period and review and consideration of public input, the waiver process usually involves significant additional dialogue between HHS and states."

The most controversial parts of the plan include requiring premiums to those with incomes below the poverty level that could prevent access to care and the work requirements for able-bodied adults who aren't primary caregivers, both conditions that Burwell has said she would not approve.

"We are prepared to continue working for as long as it takes to find a solution that builds on the historic progress Kentucky has made under Medicaid expansion and avoids moving backwards," Connolly said.

The proposal mainly targets able-bodied adults who qualify for Medicaid under the expansion and is designed to encourage participants to have a higher level of involvement in their health care. It does not affect children, pregnant women, the medically frail and adults who were eligible for Medicaid before the expansion.

Bevin has said that the state cannot afford to have 1.32 million people, nearly 30 percent of the state's population, on Medicaid.

The proposal says it "is expected to save taxpayers $2.2 billion over the five-year waiver period," by reducing enrollment in the program, but only $331 million of that would be state tax money, because the federal government covers the bulk of Medicaid costs.

The federal government is paying the full cost of the expanded Medicaid population through this year. Next year the state will be responsible for 5 percent, rising in annual steps to the federal health-reform law's limit of 10 percent in 2020. The state pays about 30 percent of the cost of traditional Medicaid participants.

Click here and follow the prompts to submit your comments. Click here to see the full report.

Kentucky's first Health Hack-A-Thon, via SOAR, will brainstorm to find solutions to Eastern Kentucky's health challenges

By Melissa Patrick
Kentucky Health News

Registration is now open for the Appalachian Health Hack-A-Thon, an action-oriented event designed to create new solutions to the health challenges in Eastern Kentucky.

"A Hack-A-Thon is an event in which people with different backgrounds and expertise form teams, collaborate within a limited time frame, and focus on a specific problem or idea in health care to come up with innovative, disruptive ideas and solutions," says the website. "By bringing together diverse minds alike in their interest for solving healthcare’s biggest challenges, problems can be diagnosed from multiple different perspectives."

The event will be held Thursday through Saturday, Oct. 6-8 at the Center for Rural Development in Somerset.

Thursday's events include a series of "high-energy presentations" and is the only day that is open to the public.

Keynote speakers at the event include U.S. Rep. Hal Rogers of Somerset, chair of the House Appropriations Committee; Dr. Nora D. Volkow, director of the National Institute on Drug Abuse; and Dr. Douglas R. Lowy, acting director of the National Cancer Institute.

Teams will be formed on Friday after all of the problems have been pitched. These teams will be charged to create and develop innovative solutions to health problems in the region, with a focus on substance abuse, obesity and diabetes.

The teams will present their ideas on Saturday and a judge will the select winners, who will be recognized with prize money and special recognition.

The event needs both participants and mentors to apply. The website notes that eligible participants include: medical professionals, engineers, designers, business people, entrepreneurs, and students. While the event is free to participants, you must apply and be accepted to attend.

The website also describes specific attributes it is looking for in those who apply to be mentors, including someone who is "engaging and helpful, avoids tearing down teams ideas in a destructive way, and instead directs conversations in a constructive way."

The event is sponsored by Shaping Our Appalachian Region and MIT Hacking Medicine. Click here for more information or call Jenna Meyer at 606-766-1160.

Almost half of Ky. counties will have only one insurer to choose from on government exchange; open enrollment begins Nov. 1

Base chart from Insider Louisville

Anthem Health Plans of Kentucky will be the only health insurer offering coverage for next year to Kentuckians on the government exchange in 54 counties. That is a sharp decrease from last year, when Kentuckians in all counties had at least two insurers, and most had three.

"The diminishing competition on health-care exchanges is not a local issue—it’s a national one," Jean West, communications director for the state Cabinet for Health and Family Services, said in an e-mail. "As has been widely reported, insurers across the country have been losing hundreds of millions of dollars in the Obamacare exchanges and can no longer sustain such heavy financial losses. Insurers are left with the choice of increasing rates, reducing benefits or pulling out of the exchange markets altogether."

USA Today reports that "up to 2.1 million people nationwide will likely have to change plans for 2017 due to insurers leaving states' [Patient Protection and] Affordable Care Act marketplaces, up from more than 1.2 million who had to find new insurers last year."

West noted that the failure of the Kentucky Health Cooperative has added further burden to the remaining insurers on the exchange. Prior to its demise in 2015, the cooperative sold 75 percent of the policies on the state's health exchange, attracting many of the state's unhealthiest people. These clients have since had to find new insurers who now must assume their risk.

"While CHFS and the Department of Insurance will continue to work with insurance providers to increase their offerings, any such efforts will continue to be handcuffed by market forces created under Obamacare," West said.

Screenshot of part of The Wall Street Journal's interactive map of
exchange insurers. Light blue counties have one, medium blue two
and dark blue three or more. Click here for the map and county data.

Anthem is the only company offering statewide coverage on the exchange in 2017. Baptist Health, CareSource and Humana Health Plan will offer exchange plans in specific areas only.

In 2017, Baptist Health will offer exchange plans in 20 counties, up from 18 in 2016; CareSource will offer plans in 61 counties, up from 46 in 2016; and Humana will decrease the number of counties it serves to nine, down from 15 in 2016.

West confirmed that Kentuckians who sign up for health insurance through the exchange will enroll on Healthcare.gov this year, instead of Kynect, the state's health insurance exchange. Open enrollment begins Nov. 1 and goes through Jan. 31.

United HealthCare, WellCare, and Aetna, which offered plans on the exchange in 2016, will not offer any state exchange plans in 2017. United will continue to offer small group plans outside the exchange and Aetna will continue to offer plans off the exchange, which means they will not be eligible for federal tax subsidies.

United, which offered plans in all 120 counties in 2016, announced in April that it would no longer participate in Kentucky's exchange, citing unsustainable losses. A Kaiser Family Foundation analysis said that the effects of United's departure would be "modest" in states where it did not offer low-cost "silver" plans. United did not offer such plans in Kentucky, where 60 percent of those who signed up through the exchange chose a silver plan in 2016.

Aetna withdrew from Kentucky's exchange in August, also citing unsustainable losses. Its withdrawal affects 10 counties in three major metropolitan areas: Boone, Campbell, Kenton, Fayette, Madison, Jefferson, Oldham, Trimble, Henry and Owen counties.

WellCare's withdrawal from the exchange will affect 12 counties: Boone, Bullitt, Campbell, Clay, Fayette, Harlan, Jefferson, Jessamine, Kenton, Laurel, Leslie and Warren counties.

USA Today notes, "Insurers need healthy people to buy insurance to offset the cost of covering the sicker ones," but current premiums are too high for many healthy consumers to afford, especially if they don't qualify for a subsidy.

Insider Louisville reports that Kevin Lucia, a senior research fellow and project director at the Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute, said that before Obamacare "insurers made money by discriminating against sick people. Now, insurers have to make money with a diverse pool of customers, including some with very high risks for health services, and some are still figuring out how to properly price their policies."

“It’s a totally different situation,” Lucia said. “We are just at the beginning” of health reform, he said. “This is a marathon.”

Teacher learns food literacy is more than teaching about healthy food; it's also about geographic and socioeconomic challenges

Cooking Club, part of Fern Creek's Food
Literacy class (Photo by Joe Franzen)

A "food literacy" class that began as a way to teach high-school students to eat healthier has turned into a social-justice exploration through the shared language of food preparation and eating, Joe Franzen writes in a "Classroom Connection" piece for The Courier-Journal.

Franzen, a food and sustainability educator at Fern Creek High School in Jefferson County, said he showed up to his first food-literacy class at FCHS with plans to teach about "healthy" foods, new and improved cooking techniques and how to grow a garden.

"My students balked," he wrote, saying they pushed back on his curriculum with real-world issues that screamed of the geographic and socioeconomic realities that often segregate people into those who can afford to eat "healthy" and have access to fresh, healthy foods and those who can't and don't.

"They complained of not having the tools to cook at home or the ability to purchase ingredients on a budget.They explained how apartments don’t have yards to dig up.They talked about how junk food tastes good," he wrote.

So Franzen said he shifted the focus of the class, realizing that it would have to deal with the "dynamic realities" of his students.

Franzen noted that one of the first changes he implemented was to ask his students: "What is your food reality? What is your definition of 'good' food? What are the recipes that your family values? What are the boundaries that you face in eating well?"

Which, he said, led to "student-written food narratives, lessons in food discourse and debate, class cookbooks, 30-student potlucks, and conversations about what people deserve, what is just and right -- all while using our city as a classroom, textbook, and laboratory to explore and critically engage."

And all of this led to "talking about socioeconomic status, income inequality, privilege, race, religion, gender, and ethnicity," he wrote. "All I started out wanting to do was teach a couple of recipes, encourage less soda consumption, and show how to put a plant in a hole."

Franzen said he was "glad that students sent back the first version of 'food literacy' and that the new curriculum now formally "looks like Food Lit., a food-themed pre-AP English course, Cooking Club, Food Sociology, Global Issues, and Environmental Club."

"Through this process, I realized what good teaching should be: responding to the needs and curiosities of the students to help them critically engage and question the world in a way that allows them to improve themselves and the community around them," he wrote.

In conclusion, Franzen challenged all of us to find common ground around the table, to build a relationship over sharing a meal, and "to engage the world around us in a meaningful, sustaining, and compassionate way," and to come back for seconds.

He wrote: Food literacy "isn’t just about eating “healthy” or learning to cook, it is about building community and building resiliency within ourselves and together during such divisive times."