KentuckyOne in negotiations for sale of major Louisville facilities; selling St. Joseph Martin to Appalachian Regional Healthcare

KentuckyOne Health could be getting close to selling several hospitals in Louisville and one in Eastern Kentucky to different investors.

KentuckyOne announced Dec. 19 that it had signed a letter of intent with Appalachian Regional Healthcare to negotiate the sale of Saint Joseph Martin, a 25-bed critical-access hospital in Floyd County.

"We are pleased to be talking with this organization to guide the future of care for this unique community,” Kathy Stumbo, president of St. Joseph Martin, said in a news release. “ARH knows this community and has the experience and insight to continue improvements and investments to support patients, physicians, employees and all in this region.”

ARH is a not-for-profit health system that serves Eastern Kentucky and southern West Virginia. It operates 11 hospitals and several other health facilities. It is the largest provider of care and the single largest employer in southeastern Kentucky and the third largest private employer in southern West Virginia, according to the release.

On the same day, KentuckyOne and its parent company, Catholic Health Initiatives, announced that they had entered into"exclusive negotiations" with BlueMountain Capital Management, a New York-based hedge fund, for the sale of some of their Louisville facilities, according to a separate news release.

KentuckyOne announced in May that it planned to sell most of its hospitals and provider facilities. The Courier Journal reported: "Besides Jewish, its flagship hospital, the health system will sell Frazier Rehab Institute; Sts. Mary & Elizabeth Hospital; Medical Centers Jewish East, South, Southwest and Northeast; Jewish Hospital Shelbyville; Saint Joseph Martin and KentuckyOne Health Medical Group provider practices in Louisville and Martin."

The sales would leave KentuckyOne with this footprint: Our Lady of Peace, a behavioral-treatment hospital in Louisville, Flaget Memorial Hospital in Bardstown, Saint Joseph Hospital and Saint Joseph East in Lexington, Saint Joseph Jessamine in Nicholasville, Saint Joseph Mount Sterling, Saint Joseph London and Saint Joseph Berea, and affiliated provider practices.

KentuckyOne notes that the negotiations have just begun and that any transactions would be subject to due diligence and regulatory approvals. Both sets of negotiations are expected to continue over the coming months, says the releases.

GOP senator pre-files bill to raise cigarette tax by $1, use money to pay for Medicaid treatment of tobacco-related illnesses

Sen. Stephen Meredith

Raising Kentucky's cigarette tax by $1 is one small step closer to reality, as Sen. Stephen Meredith pre-filed a bill Dec. 6 to do so. However, Meredith says it shouldn't be called a tax, but a "health care reimbursement assessment."

Meredith, a Republican from Leitchfield, told Spectrum News that the proposal would generate $300 million each year and that most of it would benefit the state's Medicaid program, freeing up dollars for other needs like pensions, education and workforce development.

The bill would create a $1 "health care reimbursement assessment" on every pack of cigarettes sold in Kentucky, raising the total tax to $1.60 per pack. The average state cigarette tax is $1.71. The tax would make parallel increases in other tobacco taxes.

The bill calls for 90 percent of the money to go to a reimbursement fund for Medicaid treatment of tobacco-related illnesses. The remaining 10 percent would fund tobacco-cessation programs in counties that have comprehensive smoke-free ordinances.

The bill says, "Amounts deposited in the fund shall not be used for expansion of the Medicaid program . . . and shall not be appropriated or transferred by the General Assembly for any other purposes."

Meredith told Spectrum News, “What I’m trying to do through this bill is recognize that people have the right to smoke. I don’t begrudge them that, but don’t ask me to pay for your health-care costs whenever you incur those illnesses that you know you’re going to have. It’s created a tremendous financial burden, I think, for our state.”

He said the $1 raise would create an economic incentive for tobacco users to quit, which would result in a multitude of benefits including a healthier population, decreased health costs to the state, increased productivity, healthier children and fewer kids smoking.

Kentucky has the nation's second highest adult and youth smoking rates, 24.5 and 17 percent. It also has the highest cancer death rate, and 34 percent of those deaths are related to smoking. Smoking-related health costs in Kentucky have been estimated at $1.92 billion a year.

Meredith, who was a longtime hospital administrator in Leitchfield, said he's optimistic the measure will pass the 2018 General Assembly, but recognizes the challenges.

“Everybody’s got an aversion to taxes,” he said. “That’s why we’ve had difficulty getting this done in the past. All I’m doing is asking people to be responsible, be accountable for your own health and don’t ask non-smokers to pay for your health care in the future if you’re going to choose to do this.”

Meredith's bill drew favorable comments from key legislators on the Dec. 18 "Kentucky Tonight" on KET.  "I see it not so much as an increase in taxes but an increase in the user fee," said Rep. Addia Wuchner, chair of the House Health and Human Services Committee. Her Senate counterpart, fellow Republican Julie Raque Adams, said she was interested in targeting Medicaid, partly because "We have very very high rates of smoking in the expansion population."

Raising the cigarette tax by at least $1 is a main objective of a newly formed coalition of more than 100 health-care, business, education and health-advocacy groups called Coalition for a Smoke-Free Tomorrow, staffed by the Foundation for a Healthy Kentucky. The groups have touted the tax as a public-health tool and a partial answer to the state's budget problems, without making any recommendations on how the money should be spent.

"It’s time to enact the proven measures that will reduce smoking and its related illnesses, reduced quality of life and massive health care expenditures in Kentucky," foundation President and CEO Ben Chandler wrote in an op-ed for Kentucky news outlets. "We can honor our tobacco heritage without allowing it to continue plaguing both our health and our economy. We urge you to contact your legislators and tell them you support a $1 tobacco tax increase because it’s a win-win-win for Kentucky."

Marijuana, tobacco and opioids will get different types of debate than in previous legislative sessions, lawmakers indicate

Legislators will debate what to do with drugs of several types when the General Assembly opens in Frankfort Tuesday, Jan. 2. And the debates may be different than in past sessions, if the discussion on the Dec. 18 "Kentucky Tonight" on KET is indicative.

The four lawmakers, including the two health committee chairs, indicated that the use of marijuana will be debated more openly than before, and even for recreational purposes, and that more action will be taken against the opioid epidemic.

"I think we’re gonna see a little bit of everything introduced," said Louisville Republican Julie Raque Adams, chair of the Senate Health and Welfare Committee. "I think we’re gonna see a recreational bill," in addition to legislation for medical marijuana.

"A lot of people across the state of Kentucky have told me they’re tired of talk" and want to see some votes on the issue, Adams said. "We’re gonna see a lot of testimony."

When host Renee Shaw asked if efforts to legalize marijuana would have trouble because some see it as gateway drug, or if there might be less resistance because it is seen as less harmful than opioids, Democratic Rep. Chris Harris of Pike County indicated the latter.

"I think the time is coming in Kentucky for medical marijuana," he said, adding that he has an "open mind" on the issue.

L-R: Reps. Angie Hatton, Chris Harris, Addia Wuchner; host Renee Shaw; Sen. Julie Raque Adams

Rep. Angie Hatton, D-Whitesburg, said "My constituents want to talk about it more than almost any other issue," and it offers the possibility of tax revenue. "We have to talk about it."

Rep. Addia Wuchner, R-Florence, chair of the House Health and Human Services Committee, was skeptical of medical marijuana. A registered nurse and former hospital administrator, she said more research is needed.

Harris said, "There is some track record in other states," and added, "It could help a certain group of people."

Wuchner said legislators are trying for a comprehensive approach to the opioid epidemic, and Adams said they need to discuss a holistic approach with alternative approaches to drugs as the first option for pain relief.

Adams said Kentuckians should expect to see some criminal-justice reforms aimed at steering violators into recovery rather than putting them behind bars. "The trend lines for incarceration are all going in the wrong direction," she said. "We have to be creative about this opioid problem."

Adams said she will introduce a bill to keep the state from pre-empting local smoking ordinances, which are now a focus of anti-smoking advocates because Republican Gov. Matt Bevin opposes a statewide smoking ban. The bill would ban any state limits on local smoking laws.

Adams, who favors a statewide ban, said proposals for it prompted calls for local control, and "We listened. This is a creative way for us to say, 'Hey, start doing it.'" She noted that a Senate-passed bill to ban tobacco at all Kentucky schools got nowhere in the House.

Hatton said tobacco control "needs to be local decision" because it is "a personal freedom issue for a lot of people." Harris agreed, saying smoking bans should be "a step-by-step process. We need to walk before we can run."

#SinkDiabetes campaign asks Kentuckians to shoot a trick shot to fight a disease that many in state have or are at risk of having

Shooting hoops to bring awareness and raise money for diabetes sounds like something Kentuckians could get excited about.

The Barnstable Brown Diabetes Center at the University of Kentucky says it has started a social-media campaign called #SinkDiabetes to bring awareness to a disease that affects more than 458,000  Kentuckians, or 13.4 percent of the population, more than the average state.

The campaign involves recording yourself taking a trick shot and posting it on social media with the hashtag #SinkDiabetes and tag three other people. For every #SinkDiabetes post, $10 will be donated to the diabetes center.

In addition, each person participating is asked to challenge – and tag – three more friends to participate in the #SinkDiabetes campaign. The campaign will run through the end of January.

The state's 2017 Kentucky Diabetes Fact Sheet calls the disease a "public health epidemic," adding that more than one-third of Kentuckians (37 percent) have a condition called pre-diabetes, which puts them at risk for the disease -- and most of them don't know it.

UK Markey Cancer Center gets outstanding achievement award

Lucille Parker Markey Cancer Center at UK

The Lucille Parker Markey Cancer Center at the University of Kentucky is one of 16 accredited cancer programs nationwide to receive the 2017 Outstanding Achievement Award from the American College of Surgeons Commission on Cancer.

The award is intended to recognize those cancer programs that achieve excellence meeting the commission's standards; motivate other cancer programs to work toward improving their level of quality cancer care; facilitate dialogue between award recipients and health care professionals at other cancer facilities for the purpose of sharing best practices; and encourage honorees to serve as quality care resources to other cancer programs, according to a University of Kentucky news release.

"I'm incredibly proud of the efforts our physicians, nurses, and other medical staff put in on a daily basis," Dr. Mark Evers, director of the center, said in the release. "This latest national award is another recognition of the hard work that goes on here, and the top-tier care we're able to offer patients from the Commonwealth and beyond."

Earlier this year, U.S. News & World Report named Markey one of the top 50 cancer programs in the nation. Additionally, Markey received a prestigious National Cancer Institute designation in 2013 and is up for renewal of this designation in 2018.

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."