Millions of children on Medicaid are missing free check-ups; Kentucky is a little below the national average

Millions of low-income children across the country aren't getting free preventive exams and screenings guaranteed by Medicaid, and some experts say federal and state health officials aren't doing enough to fix the problem, according to a federal watchdog report.

The report from the Department of Health and Human Services’ Office of Inspector General says that while the Obama administration has boosted rates of participation for children getting regular wellness exams, dental checkups and vision and hearing tests, it needs to do more.

The report says that 63 percent of children on Medicaid received at least one medical screening in 2013, up from 56 percent in 2006, but most states are still falling short of the department’s 80 percent goal. Only Iowa and California met that participation rate goal last year.

In Kentucky, 57 percent of the 381,231 children covered by Medicaid who should have received at least one annual screening exam did so. Most states require at least one annual exam, and more frequent exams for infants. The reports shows that Kentucky's rate is better than 20 other states and equal to the rates in North Carolina, Rhode Island and Florida.

Some experts say state officials bear most of the responsibility for the low rates because they run Medicaid, the state-federal program for the poor, reports Phil Galewitz of Kaiser Health News. The OIG reports says the federal administration should be doing more to encourage states to address the problem.

"Child health advocates cite several factors for the low completion rates, including a shortage of doctors treating Medicaid patients, states’ low pay for providers and parents’ lack of awareness about the importance of the visits," writes Galewitz.

Congress introduced the Medicaid benefit, known as the Early and Periodic Screening, Diagnosis and Treatment program in 1967. In Kentucky, the EPSDT benefit includes screenings and special services, according to the Cabinet for Health and Human Services. Preventive care, such as routine physicals or well-child check ups, is provided under the screenings program.

Last year, 514,298 children were eligible for Kentucky’s EPSDT, says the the cabinet's annual participation report. Based on that number and eligibility periods, about 507,000 screenings were expected, but only 391,079 were, for a ratio of 83%. Additionally, the report says 236,830 children received dental services of any kind, with 208,783 receiving preventive services.

Some states require Medicaid health plans to educate members about the EPSDT benefit and what it covers. Others have implemented incentive plans that offer gift certificates for screenings. According to the National Academy for State Health Policy, Kentucky requires Medicaid managed-care organizations to provide an EPSDT coordinator to coordinate case-management services and continuity of care. Click here for more information about EPSDT screenings in Kentucky.

Laundry detergent pods are sending hundreds of small children to the hospital every year; better to use traditional detergent

Laundry detergent pods, a convenience product that can be tossed into washing machines without having to measure out a liquid or powder, caused more than 700 children to be hospitalized in 2012-2013, with one confirmed death, according to a new study from Nationwide Children’s Hospital.

Photo: University of Virginia Health System

The study, published online in the journal Pediatrics, evaluated U.S. poison-control data from 2012 to 2013 and found 17,230 reports of children younger than six who had been injured from the laundry pods. That is nearly one child every hour, says the news release.

Two-thirds of the cases were one- and two year-olds, with most of the exposures reported due to ingestion.

Because the pods are usually brightly colored, young children, who naturally explore their environments orally, put them in their mouths. The water-soluble covering on the pods is easily penetrated, allowing the concentrated detergent to be ingested.

"Laundry detergent pods are small, colorful, and may look like candy or juice to a young child,” Marcel J. Casavant, co-author of the study, said in the release. “It can take just a few seconds for children to grab them, break them open, and swallow the toxic chemicals they contain, or get the chemicals in their eyes.”

While some manufacturers of laundry detergent pods have changed packaging to make pods less attractive to children, many have not.

“It is not clear that any laundry detergent pods currently available are truly child resistant; a national safety standard is needed to make sure that all pod makers adopt safer packaging and labeling,” said Gary Smith, the study’s senior author. “Parents of young children should use traditional detergent instead of detergent pods.”

Parents and child caregivers can help children stay safe by following these tips:

• Use traditional laundry detergent, it is less toxic than the pods.
• Store laundry detergent pods up, away and out of sight - preferably in a locked cabinet.
• Close laundry detergent pod packages or containers and put away immediately after use.
• Put the national Poison Help Line number (1-800-222-1222) in your cell phone and post it near your home phones.

Study in Virginia finds school lunches are healthier than home-packed lunches

Preschoolers and kindergartners at three Virginia schools tend to eat healthier when they eat school lunches compared to lunches packed at home, Roberto A. Ferdman reports for The Washington Post.

Researchers at Virginia Tech surveyed more than 1,300 lunches at three schools in Virginia, and found that parents often packed chips, sweets and sugary drinks. These items are not allowed under the recently revised National School Lunch Program.

"I wasn't expecting there to be such a strong difference between school meals and lunches packed by parents," rsearcher Alisha Farris told Ferdman. "We thought that parents would send lunches that reinforced the sort of healthy habits we hope they are trying to establish at home."

"More than 60 percent of meals packed at home had one dessert (nearly 20 percent had two or more); just under 60 percent had savory snacks, like chips; and roughly 40 percent had a soda or sugar-added juice," Ferdman reports. "The school meals were more likely to contain fruits, vegetables, naturally sweetened juices and milk."

While the sample is not nationally representative, the study says there is no reason to believe the problem is limited to public preschools and kindergartens in Virginia, Ferdman writes. A similar study in Massachusetts this year found a similar pattern for its elementary-school students.

Stricter nutritional guidelines might explain why packed lunches perform so poorly by comparison from a nutritional standpoint, Ferdman reports.

Children get between a third and one half of their daily calories, on average, while they are at school, Ferdman writes. And this study shows that the 60 percent of children who eat school lunch, appear to be getting more nutritional meals.

Kentucky has a statewide outbreak of whooping cough, perhaps because the child-immunization rate is declining

Kentucky is having a statewide outbreak of pertussis, also called whooping cough, Jennifer Wohlleb reports for the Kentucky School Advocate, the magazine of the Kentucky School Boards Association. This comes at a time when the immunization rate among Kentucky school children is declining.

At least 230 cases of whooping cough have been diagnosed so far this year, and there were more than 300 confirmed cases last year, Wohlleb reports.

“And those are just reported cases, and most of those are in children,” Kraig Humbaugh, director of the state Division of Epidemiology and Health Planning, told Wohlleb. “And young children are the ones most likely to have the severe consequences, including unfortunately, death."

Another childhood disease, measles, remains in check. Humbaugh told Wohlleb, "We haven’t seen a case of it this year, but almost all of our surrounding states have and there is currently a measles outbreak … with cases that have been imported from other countries.”

That's important to remember, Humbaugh said. “We live a global economy and every day, people can come here from other countries,” where illnesses like measles and polio are still an issue, she said. “Vaccines and immunizations are really, really important, but some people get really complacent because we don’t see them (these diseases) as much anymore, but they’re still a threat.”

During the 2013-14 school year, 81.7 percent of Kentucky sixth-graders received theTdap booster shot, which protect against tetanus, diphtheria and pertussis. That is below the national average of 84.6 percent. The state’s rate of childhood series immunizations has fallen to 72.7 percent in 2013 for 80.6 percent in 2011, according to the National Immunization Survey, Wohlleb reports.

Schools in Scott County and Hart County both had an outbreak last year and discovered that many of those getting whooping cough were at the age where they needed a booster or right before the age where they needed a booster, Wohlleb reports.

Local health departments help districts communicate with parents, and can provide them with crucial information about the course of an illness.

“Once (a student) is considered to be infectious, it would be recommended that they stay out of school until they have received five days of the appropriate antibiotic treatment, or 21 days from the onset of cough,” Sharon Ray of the Barren River District Health Department told Wohlleb. “So you can see, if we don’t find out about it until you’re three weeks into a cough illness, you’ve already been there your whole infectious period, so we can’t shorten your infection time; where if we know early, we may not keep that student from getting sick, but we may shorten their infectious time to others.”

Kentucky allows parents to exempt their children from vaccinations for medical or religious reasons; it does not allow philosophical exemptions. Humbaugh told Wohlleb that vaccines are "one of the greatest medical success stories of the 20th century," and said "fear and misinformation about vaccinations may be contributing to lower rates of immunizations in areas of the country. "

“I think one thing people fear are side effects of vaccinations,” Humbaugh, who is also a pediatrician, told Wohlleb. “I think the literature shows that certainly, and the 20th century will bear that out, the benefit of being vaccinated for childhood diseases is greater than the small risks associated with vaccinations. To me, vaccinations are like any other type of medication that you give, everything has risks; taking Tylenol has risks. But the risks are very low. These are in general safe, proven effective vaccines, all approved by the U.S. Food and Drug Administration.

Diabetes is an epidemic and needs to be treated like one, with a public-health approach, Lexington policy experts say in new book

Diabetes is often called an epidemic, but is not treated as such. Two Lexington health policy experts argue in a new book that this has to change, Tom Eblen reports for the Lexington Herald-Leader.

The Great Diabetes Epidemic: A Manifesto for Control and Prevention was written by Dr. Gilbert Friedell, former director of the Markey Cancer Center at the University of Kentucky and founder of the Friedell Committee, a statewide health care policy organization; and Isaac Joyner, a public-health policy analyst who has worked on a variety of issues in Kentucky, Texas and the Carolinas. It outlines specific steps that people, communities and the government should take in its approach to diabetes, saying the solution is a "major public health response."

"If we continue to treat diabetes on a one-patient-at-a-time basis, we can't deal with an epidemic," Friedell told Eblen. "Unless you take a public health approach to an epidemic, it doesn't work."

Kentucky has seen a 158 percent increase in cases over the last 15 years, "outpacing every other state except Oklahoma," according to the Centers for Disease Control and Prevention. Eblen reports that most cases are Type 2 diabetes, which is related to obesity.

"A flu epidemic of such magnitude would create public alarm and swift official response," Eblen writes.

The authors say the first step in changing diabetes in America is widespread, routine screening. They cite Centers for Disease Control and Prevention estimates that more than one-fourth of the people who have diabetes don't know it because they have not been tested.

In Kentucky, that means that 370,000 Kentuckians know they have diabetes, but 137,000 more might have it and not know it, Eblen reports. Officials estimate 233,000 Kentuckians have pre-diabetes, meaning they are at immediate risk of developing the disease.

"You have to find cases early, which means you have to screen people who seem well," Friedell said. "The symptoms of diabetes come on maybe 10 years after the disease starts. But nobody knows they have the disease. We're wasting 10 years that we could be doing something good for people."

Current recommendations for diabetes screening is for people with high blood pressure, or anyone older than 45. The authors say everyone older than 20 should be screened. They say this has to be viewed as a societal problem, not an individual one, Eblen reports.

The authors call for increased government and community funding and efforts toward proven diabetes prevention programs and for insurance companies to revise the way they reimburse for diabetes saying, " the longterm payoff would be huge" with these changes. Most importantly, they also call for increased public awareness and urgency.

"There has to be a sense of urgency, and there is no sense of urgency about diabetes," Friedell told Eblen. "We need to do something to get the public involved, and the public has to feel that it's important."

Friedell and Joyner will speak about the book and sign copies at 5 p.m. Friday, Nov. 14, which is World Diabetes Day, at The Morris Book Shop, 882 East High Street. They also are scheduled to testify Nov. 18 in Washington to the Congressional Caucus on Diabetes.

Kentucky gets a $7 million grant to improve survival rates for lung cancer, in which it leads the nation

The University of Kentucky, the University of Louisville and the Lung Cancer Alliance have joined in a unique project called Kentucky LEADS (Lung Cancer, Education, Awareness, Detection, Survivorship) Collaborative to assess new approaches for identifying lung cancer earlier to improve survival rates.

These efforts are supported through a $7 million grant from the Bristol-Myers Squibb Foundation’s Bridging Cancer Care initiative.

Kentucky has more cases of lung cancer than any other state and its lung cancer mortality rate is nearly 50 percent higher than the national average. This year alone, 3,500 Kentuckians will die from lung cancer, a UK news release reports.

“As Kentucky leads the nation in lung cancer mortality rates, we must step up to be a leader in finding solutions toward preventing, curing and coping with this destructive disease,” Gov. Steve Beshear said. “I strongly support this collaborative, wide-ranging effort as it coincides with this administration’s KyHealthNow goals of reducing statewide cancer and smoking rates by 10 percent by 2019. By working together, we can and will find a way to diminish the burden of this crisis in Kentucky."

The project will also develop and evaluate interventions to improve quality of life and survivorship for individuals with lung cancer and their caregivers, the release says.

"Historically there's not been a lot of research or effort put into lung-cancer survivorship because, unfortunately, there hasn't been much survivorship," said Jamie Studts, associate professor of behavioral science at UK and director of the Kentucky LEADS Collaborative.

One in two patients diagnosed with lung cancer will die within a year. After five years, only 16 in 100 patients will be alive, UKNow writes.

"Those are sobering statistics,” said John Damonti, president of the Bristol-Myers Squibb Foundation. “The timing of diagnosis is critical. Patients diagnosed at Stage 1 have a 57 percent chance of achieving five-year survival. That drops to 4 percent when patients have a late-stage diagnosis. Early detection and treatment of lung cancer, combined with education and patient support, is key to increased survival for patients living with lung cancer.”

The project will include several components: a review of how physicians treat and refer lung cancer patients across the state; the creation of a sustainable lung cancer-specific survivorship program; and a program that will promote evidence-based prevention and early detection of lung cancer in Kentucky.

Early detection has recently become more attainable because lung cancer screening guidelines have recently changed, allowing Kentucky to implement rigorous, statewide screening programs that can save lives, UKNow writes. And because symptoms of lung cancer usually show up after the disease has spread, early screening is critical to reduce deaths.

Second round of private insurance enrollment under Obamacare starts Nov. 15; rates estimated to rise an average of 4.6%

Enrollment reopens Saturday, Nov. 15, for health insurance under the federal health-reform law and the state insurance exchange, known as Kynect.

In the second year of what is typically called Obamacare, there will be new insurers, new rates, a shorter enrollment period and larger penalties for not having health insurance.

The changes in rates and subsidies will affect people who enrolled in the first round a year ago, because the factors used to calculate them, "such as age, income and the cost of a certain plan used as a benchmark," will change, report Laura Ungar and Chris Kenning of The Courier-Journal.

"PwC, an assurance, tax and consulting firm that collected individual insurance rate filings across the nation, estimated Kentucky's average premium increase on and off the exchange will be 4.6 percent," The C-J reports. (PwC was formerly known as PricewaterhouseCoopers.)

At a news conference Monday, Gov. Steve Beshear noted that premiums in the individual health-insurance market increased 8 percent or more a year before the reform law passed "and there were no subsidies or discounts to help defray costs," Jack Brammer writes for the Lexington Herald-Leader.

"Costs will vary widely," Ungar and Kenning write. "Officials said there are 70,000 premium rates between all the insurers offering various plans on the exchange, and they are still being certified so they cannot yet be made public."

Competition could be keeping rate hikes modest. Two new companies will offering policies on Kynect: CareSource and WellCare, joining five previous insurers.

Kynect provides premium subsidies based on applicants' incomes. "Officials estimate that, in total, around 290,000 Kentuckians are potentially eligible for subsidies with Obamacare plans," The C-J reports. The Kynect website has been changed so users can figure potential premiums and subsidies without actually starting applications.

State officials estimate that about 100,000 people have policies that don't comply with Obamacare rules but were allowed to keep them until 2016. "These could include more than 14,000 customers told in early October by their insurers that their plans are being discontinued," the newspaper reports. "Ronda Sloan, spokeswoman for the Kentucky Department of Insurance, said this is a business decision by insurers."

Kynect is more than doubling its call-center staff and expanding its hours to reduce wait times, which were as long as three hours last year, and is working with 2,800 insurance agents, twice as many as last year, exchange Director Carrie Banahan told the Louisville newspaper. It will also have a federally funded app for Android and Apple smartphones and a "pop-up" store in Lexington. The call center will be open from 8 a.m. to 7 p.m. Monday through Friday and 8 a.m. to 5 p.m. Saturdays.

This year's open enrollment is expected to be less hectic than last year's "because people signing up for Medicaid — who became eligible under the state's expansion of the program and made up the majority of Kynect's sign-ups last year — can enroll at any time," Ungar and Kenning write. They quote Prestonsburg insurance agent Darrell Patton: "There's not as much talk about it this time. It came and it passed, and the sun still came up the next morning."

Still, Patton said some confusion remains, and there is unhappiness with "narrow networks of doctors and hospitals or not being able to get needed services covered," the C-J reporters write.

The penalty for individuals without health coverage in 2015 will be $325 per adult or 2 percent of household income, whichever is higher, up from this year's $95 and 1 percent. The current penalty isn't very effective because taxpayers haven't been required to say on their tax forms whether they had insurance. They will on next year's forms. "Those who went without in some cases can claim an exemption on the form or provide additional documentation if one was previously granted," the writers report.

The second enrollment period will be shorter, closing Feb. 15. Beshear encouraged Kentuckians to shop around, and do it early. Those on Medicaid, form which enrollment is open year-round, do not have to re-enroll unless they want to change their managed-care organization.

Generals say obesity is a national-security issue, and the main medical reason 73% of Ky. young adults can't join the service

"Obesity is the leading medical reason why 73 percent of our young adults cannot qualify for military service" in Kentucky, two former state adjutants general write in The Courier-Journal. They endorse the Obama administration's nutrition standards for school meals.

"We must turn the tide on the obesity epidemic by instilling good eating and exercise habits from an early age. Good nutrition starts at home, but many kids get up to half of their daily calories at school so it just makes sense to ensure they’re eating healthfully there, too," write Maj. Gens. Michael Davidson and Allen Youngman.

"Unfortunately, there is a misguided effort afoot to enable schools to retreat from these improved nutrition standards," they write. "The move is driven by complaints that some students are having trouble adjusting to the healthier offerings, and that some schools are struggling to procure healthier ingredients and the necessary equipment for preparing the new meals. In response, the USDA is offering significant flexibility to these schools. They permanently removed caps on proteins because of the challenges some schools were facing, and offered flexibility on rules regarding whole grain pasta. They also extended the grant period for funds to help schools meet the new standards, and are providing workshops to help schools that are struggling learn what works from those that are succeeding.

Fear of Ebola is causing people all over the country to act on unfounded fears, and Kentucky is no exception

By Melissa Patrick
Kentucky Health News

Fearing the Ebola virus, administrators at St. Margaret Mary Catholic School in Louisville put Susan Sherman, a registered nurse and an elementary school teacher, on "precautionary leave" after she returned from a medical mission trip from Kenya, an African nation that is 3,000 miles from Ebola-stricken areas and has no known Ebola cases, Allison Ross reports for the The Courier-Journal. Sherman has since resigned from her job.

Last week, Paul Sherman, Susan's husband and a retired orthopedic surgeon, sent a letter to Louisville Archbishop Joseph Kurtz, complaining that "unfounded fears" of some parents and parish staff "are triumphing over truth and reason, " Ross reports in a separate article.

Kurtz said in retrospect that the school's decision to ask Sherman to take a leave of absence was "not the right judgement" and that he was "very open" to having her come back to work at the school again, Ross reports.

The school has also sent a letter to parents saying that it asked Sherman to take a leave because "attempts to communicate facts and reduce fear were unsuccessful," and apologizing for poor communication to her, Ross reports.

Sherman's husband responded with a letter and said his wife was not "asked" to take a leave and called the school's apology "'half-hearted' and disputed parts of the school's account," Ross reports.

Fear of Ebola was also used as part of an election strategy during the recent U.S. Senate race, reports Kentucky's U.S. Senate Race, an independent blog run by students and their instructor, Al Cross, at the University of Kentucky:

"A stealthy coterie of difficult-to-trace outside groups is slipping tens of millions of dollars of attack ads and negative automated telephone calls into the final days of the midterm campaign, helping fuel an unprecedented surge of last-minute spending on Senate races," report Nicholas Confessore and Derek Willis of The New York Times. "Much of the advertising is being timed to ensure that no voter will know who is paying for it until after the election on Tuesday." The story doesn't mention Kentucky, but a friend of ours in West Kentucky, a white man in his early 60s, said he got about 10 phone calls Sunday, most favoring Republicans, including one with a woman's voice "threatening 'African danger' from Ebola and to vote against Obama," he wrote in an email.

CBS News reports other cases of unfounded Ebola fears affecting people who had no apparent risk of exposure to the disease, including a third-grade girl in Milford, Conn., who after returning from a relative's wedding in Nigeria, which was recently declared Ebola-free, was told to not come to school for 21 days "due to concern from certain parents and teachers that she could transmit Ebola to other children," according to the lawsuit. They also report that two middle school boys in the Bronx, originally from Senegal, also with no known cases of Ebola, have been harrassed with Ebola taunts at school.

Ross cites more stories of fear from across the nation, including a certified nursing assistant in Dallas who claimed she was sent home because her daughter had visited Kenya, and a bridal shop in Akron that closed temporarily after learning that a nurse who was later diagnosed with Ebola had shopped there.

A recent press release about Ebola from Kentucky's Cabinet for Health and Family Services says,"There is no significant risk to Kentuckians at this time."

“The only individuals potentially at risk for Ebola in the United States right now are those who have traveled to affected areas of West Africa or who have been directly involved in treating cases of Ebola or close contacts to a symptomatic patient with Ebola," Health Commissioner Stephanie Mayfield said in the release.

The release reminds us: "Ebola is not spread by air, water, casual contact or food in the United States. You can only get Ebola from contact with bodily fluids of a person who is sick with or has died from Ebola, or from exposure to contaminated objects, such as needles."

The only actual Ebola case known in the U.S. right now is that of a New York physician who was infected while treating patients in Guinea. He is listed in stable condition at a Manhattan hospital, CBS reports.

Experimental drug being used to treat Ebola is being manufactured using special tobacco plants in Owensboro

A unique type of tobacco grown in Owensboro is used to manufacture the ZMapp compound that was given to two Americans who then survived Ebola. The company that produced it, Kentucky BioProcessing, has since gone into "full-scale production of the drug," Janet Patton reports for the Lexington Herald-Leader.

"All of our focus is solely on ZMapp production. We're hoping our efforts can help expedite the drug approval process," David Howard, spokesman for Reynolds American, the tobacco company that owns the facility that makes pharmaceuticals from tobacco, told Patton. The genetic makeup of tobacco makes it an easy vehicle for genetic engineering.

The drug has been sent to government agencies for testing, but it hasn't been used on any more patients since the two Americans, Dr. Kent Brantly and Nancy Writebol, who have since recovered, were given the drug, Patton writes. She also noted that "it's uncertain whether the ZMapp helped cure Brantly or Writebol," but the drug has shown "promising results in testing in primates and mice, curing most of them even after they showed signs of infection."

ZMapp is "a cocktail of antibodies that has been proven to be the most effective treatment so far in fighting off the Ebola virus," Patton writes in a separate article. It was developed while working under contract for the U.S. Department of Defense and other federal agencies to be a "post-exposure treatment for Ebola virus."

The process involves growing a unique tobacco plant and "infecting" the plant with a protein that will "battle the Ebola." The protein then reproduces inside the tobacco plant "like a photocopier." And when ready, the desired proteins are extracted from the plants and put into a serum, Patton reports.

According to the website of Mapp Biopharmaceutical, a company that collaborates with Kentucky BioProcessing, the supply of ZMapp was used up in August, Patton reports.

In September, the federal government announced that it had given Mapp an 18-month contract for as much as $42.3 million for "the development and manufacturing of the medication ZMapp toward the goal of U.S. Food and Drug Administration approval," Patton reports.

Mapp says it is is conducting studies that will help determine the safety and efficacy of the drug while improving its manufacturing process, increasing yields and scale.

"The Department of Health and Human Services is also in advanced discussions to enlist Caliber Biotherapeutics, a Texas company that can produce the drug in millions of tobacco plants," according to federal officials and pharmaceutical industry executives, Andrew Pollack reports for The New York Times.

He reports that federal officials along with two of the world's biggest charities are also looking at arranging for production of ZMapp in animal cells, a more conventional method that takes longer, but allows for for greater output.

But even if these new contracts are negotiated, Pollack reports that there will only be "hundreds or thousands of treatment courses by early next year, which would not be nearly enough if the epidemic continues to spiral out of control."

Five things you can start doing today to decrease your risk of getting diabetes, which affects one of every 10 Kentuckians

By Melissa Patrick
Kentucky Health News

Diabetes is a real problem in Kentucky and one that is not projected to get any better. You may be at risk of getting it, but there are things you can do to decrease your risk of becoming diabetic.

"Type 2 diabetes is still entirely preventable with certain lifestyle changes," Dr. Manny Alvarez writes for Fox News. "I always preach to my patients the importance of exercise and diet."

Kentucky ranks 17th in diabetes. One in 10 adult Kentuckians have been diagnosed with it and 40 percent of Kentuckians age 40-74 have pre-diabetes, according to the state Department for Public Health.

Even more worrying is the 2014 "States of Obesity" report that projects a 51 percent increase of Kentuckians with diabetes by 2030, going from an estimated 400,000 in 2010 to almost 600,000 in 2030.

Alvarez cites a study that identifies five simple habits to cut your risk of developing diabetes by as much as 80 percent:

1. Have a healthy diet, including lots of fruits and vegetables
2. Exercise three times a week for at least 20 minutes.
3. Maintain a normal body weight, which means a BMI between 18.5 and 24.9
4. Don't smoke.
5. Consume alcohol in moderate amounts.

Maintaining a normal body weight is the single most effective factor to prevent getting diabetes, according to the study, Alvarez reports. "Men of normal weight were 70 percent less likely to develop diabetes than overweight or obese men, while normal weight women were 78 percent less likely to develop diabetes."

But that doesn't mean overweight people don't benefit from incorporating these healthy lifestyle changes. "Overweight people who adopted just one of the other healthy lifestyle factors, such as exercising three times a week, could still reduce their risk of diabetes," Alvarez writes.

These suggestions should offer some hope to Kentuckians as lifestyle changes are things we have some control of and often come at little to no cost.

Sen. Mitch McConnell faces diverse pressures on the question of repealing the federal health-reform law

Incoming Senate Majority Leader Mitch McConnell says he still wants to get rid of Obamacare, and the Kentuckian is "under rapidly increasing pressure from conservatives to pursue an aggressive path to repealing the landmark health care law," but it won't be easy, Jennifer Haberkorn reports for Politico.

Ardent conservatives are calling for repeated repeal votes under budget reconciliation, which requires only 51 votes, not the 60 usually needed to do significant business in the Senate. But establishment Republicans "barely mentioned Obamacare" the day after the election, Haberkorn notes. McConnell indicated that 60 votes are needed for repeal, and it takes 67 votes to override a presidential veto.

"McConnell has said that he wants to use the Senate appropriations process to starve funding to the law. When asked about his strategy on Wednesday, he said Republicans would be 'addressing that issue in a variety of different ways' and hinted at using reconciliation by saying that 'There are some things we can do with 51 votes'," Haberkorn writes. "Reconciliation is tricky — it would require Congress to pass a budget resolution, which is no easy task, and in the end, even a successful Obamacare repeal bill would just get vetoed anyway. And by the time they’re done, Republicans would have squandered potentially months of their new majority debating health care."

Several Republican sources say that McConnell will all but certainly hold an early, symbolic full repeal vote that is expected to generate support from every Republican and probably no Democrats. It will fail to overcome the 60-vote threshold for a filibuster. Beyond that, the Republican conference will collectively decide the strategy: a full-bore attack on as much of the law as possible, or a selective picking and choosing of the most vulnerable pieces of the law," such as its tax on medical devices and the coming mandate that employers of more than 50 people insure employees who work 30 or more hours a week.

"While Obamacare on the whole remains unpopular, there are pitfalls in any repeal strategy that includes popular parts of the law," Haberkorn notes. "That includes helping people with pre-existing conditions get covered, the subsidies that make insurance more affordable, and the exchanges, which is particularly popular in McConnell’s home state of Kentucky."

Still, "In some quarters, anything other than the full-scale assault is unacceptable," Haberkorn reports. "When McConnell stated on Fox News the other day the simple fact that Republicans couldn’t repeal the whole thing, the backlash was swift. The Senate Conservatives Fund, which backed his Kentucky Tea Party primary opponent, accused him of being insufficiently committed and of 'making excuses for why he won’t deliver on his central campaign promise.' McConnell’s aides had to send out statements restating how much he despised the health law."