HIV outbreak in Appalachian Ky. 'just a matter of time;' majority of counties CDC calls most vulnerable have no syringe exchange

An outbreak of the human immunodeficiency virus, which leads to AIDS, is “just a matter of time” in Appalachian Kentucky because of conditions in the region and the lack of syringe exchanges for intravenous drug users in most vulnerable counties.

Dr. Jennifer Havens

That's what Dr. Jennifer Havens, an epidemiologist at the University of Kentucky, told the Courier Journal's Laura Ungar for a story updating the county-by-county threat first identified by the federal Centers for Disease Control and Prevention in 2016.

Using "statistics tied to injecting drugs, such as overdose deaths, prescription-opioid sales, low income and unemployment," Ungar notes, the CDC identified 220 counties in the U.S. that were most vulnerable to outbreaks of HIV or hepatitis C, a liver infection that can also be spread by needle sharing.

Kentucky has 54 of those counties, mostly in Eastern and Southern Kentucky, but 30 of them "haven’t given the go-ahead for needle exchanges," Ungar reports. "And programs approved in the vulnerable counties of Wolfe, Perry and Letcher have yet to open." Ungar's story has a national, interactive map with the ranking of each county.

Ungar adds, "Elizabeth Turner, director of the district health department covering those counties, said they’ve managed to partly fund Wolfe’s exchange but are having trouble buying needles because some of the grant money can’t be used for them. She explained the situation to a state health official this week, she said, and was told Kentucky just received harm reduction funds that will be sent out to counties, including Wolfe. Although this money also can't be used for needles, Turner is hopeful it could offset other expenses," freeing up money to buy syringes.

"HIV has been found across Appalachia, though known rates so far are lower than in urban Kentucky, where testing is more common," Ungar reports. "April Young, a University of Kentucky assistant professor of epidemiology, said less HIV testing in Eastern Kentucky means the disease could be spreading silently."

As evidence of that, "Researchers point to an explosion of HIV’s widely-accepted harbinger: the potentially deadly liver disease hepatitis C," Ungar notes. "Like HIV, 'hep C' can be spread by sharing needles. And it’s easier to contract, so it’s not uncommon to have both diseases. . . . Havens’ long-term study of Eastern Kentucky drug users found that once they start shooting up, most get hep C within a year. . . . From 2008 to 2015, Kentucky had the nation's highest rate of new, acute hep C infections, with 1,089 cases. Another 38,000 Kentuckians live with chronic hep C. "

Meanwhile, “People have forgotten about HIV. … But it’s becoming clear you have the stage set for a major increase in these infections (in places) we’ve basically ignored,” Dr. Paul Volberding, director of the AIDS Research Institute at the University of California-San Francisco, told Ungar. “Whenever we have an infectious disease and we turn our back, it bites us.”

Ungar writes, “Many believe the solution begins with fighting addiction in each family, school and community. But the sheer scope of the drug scourge dwarfs grassroots efforts."

Medicaid expansion had much bigger impact in rural areas; advocates worry about impact of tax bill on programs

By Melissa Patrick
Kentucky Health News

The expansion of Medicaid under the Patient Protection and Affordable Care Act resulted in larger coverage gains in rural areas than urban ones, suggesting that any roll-back of the program would hurt rural America the most, according to a recent University of Louisville study.

The study, published in The Journal of Rural Health, found the percentage of low-income residents who signed up for health insurance through the expansion was greater in rural regions compared to urban ones: an 8.5 percent increase, compared to a 4.1 percent increase, respectively.

These findings are especially important to Kentucky, which had more rural people sign up for Medicaid through the expansion of the program to people who earn up to 138 percent of the federal poverty level than any other state, according to the Kentucky Center for Economic Policy.

In all, 478,000 Kentuckians signed up for coverage through the expansion and 223,700 of them lived in rural areas. Medicaid as a whole covers about 1.4 million Kentuckians. For a spreadsheet of enrollment by county in June 2017, click here.

The U of L researchers used data from the 2011-2015 Behavioral Risk Factor Surveillance System and compared trend changes for coverage, access to care and health care utilization in response to Medicaid expansion among urban and rural residents.

Joseph Benitez, who led the study as an assistant professor in U of L's School of Public Health and Information Sciences, said that even with the Medicaid expansion, cost-related barriers weighed more heavily on rural residents related to things like transportation to a medical provider. He said that can be problematic for individuals who live in health provider shortage areas.

“Any efforts by the government to roll back Medicaid expansion will certainly disproportionately affect the ability of rural residents to gain affordable coverage and access to care,” Benitez said in a news release.

Health advocates fear impact of tax cuts

While there isn't much talk right now about repealing and replacing the Affordable Care Act, the tax bill that is about to become law could trigger cuts to Medicaid funding down the line to help reduce the deficit most economists expect it to create.

Janet Currie, chair of the economics department at Princeton University and co-director of the Center for Health and Wellbeing, told Daniel Bush of "PBS NewsHour" that potential cuts to Medicare and Medicaid are "by far the most important potential impact of the tax bill on the health-care system. A $1.5 trillion (or larger) deficit will necessitate spending cuts. And cutting large social programs like Medicare and Medicaid using across the board cuts is the absolute worse way to do it."

Medicaid is jointly funded by the federal government and states, with the payment mix for traditional coverage varying depending on how poor the state is. For example, the federal government pays an average of 57 percent of traditional Medicaid costs, but pays 70 percent of the costs in Kentucky.

Medicaid expansion is paid at a higher rate. The federal government paid the full amount of the expansion until 2016; states are paying 5 percent of the cost this year, rising in steps to the law's maximum of 10 percent in 2020.

New 'bridge clinics' at UK and Northern Kentucky link emergency care to opioid-addiction treatment; U of L will also have one

Patients with opioid addictions who are treated in emergency rooms at the University of Kentucky or St. Elizabeth Hospital in Northern Kentucky can now go directly into addiction treatment if they choose it.

"An essential part of the substance-use-disorder treatment system is to be able provide treatment on demand rather than sending patients who are at risk for overdose death to treatment waiting lists," Dr. Laura Fanucchi, one of the creators of the clinic, said in a UK news release. "This way we can engage patients and link to treatment at the moment of contact with the health care system, and hopefully reduce substance use related morbidity and mortality."

The First Bridge Clinic, located at the UK Center on Drug and Alcohol Research, is set up to provide evidence-based care including medications approved by the U.S. Food and Drug Administration "for opioid-use disorder, counseling services, and monitoring aimed to promote remission and recovery," says the release.

UK's "bridge clinic" is one of three that are part of a project to fight opioid abuse in the state, funded by a nearly $10.5 million 21st Century CURES Act grant that is earmarked to be spent on a combination of evidence-based projects that focus on prevention, treatment and harm reductions.

St. Elizabeth opened the second bridge clinic at its Edgewood hospital in October and is working to expand its services to other St. Elizabeth hospitals, Terry DeMio reports for The Cincinnati Enquirer. The third one will be affiliated with the University of Louisville Hospital.

The news release says that after being awarded the grant, the state began to look for ideas to address the opioid epidemic and Drs. Sharon Walsh, Michelle Lofwall and Laura Fanucchi submitted a plan to make hospital emergency departments a first point of treatment for people with addictions.

“We’re developing a new clinic and it’s going to partner closely with the ED so when patients are referred they can receive care rapidly and within the same health care system with the aid of peer support,” Walsh said in the release.

Patients with opioid-use disorders end up in an emergency room for a variety of reasons, whether it be an overdose or a "deep-seated infection" related to their injection sites. Until now, such patients would be treated for their overdose or medical condition, but would not receive care for their underlying substance disorder.

"The need for this clinic is clear," Lofwall said in the release. “If the underlying addiction isn’t treated the person goes back to active addiction and is at very high risk for death and/or reinfection requiring another hospitalization with complicated medical and surgical treatments.”

Pilot project will target men in the workplace in eight Kentucky counties, in an effort to prevent lung cancer

Eight Kentucky counties have been chosen to be part of a pilot program that will target males in the workplace to decrease lung cancer in the state, Renee Beasley Jones reports for The Messenger-Inquirer in Owensboro.

"Kentucky has the highest rate of new cases and deaths from lung cancer in the nation, and in many counties throughout Kentucky, the rates are significantly higher in males than females," Jennifer Redmond Knight, assistant professor of health management and policy at the University of Kentucky College of Public Health, told Jones.

The eight counties are Casey, Christian, Clay, Jackson, McCracken, Ohio, Perry and Warren. Jones writes that they were chosen based on their rates of lung cancer, poverty status, whether they were considered medically under-served, had low levels of literacy and high rates of hospitalizations.

The project is funded by the Centers for Disease Control and Prevention's SelfMade Health Network, which works toward tobacco and cancer prevention efforts in populations that have high disparities of both.

Kentucky Cancer Registry maps show lung cancer incidence and mortality rates
 for men in Kentucky between 2010 and 2014. Second map highlights Casey County.

The program, called Lung Cancer Prevention and Survivorship Is Good Business, will target businesses where more than half the employees are men. It will be coordinated by the College of Public Health, the Kentucky Cancer Program and the Kentucky Cancer Consortium.

The pilot is targeting men in workplaces because they have "significantly higher rates" of cancer and deaths from lung cancer, and because the Kentucky Cancer Program has learned through experience that one of the best ways to reach men with health-related information is at work, Jennifer Redmond Knight, who is also the lead investigator, told Jones.

She added that the goals of the program include: reducing the smoking rate, increasing the number of radon tests conducted in homes, reducing the number of people exposed to secondhand smoke and increasing lung-cancer screenings. The ultimate goal is to reduce lung cancer rates in Kentucky.

Radon,which is an odorless, colorless and tasteless gas, is the second leading cause of lung cancer and studies show that the combination of radon gas and cigarette smoke increases the risk for lung cancer more than either factor alone. Click here for more information about radon and to learn how to get a free radon test kit.

The pilot program will eventually develop a lung cancer work site resource kit, based on feedback from participating businesses, that can be used across the state. The pilot is expected to go through January 2019.

Jones writes that six businesses in Ohio County are participating in the program including Perdue Foods, which has an extensive wellness program. Angie Hudnall, the plant's RN health improvement program specialist, told Jones that the pilot program complements their plant's health improvement program.

She said: "The pilot program matches our focus on primary care, prevention and early intervention to improve associate health and reduce health-care costs -- for our associates and for our company."

10 states gave Medicaid clients incentives for prevention; Ky. was not among them, but pending waiver would include one

Under the Patient Protection and Affordable Care Act, 10 states participated in a program that offered incentives to Medicaid clients if they engaged in  targeted efforts to prevent chronic disease.

Patricia Alexander of California was a recipient of one of those incentives, which prompted her to get a mammogram. She told Anna Gorman of Kaiser Health News that every time she made an appointment, something came up, and it wasn't until her doctor's office promised her a $25 Target gift card that she was motivated to make the appointment and keep it. The mammogram was negative for breast cancer, but not all mammograms are.

Other states participating in the five-year demonstration projects were Connecticut, Hawaii, Minnesota, Montana, Nevada, New Hampshire, New York, Texas and Wisconsin. In all, they were awarded grants totaling $85 million, Gorman reports.

The practice of offering rewards as a motivation for patients to engage in more preventive care and to make healthier lifestyle choices has long been a practice of private health plans and the demonstration project was created to see if this practice would also work with the Medicaid population.

The states used the incentives for a variety of programs including ones to encourage people to enroll in diabetes prevention, weight management, smoking cessation and other preventive programs.

For example, California's program offered gift cards and nicotine replacement therapy to people who called the state's smoking cessation line and Minnesota's program gave cash to people who attended a diabetes prevention class and completed bloodwork, Gorman reports.

An evaluation of these programs, released in April, found that the incentives helped persuade the Medicaid beneficiaries to participate in preventive activities, but it wasn't able to show that the programs prevented chronic disease or save Medicaid money. The report noted that this was largely because the prevention of chronic diseases could take years to manifest.

Gorman reports that research on the effectiveness of financial incentives for the Medicaid population has been mixed.

She also points to a report released this year by the liberal-leaning Center on Budget and Policy Priorities that found incentives were good to change immediate behaviors like keeping a doctor's appointment or attending a class, but were less likely to change long-term behaviors, like weight loss.

“The thing that is most likely to help Medicaid beneficiaries utilize care appropriately is actually just giving them access to that care — and that includes providing transportation and child care,” Hannah Katch, an author of the center's report, told Gorman. She added that another barrier is being able to take time off work to go to the doctor.

The report says that these types of incentive programs have proven to pose administrative challenges as well as provider engagement and participation challenges. In addition, it says patient and provider education about the programs; identifying and engaging beneficiaries to participate; establishing the infrastructure to offer and provide the incentives; and the added costs to states to implement these programs have all provided challenges to such programs.

A huge motivator to these incentives programs is to help clients become healthier because insurers "know they can reduce their costs -- and increase their profits -- if their patients are healthier," Gorman writes.

Doug Hogan, spokesman for Kentucky's Cabinet for Health and Family Services, said the state doesn't have such an incentive program for its Medicaid beneficiaries, but if federal officials approve its new Medicaid program, which state officials call Kentucky HEALTH, it will have incentives to encourage members to improve their health and be active members of the community.

"The program would do so by offering My Rewards dollars for activities like accessing preventive-care services, taking health and financial literacy classes, and participating in job training programs," Hogan said. "Members can then use the dollars to access some services not covered by the Kentucky HEALTH plan. Furthermore, members can receive up to $500 from their My Rewards account once they transition to a commercial insurance plan for at least 18 months."

Gov. Matt Bevin proposed changes to Kentucky Medicaid by requesting a waiver from federal rules more than a year ago. The proposal largely targets "able-bodied" adults who qualify for Medicaid under the ACA's expansion of the program to those who earn up to 138 percent of the federal poverty level. It is expected to be approved.

Bevin's lawsuit against Planned Parenthood revived

The Kentucky Court of Appeals has reinstated Gov. Matt Bevin's lawsuit that claims Planned Parenthood of Indiana and Kentucky illegally provided 23 abortions at its Louisville clinic.

Steve Pitt, Bevin's general counsel, said in a statement: “The facts are clear and alarming: Between Dec. 3, 2015 and Jan. 28, 2016, Planned Parenthood’s Louisville facility performed 23 abortions without proper licensing or emergency safeguards in place.”  The Bevin administration is seeking fines of more than $500,000, the newspaper reports.

A Louisville judge had dismissed the case in July, finding that "Planned Parenthood had been following directions of state officials when it began offering abortions in December as part of its effort to obtain a state license," the Courier Journal reported then.

The unanimous Dec. 15 ruling by a three-judge Court of Appeals panel said, "While the Cabinet [for Health and Family Services] may have a difficult time proving its allegations, we believe said allegations are sufficient to state a claim upon which relief can be granted." The trial judge had said the charges were insufficient.

“As the ruling states, this decision is not a statement on the merits of the case,” Christie Gillespie, President and CEO of the Planned Parenthood unit, said in a statement. “PPINK sought the advice of the governmental agency charged with overseeing licensure and followed its guidance. We did nothing wrong, and we are confident the courts will agree. We are committed to providing high-quality health care for all at our Kentucky health centers, and we will continue to do so while this case is litigated.”

States use only 3 percent of tobacco revenue for tobacco prevention, and Kentucky spends even less: 0.7 percent

When cigarette manufacturers agreed in 1998 to pay billions of dollars to settle a lawsuit by states seeking reimbursement of health costs related to smoking, the presumption was that the states would spend a large part of the money on tobacco prevention. Few have, and Kentucky is among the low spenders, though it is a national leader in smoking and tobacco-related health costs.

Those points are made annually in reports by the Campaign for Tobacco-Free Kids, the American Cancer Society Cancer Action Network, the American Heart Association, the American Lung Association, the Robert Wood Johnson Foundation and the Americans for Nonsmokers' Rights and Truth Initiative.

The latest report, "Broken Promises to Our Children: A State-by-State Look at the 1998 Tobacco Settlement 19 Years Later," says states will spend less than 3 percent of this fiscal year's settlement funds and tobacco taxes – $27.5 billion out of $721.6 million – "on programs to prevent kids from smoking and help smokers quit."

The report says Kentucky will get $371 million this fiscal year from the settlement and tobacco taxes, but will spend only $2.6 million on tobacco prevention, a meager 0.7 percent. The spending is less than 5 percent of the $56 million that the federal Centers for Disease Control and Prevention says the state should spend.

Meanwhile, tobacco companies spend $250 million a year on marketing in Kentucky, and $8.9 billion nationally – "$1 million every hour – to market their deadly and addictive products," the report says.

That's way out of whack, said Charlie Ross of Mayfield, board chair of the Foundation for a Healthy Kentucky. "Health care expenses and productivity losses tied to smoking total more than $19 per pack, yet the state gets just 60 cents per pack in tobacco taxes," Ross said in a release. "It seems pretty straightforward that we need to focus more resources on preventing what's behind these costs. We'll not only reduce health-care expenditures, we'll save lives and draw more jobs to the Commonwealth from companies that need a healthy workforce to grow their business."

Ben Chandler, president and CEO of the foundation, said "Kentucky continues to make small strides in reducing smoking rates among both adults and youth, but we remain substantially higher than the national average and almost every other state. That's particularly true in Appalachian counties, where the rate hovers around 30 percent, double the national average. The single most effective way to reduce these rates is to raise the price of cigarettes through a substantial state tax increase of at least $1 per pack."

Kentucky ranked 42nd in America's Health Rankings this year, up from 45th last year, but there's little to celebrate

Kentucky moved up three notches in the latest America's Health Rankings, from 45th to 42nd, but its improvement stemmed mainly from gains in the factors that determine health, not the actual health outcomes. The state was 39th in health determinants (clinical care, policy, community and environment) but 46th in outcomes, such as the death rate from cancer, which is the nation's worst.

That was reflected in the rankings of behaviors, such as the smoking rate and the rate of drug deaths, both second largest in the nation, as well as obesity and physical inactivity. But the behavior score was helped by a high rate of high-school graduation and a low rate of excessive drinking.

The state's highest rankings came in health policy. It was ninth in the nation in the percentage of residents covered by health insurance, thanks to its expansion of Medicaid under the Patient Protection and Affordable Care Act. It also ranked better than average in some measures of community and environment, such as infectious diseases.

"Kentucky made progress in some areas, including expanding the number of residents with health insurance, but drug deaths are up dramatically, and our high rate of obesity remains a challenge," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky. "Our high smoking rate is a plague we know how to address, however. It's a huge contributing factor to our ranking as the cancer capital of the nation and our inability to reduce low birth-weight babies, heart disease and premature death. Smoking rates declined 2 percent nationally since last year, but only 1.4 percentage points in Kentucky. Raising the tobacco tax by at least $1 and enacting more smoke-free laws in counties and cities across the Commonwealth are two measures that will kick-start a greater decline in smoking rates and better health."

Since the rankings were first released in 1990, with the exception of 2008 when it ranked 39th, Kentucky has ranked in the bottom 10 states for health. It was 44th in 2010, 43rd in 2011, 44th in 2012, 45th in 2013, 47th in 2014, 44th in 2015, and 45th in 2016. Here are this year's figures:

We're in the final few days of open enrollment for insurance on healthcare.gov; automatic re-enrollment might not be the best way

Updated Dec. 11, 2017: This article has been edited to reflect that CareSource's marketplace products are not part of Humana.  

By Melissa Patrick
Kentucky Health News

You have just a few days to enroll in a 2018 health-insurance plan on healthcare.gov. Open enrollment under the Patient Protection and Affordable Care Act ends Friday, Dec. 15.

"The clock is ticking," Whitney Allen, the outreach and enrollment coordinator for the Kentucky Primary Care Association, said in an e-mail. " We encourage anyone that has questions about enrolling in a 2018 health insurance plan to contact their local application assister before Dec. 15!"

And even if you don't need marketplace coverage, Allen says you should remind others, because that seems to be the way most people are hearing about government-subsidized insurance this year.

"It seems word of mouth has been the best advertising, this open enrollment," Allen said.

The state health agency has said it is using direct mail, text messages, phone calls and e-mails to communicate with current policyholders and potential new enrollees about open enrollment because it no longer gets federal funds for outreach.

Allen said most people in southeastern Kentucky who have called for application assistance say they heard about the service from family members and friends who have used it.

Who needs coverage?

Anyone who doesn't have health coverage through a job, Medicare, Medicaid, the Children's Health Insurance Program, or other coverage that meets federal standards, needs to sign up for marketplace coverage or risk paying a penalty.

The penalty for not having health insurance in 2018 is $695 per adult and $347.50 per child, with a maximum of $2,085 per family, or 2.5 percent of the household's income, whichever is larger.

If you miss the deadline, and don't qualify for a special enrollment period, you will have to wait another year to sign up, says the healthcare.gov website.

Health advocates have encouraged consumers to actively pick a plan to make sure they are getting the best coverage for the best cost, even if they will be automatically re-enrolled, as around 80,000 Kentuckians could be if they don't pick their own plan.

Stan Dorn, a senior fellow at Families USA, an advocacy group, told Kaiser Health News that auto-enrollment doesn't take premiums or benchmark plan changes into account, which means that even if you are assigned to the same plan, your cost could be different next year.

Kaiser Health News has also reported that it's important to actively choose a plan because "if you don't like the plan you're auto-enrollled in this year you may be stuck with it in 2018, unlike previous years when people could generally switch."

In general, the federal exchange plans are more attractive to individuals and families who earn less than 400 percent of the federal poverty level because they will qualify for subsidized coverage. And those who make too much to qualify for a subsidy are encouraged to connect with a certified health insurance agent or a broker to determine whether an exchange or off-exchange plan is best for them.

CareSource, which is offering exchange plans in 61 Kentucky counties, encouraged consumers to also check to see if their doctors are on their plans network.

"Even if a plan did not include your doctor last year, check again for 2018. Some plans, like CareSource, have recently signed agreements with new provider groups. This means more doctors may be in network beginning on January 1, 2018," CareSource said in a news release.

Anthem Blue Cross Blue Shield is selling plans in the other 59 counties. Here's a healthcare.gov checklist of the information that you need to have available when you sign up for coverage:

Where can I get help?

Application assisters are available in every Kentucky county to help people sign up for coverage, and their services are free. There are also sign-up events throughout the state. To find an event in your county or an assister, go to healthbenefitexchange.gov.

Help is also available through the state call center at 855-459-6328 and the Healthcare.gov customer center at 800-318-2596, which is available 24 hours a day, seven days a week.

Click here for a livestream open enrollment information session that aired Friday, Dec. 8 on the Kentuckians for The Commonwealth Facebook page. The video features application assisters from the Primary Care Association.

Flu and pneumonia, which can result from flu, are 8th largest U.S. cause of death; officials urge all over 6 months to get flu shot

Flu season is here and will last through February or longer, prompting state health officials to encourage Kentuckians to get their flu vaccinations.

“During the holidays families and friends will gather, which increases the potential for exposure to the flu virus," Dr. Jeffrey Howard, the state's acting health commissioner, said in a news release. "We urge everyone who hasn’t received the flu vaccine, particularly those at high risk for complications related to the flu, to check with their regular health care professional, local health departments or other vaccine providers.”

Flu is a "very contagious" disease caused by a virus that spreads from person to person. Symptoms include fever, headache, cough, sore throat, runny nose, sneezing and body aches.

It can also be deadly. Flu and pneumonia are the eighth leading causes of death in the United States, according to the federal Centers for Disease Control and Prevention.

Just this week, Jennifer Earl of CBS News reported that a 20-year-old mother of two in Arizona died unexpectedly and quickly from flu.

Alani "Joie" Murrieta of Phoenix was being treated for the flu with an anti-viral medication called Tamiflu, but her health took a turn for the worse the day after her diagnosis. She was then rushed to the hospital, diagnosed with pneumonia and started treatment, but within two days of when she started feeling ill she was dead.

Murrieta's aunt, Stephanie Gonzales, warned the public to take the flu seriously.

"Don't take life for granted. If you feel sick, go to the doctor. Don't wait until your symptoms are so bad there is no turning back," she told CBS.

Kentucky's flu level as of Friday was classified as "regional," with 104 laboratory-confirmed cases, according to the state's weekly influenza surveillance report. Twelve of the state's 17 regions have had a confirmed case this flu season. As of Dec. 2, there had been no flu-related deaths reported in Kentucky.

NPR reports that the flu season could be "unusually harsh" this year because of several factors.

One is this year's early start to the season, which could make it last longer and infect more people. Another is that Australia had a severe flu season this year and the U.S. typically has a similar experience to what happens in the southern hemisphere.

Australia's bad season stemmed from a strain of the flu virus called H3N2 that tends to make people sicker than other strains, and because the flu vaccine was only about 10 percent effective against that strain this year in Australia. The U.S. is using the same vaccine as Australia, but its effectiveness in the U.S. is still unknown.

Health experts say that even an imperfect vaccine is better than no vaccine because it can help prevent or lessen the severity of the illness and also helps to promote "herd immunity" of the population.

The CDC recommends that everyone over six months of age get a flu vaccination, and especially encourages people who may be at higher risk for complications or negative consequences get one. They include:
• Children age six months through 59 months;
• Women who are or will be pregnant during the influenza season;
• Persons 50 years of age or older;
• Persons with extreme obesity (body-mass index of 40 or greater);
• Persons aged six months and older with chronic health problems;
• Residents of nursing homes and other long-term care facilities;
• Household contacts (including children) and caregivers of children younger than 5, particularly contacts of such children, or of adults 50 and older;
• Household contacts and caregivers or people who live with a person at high-risk for complications from the flu; and
• Health care workers, including physicians, nurses, medical emergency-response workers, employees of nursing home and long-term care facilities who have contact with patients or residents, and students in these professions who will have contact with patients.

Howard added, “You should also follow the advice your parents gave you to prevent flu and other illnesses that tend to circulate at this time of year – wash your hands frequently, cover your mouth when you cough or sneeze and stay home when you’re sick.”

House conservatives oppose McConnell-endorsed efforts to resume Obamacare subsidies to moderate-income people

https://www.politico.com/story/2017/12/08/susan-collins-obamacare-deal-213254

Groups pushing $1-a-pack increase in state cigarette tax make their sales pitch through an infographic

The group promoting a $1-a-pack increase in the state cigarette tax and local ordinances to ban smoking in workplaces has a new infographic to remind Kentuckians of the cost of smoking.

The graphic was created by Kentucky Voices for Health, part of the Coalition for a Smoke-Free Tomorrow, which says making the tax $1.60 per pack and raising other tobacco taxes would raise $266 million a year in revenue for the state. The average state cigarette tax is $1.71 per pack.

"Research shows that a tobacco tax increase in Kentucky must be at least $1 to achieve any health benefits," the coalition said in a news release. "Tobacco companies use coupons and other point-of-sale promotions to soften the impact of tax increases on the price of their products, so the tax increase has to be large enough to overcome those promotions."

"The current tax doesn't begin to cover the high cost of smoking in Kentucky," said KVH Executive Director Emily Beauregard. An extra dollar per pack will put a dent in those costs. More to the point of the coalition's work, it also will save lives and improve health."

Smoking's costs are measured not only in dollars, said Ben Chandler, chair of the coalition and CEO of the Foundation for a Healthy Kentucky, which staffs it. "Nearly 9,000 deaths every year in Kentucky are directly related to smoking, more than alcohol, AIDS, car crashes, illegal drugs, murders, and suicides combined," Chandler said. "If we don't start reducing smoking rates in Kentucky right now, 119,000 of today's youth will die early due to tobacco use."

The release said "5,900 Kentucky babies would be born healthier over a five-year period because their moms would quit smoking if the state enacted a $1 tax increase. The Campaign for Tobacco-Free Kids estimates that a total of 29,400 adults would quit smoking, and 23,200 kids would never start." The second page of the infographic appears below.