Low-income adults in Medicaid expansion in Kentucky and Arkansas report better health and medical care, study finds

By Melissa Patrick
Kentucky Health News

Two states that expanded Medicaid through the Patient Protection and Affordable Care Act showed a 41 percent increase in the number of enrollees with a regular health-care provider and a 23 percent increase in the share who report excellent health, according to a three-year study of Kentucky and Arkansas.

The study also found that low-income adults with chronic diseases in the two states were more likely to report that they had better health, were getting regular care and were able to afford their medications.

Kentucky and Arkansas and Kentucky both expanded Medicaid to people who earn up to 138 percent of the federal poverty line, but in different ways. Kentucky expanded Medicaid while Arkansas used federal Medicaid funding to provide private insurance to its low-income adults. The study compared them to Texas, which did not expand the program.

The report said that while Arkansas and Kentucky took different approaches to Medicaid expansion, the benefits to enrollees were nearly equal between the states.

“The Affordable Care Act is leading to substantial improvements in health care for low-income adults in Arkansas and Kentucky, and people report that their health is better too,” Dr. Benjamin Sommers, lead author of the study, said in a news release. “In contrast, many low-income adults in Texas continue to lack insurance and more frequently have to skip needed health care due to cost concerns.”

The study, published in Health Affairs, found that when compared to Texas, enrollees in Kentucky and Arkansas reported "substantially" better health, fewer emergency-room visits, increased access to care and medications, and cost savings.

                                                        graphic from report 

Kentucky has 1.4 million people on Medicaid, with 470,000 of them covered through the expansion. As of Jan. 1, Arkansas had 310,951 low-income people enrolled on its "private option" plan funded by Medicaid.

Not surprisingly, low-income adults in Arkansas and Kentucky were much more likely to have health coverage than their counterparts in Texas. Researchers found that by the end of 2016, the percentage of people in Arkansas and Kentucky without coverage had dropped 20 percentage points more than in Texas. In 2016, the uninsured rates were 7.4 percent in Kentucky, 11.7 percent in Arkansas, and 28.2 percent in Texas.

The study found that low-income adults who had gained coverage in Arkansas and Kentucky under the ACA had:

• A 41-percentage-point increase in having a usual source of health care
• A 58.6-point drop in reports of trouble paying medical bills
• A 74.7-point decline in skipping needed health care because of costs
• A 28-point drop in the likelihood of having an emergency-room visit
• A 23-point increase in the share who reported they were in excellent health
• $337 less in medical out-of-pocket spending per year

It found similar results among low-income adults with chronic illnesses who had gained coverage under the ACA, including:

• 56 percentage points more likely to report having regular care for their chronic condition than were chronically ill adults in Texas
• 51 points less likely than those in Texas to skip medications due to cost
• 20 points more likely to report being in excellent health

The study was conducted by the Harvard T.H. Chan School of Public Health. It surveyed a random sample of 10,885 adults aged 19 to 64 in November and December from 2013 to 2016 via land lines and cell phones. The study includes a demographic breakdown of the full samples in each state.

“This study, along with others, makes it clear that the Affordable Care Act’s Medicaid expansion has helped states make substantial gains in coverage while ensuring people can get and afford the health care they need,” said Dr. David Blumenthal, president of The Commonwealth Fund, which funded the study. “Repeal efforts that end the expansion threaten the health and financial security of the 12 million people nationwide who benefited from it. We must hold on to these gains and continue to work toward affordable and accessible health care for everyone.”

The House-passed health bill, called the American Health Care Act, would largely phase out the Medicaid expansion and limit federal funding of the program, reducing federal spending on it by an estimated 24 percent over 10 years. If people enrolled in the expansion went off it, they could not get back on. About 30,000 Kentuckians a month go on and off Medicaid.

Gov. Matt Bevin has said Kentucky can't afford to pay for its share of the expansion costs (5 percent this year, rising to the ACA's 10 percent limit in 2020) and has applied for a waiver that would let the state charge small, income-based premiums and would require "able-bodied" recipients to either work, volunteer, go to class or take job training, among other things.

The waiver request estimates that the changes would make the state's Medicaid rolls have 86,000 fewer people in five years than without the waiver. The waiver is expected to be approved in June and to go into effect Jan. 1.

Liberal-leaning group says that if Senate passes House health bill, or big parts of it, results will be dire for millions in rural America

Photo: businessinsider.com

People who have health insurance through the Medicaid expansion are at great risk of losing their coverage if the Senate passes the House health bill, a decision that would greatly harm rural America, says a Center on Budget and Policy Priorities report.

Republican senators have said they are "starting from scratch" and writing their own bill, but that is misleading, said Shannon Buckingham, spokesperson for the liberal-leaning group. "Make no mistake, the House bill's core provisions remain firmly at the center of Senate discussion."

Nearly 1.7 million rural Americans have health insurance through the Patient Protection and Affordable Care Act's expansion of Medicaid to those who earn up to 138 percent of the federal poverty line, about $33,000 for a family of four. Of the 470,000 who have coverage through the expansion in Kentucky, an estimated 224,000 are in rural areas.

The report says the House health bill, called the American Health Care Act, would "effectively end" the Medicaid expansion because "beginning in 2020, states would receive only the regular federal Medicaid matching rate . . . for any new enrollees under the expansion instead of the permanent expansion matching rate of 90 percent." The matching rate for Kentucky is 70 percent, so the state would have to pay 2.8 times more than under current law for each new enrollee, the report said.The bill also allows states to stop enrolling people in expanded Medicaid.

For people who don't qualify for Medicaid, the House bill would raise health-care costs by reducing tax credits that help low income people pay for premiums and out-of-pocket costs; would allow states to take away protections for pre-existing conditions; and cut taxes by more than $600 billion over 10 years, mostly for the top 1 percent of income earners.

The detailed CBPP report, which offers state-level details on many measures, found that in at least eight expansion states, including Kentucky, more than one-third of expansion enrollees live in rural areas.

Gov. Matt Bevin has said Kentucky can't afford to pay for its expansion population and has applied for a waiver that would let the state charge small, income-based premiums and would require "able-bodied" recipients to either work, volunteer or take job training, among other things. These changes are expected to make the state's Medicaid rolls have 86,000 fewer people in five years than they would otherwise. The waiver is expected to be approved in June and to go into effect Jan. 1.

The report notes that states that expanded Medicaid had the largest drops in rural people without health coverage, from 16 percent in 2013 to 9 percent in 2015. In non-expansion states, the uninsured rate dropped from 19 percent to 15 percent in 2015. Kentucky's uninsured rate dropped to 7.5 percent from 20.4 percent.

"While those numbers may seem abstract, they have tangible impacts on access to care, on health and to financial security," Mary Wakefield, former acting deputy secretary for the U.S. Department of Health and Human Services, said. For example, she said the rural states of Kentucky and Arkansas, which expanded Medicaid, saw a "one-third increase in the share of low-income adults getting regular check-ups and a two-thirds decrease in the share depending on the emergency room for care."

The report adds, "In Kentucky, state data show tens of thousands of low-income individuals have received cholesterol, diabetes and cancer screenings, and preventive dental services," as a result of expanding Medicaid.

Wakefield said Medicaid expansion has reduced people's risk of medical bankruptcy, improved treatment access for people with substance use disorders and dramatically decreased uncompensated care in rural hospitals.

"The House health bill is a threat to rural hospitals," said Jesse Cross-Call, a senior policy analyst at CBPP and co-author of the report. "Over the past few years, closures of rural hospitals around the country have been heavily concentrated in states that have not expanded Medicaid,"

The report says, "Most of the 78 rural hospitals that have closed since 2010 are in Southern states that haven't expanded Medicaid" and "uncompensated care costs as a share of hospital operating budgets fell by about half between 2013 and 2015 in expansion states."

The House bill would partially restore the Disproportionate Share Hospital payments that helped rural hospitals make up for the uncompensated care before Medicaid was expanded," but that would fall "far short of the revenues hospitals would lose," according to the American Hospital Association and others, said Aviva Aron-Dine a senior fellow at CBPP.

Cross-Call added that the expansion had created a "pathway to health coverage where before the ACA one often did not exist," noting that people who live in rural areas often have lower incomes, have more contract work and are less likely to have an employer that offers health coverage, than non-rural areas.

Tara Straw, senior policy analyst at CBPP and co-author of the report, said rural Americans will be harmed if the new health plan removes the ACAs "generous and flexible" tax credits and replaces them with credits that would be worth much less.

Straw said ACA tax credits are often higher in rural areas because the cost of insurance tends to be higher, due to low population density, a limited number of providers and little competition among insurers. She also noted that people who live in rural areas tend to be older and have lower incomes.

"Because the ACA's credit is based on the cost of an actual plan, and not a fixed dollar amount, it helps protect people from premium increases," she said. For example, the AHCA tax credit for a West Virginia enrollee would be less than half of what an ACA credit would be, $7,400 compared to $3,100, for a plan that covers less, she said.

The House bill would provide a flat tax credit varying only by age: $2,000 for people under 30; $2,500 for people age 30 to 39; $3,000 for people age 40 to 49; $3,500 for people age 50 to 59; and $4,000 for people age 60 and older.

Straw explained that while the House bill allows for a tax credit for a 60 year old to be twice as high as for a young adult, it also allows older adults to be charged five times as much.

The House bill would also repeal the ACA's cost-sharing subsidies, which are available to people with incomes below 250 percent of the poverty line and allow them to purchase coverage with lower deductibles and covers other out-of-pocket costs.

McConnell says all Senate Republicans are working on health bill, invites Democrats to join them

McConnell used a graphic on the floor to drive home his point.

Senate Majority Leader Mitch McConnell said Tuesday that all Republican senators are working on a health bill, and invited Democrats to help them.

“Can our Democratic colleagues, who promised more choice under Obamacare, really be okay with the continuing failures of Obamacare? The status quo under Obamacare is simply unsustainable and unacceptable,” McConnell said in a speech on the Senate floor. “That’s why the entire Senate Republican Conference is working together on the best way forward to bring much-needed relief to the families who’ve been left behind by Obamacare’s continuing failures. I hope our Democratic colleagues will join us in working to do so. They just sent me a letter last week where they acknowledged that Obamacare hasn’t lived up to its promises and where they effectively conceded that the status quo is unsustainable.”

McConnell recently appointed a working group of 13 Republican senators to work on a health bill and was criticized because they were all men. Since then, he has said no senator will be left out of the drafting process. Last week Democratic Rep. John Yarmuth of Louisville said McConnell wouldn't let a health bill come to a vote before the 2018 elections for fear of political damage.

Click on the chart to view a larger version of it.

McConnell prefaced his remarks by citing the headline on the latest Gallup poll, taken May 3-7: "Health care surges as top problem in U.S." The story said, "Americans became much more concerned about health care this month, with 18 percent naming it as the most important problem facing the U.S. Mentions of health care tie with mentions of 'dissatisfaction with government/poor leadership' at the top of the most-important-problems list. This is the highest percentage mentioning healthcare since November 2013, amid the troubled rollout of the government healthcare exchanges."

Gallup chart of top problems in poll during the last three months

McConnell said, "It’s not hard to see why so many Americans feel this way. They turn on the TV and hear that there will be even fewer options on the Obamacare marketplaces in state after state. They pick up the newspaper and see that even more double-digit premium increases are being proposed for too many of the Obamacare plan options that still remain. . . . It’s troubling news, especially given that so many states, like mine, have already experienced insurers fleeing the Obamacare marketplace leaving families with limited options. This year . . . 49 percent, nearly half of the counties in Kentucky, have only one insurer to choose from. And of course, having only one option is really no choice at all."

McConnell said nothing in his speech about Medicaid, the expansion of which under Obamacare covers about 470,000 Kentuckians, according to the latest figures from the Cabinet for Health and Family Services. About 80,000 people in Kentucky are covered by private Obamacare policies.

Foundation's $3 million program is helping seven counties become healthier in several ways, independent evaluation says

A initiative focused on children's health is helping the Foundation for a Healthy Kentucky change community policies and environments, improve physical activity and nutrition, and strengthen health coalitions in seven Kentucky communities, according to an independent evaluation released by the foundation today.

The grants in the five-year, $3 million "Investing in Kentucky's Future" initiative are also providing useful lessons for place-based grantmakers, said the evaluation by the Center for Community Health and Evaluation, a research center of the Kaiser Permanente Washington Health Research Institute.

The initiative is aimed at reducing the risk that today's school-aged children will develop chronic disease later in life. It has made matching grants for community health coalitions in Breathitt, Clinton, Grant, Jefferson, McCracken, McLean, and Perry counties. All are focused on preventing and reducing childhood obesity except the Louisville coalition, which is working to foster resiliency in children facing traumatic events and other experiences that can lead to toxic stress in childhood and chronic health conditions in adulthood.

"The real value of the Investing in Kentucky's Future initiative is that it's fostering the ability of these seven Kentucky communities to keep improving their residents' health long after the grant period ends," Charlie Ross, chair of the foundation's board of directors, said in a news release. "Yes, the grants have helped build some beautiful walking trails and playgrounds and ensure healthier foods at park concessions, but they've also created lasting partnerships, changed school and community policies, and developed the skills of a cross-sector coalition of people committed to making a healthier future for their children."

The evaluation listed five lessons from the initiative:

1. Community-Driven Grant Approach: Allowing community health coalitions to study and determine their own health priorities and the solutions they would employ is leading to greater grantee engagement, but also to more diverse strategies.
    
2. Coalition Approach: Requiring grantees to use or create a coalition of partners from a variety of sectors is helping build community support for the work. School engagement has been particularly important for the initiative, which focuses on school-aged children.
    
3. Planning Phase to Promote Equity: Recognizing that communities have various levels of ability to compete for and implement grant programs, the foundation included funding for a required a planning phase during which grantees would develop a structured business plan to address their selected issue. The planning phase made the grant more accessible to communities with fewer resources.
    
4. Sustainability Elements: Grant requirements that were focused on sustainability ─ the planning phase, a 50 percent cash match, a focus on changing policies in the community, and an evaluation ─ have given coalition members skills and experience to them continue to improve the health of their communities.
    
5. Shorter-Term Evaluation Measures: The foundation recognized that significant changes in complex health issues take more than five years to see, so it focused its evaluation on shorter-term changes that have been proven to lead to longer-term health improvements.

Investing in Kentucky's Future is entering its fourth year, but some communities' grants will extend into 2019 because they started later than others. The grantees are: Partnership for a Healthy McLean County, Purchase Area Connections for Health (McCracken County), Fitness for Life Around Grant County, Breathitt County Health Planning Council for Children, Perry County Wellness Coalition, Clinton County Healthy Hometown Coalition, and the Bounce Coalition (Jefferson County).

A copy of the evaluation, "Toward a Healthier Kentucky: Lesson Learned from Evaluating Place-Based Community Health Improvement," is available here. 

Rich-poor divide grows in oral health; Ky. ranks 2nd in seniors with no natural teeth; what's your county's toothless rate?

The rich-poor divide is causing many impoverished rural residents to forgo oral health care, or resort to having teeth pulled rather than pay for costly fixes, Mary Jordan and Kevin Sullivan report for The Washington Post. The rate of Americans who have lost all their natural teeth is higher in rural areas in every age group and 20 percent of all Americans over 65 do not have a single real tooth remaining. (CDC graphic: National Health Survey 2010-12 results of of people who have lost all their natural teeth)

Toothless rates among those 65 and older are especially high in the South. According to Kaiser Family Foundation data from 2014, 33.6 percent of West Virginia residents 65 and older had no natural teeth. Kentucky was second, 23.9 percent, followed by Mississippi and Oklahoma (22.5), Tennessee (22.4), Alabama (22.2), Arkansas (22) and Louisiana (20.5). (CDC graphic: Where people 65 and older have lost all their teeth)

More than 50 million Americans "live in areas officially designated by the federal government as Dental Health Professional Shortage Areas," reports the Post. "A great many of them are working poor. In these rural areas, even the water can work against people." Many people rely on well water that is not fluoridated, which helps reduce tooth decay. The Centers for Disease Control and Prevention says 25 percent of Americans are not connected to a fluoridated water system. Another problem in rural areas is a shortage of dentists.

For the percentage of adults in your county who are missing six or more teeth, go to KentuckyHealthFacts.org, click on your county and ask for its health outcomes.

While rich people can afford the luxuries of the best oral health care, poor people often resort to standing in line at free clinics, reports the Post. "High-end cosmetic dentistry is soaring, and better-off Americans spend well over $1 billion each year just to make their teeth a few shades whiter. Millions of others rely on charity clinics and hospital emergency rooms to treat painful and neglected teeth." The problem is that emergency rooms are not typically equipped to fix dental problems. That means they prescribe painkillers, which can lead to addiction, which destroys teeth, and dry mouth, which leads to more cavities.

The Zika virus has come to Ky. through travelers, and could spread at any time, but few people know or do much about it

This species of mosquito carries Zika.

By Melissa Patrick
Kentucky Health News

As temperatures and travel increase, so does the possible threat from the Zika virus, which can cause dangerous or even deadly birth defects, but many potential victims are uninformed and unprepared.

The best prevention for now may be vigilance by property owners against standing water where mosquitoes breed. Experts say those who travel to Zika-affected areas such as Florida and Texas should use insect repellents after they return to keep local mosquitoes from picking up the virus, which causes no symptoms in some people.

Nearly two out of five people who had traveled to an area affected by the Zika virus hadn't heard or seen any information about how to protect themselves or others from it, and even those who knew how to protect themselves didn't always do so, according to a recent poll.

A senior research scientist at the Harvard T.H. Chan School of Public Health presented the poll results at the 2017 Zika Conference in Lexington May 11. Dr. Gillian SteelFisher said the results emphasized the need for more preventive education, noting that many people don't realize that it "just takes one bite" to become infected.

A Kentucky study of 55 women of childbearing age who had traveled to Zika-affected areas found a similar need for more information, especially among Spanish-speaking women with less education under the age of 30, said Kristen Heitzinger, a Centers for Disease Control and Prevention fellow at the state Department of Public Health.

State Health Secretary Vickie Yates Brown Glisson called on the more than 400 conference attendees to go back to their communities and become "unwavering" in their efforts to get and deliver a simple, easy-to-understand message about Zika, its dangers and how to fight it.

Dr. Ardis Hoven (file photo)

State infectious disease specialist Dr. Ardis Hoven told the conference that local health departments will educate community leaders about the virus. For an 86-second audio clip of her remarks, via Stu Johnson of WEKU, click here.

"Our research tells us that not nearly enough pregnant women in particular, or those who are of the age to become pregnant, know about the Zika virus and what they should do to protect themselves and their unborn baby, or a potential unborn baby," Glisson said. "Overwhelming evidence has shown a link between Zika and dangerous birth defects that cause delayed development and sometimes even death in infants."

Zika is spread mostly by the bite of an infected mosquito, though it can also be transmitted through sex, and from a pregnant woman to her fetus. It circulates in many parts of the world where Kentuckians vacation, do mission trips or work.

So far, only Florida and Texas have had locally transmitted infections in the U.S., but Kentucky has the mosquito that is known to carry it. Click here to see the locations where Zika is a risk.

The virus can cause microcephaly, a condition where a baby's head is smaller than normal because the brain does not develop properly, and other birth defects in infants born to women infected during pregnancy.

It is also associated with adult Guillain-Barre syndrome, a rare disorder in which the body's immune system attacks its nerves.

The most common symptoms of Zika are fever, rash, joint pain and red or burning eyes, though many who are infected have few if any symptoms, which can be so mild they go unrecognized.

There is no vaccine to prevent Zika, and no antiviral treatment for it.

According to the CDC, 5,000 cases of Zika have been identified in the U.S. and its territories including 37 in Kentucky and 1,367 in pregnant women. Among those women, 65 gave birth to babies with some type of Zika-related birth defect.

Of the 37 Kentucky cases, four were pregnant women whose children have had no complications, but are still being monitored. All the Kentucky cases were a result of travel to Zika-affected areas or through having sex with someone who had traveled to those areas.

The state health department has adopted the tag line "Dress, Drain and Defend -- to Fight the Bite Day and Night" to help Kentuckians remember to be vigilant about mosquito control:

• Dress in light-colored, long-sleeved shirts and pants;
• Drain all standing water where mosquitoes can breed, such as birdbaths, tires, buckets, gutters and anything, however small, that may act as a vessel for rainwater;
• Defend against mosquitoes with approved insect repellents for outdoor activities at all times.

Luke Mathis, the environmental health supervisor at the Lexington Fayette County Health Department, said citizens must do their part to make sure Kentucky doesn't have a Zika outbreak.

"We could work ourselves to exhaustion, we could spend every dime of money, and it would have little effect on the mosquito population," Mathis said. Instead, he said it would be more effective to "have every homeowner check out their yard for a few minutes every couple of weeks and kick over those buckets or get rid of those tires."

"We need to begin changing people's attitude to make it socially unacceptable to breed mosquitoes in and around their property," Brown said. "It's going to take decades."

The state health department has advice for those considering travel to Zika-affected areas:

• Pregnant women and their partners should not travel to Zika-affected areas;
• Consult with a health-care provider prior to travel if you are pregnant or planning to conceive;
• Couples who are planning to become pregnant should postpone conception for six months after travel to a Zika-affected area, and should discuss plans for pregnancy with their health provider
• Follow steps to prevent mosquito bites: Dress and defend!
• Wear a condom every time you have sex, including vaginal, oral and anal sex, or practice abstinence, while in a Zika-affected area.

Advice for those who have been to a Zika-affected area after they get home:

• Women who have been exposed to the virus should use condoms or abstain from sex for at least eight weeks after symptom onset or last possible exposure.
• Men who have been exposed to the virus should use condoms or abstain from sex for at least six months after symptom onset or last possible exposure.
• Male travelers with pregnant partners should wear condoms throughout the pregnancy.
• Travelers to Zika-affected areas who have symptoms within two weeks of their return to Kentucky should contact their health-care provider.
• Travelers returning from Zika-affected areas should wear mosquito repellent for three weeks after returning, so they won't infect other mosquitoes that could bite others.
• Remember that these precautions are necessary because many infected people have no symptoms.

Dr. Grayson Brown, professor of entomology at the University of Kentucky and director of the Public Health Entomology Laboratory, said many people are concerned about the safety of insecticides, but that they shouldn't be. He said "insecticide technology has changed" in the last 50 to 60 years and that products today are "nontoxic to humans and other vertebrates, but so powerful against mosquitoes."

"If we don't use them," Brown said, "the suffering is going to be absolutely enormous." He said South Florida officials averted a crisis last summer by using insecticides to kill Zika-carrying mosquitoes. Without that, there could have been "hundreds of thousands of cases, and thousands of micrcocephalic babies. . . . They avoided a serious, serious public-health crisis."

Kentucky sprays for mosquitoes each year, but Brown said the spray in mosquito trucks kills very few Zika-carrying mosquitoes, which require a different product that is hand-applied under bushes and brush.

For further information or to sign up for health alerts, visit http://healthalerts.ky.gov/zika or the CDC website at www.cdc.gov/zika. The UK College of Agriculture, Food and Environment website also offers Zika updates.

Yarmuth says McConnell won't let a health bill get a Senate vote for fear it would backfire on Republican senators

Majority Leader Mitch McConnell says the U.S. Senate is working on its own health-care bill, but Kentucky's only Democrat in Congress said Friday that McConnell won't bring the bill to a vote in order to protect his fellow Republicans from retribution by voters, Ronnie Ellis reports for CNHI News Service.

Yarmuth (WDRB image)

“I’m convinced that Mitch McConnell will not allow anything to get out of the Senate because he doesn’t want any one of his members to have to take a vote on health care,” Rep. John Yarmuth of Louisville told Together Frankfort, a civic-engagement group. “At least a half-dozen could be vulnerable if they have to cast a tough vote on health care.”

Republicans have 52 Senate seats to Democrats’ 48, including two independents who vote with Democrats, Ellis notes. In the 2018 elections, only eight seats now held by Republicans are up, putting Democrats on the defensive. "But Democrats are feeling increasingly optimistic about their 2018 prospects – especially in the House, where they need to pick up 24 seats to gain control — in the aftermath of constituent unhappiness over the House healthcare vote and Trump’s rocky first three months in office," Ellis reports.

McConnell spokesman Robert Steurer "didn’t directly address Yarmuth’s comments, instead pointing to a floor speech McConnell gave earlier this past Wednesday in which he said the ACA continues to fail “'the American people and keeps getting worse'," Ellis reports. "He went on to say Democrats have indicated a willingness to work with Republicans on 'common-sense reforms' and said he welcomes Democrats’ input."

"With control of the White House and both chambers of Congress, Republicans are scrambling to make good on their promises while trying to preserve popular provisions" of the Patient Protection and Affordable Care Act, Ellis writes. "After a failed attempt earlier this year, House Republicans narrowly passed the American Health Care Act, which has prompted angry protests at congressional town halls. Critics say the measure will cut Medicaid by $880 billion over 10 years, weaken or eliminate the prohibition on denial of coverage due to pre-existing conditions, and ultimately cost 24 million people health-care coverage."

McConnell has named 13 Republicans to write a bill that Republicans "hope to pass on a simple majority vote through what is known as the reconciliation process," Ellis notes. "Such votes can only be taken on legislation which pertains to the budget and the federal deficit and the Senate parliamentarian must rule on whether legislation qualifies for such a vote. Otherwise, Republicans would need 60 votes to avoid a Democratic filibuster."

Yarmuth said Republicans have realized “they have no place to go on health care,” and that the only acceptable alternative to "Obamacare' is a single-payer system. “I’m convinced that within 10 years there’s going to be a major push for Medicare for everybody and it’s going to come from corporate America,” he said.

Financially strained KentuckyOne Health to sell most Louisville-area facilities, shift focus to Central and Eastern Kentucky

"KentuckyOne Health, the once-dominant hospital system across the state, announced Friday that it will sell off Jewish Hospital and many other high-profile facilities in Louisville as it refocuses on Central and Eastern Kentucky," Grace Schneider reports for The Courier-Journal. "Besides Jewish, its flagship hospital, the health system will sell Frazier Rehab Institute; Sts. Mary & Elizabeth Hospital; Medical Centers Jewish East, South, Southwest and Northeast; Jewish Hospital Shelbyville; Saint Joseph Martin and KentuckyOne Health Medical Group provider practices in Louisville and Martin," a small town in Floyd County.

"The great change and great uncertainty in the health care industry has strained our financial health," said Ruth Brinkley, KentuckyOne's president and CEO. “We understand this will bring change and questions to our employees and community partners. We have an extensive transition program underway to ease the change and ensure focus on our priories to our patients and our partners."

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

"The announcement comes 10 days after The Courier-Journal reported the health system was severing ties with doctors in the Louisville area," Schneider notes. Last month, the system announced it was trimming about 250 employees to cut costs, including the layoff of 150 workers. Others were transferred to the University of Louisville Hospital under the split between KentuckyOne and U of L Medical Center or took voluntary retirement offers. KentuckyOne has run day-to-day operations of the University of Louisville Hospital and the James Graham Brown Cancer Center under an arrangement with U of L, but the University Medical Center is to resume management July 1.

Louisville adds electronic cigarettes, hookahs to smoking ban

Electronic cigarettes and hookahs are now included in the smoking ban of Kentucky's largest city. The Louisville Metro Council voted 15-6 Tuesday night to expand its anti-smoking ordinance.

“Neither e-cigs or hookah can be deemed safe or healthy for human consumption,” said Council Member Vicki Aubrey Welch, the legislation's sponsor. Welch, a Democrat, said council members compromised with local business owners who were concerned "about the measure’s likelihood to reduce retail activity," Jacob Ryan reports for WFPL.

"Consumers can still sample electronic cigarette flavors, under the measure, and certain hookah lounges will be exempt from the regulations," Ryan reports.

Mayor Greg Fischer, a Democrat up for re-election next year, asked in February for the expansion of the ban enacted in 2008. Opposition was bipartisan.

Council Member Kevin Kramer, a Republican, "said he’s been provided with little evidence that hookah products are detrimental to users’ health," Ryan reports. Council Member Mary Woolridge, a Democrat, "called the ordinance an overreach of government regulation."

“I don’t know where all this concern is, when we have to breathe the air in West Louisville and Rubbertown,” Woolridge said, referring to chemical plants on the west side of the city. Neighboring Council Member Jessica Green, another Democrat, called the move a Fischer "publicity stunt."

The move drew praise from the Foundation for a Healthy Kentucky. "These products emit dangerous toxins into the air that are known to cause cancer and other debilitating illnesses," said Ben Chandler, president and CEO of the foundation. "While the expanded ordinance includes some regrettable exemptions that will leave some Louisvillians unprotected, this is a step in the right direction toward cleaner air and reduced health disparities."

At town hall in Benton, U.S. Rep. James Comer defends and explains his vote for House Republican health-care legislation

UPDATE, May 21: The Washington Post's Chico Harlan has a more detailed report on Comer's town halls in Benton, Albany, Edmonton and Calhoun.

U.S. Rep. James Comer in Benton (M.C. Daily photo)

"The atmosphere was, at times, tense as constituents gathered from around the First Congressional District of Kentucky to participate in a town hall meeting with U.S. Rep. James Comer Wednesday at the Marshall County Courthouse in Benton," Mary Garrison Minyard reports for the Marshall County Daily.

Comer, a first-term Republican from Tompkinsville, acknowledged that he had been criticized for supporting a Republican health bill that did not have a Congressional Budget Office analysis, but "said lawmakers had little choice in passing the bill," Minyard reports.

Comer told the crowd that 31 of the district's 35 counties "only have one insurance carrier," and noted that the main carrier for such counties in Iowa is pulling out of Obamacare. "I think we’re going to see more of that if a health care bill is not passed," he said.

"Comer said constituents needed a bill that would protect its most vulnerable residents – those with pre-existing conditions and those on Medicaid – but would lower premiums and deductibles," Minyard writes. "He said he voted for the bill because he felt it would do those things. Still, some concessions had to be made."

Minyard reports Comer said it would be "a budget breaker" for that state to pay "10 percent of the health insurance bill for almost half a million people in Kentucky," which is what the state would pay in 2020 for people covered by the 2014 Medicaid expansion. This year it is paying 5 percent.

"Comer said he supported the core concept of Medicaid, which was to provide health care assistance for poor children, low income single parents and pregnant women and the 'truly disabled.' Comer said many had taken advantage of the system, however," Minyard writes.

The biggest issue in passage of the bill was coverage of pre-existing conditions. "Comer told attendees that the bill failed on its first run several weeks ago because ultra-conservative Republicans wanted complete ACA repeal, while others wouldn’t budge on protections for pre-existing conditions," Minyard reports. The new bill lets states allow insurance companies to charge higher premiums to people with such conditions but allocates "$130 billion to set up high-risk pools to help states cover those most expensive to insure," but critics have said that is inadequate.

Jennifer Smith, a two-time cancer survivor from Paducah, said the funding would be inadequate. She told Comer, "You stated your commitment to protecting all of us with pre-existing conditions, our access to insurance and health care, but instead on May 4 you reneged on that promise and voted for the horrendous bill the AHCA. In response to the outrage from your constituents you stated on your Facebook page that the bill protected pre-existing conditions and that those protesting and distorting the truth were far left liberals like the DNC and Planned Parenthood. … The radical left wing organizations that you say are against you include the American Cancer Society, Komen, the National Patient Advocate Foundation and over 25 other cancer and health advocators, the American Medical Association, the American Nurses Association … and the AARP have also come out strongly against the bill. All the organizations have cited the catastrophic impact this will have on those of us pre-existing conditions and every other consumer of health care."

"You also neglect to mention the states have the right to opt out, so that’s almost a certainty that Kentucky’s Governor Bevin would take that option," Smith said. "The reality is that this bill will drive up cost for the poor and those with health issues to the point that there is no access, because we will not be able to afford to pay the premiums or out-of-pocket expenses."

Other constituents at the meeting objected to the provisions. "Some lay on the courthouse lawn prior to the meeting with tombstones at their heads and feet and signs that read 'I had a pre-existing condition'," Minyard reports.

Comer said "Kentucky still has a funding mechanism that other states don’t" for high-risk pools. "They don’t have to worry about getting the General Assembly to pass … it’s already in there." A 1 percent fee on insurance policies funded a high-risk pool that stopped taking new enrollees when Obamacare was implemented. The state kept the fee to pay for a health-insurance exchange that has been largely abolished, but the fee remains in place.

"Here’s the bottom line," Comer said. "If nothing is done, people with individual insurance plans and group plans are going to continue to have to pay more and more insurance costs and it’s just putting people [where] they’re choosing health care costs over food. They’re not buying medicine because they’re spending all their money on health-care premiums.”

Citing Barr's vote for Republican health-care bill, Democrats in Sixth District try to drum up electoral opposition for him next year

Colmon Eldridge and Nancy Jo Kemper
talked after speaking at the event.

A Democratic-oriented political group is trying to drum up opposition for 6th District U.S. Rep. Garland "Andy" Barr, R-Lexington, citing his vote for the Republican health-care bill.

The first featured speaker at the kickoff event by The People's Campaign was Colmon Eldridge, an aide to then-Gov. Steve Beshear when the administration embraced Obamacare in 2014. Asked afterward if he might be a candidate, Eldridge said, "It's something I'm looking at."

Eldridge told a small group at The Campbell House in Lexington, "I like Andy Barr as a person. We go to the same church," The Episcopal Church of the Good Shepherd. "If he does not have the courage to make this vote right, then we should send him packing. . . . This is life or death; this is wrong or right."

Barr's 2016 Democratic opponent, the Rev. Nancy Jo Kemper, spoke next and said that if Barr does go to church, "I hope he goes to confession," because "He puts ends above means, he bears false witness."

Kemper said she wouldn't take on Barr again, but "Beating Andy Barr will be one of the major purposes of my life the next two years." The former head of the Kentucky Council of Churches, Kemper said afterward that she will retire as minister of New Union Christian Church on June 30.

U.S. Rep. Andy Barr

Barr replied via email: "As a Christian, I try to avoid questioning other people's faith. But my faith teaches me to care about people. And that is exactly why I supported the American Health Care Act. Obamacare is driving up costs, limiting choices, and treating patients like a number in a bureaucracy instead of human beings. The bill I voted for will move us to a patient-centered model of care that will lower costs, expand choices, and provide multiple layers of protections for people with pre-existing conditions."

Barr said in a press release May 4, "After seven years of broken promises, lost coverage, skyrocketing premiums, thousands of pages of regulations, tax penalties, collapsing co-ops, fewer jobs, and state exchanges which are now in a death spiral of fewer choices and rising costs – the House of Representatives has taken a critical step in the process that will finally repeal and replace Obamacare," he said. "And we have done so in a way that provides multiple layers of protections for people with pre-existing conditions."

The bill would let states allow insurance companies to charge higher premiums to people with pre-existing conditions if doing so would improve the state's insurance market. Kemper said Barr doesn't understand that a basic principle of insurance is spreading risk among a large number of people.

Barr told Kristin Kennedy of Lexington's WKYT-TV, "A lot of the feedback that we're getting fundamentally misunderstands what we're doing to protect people with pre-existing conditions." Kennedy reports, "The congressman says the American Health Care Act gives people with pre-existing conditions more options than they currently have."

The Rev. Clark Williams, chairman of The People's Campaign, said it is a tax-exempt group under Section 527 of the Internal Revenue Code and supported Democratic nominee Jack Conway in the 2015 governor's race and a few Democratic candidates for the state House last year. He said it plans to conduct an independent campaign against Barr next year but will not recruit candidates. "We want to continue to just create the buzz," he said.

Besides Eldridge, others who have been publicly mentioned as challengers to Barr are state Sen. Reginald Thomas, right, of Lexington and Lt. Col. Amy McGrath of Northern Kentucky, left, who has declined to comment until after she retires from the Marines on June 1.

UK's Doug Scutchfield, international leader in public health, accepts Libraries Medallion for Intellectual Achievement

F. Douglas Scutchfield, M.D.

In what he called "a coda to my academic career," Dr. F. Douglas Scutchfield accepted the University of Kentucky Libraries Medallion for Intellectual Achievement Tuesday night.

Scutchfield, who retired as a UK professor in January but remains active in teaching, research and mentoring, has been an international leader in public health. He was founding director of UK's School of Public Health, now a college, and the UK Center for Health Services Research and Management. He has been chair of the Health Services Department and Preventive Medicine Department, and is a past associate dean of the College of Medicine. He was the first Peter P. Bosomworth Professor of Health Services Research and Policy.

UK President Eli Capilouto said in presenting the award that he greatly appreciated Scutchfield's willingness to teach undergraduate courses, something most professors with his portfolio don't do.

Scutchfield told the audience at the Libraries Spring Gala, "Many of my new ideas have formed as I work to prepare a presentation for students or listen to their consideration of a research topic for a thesis or dissertation." He also had some advice for his friend Capilouto and other university administrators about the need to help different academic disciplines work together to solve problems.

"The contemporary U.S. management model of the university as a business, with organizational hierarchies and operating divisions, colleges and departments, may not be the most effective organizational mechanism for addressing the creation of new and more effective ways of dealing with the problems that we should be attempting to address," he said. "If we are to best address our mission of the scholarship of integration, then we must find ways to encourage and support critical examination of new mental models and paradigms at the intersection of the academic disciplines we represent. We cannot work in silos; they must be bridged!"

As an example, Scutchfield cited the "socio-ecologic determinants of health," such as "education, jobs, socio-economic status, racial equity, housing and the built environment." He said the disciplines around those topics have "little interaction that focuses on the larger set of mental models and new paradigms to be derived from interaction about social determinants" of health.

Scutchfield said UK has "two potential illustrations of this potential," a new building where research will focus on health disparities, especially in Appalachia, and a possible planning grant from a foundation that, "if funded, leads to something bold to enhance the role of Extension in advancing health."

Born in Wheelwright, Scutchfield earned his bachelor’s degree from Eastern Kentucky University and his medical degree from UK. Following practice in Morehead, and in conjunction with that work, he began his career at UK as a field professor of community medicine. He was the first chair of the Department of Family and Community Medicine at the University of Alabama, then an associate dean of the College of Community Health Sciences. Later he became founding director of the Graduate School of Public Health at San Diego State University and held faculty appointments at the University of California campuses in Irvine and San Diego, a UK news release said.

He was certified by the American Board of Preventive Medicine in 1974 and the American Board of Family Practice from 1971 to 1985. He was a charter diplomat of the latter organization and is a fellow of both. He is a fellow of the American College of Preventive Medicine, served as a regent and president, and won the college’s Distinguished Service Award and Special Recognition Award. He has served as a member of the board and as president of the Association of Teachers of Preventive Medicine, which gave him its highest recognition, the Duncan Clark Award.

Scutchfield is a member of the Public Health Accreditation Board and serves as chair of its Accreditation Committee. The board accredits local and state health departments, and Kentucky has been a leader in getting its departments accredited.He  served as a secretary-treasurer of the Association of Schools of Public Health, a member of the Secretary of Health and Human Services Health Promotion and Disease Prevention Council, and a board member of the Public Health Foundation, which presented him with the Theodore R. Ervin Award. He In 2004, he received the Balderson Lifetime Achievement Award of the National Public Health Leadership Network.

Scutchfield was a member of the American Medical Association House of Delegates and served as chair of the AMA Section Council of Preventive Medicine on several occasions. He was elected to membership in the AMA’s Council on Medical Education, and served as its vice chair and member of its executive committee. He represented the AMA as a member of the Accreditation Council on Graduate Medical Education, the Liaison Committee on Specialty Boards, the American Board of Medical Specialties and the Committee on Allied Health Education and Accreditation. He received AMA’s Dr. William Beaumont Award as its outstanding young physician in 1985 and its Distinguished Service Award, the highest recognition of a physician, in 2003.

A skilled editor, Scutchfield has served as editor of the American Journal of Preventive Medicine and is a member of the editorial board of the American Journal of Public Health. He also served as the editor of California Medicine and the San Diego Physician, both of which won awards during his tenure as editor. He served as editor of Appalachia Medicine and a member of the editorial board of the Journal of Community Health. He is the author of numerous textbooks, text chapters and published articles in referred journals. His avocational interest in Thomas Merton resulted in a book he co-authored with Paul Evans Holbrook Jr., The Letters of Thomas Merton and Victor and Carolyn Hammer: Ad Majorem Dei Gloriam, published by the University Press of Kentucky in 2015.

Scutchfield said his interest in Merton and the humanities reflect a part of his philosophy of being a physican. "I am a firm believer in the importance of humanity to those of us in the health professions," he said. "We do not treat a disease, we treat a person, thus we must know the humanness of the individual in front of us, as well as the diagnosis and treatment of their disease." He said student in the health professions "lack adequate exposure to the humanities in their science filled schedules."

Scutchfield has an international reputation and has been a consultant to government and non-governmental organizations in Panama, China, Saudi Arabia, Israel and Germany, as well as the U.S. But he never forgot Wheelwright, once one of Kentucky's biggest coal towns. “As a scholar, teacher, mentor, administrator and public health advocate, he has never forgotten his Floyd County roots even as he became internationally recognized and honored,” Dean of Libraries Terry Birdwhistell said.

The UK Libraries Medallion for Intellectual Achievement, created in 1990, recognizes Kentuckians who have made contributions of lasting value to the Commonwealth, and promotes education and creative thought. Past recipients include authors Wendell Berry, James Still, Bobbie Ann Mason, John Egerton and Guy Davenport; historians George C. Herring, Thomas D. Clark, George Wright and James C. Klotter; journalist Al Smith; and UK geographer Karl Raitz.

UPDATE: Al Smith praises Scutchfield in an op-ed for the Lexington Herald-Leader.