Providing healthier food for students can require new equipment

Jefferson County Public Schools photo

Almost all Kentucky schools are serving meals that meet federal "standards for strong nutrition, but in order to do this, many of these same schools have to work around equipment and infrastructure challenges," Ashlie Stevens reports for WEKU-FM. A survey by the Pew Charitable Trusts found that 89 percent of the state's school districts "needed at least one piece of new equipment to better serve nutritious foods."

The average cost of that is about $50,000 per school, "which is tough considering how public school cafeterias are funded," Stevens reports. Dan Ellnor, manager of the Nutrition Service Center for Jefferson County Public Schools, told her, “No local tax dollars go to feed kids; it is a completely federal grant program. . . . If we don’t make money, we can’t reinvest in the program.”

The U.S. Department of Agriculture, which oversees the school-meals program, has grant fund to help schools buy equipment, but it is relatively small "because the need across the country is so immense," Stevens reports. Legislation in Congress would expend the program to include loans.

In Jefferson County, “Our main challenge has been refrigeration with the increased fruits and vegetables,” which require "a lot more storage space," Ellnor said. Stevens adds, "The schools also need new combination ovens to roast and steam instead of fry these foods, and sometimes they just need more physical space for food prep."

Speaker uses experiences with depression, suicide to help students in area where suicide and attempts are more prevalent

"When Drew Bergman asked students at a packed Graves County Middle School assembly on Thursday how many of them knew someone who had attempted or died from suicide, half of them raised their hands. That stark reality demonstrates how prevalent suicide is in Graves and several area counties," David B. Snow reports for The Paducah Sun.

Graves County is in the Four Rivers mental-health region, one with a significantly higher rate of 10th-grader suicide attempts (9.3 percent) than the rest of Kentucky (8.2 percent). Among adults, the county "ranked 25th among Kentucky's 120 counties with a suicide rate of 17.88 per 100,000 people," Snow notes. "Carlisle [County] led the state with 28.46, Hickman ranked fifth at 23.4, Marshall was sixth at 23.28, Ballard was 13th at 20.26, Fulton was 14th at 20, McCracken was 15th at 19.61 and Calloway was 81st at 13.94. Livingston County is 56th at 15.23."

Snow notes, "Kentucky Health News reported in November that 1 in 12 of Kentucky's high school sophomores said they had attempted suicide within the previous year. It also reported that teen suicides went from 19 in 2014 to 44 in 2016, more than doubling in a two-year period. With seven of the eight Purchase counties among the state's top 25 in suicide rate," Lourdes Hospital in Paducah invited Minding Your Mind, an organization promoting mental-health education, to send a speaker last year."

That was Bergman, who came to McCracken and Marshall counties last year. He told GCMS students that he had come "from a good family, he and his two siblings were very good students, but underneath what he called the 'country club' facade were things kept out of the public eye," Snow writes. "Bergman said his seemingly successful father was an alcoholic and his parents slept apart for most of his youth because of that. He said his father's addiction was hidden from the children until his father got in a drunken driving wreck when Bergman was in the seventh grade. That was when his parents divorced.

"This perfect childhood that I grew up living came crashing down," Bergman said. "And this is when my entire family began to deal with their own mental health issues for the first time. . . . For the first time, I began to exhibit some symptoms of depression." He attempted suicide that year, and again four years later, at age 16.

"When he was a senior, Bergman told the students at his high school about his depression," Snow writes, quoting him: "The day that I started to talk about what I had gone through is the day that I began to feel better."

Snow writes, "He encouraged the students to talk about how they feel with parents, teachers or trusted adults. He said that people need to talk about mental health issues to help remove the stigma associated with them and to help those going through them. Bergman also encouraged the students who knew someone going through problems to tell an adult, saying he would rather lose that friendship than lose that friend to suicide."

Bergman also discussed treatment for mental illness and how he has treated his depression "through medication and positive coping mechanisms, like listening to music, getting outside, relaxation, and preparing for things like tests or events to remove stress and maintain some control. He encouraged the students not to let the topic end with the assembly, to talk about mental illness with their peers, their parents and their teachers."

Tax bill would repeal requirement to have health insurance, perhaps boosting efforts to repeal and replace Obamacare

Reporters interviewed Sen. Mitch McConnell between negotiations
on the tax bill. (Associated Press photo by J. Scott Applewhite)

The tax-reform bill the Senate passed early Saturday morning, with Majority Leader Mitch McConnell of Kentucky in the driver's seat, includes a repeal of the requirement that almost all Americans obtain health insurance.

The provision, perhaps the most important part of the 2010 Patient Protection and Affordable Care Act, appears highly likely to remain in the final version of the bill that will emerge from a House-Senate conference committee. That's because it was also in the House bill and would help make up for the budget deficits caused by tax cuts, writes Paige Winfield Cunningham of The Washington Post.

Once the mandate is repealed, Republicans may find it easier to "repeal and replace Obamacare," as they vowed for seven years but have so far failed to do, because "It disposes of a major reason previous GOP measures were projected to result in fewer Americans with coverage," Cunningham notes.

Enactment of the tax bill could also lead to cuts in Medicare. "If lawmakers don’t waive a 2010 rule known as 'paygo,' aimed at keeping government spending in check, that deficit spending would trigger automatic cuts to mandatory spending," limited to 4 percent, Cunningham writes. "Sen. Susan Collins (R-Maine), who generally opposes cuts to entitlement programs," has said that McConnell has promised that Congress will waive 'paygo', "but such a decision is beyond McConnell’s ability to control. Waiving 'paygo' requires 60 votes in the Senate, and it’s not at all clear that Democrats would be willing to help Republicans save themselves from mandatory cuts." Perhaps McConnell believes enough would.

Part of the price McConnell paid for the vote of Collins, who helped kill a repeal-and-replace-Obamacare bill in the summer, was a promise for a vote on legislation to restore the insurance subsidies that President Trump ended recently. That measure, sponsored by Sen. Lamar Alexamder (R-Tenn.) and Patty Murray (D-Wash.), "seems awfully shaky," Cunningham writes. "The Senate is focused right now on the tax overhaul; yesterday House conservatives told The Hill they wouldn't support it (they've labeled it an 'insurer bailout'); and, as conservative policy wonk Chris Jacobs writes over at The Federalist, even if the payments are included in a year-end spending bill, they might not ever get made, due to mandatory sequester cuts."

Cunningham concludes, "Here's the interesting question at play over the next few weeks: Will Congress make two changes to the ACA marketplaces that are contrary to each other? Repealing the mandate undermines the marketplaces by ultimately weakening their risk pools (some healthy people drop coverage without the mandate). Making the subsidy payments (known as cost-sharing reductions) helps lower marketplace premiums, but it's kind of moot if you've already removed the key requirement underpinning the whole ACA."

If Trump signs the individual-mandate repeal into law, health-insurance companies will have to decide whether they want to sell through the Obamacare marketplaces, notes Sarah Kliff of Vox: "Are they comfortable selling in a marketplace where they have to offer all consumers coverage but healthy people can decide not to purchase? Or are they scared off by the prospect of getting swamped with sick customers? . . . By September or October of next year, we'd have a sense of whether there are some places where nobody wants to sell Obamacare. And we'll know if there are places with really high premiums, as insurance plans only their sicker customers to stick around."

Kliff concludes, "If Obamacare does truly seem to be in collapse — insurance plans fleeing the markets, premiums spiking — that might give Republicans the pretext to once again take another shot at Obamacare repeal."

FDA approves new shingles vaccine; may be available in 2018

If you had chicken pox as a child, as 99.5 percent of Americans now over 40 did, you still have the virus, and it can cause a painful rash called shingles, which can sometimes leave victims with permanent pain after the rash disappears. About 1 million Americans get shingles each year, and the Centers for Disease Control and Prevention expect one in three adults to get it.

The good news is that there are vaccines for the virus, and the better news is that the U.S. Food and Drug Administration approved an improved vaccine called Shingrix in October. It may be available in 2018, Clark Kebodeaux, an assistant professor in the University of Kentucky Department of Pharmacy Practice and Science, writes for the Lexington Herald-Leader.

"Patients will need two vaccine shots to be fully protected with Shingrix: the first dose followed by a second dose two to six months later," Kebodeaux  writes. "Clinical trials showed that the new vaccine is effective and longer-lasting than the previous vaccines."

The CDC's American Council on Immunization Practices recently voted to recommend that all healthy adults age 50 and older get Shingrix, including patients who have received Zostavax, an earlier vaccine, Kebodeaux reports.

"The Shingrix vaccine is new and is not yet available to the public, but may will be available in 2018," Kebodeaux writes. "Once available for distribution, the vaccine will likely be available at physician’s offices and pharmacies. Talk to your health care provider or pharmacist to see if it will be appropriate for you."

U of L opens clinic to treat hepatitis C, a disease for which Kentucky has the nation's highest rate of new cases

The University of Louisville Hospital has opened a new center to treat hepatitis C and expects to have more than 2,000 patient visits in its first year, according to a U of L news release.

“While Kentucky has the highest rate of new hep-C cases in the U.S., few places exist here for treatment,” Barbra Cave, a family nurse practitioner who leads the center, said in the release. “This is a much-needed service in the community.”

In the past, treating hepatitis C involved a year-long therapy that came with multiple side effects, and not everyone was a candidate for treatment. "Doctors found it challenging, and some patients opted to not get treated at all," says the release.

But today, treatment involves one pill, once a day for eight to 12 weeks, and has minimal side effects, according to Dr. Ashutosh Barve, the center’s medical director. The center also uses FibroScan, which allows staff to perform a non-invasive assessment of the liver without a biopsy, says the release.

“This is truly a success story of modern medicine. We went from discovering the basic science of the disease in the late ‘80s, early ‘90s, to finding a cure in 2014,” said Barve, a gastroenterologist.

The treatment is not inexpensive. It runs between $32,000 and $56,000 on most health plans, Dr. John Ward, director of the Division of Viral Hepatitis at the federal Centers for Disease Control and Prevention, said at a conference in Lexington in July.

New cases of hepatitis C are largely driven by intravenous drug use, but many "Baby Boomers" have the disease and don't know it, and both groups should be routinely screened for it. It is estimated that up to half of people with the disease don't know they are infected.

“People may carry the disease for decades before they have symptoms,” said Cave, who specializes in gastroenterology and hepatology.

Hepatitis C is a blood-borne virus that can live on a surface for weeks if not sterilized properly. It can cause major complications if left untreated, including cirrhosis of the liver or liver cancer.

The disease can be contracted from contaminated tattoo equipment, contaminated dental equipment or passed on from mother to baby. Cave says anyone who got a blood transfusion prior to 1992 or older veterans who were vaccinated with a "jet gun" are also at risk.

Two decades of data show Kentucky communities with strong smoke-free laws have 8 percent fewer cases of lung cancer

By Melissa Patrick
Kentucky Health News

Kentucky communities with strong laws against smoking in workplaces have fewer cases of lung cancer, according to a University of Kentucky study that says it's the first to show such findings.

Researchers found that residents of counties with comprehensive smoke-free laws, including those with city-only smoking bans, were 8 percent less likely to be diagnosed with lung cancer than those living in communities without smoke-free laws.

There was no difference in lung-cancer rates between places that don't have smoking bans and those that have moderate or weak laws. The study considered laws to be comprehensive if they covered all workplaces, including restaurants and bars; moderate if they covered indoor public places, but not all workplaces; and weak if they allowed for major exemptions.

The researchers say the findings could encourage more localities to pass smoking bans. Only a third of Kentuckians are covered by such ordinances.

"Local government can play a critical role in preventing lung cancer," Ellen Hahn, the lead author of the study, said in a UK news release. "Elected officials can ensure that all workers and the public are protected from secondhand smoke by passing strong smoke-free laws with few or no exceptions."

Hahn is a UK nursing professor and director of the Bridging Research Efforts and Advocacy Toward Healthy Environments initiative at UK.

The BREATHE researchers looked at 20 years of lung-cancer data for more than 80,000 Kentuckians 50 and older. (Few Kentuckians under 50 have lung cancer.) The state has more cases of lung cancer than any other state, and its death rate from the disease is 50 percent higher than the national average. And not surprisingly, at 25 percent, Kentucky leads the nation in adult smoking.

Jim Waters, president and CEO of the Bluegrass Institute for Public Policy Solutions, a libertarian, free-market think tank, said that while lower rates of lung cancer are "wonderful," correlation does not equal causation and therefore public policy should not be built around it. "You can't attribute deaths directly to a single cause such as smoking," he said, "since many factors usually are involved: hereditary issues, poor diet, lack of exercise and education."

Hahn said the study did take other causes of lung cancer into account. "We used a sound, well-known statistical method to consider the other factors that may have affected new cases of lung cancer, in addition to smoke-free laws," she said. "Even after taking sex, age, smoking rate, and income into account, comprehensive smoke-free laws were associated with fewer new cases of lung cancer."

Hahn said factors that protect Kentuckians from lung cancer were being female, being younger, and living in a county with a lower smoking rate or higher median household income in the county.

Waters said his institute supports education efforts to encourage people not to smoke "without the punitive action of denying individuals the right to participate in a legal practice on private property. . . . Where does that end? We don't believe such reasoning will end with anti-smoking policies."

Hahn replied, "Research shows that simply educating the public not to smoke does not work to lower smoking rates or to reduce disease from tobacco smoke exposure. Smoke-free laws are known to reduce disease," heart attacks and hospital visits for emphysema and asthma, as BREATHE summarizes. "Just as we have laws to prohibit drunk driving (alcohol is legal), smoke-free laws prohibit smoking (legal) indoors where the second-hand smoke can harm workers and the public."

Ben Chandler, CEO of the Foundation for a Healthy Kentucky and chair of the recently launched Coalition for a Smoke-Free Tomorrow, called on Kentuckians to use this research to pass more smoke-free laws.

"We know that the Kentucky communities with smoke-free laws covering every workplace and public building are protecting the freedom of their residents and visitors to breath air untainted by dangerous secondhand smoke," Chandler said. "We know that a secondary benefit of these laws is that they help reduce smoking. But here's solid evidence from more than 20 years of data showing a significant decline in lung cancer."

The latest Kentucky Health Issues Poll on the issue found that 71 percent supported a statewide law to ban smoking in public places and the workplace. The state House passed such a ban in 2014, when it was controlled by Democrats, but the bill died in the Republican-controlled Senate, and Republican Gov. Matt Bevin, who took office in 2015, says smoking bans should be a local issue.

The study was published in Cancer, a journal of the American Cancer Society. An editorial in the journal said the "unique and important" study "has shared an incredibly valuable insight into the impact of smoke-free ordinances on lung cancer mortality" and emphasizes "the need for statewide, not municipal, enforcement for maximum efficacy."

USDA nixes further reduction of salt in school lunches

The U.S. Department of Agriculture announced Nov. 29 that it's halting an Obama-era plan to gradually reduce the amount of salt in school lunches each year. But the new plan would keep current sodium level targets unchanged through 2019. "Those targets are currently not more than 1,230 milligrams per meal for elementary, 1,360 mg for middle and 1,420 mg for high schools," Maria Danilova reports for The Associated Press.

The targets cover only meals served to students at breakfast and lunch, not a la carte items sold during meal times or vending machines and other sources of non-meal food sales. Public schools nationwide require that all such non-meal foods meet the nutritional requirements of the USDA's Smart Snacks Standard, first implemented in 2014. Those standards require that snacks be lower in sodium.

Margo Wootan of the Center for Science in the Public Interest said current sodium levels are too high, and the high-school sodium target is two-thirds of a child's daily recommended intake. "This is locking in dangerously high levels of salt in school meals," she told Danilova. The federal Centers for Disease Control and Prevention backs up this claim, saying that about 90 percent of school-age U.S. children eat too much sodium daily, and that 1 in 6 children have raised blood pressure (which can be lowered partly with a healthy diet that includes less sodium).

In Kentucky, 33.5 percent of children age 10-17 are overweight or obese, compared to 31.2 percent nationwide. A diet high in sodium is strongly associated with obesity.

Agriculture Secretary Sonny Perdue has criticized the sodium restrictions, saying that children won't eat the healthier meals and that food gets thrown away.

The USDA's Food and Nutrition Service is also keeping in place a program that allows school districts to opt out of a requirement to supply whole grains in lunches, if the schools feel they can't procure enough whole-grain products.

Even if Obamacare automatically re-enrolls you, check out your options; open enrollment ends earlier this year: Dec. 15

By Melissa Patrick
Kentucky Health News

This is the first year that more than 80,000 Kentuckians with a 2017 health insurance plan on the federal exchange will be automatically re-enrolled in a 2018 marketplace plan. But that doesn't mean they shouldn't check out other options before open enrollment ends Dec. 15.

"People should not automatically assume that they are going to get re-enrolled in something that is going to work for them," said Emily Beauregard, executive director of Kentucky Voices for Health. "I think it's important that people still log in, see what their plan options are, make sure that if they have been auto-assigned to a plan that it is going to work for them, and not wait until it is too late."

So far, 27,979 Kentuckians have actively selected a 2018 health plan on Healthcare.gov during the first month of open enrollment, according to the Centers for Medicare and Medicaid Services.

This number includes both new enrollees and returning members who have actively selected a health insurance plan on Healthcare.gov. It does not include those who have been been automatically re-enrolled, nor does it indicate how many re-enrollees have compared plans and decided to stick with their old one.

During the same time frame last year, when there was no automatic enrollment, CMS reported 20,276 Kentuckians had signed up for a 2017 health plan on healthcare.gov.

The Kaiser Family Foundation also has warned people to make sure they are happy with their re-enrollment plan because they won't be able to change it in January, as they have in the past.

Whitney Allen, the outreach and enrollment coordinator for the Kentucky Primary Care Association, encouraged people to make an appointment with their local application assister.

Allen said assisters can help ensure that Kentuckians who have been auto-enrolled have been placed in the best plan for them in 2018, and can help people understand that even though their premiums have gone up, so have the tax credits that help them pay for their health insurance -- which she said has caused a lot of "sticker shock" and confusion.

"So a lot of folks are getting plans that are cheaper and with better coverage than their 2017 plan," she said. "But it's actually taking those folks to come in and to schedule an appointment to meet with an application assister to understand that."

Allen added that many people in southeastern Kentucky, where she works, still don't know it's time to sign up for their 2018 Obamacare plan or that open enrollment ends much earlier thus year, which she said is largely because of the "drastic" cuts to advertising and marketing budgets this year.

"If folks aren't reading the notices that they are getting in the mail, then basically they wouldn't know that it is open enrollment," Allen said.

The state's health agency has said it is using direct mail, text messages, phone calls and emails to communicate with current policyholders and potential new enrollees about open enrollment because they no longer get any federal funds for outreach.

Adding to the confusion, some Kentuckians who are enrolled in a plan that will not be available next year will qualify for a special enrollment period that gives them until March 1, 2018 to enroll in a new plan.

John Watkins, the acting executive director of the state's Kentucky Health Benefit Exchange, said in an e-mail that enrollees who have plans that will not be continued next year should have received notice of this in October, and may have received another notification from Healthcare.gov telling them what plan they were placed in.

In other words, it's important that you don't assume that you will qualify for a special enrollment period unless you have been notified by your insurer or healthcare.gov that your plan will no longer continue or was cancelled.

Beauregard encouraged Kentuckians to err on the side of caution when it comes to this year's special enrollment period and to go ahead and sign up before Dec. 15 if they can, and to seek the help of an application assister to help with the special enrollment paperwork if they can't.

Assisters are available in every Kentucky county to help people sign up for coverage, and their services are free. There are also sign-up events throughout the state.

To find an event in your county or an assister, go to healthbenefitexchange.gov. The site also includes net payment examples for all regions of the state and 2018 sample scenarios for individuals and families.

Help is also available through the state call center at 855-459-6328 and the Healthcare.gov customer center at 800-318-2596, which is available 24 hours a day, seven days a week.

Study: Combination of a low-salt and heart-healthy diet is as good as drug therapy for many adults with high blood pressure

A new study finds that cutting back on salt and following the heart-healthy DASH diet can lower blood pressure, a disease that affects almost two out of every five Kentuckians.

“Our results add to the evidence that dietary interventions are as effective as—or more effective than—anti-hypertensive drugs in those at highest risk for high blood pressure, and should be a routine first-line treatment option for such individuals,” Dr. Stephen Juraschek, a study co-author, said in a news release. Juraschek is an instructor of medicine at Harvard Medical School and an adjunct assistant professor at Johns Hopkins University School of Medicine.

Previous guidelines defined high blood pressure as 140/90 milligrams of mercury (mm/Hg) or higher, but guidelines released this year have re-defined it as 130/80 mm/Hg or higher. High blood pressure increases the risk of stroke, kidney disease, heart attacks and heart failure.

The four-week study, published in the Journal of the American College of Cardiology, included 412 adults between the ages of 23 and 76 who had high blood pressure or were at risk of having it. They were asked to either stay on a "regular" diet or to switch to the Dietary Approaches to Stop Hypertension, or DASH, diet. DASH limits foods high in saturated fat and sugar, and is high in fruits, vegetables, whole grains, low or fat-free dairy, fish, poultry, beans, seeds and nuts.

They were also divided into three groups that received varying amounts of salt. One was allowed about a half a teaspoon per day, another was allowed about a teaspoon per day and the third group was allowed about 1.5 teaspoons a day. To reduce the risk of heart disease and stroke, the U.S. Food and Drug Administration recommends a maximum of about 2,300 mg of sodium per day, which is nearly one teaspoon of salt.

None of the study participants took blood-pressure medicines. Their baseline systolic blood pressures (the top number) ranged from 120 to 159 and their diastolic blood pressure (the bottom number) was between 80 and 95.

The participants were sorted into four groups: 120–129 mm Hg, 130–139 mm Hg, 140–149 mm Hg, and 150 mm Hg or greater.

The results varied based on which regimen the participants followed.

Those who followed the DASH diet with high sodium and had a systolic pressure of 150 or greater, had an 11-point average drop in systolic pressure. The effect was much less, a 4-point drop, among those whose beginning systolic pressure was less than 130.

The effect was even greater for those who were on the low-sodium DASH diet. Those who started with a systolic pressure of less than 130 had a 5-point drop in pressure; those who started between 130 and 139 had a 7-point drop; and those who began between 140 and 149 had a 10-point reduction.

The biggest impact was among those who followed the low-sodium DASH diet and started out with a systolic blood pressure of 150 or greater. They had an average drop of 21 points.

Juraschek called the findings "huge" and said they suggest that those at highest risk for serious hypertension achieve the greatest benefit from the combination diet.

The researchers said further research is needed to determine how the combination diet affects people with systolic blood pressure of 160 or greater or in persons with prior heart disease or diabetes.

Here are some holiday dining tips for people who have diabetes, a disease that affects almost 460,000 Kentuckians

Diabetes UK photo

The food and festivities that are part of the holiday season can make it hard to eat healthy, especially if you are one of the almost 460,000 Kentuckians who have diabetes.

But it doesn't have to be if you make a plan and stick to it, says the American Association of Diabetes Educators. To help make this plan, the association created a collection of "Holiday Season Eating Tips" with strategies to help people with diabetes enjoy the holiday season and maintain their blood sugar levels.

When it comes to eating big meals, the association's tip-sheet suggests: not skipping meals; limiting the number of starchy foods on your plate; choosing fruits and vegetables served raw, grilled or steamed; and sticking to calorie-free drinks. And if you choose to drink alcohol, which can lower blood sugar and interact with diabetes medicines, limit the amount and drink it with food.

If you are the one preparing the food, make sure you include healthy food choices like fruits, vegetables and lean meat; avoid frying or adding extra fat during cooking; and avoid sampling the foods more than necessary while you are cooking.

Another way to control your holiday portions is by using the "diabetes plate method," and foregoing seconds, says an article on The Diabetes Council website that also offers tips on managing diabetes during the holidays.

This method involves filling up half of your 9-inch plate with non-starchy, low carbohydrate vegetables, one fourth of the plate with a lean meat or protein and the other fourth of your plate with a carbohydrate of your choice. This method also allows for two more carbohydrate servings, which could be milk, fruit or a higher carbohydrate dessert.

As for all of those holiday treats, the association's tip-sheet recommends taking small portions, eating slowly and savoring every bite.

Holiday parties provide their own set of challenges when it comes to making healthy food choices, including the opportunity to graze, which can lead to poor food choices and overeating.

The tip sheet emphasizes the importance of not skipping meals, which can lead to overindulgence because you will arrive at the party hungry. It also recommends that you study all of the food options before deciding what to put on your plate, adding that if you choose something you don't enjoy, don't eat it.

And as always choose raw vegetables first, with only a small amount of dip (or skip it entirely); eat chips and crackers in moderation; sip on water or mineral water; and don't hang out near the food table.

The association also reminds people with diabetes to check their blood sugar regularly throughout the holidays, possibly adding a few extra checks in on party days to help guide your choices.

The federal Centers for Disease Control and Prevention offers some additional tips for people with diabetes to "holiday proof" their meal plans.

One of them reminds people with diabetes to make sure they eat close to their usual mealtime to keep their blood sugar steady, and if the holiday meal is to be served later than normal, eat a small diabetes-friendly snack at their usual mealtime and eat a little less when the meal is served.

Others include cutting back on carbohydrates during the main meal to allow for a sweet treat; making sure you are sleeping seven to eight hours per night because sleep loss can make it harder to control your blood sugar and tends to make people eat more and prefer high-fat, high-sugar foods; finding ways to fit in your favorite holiday dishes; and to make sure you keep moving, even if your physical activity is broken up into smaller chunks to fit your busy schedule.

And if you need further help with your diabetes management during the holidays, talk to your diabetes educator.

Many Kentuckians with Obamacare plans got premium notices that over-estimated costs for 2018; see HealthCare.gov for facts

By Melissa Patrick
Kentucky Health News

With a shortened enrollment period, huge cuts in advertising and in-person assistance, and ongoing efforts to repeal and replace the federal health law, it's no wonder many Americans are confused about whether they can or should sign up for health coverage on government marketplaces this year.

Perhaps the most basic facts are these: The Patient Protection and Affordable Care Act, also known as Obamacare, is still the law of the land; it still requires everyone to have health insurance or pay a penalty; and the Dec. 15 deadline to sign up for a plan is fast approaching.

The requirement to have health insurance is designed to spread the risk and hold down costs. The penalty for not having it in 2018 will be $695 per adult and $347 per child, with a maximum of $2,085 per family or 2.5 percent of the household's income, whichever is larger.

Another possible source of confusion is that many returning Obamacare customers received renewal notices from their insurer that underestimated their 2018 monthly premium estimate. The notices used the customers' 2017 tax credit for the estimate instead of the larger 2018 tax credit, which could be causing "significant -- and misleading -- sticker shock," says the Kaiser Family Foundation.

Tax credits are available to people who earn between 100 and 400 percent of the federal poverty line to help reduce Obamacare premiums. The smaller your income, the larger your tax credit.

The practice of using the previous year's tax credit amount to determine the upcoming year's estimate wasn't as much a problem in the past because there wasn't much change from year to year in premium costs.

Tax credits will be larger in 2018 because they are based on the cost of benchmark "silver" marketplace plans, which have increased significantly in most markets for 2018 as a result of the federal government no longer paying a cost-sharing payment to insurers to keep these costs down. Generally, people who have had little or no changes in income and qualify for a tax credit will get a bigger one in 2018, and that will keep their monthly premium about the same.

Kaiser offered an example of the differences in estimated and actual costs of a 2018 silver plan for a 40-year-old in Louisville with income of twice the poverty level.

Such a person would pay the same $127 per month for a benchmark silver plan after using the appropriate tax credit. But if the 2017 tax credit is applied to the 2018 premium, as some renewal notices did, that calls for a monthly cost of $277, more than double this year's.

Elizabeth Kuhn, a spokeswoman for the Kentucky Public Protection Cabinet, said in an e-mail that between Nov. 1 and Nov. 22, about 9 percent of the calls to the state's Department of Insurance Consumer Protection Division were related to the federal marketplace, HealthCare.gov, including calls about this issue.

"The department representatives have explained that premiums could potentially be lower," she said. "Also, the premium notices sent to policyholders by insurers referenced that the 2018 premiums were estimates."

In Kentucky, Anthem Inc. is offering plans in 59 counties and CareSource, a Humana Inc. plan, is handling the other 61. Fran Robinson, a spokeswoman for CareSource, said its premium-estimate notices used the 2017 tax credit instead of the higher 2018 tax credit.

Robinson said the notices stated that the premium estimate was only an estimate, and encouraged recipients to update their information on Healthcare.gov to get their actual 2018 premium amount. She said they have explained this to any consumers who have called about this issue and encouraged them to update their accounts to get an accurate premium amount.

Anthem did not respond to the same inquiry from Kentucky Health News.

Suzanne Craig, program manager of the Community Access Project for the Green River District Health Department, told WKMS in Murray that "substantial numbers" of people are signing up for their ACA plans and many are fearful that they will lose their coverage.

"We are seeing more than we expected. These enrollments are taking longer because people have more questions," Craig told Rhonda Miller of WKMS, the Murray State University station.

WHAT CONSUMERS NEED TO KNOW, from Kentucky Health News:

Don't assume you can't afford a health insurance plan this year, especially if you got a notice that says your premium will be higher in 2018 than it was in 2017. Instead, to get the most accurate estimate go directly to Healthcare.gov, update your information and view the cost of all the plan options after the 2018 credit is applied.

Remember that help is available in person, by phone and online.

Every county in Kentucky has an application assister, formerly called Kynectors, to help consumers sign up for health coverage. They are offering sign-up events throughout the state.

To find an event in your county or an assister, go to healthbenefitexchange.ky.gov. The site also includes net payment examples for regions of the state and 2018 sample scenarios for individuals and families. It also provides answers to a list of frequently asked questions.

Kaiser Family Foundation offers a health insurance marketplace calculator to help consumers estimate their 2018 marketplace costs.

Help is also available through the state call center at 858 855-459-6328 and the Healthcare.gov customer center at 800-318-2596, which is available 24 hours a day, seven days a week.

Progression of Alzheimer's disease can be slowed, even though its cause isn't known and there is yet no cure for it

People with Alzheimer's disease can do something about it.

That statement may surprise you, because no cure has been developed for the disease, and we aren't even sure what causes it. But that doesn't mean its progress can't be slowed.

"Medications and management strategies may temporarily improve symptoms, and can often slow progression," Dr. Graham Garrison of KentuckyOne Health Neurology Associates wrote for the Lexington Herald-Leader.

Garrison's column touched on many basic facts about Alzheimer's, including:

"As Alzheimer’s disease progresses, it destroys the memory and other important mental functions. Those suffering from the disease may first notice an increase in forgetfulness or mild confusion, but over time, will begin to forget recent memories. Someone with Alzheimer’s disease may find themselves repeating questions, forgetting conversations or appointments, getting lost in familiar places, forgetting the names of objects or family members, misplacing possessions, or having trouble taking part in conversations. Early on, patients may not be aware of the presence or degree of their impairment, which is typically more evident to others. When a loved one is suffering from Alzheimer’s disease, family members may notice changes in their personality and behavior, including depression, social withdrawal, mood swings, lack of trust in others, wandering, change in sleeping habits, loss of inhibitions, irritability and delusions."

Garrison concludes, "If you or someone you know are exhibiting early signs of Alzheimer’s disease, speak to a physician about your condition. A physician can check you for other, treatable causes of these symptoms, or other forms of dementia."