Tackling obesity in Kentucky can be a touchy subject

KentuckyHealthFacts.org map; click on it for larger version

SLADE, Ky. -- Among the topics covered in "Covering Health: A News Workshop" Nov. 11 at Natural Bridge State Resort Park was one of Kentucky's biggest pairs of health problems: obesity and diabetes.

Reporting on obesity can be intimidating for journalists, said Danielle Ray, graduate intern at the Institute for Rural Journalism and Community Issues, who presented on the topic. "It’s a really awkward topic to approach," she said. "You feel like you’re embarrassing people." Reporting the facts about obesity is not intended to shame people, she said, noting that readers, viewers and listeners are at risk for life-threatening, yet preventable obesity-related illnesses, especially those in rural Kentucky counties.

Kentucky's obesity rate is the nation's fifth highest, with nearly 35 percent of adults categorized as obese on the basis of their height and weight. That number has been rapidly climbing for more than 25 years, according to the State of Obesity report. In 2000, about 22 percent of Kentuckians were obese; in 1990 the figure was less than 13 percent.

County-level map from KentuckyHealthFacts.org

Obesity is associated with diabetes and hypertension, or high blood pressure. Kentucky ranks fourth in the nation for diabetes, with more than 13 percent of the adult population diagnosed with type 2 diabetes.

The state ranks sixth highest in the nation for hypertension, with 39 percent or 1.8 million Kentuckians diagnosed with high blood pressure.

Hypertension, like diabetes, puts people at risk for other serious medical problems, including stroke, heart attack, renal disease and dementia.

Obesity also increases a person's likelihood of developing other conditions like heart disease, arthritis and cancer.

Childhood obesity may be an even greater problem in the state. Kentucky has the third highest rate of obese high-school-aged children, nearly 20 percent. Childhood obesity becomes intertwined with other factors that make the cycle hard to break. Most notably, children from low-income families are at a greater risk of obesity and its subsequent health problems, the report notes.

The workshop was presented with support from the Foundation for a Healthy Kentucky, which funds the rural-journalism institute to produce Kentucky Health News. The institute is part of the School of Journalism and Media in the College of Communication and Information at the University of Kentucky.

To find local information on obesity, visit Kentucky Health Facts or County Health Rankings.

Study finds Medicaid is paying for more emergency-room visits while charity care and self-pay visits drop

Emergency room visits have remained fairly steady in Kentucky since 2012, but have increasingly been covered by Medicaid since the implementation of the Patient Protection and Affordable Care Act, according to a study.

The study for the Foundation for a Healthy Kentucky found that last year Medicaid paid for 46.9 percent of ER visits, up from 30.2 percent in 2012. Conversely, charity and self-pay covered visits to the ER dropped to 5.9 percent last year from 23.2 percent in 2012.

SOURCES OF PAYMENTS TO HOSPITAL EMERGENCY DEPARTMENTS

"We're seeing an expected shift in payment from charity care to Medicaid in these early years of the Affordable Care Act implementation, but the ACA is only a part of the answer to reducing the volume of ER use," Ben Chandler, president and CEO of the foundation, said in a news release.

Chandler said the state needs to enact policies to help Kentuckians establish regular doctor visits and seek preventive care. "That's a much less expensive approach, and it results in much better long-term health than going to the hospital in an emergency," he said.

WAVE-TV reported in August that 2.4 percent of Kentucky Medicaid's ER costs in 2015, or $9.3 million, were for non-emergency cases.

Gov. Matt Bevin's new Medicaid plan, which is under negotiation with the federal government, calls for up to a $75 fee for Medicaid-expansion members who use the ER for non-emergencies. Traditional Medicaid users would not be subject to the fee.

The report comes from the State Health Access Data Assistance Center at the University of Minnesota, which the foundation is paying more than $280,000 to study the impact of the federal health-reform law in Kentucky over three years. This study is a quarterly snapshot of April, May and June.

In 2014, Kentucky hospitals reported 2.1 million ER visits, which was nearly identical to the number of visits in 2012. Visits rose slightly to 2.2 million in 2015, according to the report, but it cautions, "More long-term data is necessary to determine whether that represents a year-to-year fluctuation or an actual increase."

An earlier report from the same study found that about 29 percent of those who used the emergency department said it was because of a medical emergency. Almost 29 percent said they did so because other facilities weren't open when they needed care, and 18 percent only named a specific health condition. Seven percent said they were following a doctor's order, 3 percent said the emergency department was nearby, and 3 percent said they were taken by a first responder. Eight percent gave other answers.

The release notes that other studies have found a pattern of initial increase of ER use after Medicaid expansion, followed by a slowing down. It also noted that research shows that the increase in ER use cannot be primarily attributed to the uninsured.

The earlier report found that 42.4 percent of Kentuckians who used the emergency department were uninsured, 48.2 percent had public insurance and 34.1 percent had private insurance.

"ER use has been rising for two decades across the country, but it's not the uninsured who are going more often," Chandler said. "It's going to take a combination of delivering care differently, ensuring that people have a regular doctor they can get in to see when needed, better care coordination, and more education before we see a sustained reduction in ER use."

Bevin adds a synthetic painkiller that is abused like heroin to the state's list of controlled substances

Image: foxnews.com

Gov. Matt Bevin issued an emergency regulation Nov. 15 to place a synthetic painkiller called U-47700 on a controlled-substance list in Kentucky and make it subject to criminal drug penalties.

“New illicit deadly drugs are making their way into our communities and destroying lives,” Bevin said in a news release. “More than three Kentucky families a day are shattered by a drug overdose. . . . This executive order gives our law enforcement officers the immediate support they need to help save lives.”

Drug overdoses are the leading cause of accidental deaths in Kentucky. In 2015, 1,248 Kentuckians died of overdoses, up from 1,088 in 2014.

The emergency regulation also allows other drugs that are classified as controlled substances to be automatically placed in the same drug class in Kentucky. "This allows the process to be expedited, instead of reopening the regulation every time a new synthetic drug is discovered," says the release.

The emergency regulation places U-47700, nicknamed "pink", in the same drug class as heroin and fentanyl, the category for drugs that have no medical purpose and present high potential for abuse.

Van Ingram, executive director of the state Office of Drug Control Policy, told Bill Estep of the Lexington Herald-Leader that  most U-47700 in the U.S. comes from China and is sold over the internet, where it is sometimes advertised as being legal. Ingram said there have been three cases in Kentucky.

"We want to send a message that it's not legal in Kentucky," he said. "It's dangerous."

The U.S. Drug Enforcement Administration has also added U-47700 to the list of Schedule I drugs. It was associated with 46 confirmed fatalities in 2015 and 2016, according to the DEA news release.

"Because substances like U-47700 are often manufactured in illicit labs overseas, the identity, purity, and quantity are unknown, creating a 'Russian Roulette' scenario for any user," said the DEA news release.

Kentuckians are likely to need help signing up for health insurance on the federal exchange, especially in east and south

Kentuckians looking for a 2017 health plan on the federal exchange will likely need some help signing up, if a study of last year's need for support on the former Kynect exchange is any indication.

The Foundation for a Healthy Kentucky study found that more than half of Kentuckians (52.3 percent) who got their health insurance through Kynect last year worked with a kynector, a person who helped them sign up. The study also found that 41.7 percent contacted the Kynect call center and 38 percent visited the Kynect website.

"As the commonwealth transitions away from Kynect and into a supported state-based marketplace using the federal portal Healthcare.gov, this report tells us that more than half may be reaching out for one-on-one assistance, either in person or by phone, during the process," Ben Chandler, president and CEO of the foundation, said in a news release.

The report comes from the State Health Access Data Assistance Center at the University of Minnesota, which the foundation is paying more than $280,000 to study the impact of the Patient Protection and Affordable Care Act over three years. This study shows a quarterly snapshot of April, May June 2016.

Kentuckians who qualify for insurance subsidized by federal tax credits, called qualified health plans, are signing up on HealthCare.gov during this year's open enrollment, which began Nov. 1 and goes through Jan. 31. (Individuals must sign up by Dec. 15 to get coverage that begins Jan. 1.)

The state has extended contracts with the same organizations that provided kynectors for Kynect, but they are now called "application assisters" and every county in Kentucky is served by one of these organizations, according to the Cabinet for Health and Family Services. You can find an application assister by clicking on a search button on the Kynect website or by calling Kynect's customer services at 855-459-6328.

Use of Kynect was higher in Eastern and Southern Kentucky.

Chandler said the need for assistance "is likely to be greatest in Eastern Kentucky, where a larger proportion of residents accessed their 2016 coverage through Kynect."

The report found that the highest rate of Kynect enrollment in 2016 was in Eastern Kentucky, at 33.9 percent, and the lowest was in Northern Kentucky at 16 percent. Western Kentucky (27.8 percent), greater Louisville (22.5 percent), and greater Lexington (21.9 percent) were all closer to the state average of 25.8 percent.

Of the nearly 26 percent of Kentucky adults who got their health coverage for 2016 through Kynect, just 5 percent enrolled in private individual-market coverage and 95 percent enrolled in Medicaid, the report said.

WFPL of Louisville reported in early November that an application assister in Manchester, Sharon Bush, said many people in southeastern Kentucky don't have or use information technology, adding to the challenge of getting people signed up in the region. For example, HealthCare.gov requires an e-mail account to sign up. Another challenge is that application assisters can no longer get into the system to enroll their clients as they could on Kynect, so consumers must be able to do it themselves or work with a company that has bought the software to do so.

Health Status of Kynect Enrollees

Kentuckians who used Kynect tended to have poorer health. "If last year's numbers hold true, those looking to buy insurance or sign up for Medicaid via the federal portal will have poorer health than their counterparts who already have insurance," Chandler said.

The report said 45 percent of those who enrolled through Kynect said they were in fair or poor health, compared to 28 percent of Kentucky's non-elderly adult population.

Click here for tips on picking a health plan on Healthcare.gov, including the types of plans available and quality ratings.

Ky. leads nation in rate of hepatitis C infections but new drugs to treat the disease are so expensive they're out of reach for most

Kentucky's rate of hepatitis C infections is seven times the national average, but expensive new drugs to treat the disease remain largely out of reach for residents of the state, Andrew Joseph reports for Stat, a health publication of The Boston Globe.

“It’s very hard to see the patient and just tell them, ‘I can’t treat you’,” Dr. Fares Khater, an infectious-disease doctor in Whitesburg, told Joseph.

The story is an in-depth look at hepatitis C and access to treatment in Kentucky. "Over the past year, only 3 percent of the state's Medicaid beneficiaries with the disease received treatment," Joseph reports, primarily because the list price of some 12-week hepatitis C treatments can approach $100,000.

Joseph writes from Hazard: "The patients here ask about the treatment by name. They’ve seen the crisp, alluring ads on TV and heard the soothing spots on the radio: Harvoni, they know, could cure their hepatitis C. But in this town . . . Harvoni and other new hepatitis C drugs remain largely out of reach."

Laura Combs, a Knott County nurse
practitioner, has diagnosed hepatitis
C in many recovering drug users.
(Stat photo by Sam Owens)

Joseph suggests that Kentucky could be a case study on the effects of hepatitis C and what happens when demand for specialists, surveillance and treatment exceeds the ability for the health system to handle. Kentucky's high infection rate, No. 1 in the nation, is driven by intravenous drug abuse.

"In fiscal 2016, hepatitis C treatments — delivered to fewer than 900 of the 29,000 hepatitis C patients covered by Kentucky’s Medicaid program — ate up 5 percent of the program’s pharmacy budget," Joseph writes. He quotes Doug Thoroughman, Kentucky's acting state epidemiologist: "We don't have the capability to deal with this because we don't have the resources."

Hepatitis C is a viral disease that attacks the liver, It can cause liver cancer, cirrhosis and scarring called fibrosis. It is the nation's leading cause of liver transplants, and an estimated 19,000 people die from hepatitis C-related complications each year. Symptoms typically occur only after the liver is damaged, which can take years after getting the virus. As a result, an estimated 2.7 million to 3.9 million Americans are infected with hepatitis C and don't know it.

Many who are infected are Medicaid recipients. Gov. Matt Bevin has asked the federal government to approve changes in Medicaid, including a rule that would require many beneficiaries to pay premiums. Advocates for underserved populations warn that even small fees would be too expensive for many to keep their insurance.

Most new hepatitis C cases are spread through the sharing of needles and other injection tools, and this patient base "is demanding hard choices be made about who gets treatment first," Joseph writes.

"To qualify for treatment, some beneficiaries in Kentucky, for example, must have stage 3 or 4 liver fibrosis (on a four-stage scale) and show they have not used alcohol or drugs for six months, in part to reduce the chances that someone treated gets reinfected," he writes.

But Dr. Uday Shankar, a Hazard gastroenterologist, told Joseph that everyone who is infected should be treated.

“You need everybody to be cured,” Shankar, who estimated that only 10 percent to 20 percent of his patients have been approved for treatment, said. “If you don’t cure them today, one person will transmit to five people. Especially youngsters — they have a long way to go.”

Jennifer Havens, an epidemiologist at the University of Kentucky, has been tracking hundreds of drug users in Perry County since 2008, detailing what drugs they use, with whom they use drugs, and if they can get substance abuse and medical treatment. "Their research, as well as work done in Austin, Ind., suggests it is possible to track how diseases like HIV and hepatitis C spread through close networks of drug users and to pinpoint the people most likely to infect others," Joseph writes.

The research suggests that it might be possible to treat the patients with hepatitis C who are most at risk of infecting others as a form of prevention, Joseph writes. That may not be realistic at this point, Havens said, but “there’s got to be a way to come up with a formula in the future to find out who would be best to treat in a limited-resource setting.”

Foundation for a Healthy Kentucky announces four new members for its Community Advisory Committee

The Foundation for a Healthy Kentucky announced four new members of its Community Advisory Committee Monday, Nov. 14. The 31-member committee serves as a liaison between Kentucky communities and the foundation's board of directors, and appoints a majority of the board.

The new members appointed by the CAC will serve a three-year term. They are public-health professor Angela Carman of Madison County, retired judge Roger Crittenden of Franklin County, former health-care executive Keith Knapp of Oldham County, and youth-service-center director Charity Fuson of Laurel County.

"Each member hails from a different area of Kentucky and each will offer their own unique expertise and input to the Foundation's work, and give us greater insight into the health issues facing the Commonwealth," said Ben Chandler, president and CEO of the foundation, said in a news release.

The CAC officers for the coming year are Robert Slaton of Georgetown, who will serve as chair; LeChrista Finn of Lexington, who will be vice-chair; and Tim Marcum of Louisville, secretary.

Carman is an assistant professor in the University of Kentucky's College of Public Health, director of practice and experiential education for the college; and a public-health management consultant to local health departments and hospitals. She earned a business degree Berea College and an MBA at Eastern Kentucky University.

Crittenden spent 25 years as a circuit and district judge for Franklin County and served as a senior judge from 2006 until 2010. He is a graduate of UK's College of Law and Georgetown College, and attended the Fels Institute of Government, a graduate program in public policy and public management at the University of Pennsylvania. He is a U.S. Army veteran of the Vietnam War.

Knapp is an associate professor of health sciences at Bellarmine University and an adjunct assistant professor at the University of Louisville and Western Kentucky University. He has a Ph.D. in gerontology from UK, a master's in health administration from Xavier University and a bachelor's in behavioral sciences from UK.

Fuson is director of the Youth Service Center at South Laurel Middle School in London and serves on many community boards related to youth and health. She received her bachelor's degree from EKU.

Click here to read more about each of the new CAC members.

Journalists gather to hear why and how to cover health, get a myriad of story ideas, sources and approaches

SLADE, Ky. -- Kentucky journalists interested in covering health got plenty of information and hopefully some inspiration Friday at "Covering Health: A News Workshop" at Natural Bridge State Resort Park.

The workshop was presented by the University of Kentucky's Institute for Rural Journalism and Community Issues with support from the Foundation for a Healthy Kentucky, which funds the institute to produce Kentucky Health News.

Jennifer P. Brown, former editor of the Kentucky New Era,
discussed how a small daily newspaper can cover health topics.

Journalists heard a battery of reasons for covering health, and how to find and use local health data. They were urged to overcome reluctance to report bad news, and to publish special newspaper sections on health.

Institute Director Al Cross told the journalists that covering health is important because it is the most important issue facing the state, "and probably your community." He cited the state's dismal health statistics, including: No. 1 in cancer deaths, lung-cancer deaths, deaths related to smoking, heart disease, hepatitis C, overuse of antibiotics and preventable hospitalizations ."They take care of us and then we don’t take care of ourselves," Cross said.

He noted other poor rankings: Second in smoking, heart attacks, high cholesterol, poor physical health days, and insufficient sleep; third in percentage of deaths from drug overdoses, fourth in diabetes, physical inactivity and poor mental-health days; fifth in adult obesity, sixth in stroke and sixth in hypertension, or high blood pressure (one of 2 states where the rate rose last year).
Cross said the state's poor health status hurts all Kentuckians, through higher insurance premiums, state taxes that pay for Medicaid, jobs that don’t come (or leave) due to high health costs and drug use in the workforce. He said that if Kentucky could reduce its No. 1 health problem, our high rate of smoking (26.5 percent), just to the recent U.S. average (18 percent), we would save $1.7 billion on health care the next year, with the average Kentuckian saving $400.

Melissa Patrick, senior reporter for Kentucky Health News, showed the journalists how to gather and use local health data. She said the foundation's KentuckyHealthFacts.org site "is just the best one-stop shop for information."

Cross said the annual County Health Rankings from the University of Wisconsin provide an easy rundown of a county's health status, but many newspapers have never reported them, apparently reluctant to go out of their way to report information that reflects poorly on the community. "The worse your health ranking, the less likely you are to read about it in your local newspaper," he said. "The better your ranking is, the more likely you are to read about it."

He said that pattern didn't hold true in 2014, but recurred in 2015, albeit with a smaller sample. He said the ratings don't change much from year to year, so newspapers are less likely to report them, but should do so every year because of the impportance of community health.

Cross also urged the journalists to report the ratings of Medicaid managed-care companies, since Medicaid members can change their MCO through Dec. 16; and to follow county health boards, which under state law have responsibility for their county's health. For a copy of his PowerPoint presentation, click here.

Covering a local hospital can be difficult if it is privately owned, but if it is charitable, its report to the Internal Revenue Service is a public document that can provide useful information, said Jennifer P. Brown, former editor and opinion editor of the Kentucky New Era in Hopkinsville.

Sharon Burton, editor and publisher of the Adair County Community Voice in Columbia, spoke about her paper's success with special sections on health, which she said she always includes when publishing a sample-copy edition that is mailed to every postal address in the county. "It's the easiest sale," she said. "The wonderful thing about a health section is, it can be as much work or as little work as needed," because Kentucky Health News and other sources have plenty of stories to go between the ads. But she said every story needs a call to action for readers who think, "This resonates with me; now what do I do?"

The workshop also included sessions on smoking, cancer, obesity, vaccinations, drugs and syringe exchanges, the need to consider the health effects of government and institutuional policies, add a luncheon keynote speech by Van Ingram, director of the Kentucky Office of Drug Control Policy. A story on Ingram appears below; reports on other sessions and/or their PowerPoint presentations will be posted here soon.

State drug-control policy office's legislative package will include putting overdose incidents into prescription database

By Melissa Patrick
Kentucky Health News

SLADE, Ky. -- The executive director of the Kentucky Office of Drug Control Policy said Friday that his office is working on a legislative package that includes putting overdose incidents into the state's electronic prescription drug monitoring program, and offered a comprehensive overview of the problem, saying it will take 20 years to solve.

"We hope to be releasing a 2017 plan very shortly," Van Ingram said at "Covering Health: A News Workshop," sponsored at Natural Bridge State Resort Park by the Institute for Rural Journalism and Community Issues and the Foundation for a Healthy Kentucky.

Ingram's PowerPoint presentation had many such
charts and graphs. For a copy of it, click here.

In 2015, 1297 Kentuckians died from a drug overdose. This was up from 1,087 in 2014 and up from 246 in 2000.

Ingram said approximately 28 percent of the 2015 overdose deaths had heroin in their system and approximately 34 percent had fentanyl, and most of them had a combination of drugs in their system.

 "Almost every time you've got heroin, you've got a benzodiazepine also," he said. "What a person generally dies of is drug toxicity."

He added that 56 percent of the people who died from an overdose in 2015 had an opioid prescription written in the prior 6 months to their death, 33 percent had a current opiod prescription and 21 percent had an overlapping opioid or bezodiazepine prescription at the time of their death.

"They really need to know whether or not that person has had an overdose incident," Ingram said of his offices plans to include this data in KASPER to better help physicians in their prescribing. Ingram said that while there has been some decrease in heroin seizures in the state, fentanyl is on the rise.

"And that's a trend that I predict will continue," he said, noting that the "profit margin is amazing" for this drug, with dealers making up to $1.6 million dollars for a $6,000 investment or up to $6 million if they have the ability to create fake pills.

"This is a business model that is not going anywhere," he said.

DEMAND, SUPPLY AND TREATMENT

Ingram said that while the United States has only 5 percent of the worlds population, it uses 99.3 percent of all hydrocodone combination products and 82 percent of the oxycodone.

"We lose 129 people in this country every day. That's a small commuter airplane crashing every day. If we had a plane crashing every day, do you think we'd figure it out? . . . Of course we wouldn't have anyone lobbying to keep plane crashes going. There are people lobbying to keep this number here. And they are a powerful lobby," Ingram said. "If we don't change these numbers nothing in this country changes and this opiod epidemic goes nowhere. We'll just keep throwing Band-Aids on it."

Ingram noted that the Centers for Disease Control and Prevention recommends that providers only prescribe a three to seven day supply of pain pills after a procedure. He also said we need to start using opioids as a last resort for pain, that reimbursement rates must change to allow providers more time for evaluation and that reimbursement rates must also include alternative treatments for pain. And just as importantly, he said that we as a society have to stop wanting a quick fix for pain.

Ingram said the federal government has finally taken notice of this problem, but that he wished they had paid attention to Hal Rogers back in 2004 when "he was running up and down the halls telling everybody, but nobody would listen." We need to "lay groundwork with good policy" that will make an impact over time, it took 20 some years to create this problem and it will likely take 20 more to solve it, he said.

Ingram pointed out that the solution to the opioid epidemic is greater than just saying, "Why don't these people quit?" He explained that because of how opioids affect the brain, people who are addicted to them need the drug, just like we need food and water. And because of this, we need every available resource to treat it, including: medication assisted treatment, peer led recovery, intensive outpatient treatment and residential treatment.

"We need it all," he said.

HISTORY

Ingram said it is important to recognize that conditions leading up to this "perfect storm" of opoid abuse have been in the making for the last 20 years. He pointed out that it began with Purdue Pharma's marketing campaign for OxyContin, which was heavily marketed in Appalachia. He noted that Appalachia had eight of the top ten zipcodes for the highest number of opioid prescriptions between 1998 and 2000.

"Appalachia was ground zero for this entire epidemic," he said.

Ingram said the increase in lobbyists pushing for increased treatment of pain;The Joint Commission's decision to establish pain as the fifth vital sign; and the decision to tie hospital reimbursements to patient satisfaction surveys, which asks patients if their pain has been adequately addressed, also contributed to the current problem.

In addition, he extended the blame to individuals wanting quick fixes for their pain; physicians who over-prescribed them; and the health insurance industries poor reimbursement policies for alternative treatments to pain.

Further, Ingram said the problem has been exacerbated by the introduction of abuse deterant formulas for pain pills; an increase in intravenous drug use; the increased awareness of prescribers; and the drug cartels recognition and response to the demand.

"All these things come together to form the perfect storm that we have today," he said.

ADDITIONAL DETAIL

Age of Decedents from overdose deaths in 2015

Ingram also pointed out that most people who overdosed in 2015 were between the ages of 45 and 54 (372), followed by 35-44 (341) and then 25-34 (288).

"This is not just a young person disease," he said. "These are people who have probably had an opioid use disorder for a decade or longer."

Ingram noted that the 2015 anti-heroin bill increased access to treatment, enhanced penalties for major drug traffickers and increased access to Naloxone.

He said the "Good Samaratin" provision of the law, which allows a person to seek medical help for an overdose victim and stay with them without being charged, was already "making an difference," noting that the first months of 2016 were looking "a lot better than they did last year."

"My early prediction on this is that this is making an impact," he said, "I think more people are calling"

He also said that since the state has increased access to Naloxone, 1200 pharmacist are now trained to dispense it and that there are 300 locations dispensing it across the state. He added that the ODCP has recently launched an interactive website that connects zipcodes and counties with the closest places to get it.

Ingram recognized that syringe exchanges remain controversial, but said that after learning about them, he now considers himself the "poster boy for syringe exchange." He pointed out that a lot more happens at needle exchanges than just the exchange of dirty needles for clean ones, including, medical treatment, HIV and hepatitis C testing and counseling.

Annual Great American Smokeout is Thursday, Nov. 17

If you're one of the approximately 1 million Kentucky adults who smoke, and are in the majority who say they'd like to quit, the Great American Smokeout may be for you. It is Thursday, Nov. 17.

The annual event, promoted by the American Cancer Society, doesn't necessarily ask smokers to quit on that day. It encourages them to make a plan to quit, and quit smoking on a certain day. "Getting effective help through counseling and medications can increase the chances of quitting by as much as threefold," says the federal Centers for Disease Control and Prevention.

The cancer society says, "Encourage someone you know to use the date to make a plan to quit, or plan in advance and then quit smoking that day. By quitting – even for 1 day – smokers will be taking an important step toward a healthier life and reducing their cancer risk."

"In the more than 50 years since the surgeon general’s first report on smoking and health, cigarette smoking among U.S. adults has been reduced by approximately half," the CDC reports. "However, since 1964, an estimated 20 million persons have died because of smoking, which remains the leading preventable cause of disease, disability, and death in the United States. About two out of three adult smokers want to quit smoking cigarettes, and approximately half of smokers made a quit attempt in the preceding year."

Additional information and support for quitting smoking is available at 800-QUIT-NOW(784-8669). The CDC’s "Tips From Former Smokers" campaign offers additional resources for quitting at http://www.cdc.gov/tips.

Kentucky has the nation's second highest smoking rate, 26.5 percent of adults.

1 in 9 in Ky. have been diagnosed with diabetes, and you could have it and not know it; here are symptoms and risk factors

KentuckyHealthFacts.org map with latest available data, adapted
by Kentucky Health News; click on map to view a larger version

One of nine people have diabetes in Kentucky, which has "all the social ills that cause diabetes to fester," Laura Ungar and Darla Carter report for The Courier-Journal. "Chief among them is poverty, which makes it tough to eat well, find safe places to exercise or get to the doctor and avoid complications such as blindness and amputations."

Dr. John Buse, diabetes center director at the University of North Carolina, told the Louisville newspaper that a colleague once told him: “Diabetes is a death sentence for the poor and a nuisance for the wealthy.” One in five Kentuckians live below the federal poverty line, third among the states. Other major risk factors include obesity (35 percent of Kentuckians are obese, fifth in the nation) and physical in activity (fourth in the nation).

Diabetes in the state "has skyrocketed in the last two decades and shows no sign of slowing," the reporters write. "Kentucky’s rate of diagnosed diabetes shot up from 4.3 percent in 1994 to 11.3 percent in 2014, ranking the state sixth worst in a nation that has seen diabetes double over that time." The disease "takes thousands of lives each year and the American Diabetes Association estimates related medical costs and lost productivity total around $3.85 billion in Kentucky."

Because those figures are based on poll questions asking people if a doctor has ever told then they have diabetes, the actual numbers are larger because many people have diabetes and don't know it. The C-J reports, "You may notice no symptoms at all, but here are some common ones, according to the American Diabetes Association:

• Frequent urination
• Feeling very thirsty 
• Feeling very hungry - even though you are eating
• Extreme fatigue
• Blurry vision
• Cuts or bruises that are slow to heal
• Weight loss, even though you are eating more (Type 1)
• Tingling, pain or numbness in the hands or feet (Type 2)

"Anyone 45 years or older should consider getting tested for diabetes, especially if you are overweight," the reporters write. "If you are younger than 45 but are overweight and have one or more additional risk factors, consider getting tested. They include: 

• Having a parent, brother or sister with diabetes
• Being African American, American Indian, Asian American, Pacific Islander or Hispanic American/Latino heritage
• Having a prior history of gestational diabetes or birth of at least one baby weighing more than 9 pounds
• Having high blood pressure measuring 140/90 or higher
• Having abnormal cholesterol with HDL ("good") cholesterol of 35 or lower, or a triglyceride level of 250 or higher
• Being physically inactive (exercising less than three times a week)

In wake of Trump's election, Bevin administration says it will keep negotiating with Obama officials about Medicaid waiver request

Donald Trump and President Obama met Thursday.
(Photo: Michael Reynolds, European Pressphoto Agency)

By Al Cross
Kentucky Health News

The administration of Gov. Matt Bevin says it will continue negotiations with federal officials about its requested waiver of some Medicaid rules despite the election of Republican Donald Trump, who vowed in his campaign to "repeal Obamacare" but now says he will keep parts of it.

“Until changes occur at the federal level, the Bevin administration will continue to work within the confines of federal law as written,” said Doug Hogan, spokesman for the Kentucky Cabinet for Health and Family Services. “To that end, the Bevin administration will continue to negotiate in good faith with the U.S. Department of Health and Human Services."

It remains unclear what effect the election might have on HHS officials, who have often cited Kentucky as an Obamacare success story and might be motivated to preserve as much of it as possible. But the election may create a better negotiating position for the Republican governor, who has said he is ready to end his Democratic predecessor's expansion of Medicaid to about 440,000 people.

Bevin's waiver request asks for permission to require premiums to those with incomes below the poverty level and require work or training for able-bodied adults who aren't primary caregivers, both conditions that HHS Secretary Sylvia Burwell has said she would not approve.

Trump will take office Jan. 20. Hogan said that when things change at the federal level, "We will respond accordingly."

Bevin has said that the state cannot afford to have 1.32 million people, nearly 30 percent of its population, on Medicaid. His proposal says it "is expected to save taxpayers $2.2 billion over the five-year waiver period," by reducing enrollment in the program, but only $331 million of that would be state tax money, because the federal government covers the bulk of Medicaid costs.

The federal government is paying the full cost of the expanded Medicaid population through this year. Next year the state will be responsible for 5 percent, rising in annual steps to the federal health-reform law's limit of 10 percent in 2020. The state pays about 30 percent of the cost of traditional Medicaid participants.

Republicans have long proposed that Medicaid funding change to block grants, which would give the states certain amounts of money and more flexibility to write rules. That seems likely to be a part of any replacement of the 2010 Patient Protection and Affordable Care Act. But that will be a complicated task.

“It’s anybody’s guess what President Trump and a Republican Congress will do. Just repealing the Affordable Care Act is not a serious option unless they have something to replace it with,” former 6th District U.S. Rep. Ben Chandler, who voted against the law and now heads the Foundation for a Healthy Kentucky, told John Cheves of the Lexington Herald-Leader.

“The reality on the ground is that Gov. Bevin won his election in Kentucky and Donald Trump has now won his election nationally,” Chandler said. “It is incumbent on the rest of us to work with them in any way that we can to see that whatever they propose will hopefully make our people healthier. And I’ve got to believe that they want that same result.”

Trump reiterated Friday that he wants to keep the part of the law that prevents insurance companies for denying coverage because of pre-existing conditions. "But the insurance industry has long said it would have a hard time abiding by this rule unless virtually all Americans are required to have insurance," reports Amy Goldstein of The Washington Post.

Post business reporter and columnist Steven Pearlstein explains,  "To guarantee that people with pre-existing conditions can get affordable health insurance, you need to have rules requiring guaranteed issue and community rating," charging roughly the same prices in a geographical area. "To keep insurance companies in business because of guaranteed issue and community rating, you need to have an individual mandate" for everyone to buy insurance. "And because poor people can’t afford health insurance, you need subsidies. Combine all three, and what you have, in a nutshell, is ... Obamacare.

"Yes, it’s a bit more complicated than that, but not much. It’s possible to allow insurance companies charge twice or three times as much, to people who are older or sicker. You can let healthy people buy somewhat more bare-bones 'catastrophic' policies to satisfying their obligation under the individual mandate. You could even avoid community rating by sending sick people into 'high risk pools' where their premiums would be subsidized by a tax on everyone else’s health care premiums.

"But at the end of the day, once you decide that everyone, regardless of age or medical condition, should be able to buy health insurance at an affordable price, you have essentially bought into the idea that young and healthy people have an obligation to subsidize the older and sicker people in some fashion. And once you do that, it’s sort of inevitable you end up where every health reform plan has ended up since the days of Richard Nixon. You end up with some variation on Obamacare."

McConnell wants to pass bill to spur medical research before Congress adjourns; measure has big supporters and critics

Senate Majority Leader Mitch McConnell says he has two main priorities as Congress wraps up its business: funding the government and passing a bill called the 21st Century Cures Act, which would boost funding of research at the National Institutes of Health.

"You haven't heard much about it yet, but it's extremely important, McConnell said at his post-election news conference in Louisville. "We need to take advantage of today's technology to really jump-start the medical field."

McConnell said President Obama and Vice President Biden, who will leave office Jan. 20, want to get the bill passed because "The president's particularly interest in precision medicine," and Biden wants more cancer research because his son, Delaware Attorney General Beau Biden, died of cancer last year.

"I'm interested in regenerative medicine," McConnell said. "Unless you can get in a clinical trial, you can't get stem cells from your own body to treat another part of your body. He said he was motivated by the experience of a Tennessee man whose blindness was cured by stem-cell treatment.

The NIH budget has stagnated because of automatic budget cuts known as sequestration. A study published last year in Health Affairs concluded that most transformative drugs come from federally funded research, not from drug manufacturers, which cite research costs as a reason they need to make their higher profits than most other industries.

Still, makers of drugs and medical devices are strong supporters of the bill, because it would expedite regulatory approval of them new drugs and medical devices. That has drawn criticism from the industry's lobbying adversaries.

The consumer lobby Public Citizen says the House-passed bill would "undermine the FDA's ability to ensure the safety and efficacy of medical devices ... effectively lower FDA approval standards for antibiotics and antifungals ... weaken reporting requirements of the Physician Payment Sunshine Act, allowing for secret influence by pharmaceutical and medical-device companies ... hasten the rise of resistant superbugs by giving hospitals incentives to use new antibiotics rather than conserving them for appropriate use" and bar generic entry of medicines into the market for longer periods."