Number of Ky. parents claiming religious exemption for kids' shots rises 59% after new state rule makes exemption easier to get

Lexington Herald-Leader photo

More Kentucky children are not being immunized "for medical and religious reasons," Ashleigh Mills reports for Spectrum News. "Doctors worry the number could be growing because of misinformation circulating online."

In the last school year, parents of 442 sixth graders exempted them from vaccines. That was only 1.5 percent of the total, but an increase of 59 percent from the 278 in the 2016-17 school year.

One likely reason for the increase was a regulation enacted by the administration of Gov. Matt Bevin, which made it easier for parents to invoke a religious exemption. It allows them to download a form, have it notarized and submit it to their school upon enrollment, instead of having to obtain it from their health-care provider along with their signature.

"Groups like the Kentucky Vaccine Rights Coalition support the exemptions and health choice not to vaccinate," Mills reports. "However, Spectrum News One was turned down for an interview with the group."

Julie Miracle, a nurse consultant with the Cabinet for Health and Family Services, told Mills, "I think there is miscommunication out there. I think that people are looking on the internet, and there’s you know, false information out there. [Children] would not be protected, and so when they get those exemptions, that they are vulnerable to those diseases."

Miracle encourages parents to use authoritative sources, such as the federal Centers for Disease Control and Prevention, for information on vaccines.

Advocates worry Medicaid plan will cause the most vulnerable to be kicked off rolls, say 'medically frail' designation is inconsistent

By Melissa Patrick

Kentucky Health News

As Kentucky moves toward implementing a stricter Medicaid plan, a group of providers, consumers and health advocates say they worry that its penalties, work rules and "onerous reporting requirements" will cause people to lose their coverage, especially those in the state's most vulnerable populations.

The group participated in a Dec. 5 Insure Kentucky news conference. Insure Kentucky, led by Kentucky Voices for Health, is a coalition of nonprofits that promote policies to improve access to care for all Kentuckians.

The state calls its new Medicaid plan Kentucky HEALTH, for "Helping to Engage and Achieve Long Term Health." It is also referred to as the "waiver," since it is implemented through a waiver of normal Medicaid rules.

Among other things, the plan will require "able-bodied" beneficiaries to work, volunteer, participate in job training or go to drug treatment at least 80 hours a month, and then report the hours. Failure to report would result in loss of coverage, though it could be regained by taking a course in financial or health literacy.

The original version of the plan was vacated in late June just days before it was set to roll out. U.S. District Judge James Boasberg of Washington, D.C., ruled that, among other things, Health and Human Services Secretary Alex Azar had not fully considered the state's projection that in five years under the plan the state's Medicaid rolls would have 95,000 fewer people than without the plan.

Federal officials re-approved the plan Nov. 20. It is tentatively set to start April 1, with the work and community engagement requirements to be phased in regionally, but more legal action is expected.

Kentucky HEALTH has a long list of exemptions for "medically frail" people, including those who are chronically homeless, have a severe mental-health diagnosis or are victims of domestic violence. But advocates on the press call said the "medically frail" designation process has been inconsistent.

Krista Seymour, a freelance television producer, said that while she was able to work and had steady employment, her work schedule varies each month, often because a medication she takes for thyroid cancer makes her too sick to work. She said she must take the medicine for the rest of her life, or die.

Seymour said she has applied for medically frail status, but has been denied twice because the state says she's not frail enough to qualify. But Seymour says: "I cannot get anybody to actually give me a name or a criteria of what actually meets a medically frail designation."

Until Kentucky HEALTH is implemented, there is no official "medically frail" status.

Ramona Johnson, president and CEO of Bridgehaven Mental Health Services, said her organization has experienced similar difficulties in getting some of their members a "medically frail" designation.

“We’ve been advised on more than one occasion that anyone who is diagnosed with a severe and persistent mental illness will automatically be considered medically frail and therefore exempt from the work or community engagement requirements, but we really have not found this to be true with any consistency, and we’ve been submitting information on our members for several months," she said. "The managed-care organizations that we work with are receiving denials of medically frail status on some of our members, all of whom have a severe and persistent mental illness."

Johnson said her organization supports work programs for their members, but would like to see the requirements be based on a person's capacity to work, not a set number of hours. She said many of their members work in jobs that are tailored to their abilities, and they simply can't manage a 20-hour work week. In addition, she said the reporting requirements would be an issue for her members.

“For those of our members who can and do work, the 20 hours a week or the 80 hours a month expectation is really very arbitrary and quite unrealistic," she said. "When they lose Medicaid coverage as a result of this, then we have a group of very vulnerable people who are at risk of becoming symptomatic without treatment." She added that research shows that when this happens, people with severe mental illness often end up in the emergency room or jail, or homeless.

Andrea Miller of the Kentucky Coalition Against Domestic Violence voiced concern that victims of domestic abuse will have to self-report and identify as a victim to get a medically frail designation.

Doug Hogan, spokesman for the Cabinet for Health and Family Services, said in an e-mail that there is an appeals process for people who believe they are inappropriately denied a medically frail designation.

Hogan said there are three ways to be designated as medically frail: through an automated tool based on claims data; a provider's attestation for medical or mental-health conditions that don't have adequate claims data; or through self-attestation if the person is chronically homeless, a victim of domestic violence or if they have difficulty completing one of the "activities of daily living."

He added that providers have access to an online guidance for filling out the attestation forms, which  includes a long list of conditions that would qualify as medically frail.

"To be clear," he said, "Medicaid sets the state policy, and the MCOs [managed care organizations] administer according to policy, so that practices are consistent across the state."

The three organizations that filed suit against the waiver are expected to file an amendment to their case soon. Cara Stewart, an attorney with the Kentucky Equal Justice Center, one of the three organizations that filed the lawsuit on behalf of 16 Kentucky Medicaid recipients, said last week that they were working on amending their complaint, but first had to check with all of the plaintiffs since some of their circumstances had changed since the suit was filed.

Stewart is hopeful the plan can be blocked again. "It's hard to expect a different result with everything the same," she said.

Emily Beauregard, executive director of Kentucky Voices for Health, said "This waiver is nearly identical to the original plan with the same types of barriers and red tape, and completely ignores new evidence that reporting requirements only work to reduce coverage."

Beauregard was referring to the more than 12,000 people who have fallen off the Arkansas Medicaid rolls since the state implemented its work and reporting requirements, as well as a recent report that shows 10,000 Supplemental Nutrition Assistance Program (formerly food-stamp) recipients in Kentucky have lost this benefit since the state implemented similar work and reporting requirements.

As more lack health insurance and signups lag, Modern Healthcare editor worries what will happen if economy slows

The share of Kentucky children without health insurance rose last year.

"This shouldn't be happening," Editor Merrill Goozner writes in a Modern Healthcare editorial titled, "The canary in the open-enrollment coal mine."

Goozner is writing about an increase in the number of uninsured children and a decrease in the number of people who are signing up for federally subsidized health insurance for 2019. "The share of Americans without health coverage will undoubtedly tick up next year for the first time in nearly a decade," writes Goozner.

"This dubious achievement arrives just as the U.S. economy is nearing full employment," a time when employers are bolstering their benefit packages to attract workers, and people working in jobs that don't offer health insurance are finally making enough money to buy some, he writes.

"It clearly took a lot of work by the Trump administration and the current Congress to undermine the exchanges where individual policies are sold," he writes, ticking off many of their efforts to do so: removing insurance price stabilizers, ending cost-sharing subsidies for patients, slashing marketing and advertising budgets, expanding the availability of "short-term" plans, and doing away with the individual mandate that imposed a penalty for not having health insurance.

"If the current sign-up rate holds through the end of open enrollment on Dec. 15, more than 2 million fewer people will choose plans on the exchanges for 2019, about a 17 percent decline from 2018," he writes. "This will almost entirely offset the increase in employer-based coverage that one would expect from an improving economy."

He adds that states being allowed to add work requirements to their expanded Medicaid populations will only exacerbate this problem, pointing to Arkansas, which has dropped 12,000 from its Medicaid rolls since it implemented its work requirements three months ago. "It could get much worse," he writes, since Centers for Medicaid and Medicare Services Administrator Seema Verma has vowed to push for the requirements.

In addition to Arkansas, the Department for Health and Human Services has approved Medicaid work requirements in Kentucky, Indiana, New Hampshire and Wisconsin, with approvals pending for Alabama, Arizona, Kansas, Maine, Michigan, Mississippi, Ohio, South Dakota and Utah.

"It's poor timing for ideological rigidity," he writes. "If the economy slows next year, which many economists predict, the last thing you want to do is create higher hurdles for low-income people needing Medicaid." But with only one week left in open enrollment, Goozner writes that "the die for next year is mostly cast."

He warns that hospitals and providers need to begin preparing now for the coming fiscal realities, noting that they should expect another "upward lurch" in uncompensated care next year and prepare for a freeze on hiring.

He concludes: "You'd think the Trump administration would understand that's not what it wants going into a two-year battle to win re-election."

U of L withdrawal of some services from Jewish Hospital puts Louisville's only adult organ transplant center at risk

Jewish Hospital has a prominent place along
Interstate 65. (Courier Journal photo by Sam Upshaw)

"The University of Louisville may soon stop providing important medical services at Jewish Hospital — a move that could jeopardize the only adult organ transplant center in the city" and one of only two in Kentucky, Morgan Watkins reports for the Courier Journal. "All of the physicians who perform lung, kidney, liver, pancreas, heart and dual organ transplants at Jewish Hospital are employed by U of L, according to the university."

U of L President Neeli Bendapudi said last month that the university was starting to move some medical services from Jewish to University of Louisville Hospital and elsewhere because of "the current uncertainty around" Jewish, which is for sale and at risk of closing.

"If the university is no longer providing the surgeons to do transplants, then there’s nobody to do the transplants at Jewish Hospital. It’s not like you can bring in somebody overnight," colorectal surgeon Wayne Tuckson told Watkins. He works for KentuckyOne Health, the Catholic Health Initiatives subsidiary that owns Jewish. CHI, which has had financial problems, is merging with Dignity Health of San Francisco.

"U of L has been making contingency plans for its solid organ transplant program, but shifting such operations from one hospital to another isn't an easy or quick process, according to Laura Aguiar, principal and managing partner of Transplant Solutions LLC, which works with transplant programs around the country," Watkins reports. The other transplant programs in Kentucky are at Norton Children's Hospital in Louisville and the University of Kentucky.

Two big contracts between KentuckyOne and U of L expire at the end of this month, Watkins notes: "Under those agreements, KentuckyOne agreed to provide a minimum of about $35.6 million to the university for 56 medical resident positions at Jewish Hospital and the Frazier Rehab Institute, as well as for a variety of services performed by U of L employees, including heart and brain surgeries. . . . Also, U of L physicians serve as medical directors for the lung and liver transplant programs at Jewish. Even Jewish's chief of surgery works at U of L's school of medicine."

KentuckyOne spokesman David McArthur told Watkins, "An agreement is not required for U of L physicians to practice at Jewish Hospital, and we welcome and encourage their continued service. Our desire and intent is to continue to provide comprehensive services for the community. If the university chooses to relocate their physicians to other area hospitals, it will impact the services available at Jewish Hospital." He said the company and the hospital are still in "productive discussions." Watkins reports KentuckyOne has agreed to fund the 56 U of L residents at Jewish Hospital and the Frazier institute through June 30.

News media welcome at Dec. 10 half-day e-cigarette conference in Louisville; remote viewing available at 5 locations across state

The Coalition for a Smoke-Free Tomorrow will hold a half-day conference on electronic cigarettes Dec. 10 in Louisville, and has added two more remote viewing locations, in Florence and Richmond. The other remote viewing locations are in Bowling Green, Hazard and Paducah. The news media are welcome to attend.

The Louisville conference is full, but is accepting names for a waiting list. Space is available in all of the remote viewing locations.

The conference, titled "Next Generation Tobacco: The Impact of E-Cigarettes on Kentucky's Future Health," will focus on the recent explosion in youth and young adult use of Juul and other electronic cigarettes and the health impact of these products, as well as an update on federal proposals to restrict sales.

Speakers will also provide updates on who else uses e-cigarettes, what's in them and the role that flavors play in market growth.

New data from the federal Centers for Disease Control and Prevention shows that e-cigarette use among high-school students increased 78 percent in the past year and middle-school use went up 48 percent, largely because of the introduction of Juul and Juul-like products.

The Foundation for a Healthy Kentucky and Kentucky Youth Advocates, both founding partners of the coalition, will also release a focus group report regarding Kentucky youth attitudes and perceptions about e-cigarettes.

The conference will be held Monday, Dec. 10 from 8:30 a.m. to 12: 15 p.m. at the office of the foundation, 1640 Lyndon Farm Court in Louisville, with the foundation and KYA hosting a news conference at 11 a.m. to reveal what they learned during focus groups with students from five high schools around the state, convened to get teen perceptions about Juul and other popular e-cigarettes.

The news conference will be followed by a panel discussion of the policy implications of the focus group results as well as the information shared in the earlier morning sessions.

Remote viewing locations will be at the Bowling Green Chamber of Commerce, 710 College St.; Baptist Health Paducah, Barnes Auditorium in the Carson-Myre Heart Center, 2501 Kentucky Ave.; Northern Kentucky Health Department , 8001 Veterans Memorial Dr., Florence; the Madison County Health Department, 216 Boggs Lane, Richmond; and the University of Kentucky Center of Excellence in Rural Health, Room 214, 750 Morton Blvd., Hazard. The UK center asks those coming to Hazard use the free parking and shuttle service on Roy Campbell Drive (see map).

The conference is free, but registration is required for all locations. A light breakfast will be served at all locations and continuing education credits have been approved for physicians, physician assistants, nurse practitioners and nurses. Click here to be put on the Louisville location waiting list. Click here to register for the remote viewing locations. Click here for a full agenda.

Resources meet volunteers: Foundation for a Healthy Kentucky, Friedell Committee for Health System Transformation merge

By Melissa Patrick
Kentucky Health News

The Foundation for a Healthy Kentucky and the Friedell Committee for Health System Transformation have joined together and will function as one organization, a change that takes effect immediately.

In announcing the merger, the groups "emphasized the organizations' congruent missions and committed volunteers, and the value of speaking with a single, amplified voice to influence community and statewide health policy change," says the release.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky,
at Dec. 3 luncheon announcing a merger with the Friedell Committee.

The groups announced the union at a Dec. 3 luncheon to honor the late Dr. Gil Friedell, who founded the committee and was well-known for his mantra: "If the problem is in the community, the solution is in the community."

J.D. Miller, chairman of the Friedell Committee, citing the quote, said this philosophy was something they all agreed on.

"One of the things that is important to all of us is to be engaged in our communities . . . I think we all believe that and that we all understand that whatever we want to do in health and advocacy, it must be with community engagement," Miller said.

Bonnie Hackbarth, spokeswoman for the foundation, said after the luncheon that many committee members had already joined the foundation's Community Advisory Council. Its members advise the foundation's overall policy and strategic direction, and serve as liaisons to Kentucky communities.

"Potentially tripling the size of our council and adding Friedell Committee members' wealth of knowledge and expertise means reaching far deeper into Kentucky communities," LeChrista Finn, incoming chair of the advisory council, said in the release. She added that the new members will also help the foundation "better understand both the local issues and local solutions."

"This is one of the most engaged, dedicated groups of health advocates in our state," Miller said.

Richard Heine (Photo: Foundation for a
Healthy Kentucky)

Richard Heine, executive director of the Friedell Committee, said after the luncheon that he was "very pleased" with the merger.

"I think that what we bring is a lot of community presence and I think they are going to benefit particularly in the council to have our people, community level people," he said. "And we've done a lot of thinking about what needs to happen in terms of health care in the future, so I think we bring a lot of that with us when we come."

Asked what the foundation offered the committee, Heine said funding and resources.

The news release said the legacy of the Friedell Committee, especially in the areas of diabetes and obesity prevention, will continue through the foundation.

"The prevention of obesity and diabetes is among the work included in the foundation's 2019-2020 strategic plan, which we just approved," Mark Carter, chair of the foundation's board of directors, said in the release. "Our hope is to leverage Friedell Committee members' expertise in this area to better bring coordinated community-wide solutions to this increasingly serious societal health issue."

Miller said Friedell was aware of the potential merger before his death on Sept. 23.

"He was very much in support of joining together with the foundation, which was very important to us," Miller said. "We realized that as we joined, we could actually increase the impact of both organizations. And more than increasing the impact, we could learn from each other."

Jane Chiles, who was chair of the Friedell Committee for several years and is now chair of Kentucky One Health, said Friedell's legacy had come full circle, noting that he had been part of the vision for the foundation when it was "just a twinkle in the eye."

"The circle is complete," she said.

Foundation President and CEO Ben Chandler said, "We are so excited about this unification. It is something that's come full circle and I hope Dr. Friedell would be pleased. We want to continue making progress together and I think we can really, really attain great things."

Chandler announced that the Foundation's Healthy Kentucky Policy Champion of the Year award has been renamed the Gil Friedell Health Policy Champion award.

UK College of Dentistry fighting oral cancer in Eastern Ky. with help of $1 million grant from United Health Foundation

Getty Images

"The University of Kentucky’s College of Dentistry is launching a project to eradicate oral cancer in Eastern Kentucky," Dr. Stephanos Kyrkanides, dean of the college, writes in an op-ed for the Lexington Herald-Leader. "It’s an initiative that will address, head-on, barriers impacting oral health in the region — namely, a lack of awareness regarding oral health risks, and lack of access to opportunities for early diagnosis, dental care and treatment."

The project is funded partly with a $1 million grant from the United Health Foundation, which targets "the high prevalence of oral cancer in Harlan, Letcher and Pike counties," Kyrkanides writes.

The overall three-year program aims to create a better understanding among Eastern Kentuckians about "the symptoms of oral cancer, as well as raising awareness of the links between heavy alcohol and tobacco use and oral cancer," the dean says. "It also will implement about 1,000 oral cancer screenings at local health departments, help connect patients who need additional care to cancer specialists in Lexington, and aid in their travel to Lexington."

Jewish Hospital's finances remain shaky, increasing worries in the Louisville area that it can't be sold and will close

Jewish Hospital in downtown Louisville has 462 beds.

Louisville's Jewish Hospital continues to lose money, apparently raising the chances that it could be closed rather than sold.

The hospital and St. Mary’s Healthcare, which operate as a unit of KentuckyOne Health, "recorded operating losses of $17.7 million in the quarter ended Sept. 30, which was slightly better than the period a year earlier, when operating losses exceeded $20 million," Boris Ladwig reports for Insider Louisville. "Nonetheless, losses in for the most recent quarter were at nearly $1.5 million per week, which is worse than the average weekly losses from the whole of last year, according to a new report filed by Denver-based Catholic Health Initiatives," which owns KentuckyOne.

CHI said it still expects its Louisville-area assets to be completed by June 30, 2019, but unnamed "sources have told Insider that the deal is in trouble and that some parties are planning for the facility’s closure," Ladwig reports. "About a year ago, the health system said that it had entered exclusive negotiations with New York-based alternative asset management firm BlueMountain Capital Management. Spokesmen for both KOH and BMC told Insider via email Friday that the parties remained in productive discussions."

However, the parties declined to answer Ladwig’s questions, "including whether BMC wants to acquire all of the assets, or whether it is trying to carve out Jewish Hospital," he reports. "KOH also wouldn’t provide additional details on the performance of Jewish Hospital."

CHI’s report combines the performance of Jewish with Sts. Mary and Elizabeth Hospital. "It’s unclear from the report whether both are losing money, or whether, for example, a profitable St. Mary’s Healthcare is, at least to some degree, offsetting the operating losses at Jewish," Ladwig reports.

"Sources also have told Insider that University of Louisville President Neeli Bendapudi recently traveled to Frankfort to seek help from state officials with challenges related to Jewish Hospital but was rebuffed," Ladwig writes.

"Just days after that trip, Bendapudi publicly cited 'the current uncertainty around Jewish Hospital' as the impetus for the university having 'begun a process of transitioning service lines to University of Louisville Hospital and elsewhere.' A university spokesman later said that the institution merely was making contingency plans because of the impending end of an academic affiliation agreement the university has with KOH. That agreement, which was amended in February, calls for KOH to give UofL at least $35.6 million through Dec. 31 to pay for, among other items, 51 full-time resident positions at Jewish Hospital. However, that agreement is scheduled to end on Dec. 31, meaning the payments will stop."

Ladwig reports, "Local health-care experts have said that the closing of the hospital would have far-reaching consequences for many parts of the Louisville community because the 462-bed downtown facility employs thousands of highly skilled and highly paid health-care professionals. It also takes care of tens of thousands of patients, many of them on Medicare and Medicaid."

The best defense against the flu is a vaccine, but many don't get vaccinated because of persistent myths – all debunked here

By Melissa Patrick
Kentucky Health News

Health officials encourage everyone six months and older to get a flu shot every year, because it's your best defense when it comes to fighting influenza. But official encouragement goes only so far. In fact, most Kentucky adults and nearly half of its children don't get vaccinated in a typical year.

The last flu season was considered one of the deadliest flu seasons ever, killing an estimated 80,000 people nationwide – 325 in Kentucky, where only 41 percent of adults got a flu shot and 55 percent of children did, according to the federal Centers for Disease Control and Prevention.

Kentucky continues to be under an influenza threat the CDC defines as "regional," with confirmed cases in 13 of the state's 17 health regions. So far this season, Kentucky has had 118 confirmed cases of the flu and two deaths from it, according to the state Department for Public Health's weekly influenza surveillance report.

Many reasons are given for not getting a flu shot. Some don't get vaccinated because they believe it causes the flu. Not so. Some believe it's better to get the flu than the flu vaccine. Not so. Or they don't understand that they need to get a new vaccine every year, or say it doesn't work well enough to bother with it.

The CDC debunks all these myths and misconceptions. Here's what it says:

Can a vaccine give you the flu? The answer is unequivocally no. Flu shots cannot give you the disease. Flu shots are made two ways, with an "inactivated" or killed flu virus or by using only part of a flu virus to produce the vaccine. In other words, there is nothing in the vaccines that can infect you.

And while nasal-spray flu vaccines do have live influenza viruses, the CDC says they are weakened and will not cause a person to get the flu.

One reason for this persistent myth is because the flu virus is constantly changing – which creates confusion and distrust of the vaccine – and some years the vaccine doesn't cover the most prevalent, circulating strain of the virus – which is what happened last year.

"It may not sound like much if people expect the flu vaccine to rival vaccines for measles or polio, but a vaccine that is 40 percent effective has a 40 percent chance of completely preventing infection," writes Emily Sohn of The Washington Post, citing Vanderbilt University infectious-disease specialist William Schaffner. His math adds up to "millions of people protected from a severe illness and hundreds of thousands kept out of hospitals," Sohn notes.

In years when the vaccine is a good match for the dominant strains, people who get it are 40 to 60 percent less likely to get the flu, according to the CDC. And other studies show that vaccination can reduce the severity of the illness in people who get sick despite being vaccinated.

Is it better to get the flu than the flu vaccine? Again, the answer is no. Any flu infection comes with a risk of serious complications, hospitalization or death, even among otherwise healthy children and adults. Getting the flu is particularly dangerous among young children, older adults and people with chronic health conditions.

Do I need a flu vaccine every year? Yes, a flu vaccine is recommended each year for everyone six months and older. Not only do the strains change from year to year, but even if the same strains exist, a person's immune protection from the vaccine diminishes over time.

So why do people feel bad after they get a flu vaccine? The CDC offers several explanations: They could be ill from other respiratory viruses, since the vaccine only protects against flu; they could have been exposed to the flu before they got their vaccine or during the two weeks it takes for the vaccine to kick in; they could have the flu, but from a different strain than the vaccine was designed to protect against; or they could actually have the flu, since the flu vaccine varies in how well it works and some people who get vaccinated may still get sick.

Should I get vaccinated twice for added immunity? No. Studies have not shown any benefit to this in adults during the same flu season, even among elderly persons with weakened immune systems. Except for some children, the CDC says only one dose is recommended each season.

When is it too late to get vaccinated? As long as the flu vaccine is circulating, you can and should get vaccinated. The season usually peaks between December and March most years, but can occur as late as May. And remember, it takes about two weeks after the vaccination for the recipient to develop immunity.

Is the "stomach flu" really the flu? No, people will say they have the "stomach flu" to describe illnesses with nausea, vomiting or diarrhea, which are rarely the main symptoms of the flu in adults, though they can be in children. The flu is a respiratory disease, not a stomach or intestinal disease.

If you're looking for a place to get your flu shot, the CDC offers an interactive "flu vaccine finder" that allows you to type in your ZIP code to find nearby locations that offer flu shots. Local health departments also offer the vaccine.

Deadline to sign up for health insurance on Healthcare.gov is Dec. 15, but most who qualify didn't know that last month

By Melissa Patrick
Kentucky Health News

With just two weeks left to sign up for federally subsidized health insurance for 2019, time is running out. The deadline for open enrollment on Healthcare.gov is Dec. 15, and fewer Kentuckians are enrolled than at this time last year.

Four weeks into the six-week enrollment period, Kentucky enrollment on the federal exchange was 22,565. That was 5,414 fewer than the 27,979 who had enrolled by that time last year. Nationally, 356,347 fewer people had signed up. These numbers only reflect people who had signed up for a new plan or who had actively chosen a plan; those who already have plans on Healthcare.gov and don't choose a new one will be automatically re-enrolled, and those numbers haven't yet been included in the enrollment reports.

"Last year, just under half of the signups came in the final week due to auto-enrollment," Dustin Pugel, a research and policy analyst for the Kentucky Center for Economic Policy, said in an email. "So I have no reason to expect we won't see a big jump again this year the week of Dec. 15."

That said, Pugel cautioned that he is uncertain how the enrollment numbers will end up, noting that while the marketing and outreach budgets were cut, open enrollment got a lot of free publicity last year because Congress debated repealing the Patient Protection and Affordable Care Act, also called Obamacare, from January to early October.

"This year, open enrollment is neither getting the free attention nor the paid outreach and marketing, so I am concerned that many who qualify won’t end up getting coverage because they don’t realize they qualify for financial assistance, or that the open enrollment period is short (again)," Pugel said.

The open enrollment period originally lasted last three months, but the Trump administration shortened it last year to 45 days.

Most people don't know the deadline is looming.

According to a Kaiser Family Foundation tracking poll taken Nov. 14-19, only one-fourth of people aged 18 to 64 who buy their own health insurance, or are uninsured, knew that the last day to purchase health insurance on Healthcare.gov is Dec. 15.

Sixty-one percent said they didn't know when the deadline was, and 16 percent either had the date wrong, said there was no deadline, said the deadline had passed, or refused to answer the question.

Fewer than half of those polled said they had heard or seen any advertising in the past 30 days from an insurance company attempting to sell health insurance. Only 31 percent, said they had heard or seen information about how to get health insurance under the health care law. Most television commercials are for Medicare enrollment, which ends Dec. 7.

Another possible reason for lower sign-ups is that this is the first year people don't have to pay a penalty for not having health insurance, referred to as the removal of the individual mandate. But the problem with this theory is that most people don't know the requirement has been repealed.

According to the poll, 38 percent didn't know there was no longer a penalty for not having health insurance. An additional 31 percent, were unsure. Only 31 percent knew the law had changed.

The poll also found that about half of those who were uninsured or buy their own coverage said they plan to buy insurance for 2019, despite the elimination of the fine, while 42 percent said they would choose to go without coverage.

The Trump administration has also finalized a rule that allows the sale of short-term health insurance policies -- which are generally less expensive than the ACA-compliant plans and offer limited coverage -- that could lure some away from buying insurance on the exchange.

The poll found that 70 percent of those who purchase their own insurance or are uninsured said they would choose to keep the plan they have now and 21 percent of them said they would buy a short-term plan. Click herefor a Kaiser Family Foundation fact sheet on short-term plans.

Time's a-wastin'

The bottom line is that it's time to sign up for health insurance on Healthcare.gov if you want health insurance next year.

Don't assume you can't afford it, because most people in the marketplace qualify for financial help to lower their costs. The Cabinet for Health and Family Services has reported that about 80 percent of Kentuckians enrolled through the federal exchange qualified for tax credits and subsidies that reduced their premiums.

It is also suggested that even if you have a plan on Healthcare.gov, it's a good idea to look at all of your options each year to make sure you have the plan that best suits your needs.

Where can I find help?  The state-based call center is available at 855-459-6328 to help assist Kentuckians with where to go for coverage, answer questions and pre-screen for eligibility. The Healthcare.gov customer service center (800-318-2596) is also available 24 hours a day, seven days a week.

 Click here to find an application assister or an insurance agent near you. Click here to see a list of outreach events in each county.

Whitney Allen, the coordinator of community development and outreach for the Kentucky Primary Care Association, said this about application assisters: "Assisters are trusted members of the community you live in that are experts in the health insurance enrollment process and offer free, unbiased help. From Medicaid to Marketplace, they are the one-stop-shop to answering your health insurance questions about getting covered, staying covered and how to use your health insurance effectively."

Healthcare.gov provides a shopping tool to allow you to preview 2019 plans and estimated prices before you log in.

 The Kaiser Family Foundation also offers a Health Insurance Marketplace Calculator to provide estimates of health insurance premiums and subsidies for people purchasing insurance on their own on Healthcare.gov. It allows you to enter your income, age and family size to estimate your eligibility for subsidies and how much you should spend on health insurance. It will also allow you to see if you qualify for Medicaid.

Among the 50 states, Kentucky, which is 26th in population, ranked fourth in the death rate from drug overdoses in 2017

Kentucky had the fourth highest rate of drug overdoses among the states in 2017, fifth when the District of Columbia is added to the list, according to a new report from the federal Centers for Disease Control and Prevention.

Kentucky had 37.2 overdose deaths per 100,000 people. West Virginia had the highest rate, 57.8, and Ohio was second with 46.3. Pennsylvania and D.C. were close behind at 44.3 and 44, respectively.

Pennsylvania, the largest of those states, had the most overdose deaths, 5,388. Ohio was second with 5,111 and Florida, the third most populous state, was close behind with 5,088. Kentucky had 1,566 deaths, the 15th largest number, and West Virginia had 974. Those two states are 26th and 38th in population.

"The national report echoes many trends found in Kentucky’s annual overdose report for 2017, especially the increase in deaths due to fentanyl," a synthetic opioid that can be 50 times more potent than heroin, Linda Blackford reports for the Lexington Herald-Leader.

Kentucky's report, released in July, showed an 11.5 percent increase in drug-overdose deaths from 2016, with more than half from fentanyl. The number of heroin deaths decreased, but overdose deaths from methamphetamine surged, with meth being found in 29 percent of cases.

"Unlike opioid use, meth addiction cannot be addressed with medication assisted treatments, such as buprenorphine," Blackford notes.

Read more here: https://www.kentucky.com/news/state/kentucky/article222358725.html#storylink=cpy

Read more here: https://www.kentucky.com/news/state/kentucky/article222358725.html#storylink=cpy

'It's not about losing coverage, it's about having fewer members enrolled in Medicaid,' state health secretary says of new plan

By Melissa Patrick
Kentucky Health News

The administration of Gov. Matt Bevin changed very little in the Medicaid plan that was recently re-approved by the Trump administration, which means "able-bodied" members of the program will soon have to work or participate in certain activities 80 hours a month to keep their health insurance.

Health Secretary Adam Meier and Deputy Health Secretary Kristi Putnam
speaking about the state's new Medicaid plan, Kentucky HEALTH

The new plan, called Kentucky HEALTH for "Helping to Engage and Achieve Long Term Health," also includes premiums, deductibles or co-payments, strict reporting requirements and lock-outs for non-compliance. It is tentatively set to start April 1, with the work rules and other community-engagement options to be phased in regionally.

Kentucky HEALTH will largely affect the nearly 500,000 Kentuckians who have gained health coverage through the 2014 expansion of the program to those who earn up to 138 percent of the federal poverty line ($16,653 for an individual). Kentucky has about 1.4 million people on Medicaid, but only 165,000 are expected to come under the community-engagement requirements.

Health Secretary Adam Meier told the legislature's Joint Committee on Health and Welfare and Family Services Nov. 27 that the community-engagement rules will likely roll out in Northern Kentucky first, as was scheduled before a federal judge blocked the previous version of the plan.

On June 29, two days before the rollout was to start, District Judge James Boasberg of Washington, D.C., sent then plan back to the U.S. Department of Health and Human Services for review, ruling that, among other things, HHS Secretary Alex Azar had not fully considered the state's projection that in five years the Medicaid rolls would have 95,000 fewer people with the plan than without it.

Asked if there was a chance it could be blocked again, Meier said, "There's always a chance."

After the committee meeting, Cara Stewart, an attorney with the Kentucky Equal Justice Center, one of the three organizations that filed the lawsuit on behalf of 16 Kentucky Medicaid recipients, said they were working on amending their complaint. "It's hard to expect a different result with everything the same," Stewart said.

During the meeting, several Democrats on the committee voiced concerns that thousands of Kentuckians could lose their health coverage because of the new Medicaid rules.

Rep. George Brown, D-Lexington, asked Meier exactly how many people were expected to lose coverage as a result of these new requirements.

Meier said he didn't have a "crystal ball" to determine that number, but assured him that the state has worked "diligently" with the Centers for Medicare and Medicaid Services to provide appropriate exemptions and to protect Kentuckians from any unintended consequences that could occur under the new rules.

"The same people that have access today will have access post-implementation," Meier said.

Brown noted the importance of keeping track of the numbers of Kentuckians who might fall through the cracks under the new plan. He said, “The 95,000 prospective citizens that are going to lose health care coverage is problematic. I think we have to be concerned with what happens with them."

Meier took issue with the term "losing coverage," saying, "It's not about losing coverage, it's about having fewer members enrolled in Medicaid. . . . If we can move more people to private-market insurance coverage, that’s a good thing. And that’s what this waiver is designed to do.”

Rep. Mary Lou Marzian, D-Louisville, noted that many Kentuckians who will be affected by Kentucky HEALTH are already working, but their employers don't offer health insurance. She asked what jobs were available for them to move to that offered health insurance.

Meier said that while many are expected to move to higher paying jobs that offer health insurance, others will move to higher paying jobs that will price them out of Medicaid and into what is called a qualified health plan on the federal exchange, otherwise known as Obamacare.

A Kentucky Center for Economic Policy report shows that between 1980 and 2016 the percentage of Kentucky employees getting health insurance at work dropped from 80 percent to 54.5 percent respectively.

Meier said that in the last five to six months, Kentucky has seen an enrollment decline of "probably around 41,000" and attributed this to an improving economic climate. "The number one reason that people are not enrolling is because they are making too much income," Meier said after the meeting.

Meier was referring to a decline from 1,434,024 members in May to 1,392,293 in September. Most of that drop, 21,508 occurred from May to June. From September 2017 to September 2018, overall enrollment dropped by 35,571, or 2.5 percent, from about 1.43 million to about 1.39 million. Expansion enrollment, which would be much more sensitive to improvements in the economy like those Meier mentioned, dropped 5.26 percent during the period.

After the meeting, Meier assured reporters that the health cabinet will be conducting a "robust evaluation" of what happens to Medicaid beneficiaries on the new plan, including tracking of labor and wage data, reasons for disenrollment, enrollment in federally subsidized insurance, and qualitative interviews.

Rep. Joni Jenkins, D-Shively, asked what Kentucky has learned from other states, like Arkansas, where more than 12,000 people have lost Medicaid coverage since the state implemented its work requirements in June.

“We’re in a little different situation than Arkansas," Meier said. "They had utilized existing infrastructure and they operationalized very quickly. In Kentucky, we’ve been planning for several years now how to operationalize this."

In addition, Meier said it's not yet clear why Arkansas Medicaid recipients lost their coverage and that it's important to "hold our collective analysis until we have a little bit more better data to analyze what's happening and then use that data in a way that is constructive to inform policy and outreach."

Deputy Health Secretary Kristi Putnam said Medicaid members will get information about the new plan 30 days before any changes in their benefits, and that information will be posted on social media and a Cabinet for Health and Family Services website. The cabinet is working with various community partners, including the Foundation for a Healthy Kentucky, to push the information.

In addition to Arkansas and Kentucky, HHS has approved Medicaid work requirements in Indiana, New Hampshire and Wisconsin, with approvals pending for Alabama, Arizona, Kansas, Maine, Michigan, Mississippi, Ohio, South Dakota and Utah.