Baptist settles dispute with Humana, but not United and WellCare

Baptist Health Lexington

By Deborah Yetter
Kentucky Lantern

Baptist Health and Humana have ended a months-long standoff over Kentuckians with health coverage through Medicare Advantage and commercial insurance plans, the companies said Thursday, March 14. But Kentucky's biggest hospital chain is still on the outs with two other major insurers.

Effective April 1, Baptist physicians again will accept those patients as “in network”— meaning they would not be subject to potentially higher costs or limits on services.

The news, which affects tens of thousands of Kentuckians including many state retirees, was announced through separate press releases.

“After several months of productive negotiations, Humana is pleased to have reached a new, multi-year agreement with Baptist Health Kentucky,” Eric Bohannon, Humana Medicare regional president, said in the release.

Baptist hailed the move as good for patient care. “We are committed to improving the health of our communities and our goal is to ensure every patient the high-quality, timely care needed,” said Dr. Isaac J. Myers II, chief health integration officer for Baptist Health.

The releases didn’t explain how the companies resolved differences that led Baptist Health to drop Humana as a network provider for its physicians on Sept. 22.

Medicare Advantage plans, which oversee health care for most Medicare enrollees, including about 102,000 Kentucky state-government retirees, have been a growing source of contention between health providers and the private insurance companies that offer them.

Baptist has cited delays in payments and denial of care by such private insurers as the source of dispute.

“The concerns we face with Medicare Advantage plans are similar to the concerns expressed by many providers across the country and echoed by hospital associations that represent them: coverage criteria applied by the plans result in denials and delays of medically necessary care to our patients,” Baptist spokeswoman Kit Fullenlove Barry said in January.

Effective Jan. 1, Baptist also ended agreements with United HealthCare and Wellcare for Medicare Advantage coverage for services including physician and hospital care — meaning all such care is considered out of network. Barry said Baptist has not reached agreements with United or Wellcare.

The growth of Medicare Advantage plans has been a source of increasing concern to advocates who argue that patients suffer through practices such as denials of care, delays while care is authorized and other restrictions.

Among those advocates is longtime Louisville health reform activist Kay Tillow, who told the Kentucky Lantern in January that such plans are sacrificing the benefits of Medicare for seniors. “The profit motive is destroying patient care,” she said.

Insurance companies that provide Medicare Advantage plans argue they offer better care at less cost and, in some cases, extra benefits to seniors. But they are able to do that through limiting benefits and patient choices.

Website that helps Kentuckians find addiction treatment now helps them find naloxone, the drug that reverses opioid overdoses

Photo from Kelley-Ross Pharmacy Group

Kentucky Health News

The FindHelpNowKy.org website, which helps Kentuckians find addiction treatment, now also can help them find places to get naloxone, which reverses opioid overdose.

The website, which has been used over 240,000 times to facilities since its inception in 2018, now also includes social-services resources and locators for recovery housing and mental-health treatment.

In 2022, a Kentucky survey found that 73 percent of respondents said they didn't know where to get naloxone, often known by the leading brand, Narcan.

“We are making it easier for Kentuckians to find the life-saving help they need,” Gov. Andy Beshear said in a press release. “While there is always more work to be done, we are taking another step forward on our mission to help our families fight and overcome addiction.”

Naloxone has become more available thanks to retailers, grants, reduction of stigma associated with addiction, and proactive distribution by community organizations,local health departments, recovery centers and regional prevention centers, the release said.

In addition to the central hub of FindHelpNowKy.org, some of the services can also be reached at FindMentalHealthNowKy.org; FindRecoveryHousingNowKy.org and FindNaloxoneNowKy.org. The latter website provides overdose prevention and response training relevant to people most likely to witness overdose.

“People can and do recover from addiction and mental health issues,” said state Health Secretary Eric Friedlander said. “And our goal of bundling these services in one central location will only make that journey to recovery easier across the continuum of risk.”

The collaborators on this website are the Kentucky Injury Prevention and Research Center and the state departments for Public Health and Behavioral Health, Developmental and Intellectual Disabilities.

“Addiction and mental health issues affect Kentuckians in every county and every ZIP code,” said Dr. Katie Marks, commisisoner of the latter department. “There should be no shame in seeking help and no barriers to finding evidence-based, compassionate care and treatment. These website updates address that at its core – getting our fellow Kentuckians on their road to recovery with resources that are close in proximity and right for them.”

The National Alliance on Mental Illness says 1 in 20 U.S. adults experience serious mental illness each year. In Kentucky, 189,000 adults are reported as having a serious mental illness, the release said.

If you or a loved one are struggling with addiction, the KY HELP Call Center can connect you to treatment by calling 833-8KY-HELP (833-859-4357). Visit the Kentucky State Police website to find a police post where those suffering from addiction can be paired with a local officer who will assist with locating an appropriate treatment program through KSP’s Angel Initiative. Call, text, or online chat 988 to connect with suicide-prevention, mental-health and substance-use-disorder counselors. They are available to all Kentuckians 24/7/365, the release said.

Physician who treats only seniors endorses CDC recommendation that everyone over 65 should get a Covid-19 booster this spring

By Laurie Archbald-Pannone
Associate professor of medicine and geriatrics, University of Virginia

In my mind, the spring season will always be associated with Covid-19.

In spring 2020, the federal government declared a nationwide emergency, and life drastically changed. Schools and businesses closed, and masks and social distancing were mandated across much of the nation.

In spring 2021, after the vaccine rollout, the Centers for Disease Control and Prevention said those who were fully vaccinated against Covid-19 could safely gather with others who were vaccinated without masks or social distancing.

In spring 2022, with the increased rates of vaccination across the U.S., the universal indoor mask mandate came to an end. In spring 2023, the federal declaration of Covid-19 as a public health emergency ended.

Photo from Senior Lifestyle

Now, as spring 2024 fast approaches, the CDC reminds Americans that even though the public-health emergency is over, the risks associated with Covid-19 are not. But those risks are higher in some groups than others. So the agency recommends that adults age 65 and older receive an additional Covid-19 vaccine, which is updated to protect against a recently dominant variant and is effective against the current dominant strain.The shot is covered by Medicare. But do you really need yet another Covid-19 shot?

As a geriatrician who exclusively cares for people over 65 years of age, this is a question I’ve been asked many times over the past few years.

In early 2024, the short answer is yes.

Compared with other age groups, older adults have the worst outcomes with a Covid-19 infection. Increased age is, simply put, a major risk factor.

In January 2024, the average death rate from Covid-19 for all ages was just under 3 in 100,000 people. But for those ages 65 to 74, it was higher – about 5 for every 100,000. And for people 75 and older, the rate jumped to nearly 30 in 100,000.

Even now, four years after the start of the pandemic, people 65 years old and up are about twice as likely to die from Covid-19 than the rest of the population. People 75 years old and up are 10 times more likely to die from Covid.

Vaccination is still essential

These numbers are scary. But the No. 1 action people can take to decrease their risk is to get vaccinated and keep up to date on vaccinations to ensure top immune response. Being appropriately vaccinated is as critical in 2024 as it was in 2021 to help prevent infection, hospitalization and death from Covid-19.

The updated Covid-19 vaccine has been shown to be safe and effective, with the benefits of vaccination continuing to outweigh the potential risks of infection.

The CDC has been observing side effects on the more than 230 million Americans who are considered fully vaccinated with what it calls the “most intense safety monitoring in U.S. history.” Common side effects soon after receiving the vaccine include discomfort at the injection site, transient muscle or joint aches, and fever.

These symptoms can be alleviated with over-the-counter pain medicines or a cold compress to the site after receiving the vaccine. Side effects are less likely if you are well hydrated when you get your vaccine.

Repeat infections carry increased risk, not just from the infection itself, but also for developing long Covid as well as other illnesses. Recent evidence shows that even mild to moderate Covid-19 infection can negatively affect cognition, with changes similar to seven years of brain aging. But being up to date with Covid-19 immunization has a fourfold decrease in risk of developing long Covid symptoms if you do get infected.

Known as immunosenescence, this puts people at higher risk of infection, including severe infection, and decreased ability to maintain immune response to vaccination as they get older. The older one gets – over 75, or over 65 with other medical conditions – the more immunosenescence takes effect.

All this is why, if you’re in this age group, even if you received your last Covid-19 vaccine in fall 2023, the spring 2024 shot is still essential to boost your immune system so it can act quickly if you are exposed to the virus.

The bottom line: If you’re 65 or older, it’s time for another Covid-19 shot.

This article was republished from The Conversation, a platform for journalism by academics.

If you are diagnosed with cancer and you smoke, that's one more reason to stop, says UK doctor who co-chaired national survey

Smokers who have cancer have a better chance of overcoming the disease if they stop smoking, but not all cancer-treatment programs do a good job of encouraging patients to quit, according to a national quality improvement project led by the American College of Surgeons.

"The results, published in JCO Oncology Practice, represent one of the largest national surveys examining the quality of tobacco treatment in cancer care in a wide range of clinical oncology settings, including academic facilities and community cancer programs," says a news release about the study.

Timothy Mullett, M.D.

“While many people understand the role of tobacco in terms of causing cancer, they may not understand the impact that tobacco use has when patients are being treated for cancer,” said Dr. Timothy Mullett, medical director of the Markey Cancer Center Network at the University of Kentucky, chair of the surgeons' college Commission on Cancer and co-author of the study.

“Many providers may not think about tobacco cessation in terms of treatment,” Mullett said in the release. “But just like there are effective treatments for high blood pressure or thyroid disease, there are effective treatments for tobacco use. That’s the disconnect we’re trying to highlight in this study.”

Mullett said persistent smoking among patients diagnosed with cancer is associated with many treatment-related complications, including recurrence of the cancer, premature death, and increased treatment costs, Despite these risk factors, polls suggest that nearly 25% of new patients with cancer are smokers, and of the estimated 18 million cancer survivors in the U.S., 16% report they smoke. Many patients report wanting to quit, but fewer than 10% are successful.

The survey by leaders of the surgeons' group found that only 42% of the cancer-treatment programs reported documenting a smoking-cessation treatment plan, 41% reported regularly assisting patients with quitting , providing self-help information (27%), individual counseling (18.2%), and referring patients to an affiliated tobacco treatment program (26%). Only 18% reported regularly prescribing medications for smoking cessation.

“We showed that incorporating tobacco treatment into cancer treatment is feasible and that it can be done in large and small programs,” Mullett said. “Incorporating resources and referrals on tobacco treatment into cancer care requires training and time. Both of those are hard to find in a busy cancer practice, but we need information like this to be recognized by facilities so they can put resources into tobacco treatment and help connect patients with effective resources on tobacco cessation.”

Contrary to Trump's musings, McConnell says efforts to repeal the 2010 Patient Protection and Affordable Care Act are 'largely over'

Senate Republican Leader Mitch McConnell waited for President Biden to arrive for the State of the Union speech Thursday, March 7, in the House chamber. (Pool photo by Shawn Thew, via Associated Press)

Kentucky Health News

Obamacare, now into its second decade, is pretty much here to stay.

So says Senate Republican Leader Mitch McConnell of Kentucky, contradicting former President Trump’s comments that he is still looking at ways to repeal and replace the 2010 law.

“We had a fight over that a few years ago,” McConnell told reporters Tuesday, referring to how Republicans fell short of doing that in 2017 because a few of them opposed the reversal.

“If he can develop a base for revisiting that issue, obviously we’d take a look at it, but it seems to me that’s largely over,” McConnell said of the repeal-and-replace effort, which never had a replacement measure.

McConnell's statement "gave voice to the view shared by many Republican senators that the Affordable Care Act, also known as Obamacare, will be the law of the land for the foreseeable future," writes Alexander Bolton of The Hill.

McConnell endorsed Trump last week, despite their serious differences over more than three years. He said Tuesday, “I’m going to leave the issue development in the presidential campaign up to the campaign.”

Trump said he is “seriously looking at alternatives” if he is elected and Republicans keep control of the House and regain control of the Senate.

“The cost of Obamacare is out of control, plus, it’s not good Healthcare. I’m seriously looking at alternatives,” Trump wrote on his Truth Social site last year. “We had a couple of Republican senators who campaigned for six years against it, and then raised their hands not to terminate it. It was a low point for the Republican Party, but we should never give up!”

Trump exaggerated or misstated the campaign positions of Sens. Susan Collins (R-Maine), Lisa Murkowski (R-Alaska) and the late Sen. John McCain (R-Ariz.), who "voted with Democrats to defeat a narrowed-down proposal to repeal the Affordable Care Act without putting a new health care subsidy program into effect," Bolton notes.

President Biden defended the law during last week's State of the Union speech.

“Over 100 million of you can no longer be denied health insurance because of a preexisting conditions. But my predecessor and many in this chamber want to take — the prescription drug away by repealing the Affordable Care Act. I’m not going to let that happen. We stopped you 50 times before, and we’ll stop you again.”

The main impact of the law in Kentucky has been the expansion of Medicaid to households with annual incomes up to 138 percent of the federal poverty threshold. In February, 1.56 million Kentuckians, more than a third of the state's population, were enrolled in the federal-state program. For details, with county-by-county numbers, go to https://www.chfs.ky.gov/agencies/dms/stats/KYDWMMCC20240215.pdf.

Coleman wants opioid commission to shift focus to prevention, especially among youth; leaves small door open to ibogaine

By Melissa Patrick
Kentucky Health News 

Kentucky Attorney General Russell Coleman laid out his mission for the next phase of the Kentucky Opioid Abatement Advisory Commission Tuesday, calling on them to focus on building a "gold-standard statewide prevention program" with settlements paid by opioid makers and distributors.

Attorney General Russell Coleman (Photo provided) 

"It's a plan of zealous collaboration, zealous collaboration," he said. "To be successful, the Office of the Attorney General and this commission must have a strong partnership. We must also further connect this body with organizations throughout our commonwealth . . . to focus on that necessary three-legged stool of treatment, prevention and enforcement." 

Coleman called on the commission to focus on prevention as it considers the coming round of grant applications. "I encourage you to place a strong emphasis on boosting Kentucky’s critically needed prevention efforts," he said.

Coleman added that his office is in the midst of developing new youth prevention initiatives that focus on education.  

"When we're in an environment where children are experimenting with these dangerous substances as early as 11 – we're seeing it in late elementary school – we have to have conversations with our kids earlier and earlier," he said. Later adding, "It's our responsibility, yours and mine, to prepare them for this threat they are facing in a new threat environment." 

When asked what his vision for a statewide prevention program would look like, Coleman told reporters that it will be important to look at what states such as Georgia, Tennessee, Virginia and Mississippi are doing. 

He said Virginia has a robust "one pill can kill" prevention effort and Mississippi had rolled out a "very creative approach that uses name, image and likeness of Ole Miss players to be able to engage and get that message out there, to permeate in the social media space. I would love to institute a program here that looks a lot like what is ongoing in the state of Mississippi." 

As for treatment and enforcement, Coleman said Kentucky is doing a great job in most of the state when it comes to treatment beds, and he told reporters that the drug cartels in Mexico are doing a great job of getting these substances into the U.S., which means collaboration is key, saying there is a need to "tear down the silos between federal, state and local" enforcement efforts.

"Again, we have to do very strong enforcement piece, but it has to be alongside a stronger prevention effort and continuing to treat our addicted neighbors," he said. 

In Kentucky, half of the nearly $900 million in settlement money is being distributed among cities and counties, and the other half is controlled by the commission, which is housed in Coleman's office.

So far, the commission has awarded 59 grants totaling about $21.5 million, with 23 aimed at prevention, totaling about $8 million; and 36 toward treatment and recovery, totaling about $13 million – but in addition to $10.5 million the legislature allocated in 2022 for behavioral-health treatment as an option to incarceration in Clark, Christian, Daviess, Greenup, Hopkins, Kenton, Knox, Mason, McCracken and Warren counties.

So, only about a fourth of the total state funding from the settlements has gone to prevention, which Coleman wants to emphasize.

Ibogaine

Coleman asked the commission to drop a proposal by its previous director to fund research aimed at legalizing the psychedelic drug ibogaine for drug treatment, saying he had given the idea "careful study, thorough consideration and honest conversation." 

"In that spirit, I respectfully ask this commission to step back from previous proposals to allocate $42 million to ibogaine research and the unproven, expensive clinical trial for a psychedelic that is, as you know, currently a Schedule 1 drug in the United States."

Noting that some call the settlements "blood money," he said "This is too precious to gamble away with that degree of risk at that amount."

He said he will ask Commission Director Chris Evans to propose a $5 million pool of resources for research and innovation grants that could be open to applications for funding research on ibogaine. 

"If someone brings forward an ibogaine research proposal that fits the criteria of this new innovative grant proposal, I hope this commission will give it full and fair consideration," he said. "It's not zero sum."

Ibogaine is a psychedelic derived from the African iboga plant. It is illegal everywhere except Mexico and New Zealand and has been reported to reduce or eliminate drug-withdrawal symptoms, but comes with some risk to the heart in some people. 

The proposal to commit about 5 percent of the settlement money on clinical trials that could lead to federal approval of the ibogaine for treatment of opioid-use disorder was led by former director Bryan Hubbard, who had been appointed by then-Attorney General Daniel Cameron.

Hubbard is continuing this effort in Ohio. The Lexington Herald-Leader reported in late February that he has signed a contract with the State of Ohio. Hubbard told the newspaper he is working for the state to “deliver novel treatment access and research opportunities for veterans and opioid-dependent individuals” and is partnering with an Ohio-based foundation to “create the framework for ibogaine clinical trials in Ohio.”

Bipartisan praise from commission

Commission member Karen Butcher, whose son died of an opioid overdose, told Coleman that she was pleased that ibogaine could still be considered for clinical research. "It's no secret that I've been the loudest proponent for that," she said. 

State Health Secretary Eric Friedlander, after describing himself as on the other end of the spectrum in support of ibogaine, praised the vision of Coleman, who is a Republican.

"I want to thank you. You're laying out a vision for us. You're here with us today. You are really taking the bold step and the responsible step and the brave step of putting yourself out there. Giving us a vision around prevention, addressing head-on some of the things that we haven't agreed on in this committee," said Friedlander, who works for Democratic Gov. Andy Beshear.

Commission member Jason Roop, a pastor who has said he is in recovery, called on Coleman to not lose sight of the fact that addiction is generational, saying it is important to tackle this problem holistically and not in silos: "I would encourage all of us to consider addiction from a holistic standpoint, prevention, treatment, law enforcement, all of it kind of going together to represent our efforts."

Bill aimed at curbing Kentucky's youth 'vaping epidemic' passes House; Ky. Youth Advocates calls on Senate to make it stronger

By Melissa Patrick
Kentucky Health News

A bill to curb what its sponsor called the youth "vaping epidemic" in Kentucky passed the state House on Monday and is now in the Senate. 

Rep. Rebecca Raymer

Sponsor Rebecca Raymer, R-Morgantown, told her colleagues that she was inspired to work on the issue after hearing from school officials across the state about how "rampant the vaping is in our schools." 

Raymer said there is a "vaping epidemic," and most vape products being confiscated from students are not even authorized by the federal Food and Drug Administration.  

House Bill 11 passed on a 62-26 vote, with concerns voiced from members of both parties that it would do little to stop youth from vaping, but would harm small vaping businesses. 

The bill would require businesses that sell vaping products to acknowledge that in their annual business filings with the secretary of state, who would share it monthly with the Kentucky Department of Alcoholic Beverage Control and the state Department of Revenue.  ABC would then be responsible for creating a system that identifies and publishes the retailers who violate the law.

The bill would fine retailers $100 to $500 for a first offense of selling vaping products to anyone under 21, which is consistent with existing law. The penalty for a second offense would be $1,000 and $5,000 for a third violation. A retailer with a fourth violation in two years would be banned from selling vapes. The bill also sets fines for manufacturers and wholesalers. 

Terry Brooks, executive director of Kentucky Youth Advocates, lauded the bill's passage, saying it takes important steps to reduce youth access to addictive nicotine products. But he called for teh Senate to strengthen it. 

"Provisions of this bill will provide a more complete understanding of the retail landscape by creating a database of tobacco and nicotine product retailers, which is a critical first step to ensure that bad actors selling to underage kids are penalized," Brooks said in a news release. "But the ability to hold retailers accountable for responsibly selling tobacco and nicotine products relies on regular compliance checks for underage sales violations."

He added, "Youth have been targeted with flavored vape products and can quickly become dependent, but there are opportunities to stop this cycle. As HB 11 advances, we hope this bill can go even further by ensuring that regular compliance checks are included in statute." 

Legislators heard a similar plea from Mallory Jones, a junior at George Rogers Clark High School in Winchester, at the March 7 committee hearing. 

"Addressing the source of these products is critical to reducing youth access and initiation of nicotine, but the rules are only as good as the enforcement that we put behind them," she said. 

According to the 2021 Youth Behavioral Risk Factor Surveillance System data, 45% of Kentucky's high-school students said they had used an electronic vapor product, 22% of them were current users, 8% were frequent users, and 7% used the products daily.

Asked how they got them, 12% said they usually bought them at a convenience store, supermarket, discount store or gas station.

Among Kentucky middle-school students, 24% said they had ever used an electronic vapor product, 11% said they were current users; nearly 3% said they were frequent users, and 2% said they used the products daily. 

Opposition to the bill

During the House debate, Rep. Savannah Maddox, R-Dry Ridge, said she opposed the bill because it would ban products meant to be used by adults.

“This is being proposed as something that is designed to reduce harm in minor children, when in reality it will do no such thing. These products are already illegal,” she said. “What it will do is harm Kentucky’s businesses.”

Rep. Rachel Roarx, D-Louisville, brought up the concerns voiced by vape-shop owners to the committee, including documentation that showed convenience stores are the bad actors when it comes to selling vapes to minors, and their concerns that the only FDA-approved products have high nicotine levels. She also voiced her concerns that this bill is "granting a monopoly to certain companies." 

Rep. Daniel Grossberg, D-Louisville, said over 90% of his 4,000 emails and phone calls about the bill, many of them small business owners, had asked him to vote against it.

He said "The real problems [are] flavoring and marketing that target our kids," and called for "stricter controls and enforcement for those who sell to minors, and regulate both the potency and the purity of these products. Rather than us ceding control to the FDA, who has done nothing effective about this. I too want to protect our kids."

Raymer said several times that the FDA has been granted authority to regulate these products, and that this bill is simply following what the FDA says.

"I don't think the FDA has done a great job in going through this list, but that is what we have to work with," she said. " And this is how we get the products that are being geared towards these minors off the shelf and products that have gone through no safety checks, we don't know what's in them. . . . They're not just harmful for youth, they're harmful for all Kentucky consumers."

State health chief says measles risk stems from pandemic's anti-vaccine 'ideologies'; discusses how to lose weight, need for sleep

WKYT news anchor Bill Bryant, left, interviews state Health Commissioner Steven Stack, M.D.

This story has been updated.

By Al Cross
Kentucky Health News

In a wide-ranging TV interview, state Health Commissioner Steven Stack warned Kentuckians that not enough of them are vaccinated for measles, which he said is an outgrowth of reaction to the Covid-19 pandemic and the measures taken against it.

Stack reflected on his work in the pandemic and talked about other health concerns, including the opioid epidemic, weight-loss drugs and the need for Kentuckians to get more sleep, in an interview that aired Sunday, March 10, on WKYT's "Kentucky Newsmakers" with Bill Bryant.

As of March 7, the Centers for Disease Control and Prevention had recorded 45 cases of measles in 17 states: Arizona, California, Florida, Georgia, Illinois, Indiana, Louisiana, Maryland, Michigan, Minnesota, Missouri, New Jersey, New York, Ohio, Pennsylvania, Virginia and Washington.

Stack said measles was declared elimiated in the U.S. in 2000, but it has returned because vaccination rates have dropped to 90 percent. The disease may be the most contagious, and epidemiologists say 95 percent of a population needs to be vaccinated to protect those who can't or won't get the shot.

Stack said the measles-mumps-rubella (German measles) vaccine has been used since 1971, and is very effective. "We’ve got to get the public I hope, to accept that these tools help to prevent us from having far worse problems, like little babies who can't get vaccinated getting seriously ill." Children younger than 6 months are ineligible for vaccination.

Pew Research Center graph, based on Pew polling by party

Why have vaccination rates for contagious diseases dropped? "It's all gotten caught up in the Covid pandemic, in the narrative, in the ideologies that have unfortunately become associated with public health and medical science," said Stack, a physician.

Asked if he and Gov. Andy Beshear made the right calls in the pandemic, he said "I think we did the best we could with what we knew at the time." He said Kentucky outperformed most other states, considering its lower health status, which made it more vulnerable.

Stack said he and Beshear "balanced saving the most poeple [with] other harms that are worse than what you're trying to prevent." He said Kentucky's death toll of 20,000 was "far from what it would have been had we not intervened," noting that an intiial estimate was it could lose 1 to 2 percent of its population: 45,000 to 90,000 people.

Looking ahead, Stack said people 65 and older and those with other risk factors should get a Covid-19 booster this spring, and everyone should get an annual booster, much like has long been done for influenza.

Other health issues

Kentucky leads the nation in the percentage (about 2.1%) of population that has received a prescription for one of the new drugs created to fight obesity and diabetes, which can also aid weight loss.

"Overweight and obesity is a big problem in Kentucky," Stack said, noting that 38% of Kentuckians weigh too much. "That leads to diabetes, it increased your risk of cancer and cardiovasculat disease, like stroke and heart disease. It's really a major issue for us to address."

As for the drugs, "People are understandably desperate to find ways to get it under control," he said. "It's really too early to say what the long-term outcome of those medications will be. Some people have had wonderful benefits from it, have lost a lot of weight and improved their overall performance. Some individuals have had a difficult time tolerating it: persistent nausea, vomiting, or an unlucky small number with pancreatitis, so time will tell on those.

"Right now I think what we really need to do is try to think about ways to improve our environment so it's easier to eat healthier -- fresh fruits and vegetables -- and do mild things, like just go for a walk three or four days a week for 35 to 45 minutes; if you could do simple things like that, most of us could actually lose the small weight that we have to avoid becoming diabetic."

Kentucky is also one of the states most affected by the opioid epidemic. Stack said it has evolved because "The criminals keep getting more creative in the cocktails they put together and they're becomeing more and more lethal for people."

Speaking on the weekend that the nation moved its clocks to daylight saving time, Stack said lack of sleep is also a major health issue, especially for teens, who need more of it.

He said teens and adults "disrupt our sleep" with big and small screens, on TVs and smartphones. "We’ve got to get better sleep hygiene," he said, "and set out the time we need to get that eight hours of sleep."

Poll: 12% of U.S. voters say abortion is their top voting issue

Kentucky Health News

About one in eight voters said in a national poll last month that abortion will be the most important issue influencing their votes this year, and most opposed the 16-week abortion ban that former president Donald Trump has reportedly discussed endorsing.

Most voters who say abortion is the most important issue to their vote say abortion should be legal in all cases. "This is a significant shift from elections prior to the Supreme Court’s decision to overturn Roe v. Wade, when abortion voters were largely those who identified as pro-life," says the Kaiser Family Foundation, which sponsored the poll.

Though the issue has become a major dividing line between the major political parties, 43% of Republicans say abortion should be legal in most or all cases. However, "Few Republicans who want abortion to be legal seem ready to buck their party over the abortion issue," the foundation says.

Asked about a national 16-week abortion ban, 58% of voters oppose it; 63% of Republicans favor it.

Kentucky has both a six-week abortion ban and a law that bans all abortions except those needed to save the woman's life or prevent serious, permanent damage to a life-sustaining organ.

The national poll found Americans largely supportive of abortion rights. Examples include:

• 66% support a federal guarantee of abortion rights.
• 86% of adults, including large majorities of Democrats, independents, and Republicans, said they would allow abortion in pregnancy-related emergencies such as miscarriages.
• More tahn 60% oppose making it a crime for health-care providers to mail abortion pills to patients in states where abortion is prohibited, and policies that prohibit clinics that receive federal funds from providing abortions or referring patients to abortion providers.

Asked how they think about abortion, most said it is an issue of individual rights and freedoms (81%), a health-care issue (68%) and a moral issue (62%). Only 41% see it as a religious issue, but 41%of Republicans do.

"Many voters, especially Democrats, see the 2024 election as a high-stakes election for determining the future of access to abortion and contraception," the pollsters said. Half of voters say they think the elections for president, Congress, and state legislatures will have a 'major impact' on access to abortion." That view is driven by Democratic voters (about two-thirds) and those who say abortion is their most important voting issue (about 70%).

The poll was conducted Feb. 20-28, online and by telephone among a nationally representative sample of 1,316 U.S. adults, including 1,072 registered voters. Interviews were conducted in English and in Spanish. The margin of sampling error is plus or minus 3 percentage points for the full sample and 4 percentage points for the sample of registered voters. For results based on other subgroups, the margin of sampling error may be higher.

Emergency-room visits for respiratory illness keep declining, but flu activity remains elevated, and hospital admissions for it are up

State Department for Public Health graphs, adapted by Kentucky Health News

By Melissa Patrick
Kentucky Health News

Kentucky's influenza levels remain elevated and hospitalizations for respiratory illness remain high, even though emergency-department visits for respiratory illness have stayed on a rough plateau since mid-January, according to the state Department for Public Health.

In the week ended March 2, Kentucky saw a 13% drop in emergency-department visits for respiratory illness, to 3,175. Flu continues to be the driver for this high number.

Hospitalizations for flu increased slightly, but overall admissions for the three respiratory diseases tracked by the state dropped 7%, to 491. In addition to flu, the state tracks Covid-19 respiratory syncytial virus (RSV).

Letcher County is the only Kentucky county to have a high rate of Covid-19 hospital admissions in the week ended March 2, with 23.2 admissions per 100,000 people, according to the Centers for Disease Control and Prevention. 

Sixteen Kentucky counties had a hospital-admission rate between 10 and 19.9 per 100,000 people, considered "medium" by the CDC. That included Pike County, just north of Letcher. The others are in Western Kentucky: Union, Ohio, McLean, McCracken, Marshall, Lyon, Livingston, Hickman, Henderson, Hancock, Graves, Daviess, Crittenden, Carlisle and Ballard counties. 

For two weeks in a row, ED visits for respiratory illness have declined in children aged 5 to 17, dropping to 723 in the week ended March 2. Like adults, these visits have been driven by the flu. This age group had 14 hospital admissions in the week, 12 for flu and two for Covid-19. 

The state reported 3,603 laboratory-confirmed cases of the flu in the week ended March 2 and 1,983 lab-confirmed cases of Covid-19. Both of these numbers have dropped for three weeks in a row. 

Since the flu season began in October, the state has recorded 414 Covid-19 deaths and 97 flu deaths, 75 of the latter since the first week of January. One Covid-19 victim and one flu victim have been children.

Bill is moving to create database (but not licensing) of vape retailers, raise fines and bring state law in line with FDA rules

A customer vapes at a shop in Richmond, Va. (Associated Press file photo by Steve Helber)

By Melissa Patrick
Kentucky Health News

A bill to create a statewide database of retailers that sell vaping products, and align state law with federal restrictions on the products, is moving through the Kentucky General Assembly.

House Bill 11, sponsored by Republican Rep. Rebecca Raymer of Morgantown, was approved with a committee substitute by the House Health Services Committee on March 7 and was posted for possible action by the House starting Monday, March 11. 

After nearly an hour of discussion, HB 11 was approved 14-1-3, with Rep. Felicia Rabourn, R-Pendleton (Henry County), voting no and Democratic Reps. Adrielle Camuel of Lexington, Rachel Roarx of Louisville and Lindsey Burke of Lexington passing. 

Rep. Rebecca Raymer

Raymer said she began working on the bill after learning that most items confiscated in Kentucky schools are flavored and disposable vapes,and “I found out that these vapes are not even supposed to be offered for sale,” under rules of the U.S. Food and Drug Administration.

She said opponents would say that the bill will all such products off the shelf, but “That is simply not true. There are other states that have used the same definitions that we are using. I think Alabama is one of the states and they have about 1,600 products on their registry of things that can still be sold.”

Raymer said Congress is lobbying the FDA to create a concise list of what is legal and not legal, and “We are not the regulatory authority over these products. We don't get to decide what is legal and illegal.”

Dr. Britt Anderson, a pediatric emergency-medicine physician and vice-president of the Kentucky Chapter of the American Academy of Pediatrics, told the committee that she sees children come into emergency rooms addicted to nicotine and unable to stop vaping, which makes them cough and wheeze and be unable to exercise.

Vaping has become much more common among Kentucky schoolchildren than smoking. While the long-term effects of vaping on young people's health are unknown, Anderson said what we do know about vaping and nicotine use in youth is not "cutting-edge science." 

"We do know that they cause lung injury and changes to brain development during a crucial stage of life," she said. "And it's not just the nicotine. The complete ingredient list may contain fine particles and other carrier solvents that are unhealthy as well."

Mallory Jones, a junior at George Rogers Clark High School in Winchester, told the legislators that high schoolers can easily purchase vaping products despite the age restrictions.

"Once one person in a friend group starts using e-cigarettes, word gets around of where you can buy these products illegally, and it spreads like a domino effect," she said.

Jones lauded the bill, saying, "Addressing the source of these products is critical to reducing youth access and initiation of nicotine, but the rules are only as good as the enforcement that we put behind them."

Griffin Nemeth, coordinator of the #iCANendthetrend Youth Advisory Board at the University of Kentucky, noted that while HB 11 does not allow Kentucky to join the 40 other states that have some form of comprehensive tobacco retail licensure, it does allow the state to have a better understanding of the retail environment.

But he added that alone is not enough to make a difference: "It is with, and only with, the three combined elements of a retailer database, compliance checks and stiff penalties for violations that we can implement comprehensive prevention at the point of sale." 

Opponents of the bill

Troy LeBlanc, a retailer and manufacturer of vape products, said he supports efforts to decrease youth use of them, but said this bill won't do that because the bulk of the products approved by the FDA are sold in convenience stores and that's where most of the bad actors are when it comes to selling these products to youth.

"I urge you to change this bill to put these products in 21-and-over stores and have them policed by the ABC and have them fined with major fines . . . Make sure that the fine hurts enough to where people will not do it," he said. 

LeBlanc also said this bill would eliminate access to low-nicotine products while allowing sale of high-nicotine products made by large companies. 

He said the average nicotine level of products sold in vape shops is 3 milligrams per milliliter, while the large companies like Altria (formerly Philip Morris), make products with a much higher nicotine content.

"I don't believe it's the right bill because all it's going to do is to make sure that Altria is the main seller in every convenience store . . . . Juul is going to be all over the state," he said. "Juul also does not offer any nicotine product that's lower than 30 milligrams per milliliter." 

LeBlanc also pushed back on Raymer's claim that Alabama allows 1,600 products on their shelves, saying that after dissecting the list, "There are only eight brands on there of flavored nicotine." 

Mike Reichert of Campbell County, who said he owns two vape shops in Northern Kentucky, said this bill would likely cause his shops to close. 

"Most of the products that I sell would be banned as this bill is currently written," he said. "It would almost certainly cause my stores to close." 

Reichert said he got into the business to help people quit smoking, making that possible by selling the lower-nicotine products that can be tapered down to zero nicotine in his store. He agreed with LeBlanc that sales should be limited to 21-and-older stores, with higher fines to keep the bad actors out. 

Tommy Wilson of Pulaski County, who said he owns two vape stores, also pushed for such a move, which he said would likely make this issue go away. 

Wilson said he had helped thousands of people get off nicotine via combustible cigarettes and move to a lower-dose vaping product. 

“We too don't want youth vaping," he said. "But that said, we feel like it’s an adult’s choice to be able to find something that they deem is less harmful to their body. . . . Is it perfect? Maybe not, but is it better than 3,000 chemicals and burning smoke going into your lungs? I feel it is." 

The committee chair, Rep. Kim Moser, R-Taylor Mill, asked the opponents of HB 11 to keep talking to the bill sponsor to see if any tweaks can be made. 

"No one wants to do anything that is going to put anyone out of business," she said. "That's not our goal." 

Legislators' concerns

Rep. Josh Bray, R-Mount Vernon, asked the vape-shop owners if they're selling products that are not FDA-approved, prompting them to walk through the history of vaping products in the U.S., the ongoing methodology challenges to get products approved by the FDA and the legal challenges surrounding this issue. 

Earlier in her remarks, Raymer noted that she understands that those in opposition of this bill don't like the FDA process for regulating these products, but the bottom line is that the FDA has that authority. 

"And so we, as a state, have an obligation to offer some protection to our citizens," she said. "If we know these products are not authorized, they are not legal per the FDA, we shouldn't have them."

Roarx, one of the Louisville Democrats, said she appreciates the bill’s goal to keep Kentucky youth away from nicotine products, but said she has concerns that the bill might have unintended consequences on the tobacco and e-cigarette industry by creating a monopoly.

“I hope we can continue to make progress to make sure that we’re not just giving a couple of brands a monopoly on the entire industry,” Roarx said. 

The bill would take effect Jan. 1, 2025. Among other things, it would:

• limit the sale of products to those authorized by the FDA and would punish retailers who sell unauthorized products to anyone under 21 years of age;
• require businesses that sell vaping products to acknowledge that in their annual business filings with the secretary of state;
• require the secretary of state to create a list of the businesses and share it monthly with the ABC and the state Department of Revenue;
• require the ABC to create and maintain a tobacco database and reporting system, to be published monthly;
• set rules around how manufacturers, wholesalers and retailers sell and distribute the products;
• establish fines for manufacturers, wholesalers and retailers for noncompliance; and
• allow police officers and ABC investigators to issue a uniform citation for any violation of the law. The citations would then be reported to and enforced by the ABC.

What are the fines? 

The bill would require any manufacturer of products covered by the federal Tobacco Control Act to sell authorized products to wholesalers and retailers. A manufacturer that violates this section would be subject to a fine of $25,000 for a first violation, $50,000 for a second violation and $75,000 for third and subsequent violations.

It would ban a wholesaler from selling unauthorized products and from selling authorized products to a retailer until it verifies that the retailer is not in the tobacco non-compliance database and reporting system. Violators would be subject to a $5,000 fine for the first violation, and $15,000 for the second and subsequent violations.

State law already bans sales to minors, with a fine of $100 to $500 for the first violation and $500 to $1,000 for the second violation. The bill would require the second-violation fine to be $1,000 and set a $5,000 fine for a third violation. A retailer with a fourth violation in two years would be banned from selling vapes. That would also apply to retailers who don't pay fines within 60 days.

State and federal lawmakers say they're still trying to rein in health-insurance middlemen, called pharmacy-benefit managers

By Melissa Patrick
Kentucky Health News

A day after Gov. Andy Beshear talked at a White House roundtable about Kentucky's moving to one pharmacy-benefit manager for Medicaid, First District U.S. Rep. James Comer, spoke at another Washington event about his efforts to reform PBMs as chair of the House Committee on Oversight and Accountability.

U.S. Rep.  James Comer

“The focus of what PBMs' role should be, should be to help the consumer have more choice, have lower costs," Comer said at a March 7 event hosted by The Hill. "But what’s happening is the focus now with the PBMs is which drug can we make the most profit off of, regardless of what’s best for the patient. And I don't think that's a good business model." 

PBMs are middlemen between insurance plans and drug manufacturers; they determine what drugs are offered, how much someone pays for the drug, and how much pharmacists are paid.  

Earlier this year, Comer's committee passed with broad bipartisan support the Delinking Revenue from Unfair Gouging (DRUG) Act, which would rein in practices by some PBMs that offer health plans under federal employees' health program. 

Comer said PBM reform remains a priority, and his committee has received more than 40,000 pages of documents for a report that will be released "very soon." He said his panel will have another hearing once the report is release to discuss next steps.

He said those who understand the issue "realize that PBMs have actually added cost to the consumers" at a time when everyone recognizes that the rising cost of prescription drugs is not sustainable. 

Despite congressional concern about the issue, the government-funding bills just signed by President Biden do not include PBM reforms. Asked if they could pass in the "lame duck" session after the November elections, Comer, using his own committee as an example, said, "I think something can always be done before." 

Comer said much of the problem comes from three major PBMs controlling 80% of the market, noting that they are owned by health-insurance companies and have their own mail-in pharmacies. 

“I believe PBMs have had a negative impact on competition, especially among community pharmacists,” he said. “I believe they have an unfair competitive advantage. I believe they’re doing a lot of things that are unethical at best and should be illegal at worst with respect to – I would even go as far as saying extorting fees from independent pharmacies. We’re losing independent pharmacies.”

Kentucky lawmakers have been working on PBM issues for years. Most recently, in 2020, they passed a bill sponsored by Sen. Max Wise of Campbellsville, a Comer ally, that required the state to hire a single PBM for the state's Medicaid program. Before this law, each of the six companies that manage Medicaid for the state had its own PBM.  

At the White House roundtable, Beshear talked about the legislation and how he began investigating PBMs' drug-pricing methods when he was attorney general in 2016-19.

“That single PBM that answered to us, and not to any other company, has allowed Kentucky Medicaid to maximize drug rebates and has saved our Kentucky families about $300 million since we've done it,” he said. “And it allowed us to understand more about how to get the right price.”

Kentucky PBM reform efforts are ongoing

Wise's latest PBM reform measure is Senate Bill 188, which involves PBM reform efforts on the commercial market.  

State Sen. Max Wise

“I’m optimistic this measure will yield similar savings by applying the same standards to the commercial market, effectively cutting costs for Kentuckians with private health insurance plans,” Wise said in a Feb. 8 news release about the bill.  

SB 188 "aims to empower citizens to choose where they purchase their medication, prevent further closures of community pharmacies and ensure fair reimbursement rates for these essential health care providers," said the release.  

SB 188 has been assigned to the Banking and Insurance Committee. It has not yet been heard or voted on in committee, but has received its first reading, an indication that it has a chance for passage. 

Another bill that addresses PBMs passed out of the House Health Services Committee on March 7. House Bill 190, sponsored by Rep. Scott Sharp, R-Ashland, was approved unanimously and was placed in the House for possioble action as early as Monday, March 11. 

State Rep. Scott Sharp

HB 190, as amended by a committee substitute, would allow people to receive their medication directly from the mail, but if it does not get there in time, they would have the option to purchase it from their local pharmacy at the same price it would cost if it was mailed to them.  

Sharp said he was prompted to file this bill because of a personal experience. 

He said he went to his local pharmacist to get a drug for a family member who was having some trouble getting it delivered. He said he was told it would cost $400, instead of the $36 it would cost if it came by mal. 

Upon talking to his PBM, he learned that this was the "penalty" for using his local pharmacy, instead of getting it mailed direct. Since, he said he's learned that this is a common problem and that's why he wants to "fix it."