63 percent of Kentucky's children get their health insurance through Medicaid or the Children's Health Insurance Program

By Melissa Patrick
Kentucky Health News

More than 60 percent of American children are enrolled in Medicaid or the Children's Health Insurance Program, according to the Centers for Medicare and Medicaid Services data.

Photo: thenationalcouncil.org

Kentucky's numbers were just a bit higher, with 63 percent of the state's 1 million children enrolled in one of the two programs. That amounts to 642,364 children. Nationally, the programs cover 46.3 million of more than 74 million children.

"Kentucky leaders have taken several steps in recent years to make it easier for children to enroll and stay enrolled in health coverage, which has led to vast increases in the number of children with health insurance," Terry Brooks, executive director for Kentucky Youth Advocates, said in an email.

Brooks added, "Research shows us that, in addition to making it easier for children to enroll in coverage, providing affordable health coverage for parents is an important way to improve overall family health and reduce the number of uninsured children."

Children are eligible for Medicaid if they are between the ages of 1 and 18 with a family income up to 159 percent of the federal poverty level. They are eligible for CHIP, as the Children's Health Insurance Program is commonly called, with a family income between 160 percent and 213 percent of the poverty level.

The two programs have the same benefits, including doctor visits, dental care, hospitalization, outpatient services, psychiatrists, laboratory tests and X-rays, vision exams, hearing services, mental health services and prescription medicines.

Nationally in 2017, about four times as many children were enrolled in Medicaid as in CHIP, 36.9 million and 9.5 million, respectively. In Kentucky, nearly six times as many children were enrolled in Medicaid as in K-CHIP in 2017, 545,985 and 96,379 respectively.

Kentucky has a relatively high share, 25 percent, of children living in poverty (annual income of $24,036 or less for a family of four); 12 percent are in deep poverty (annual income of $12,018 or less for a family of four), according to the 2017 Kentucky Kids Count report.

In 2016, the most recent year for which state-by-state age population data are available, 38 states had more than half of their children enrolled in one of the programs at some point during the year, Philip Bump of The Washington Post reports.

Bump notes that North Dakota was the only state that had fewer than one-fourth of its children enrolled in either CHIP or Medicaid at some point during the year; and New Mexico, with more than 80 percent of its children enrolled in one of the two programs at some point, had the highest percentage of enrollment.

WellCare says it reduced opioid dispensing 55% among 1,300 Kentucky Medicaid members targeted due to risk for addiction

WellCare Health Plans, one of the insurance companies that manages care for Medicaid patients in Kentucky, says it cut opioid prescriptions among a targeted group of Kentucky members by more than half.

Bill Jones, president of WellCare of Kentucky, wrote in an op-ed for newspapers, "WellCare identified 1,300 members who, based on their refill patterns and other factors, appeared to be at risk for developing an opioid addiction. These members were connected to one pharmacy, one physician and one care manager — a team approach in which everyone on the team was aware of the entire case history. The result: opioid dispensing dropped by 55 percent."

Jones added, "This kind of innovative approach is successful because it addresses opioid abuse at the root, helping people – many of whom are living with pain – find a healthy path forward that works to lower the risk of opioid addiction."

WellCare says it has taken other steps to fight the problem. Jones said the company donated $35,000 to support addiction recovery programs in the state, most of it to Addiction Recovery Care, which operates seven residential facilities in Eastern Kentucky.

"In Illinois, WellCare has implemented programs to encourage doctors to refer members to substance abuse treatment if they are at-risk for addiction – and to encourage members to keep follow-up appointments," Jones wrote. "In another intervention program, WellCare helped educate Medicare members on alternative treatments, conducted proactive outreach out to prescribers and connected members to WellCare’s behavioral health case management teams for support. As a result, between 2015 and 2017 opioid utilization dropped by 43 percent."

Federal judge says he will rule in Medicaid lawsuit by June 30; changes are set to start rolling out, county by county, on July 1

After hearing oral arguments Friday, a federal judge in Washington, D.C., said he will rule by June 30 whether federal law allows states to require people in Medicaid to work or take schooling -- the most controversial part of a Kentucky Medicaid revamp that is scheduled to begin in Campbell County July 1 and be underway in all but eight counties by December.

U.S. District Judge James Boasberg noted the July 1 date after listening to lawyers for the state, the federal government and 16 Kentucky Medicaid beneficiaries who sued the U.S. Department of Health and Human Services, claiming that the Centers for Medicare and Medicaid Services waiver allowing Kentucky's changes is illegal.

The plaintiffs said the plan's work and reporting requirements would be "onerous" and "would end up limiting access to health insurance, the prime objective of Medicaid," Lesley Clark reports for the Lexington Herald-Leader. Ian Gershengorn, an attorney with the National Health Law Program, told Boasberg that "The obvious intent is to undermine Medicaid."

"Government lawyers argued that states would be more likely to embrace Medicaid expansion if they could impose similar restrictions," Clark reports. Boasberg "could put all these expansion programs on the chopping block," Deputy Assistant Attorney General Ethan Davis, representing HHS, told him.

Kentucky was the first state to get a waiver for a work-or-education requirement. "The outcome of the case could affect the fate of similar Medicaid work requirements approved by the CMS in Arkansas, Indiana and New Hampshire," Dickson reports. "Arizona, Maine, Mississippi, Michigan, Utah and Wisconsin are seeking similar waivers." Virginia is expected to join the group, following legislative enactment that wouldn't have passed without agreement on a work requirement.

Opponents of the changes "said they don’t believe HHS’s argument," Nathaniel Weixel reports for The Hill, a Washington publication. Boasberg, an appointee of Barack Obama, "appeared skeptical of the arguments used by the defendants, and his questions largely ignored them."

Boasberg pressed Davis to explain how "community engagement" requirements such as work or schooling help with health care, "adding that promoting health and medical assistance are 'two different things'," Clark reports. "Davis said the program includes a boost for addiction treatment and noted that 'a variety of studies' have shown a relationship between health and community involvement."

"The goal here is not to have benefits cut," Davis said, adding that saving money wasn't a goal of the waiver, but "a happy side effect." The state has estimated that in the next five years, estimated Medicaid spending of $37.2 billion would be reduced to $35 billion, because the program would have 95,000 fewer members with the waiver than without it -- partly from members' failure to meet new requirements. (Tens of thousands of Kentuckians go on and off Medicaid each month.)

Initially, Bevin said the plan was the only way the state could afford to continue expansion of Medicaid to people with incomes up to 138 percent of the federal poverty level, implemented by his Democratic predecessor, Steve Beshear, in 2014. "More recently, however, Bevin has told reporters that he doesn't know 'nor do I really care' what the cost savings would be," Clark notes. "The more important goal is helping dependent people to become healthy and productive, he said."

Nevertheless, Bevin's deputy general counsel, Matthew Kuhn, told Boasberg that the plan would keep the state from spending money it "does not have," and "this is the only way we could afford to have expanded Medicaid."

Bevin has said that without work requirements, he would eliminate the expansion, which at last count covered 493,000 Kentuckians. A county-by-county spreadsheet of enrollment in Medicaid, as of January 2018, is at http://www.uky.edu/comminfostudies/irjci/MedicaidbycountyJan2018.xlsx.

"Gershengorn argued that Medicaid, unlike some other forms of public assistance, is not a job-training program, and the Trump administration lacks the authority to transform it into one," Clark reports.

Gershengorn argued that the waiver "did not support the Medicaid Act's purpose of furnishing medical assistance," Virgil Dickson reports for Modern Healthcare. Gershengorn said, "Unlike some other public assistance programs, Medicaid is not a jobs-training program, and the administration does not have the authority to turn it into one. The rule of law requires that the president adhere to and uphold federal law, not subvert it."

Weixel writes, "The work requirements get the most attention, but Kentucky’s waiver was notable for other reasons. It was the first state to charge premiums up to 4 percent of a person’s income. The current limit has been 2 percent. Kentucky was also the first state to lock people out of coverage for up to six months for failure to timely renew their coverage or to alert the state if their income or family circumstances have changed. Beneficiaries can also be locked out if their income is at least 100 percent of the poverty level and they fail to pay premiums. The Trump administration lawyers argued the lockouts are much more flexible than some that were approved under the Obama administration."

The American Medical Association said Thursday that it opposes lockouts. “Discontinuing health care for thousands of our most vulnerable citizens for failure to meet administrative burdens is a cruel, bureaucratic response to our neediest patients,” AMA board member William McDade said in a press release. “As physicians, we recognize that many of our Medicaid patients lead complicated, difficult lives, and we should value empathy over rigid adherence to red tape.”

Military members are providing free screenings and medical care in Breathitt, Owsley, Lee and Estill counties through June 24

The Kentucky Air National Guard is leading an effort to provide free medical screenings and care at four adjoining counties in Eastern Kentucky through June 24.

Starting June 15, the guard's 123rd Medical Group, Navy Reserve and active-duty Air Force and Navy personnel will offer medical screenings, non-emergency treatments; physical examinations for student athletes; dental exams, cleanings, fillings and extractions; eye exams, and single-prescription eyeglasses.

Clinics are being held at Lee County High School in Beattyville, Owsley County High School in Booneville, Estill County High School in Irvine and Breathitt County High School in Jackson, from 8 a.m. to 4 p.m. Monday through Saturday, and noon to 4 p.m. Sunday.

Residents of other counties can receive screenings and care, as long as they are at least 2 years old. Insurance cards and identification are not being required.

The 215 military members in "Operation Bobcat" will see patients on a first-come, first-served basis. A similar effort in Western Kentucky in 2016 provided more than 13,000 medical, dental and optometric procedures. More than 1,500 pairs of prescription eyeglasses and $20,000 worth of medications were provided free, according to a news release from the guard.

The Kentucky Department for Local Government, which is cosponsoring the program, is hosting a resource center with information on wellness, nutrition and immunizations.

The program is designed to simulate how military medical responses are conducted in times of crisis, conflict or disaster, the guard said in a news release.

“This kind of training helps hone our expeditionary skills so we’re ready to deploy at a moment’s notice to provide care anywhere in the world,” said Lt. Col. Amy Mundell, a medical administrative officer in the Guard’s 123rd Medical Group.

Local Government Commissioner Sandra K. Dunahoo said, “We’re very pleased to support a program that gives our military health-care troops essential training in field operations and logistics, keeping their skills sharp so they can be prepared to respond wherever they’re needed. At the same time, the program will be providing crucial services to citizens of the commonwealth who may not have ready access to care. This is a win for everyone.”

Woman who lost 100 lbs. gives message of hope to the 68% of Kentuckians who are overweight: 'If I can do it, anyone can do it'

Liz Hopkins before and after losing 100 pounds
(Photos submitted to the Owenton News-Herald)

It took back surgery and the very real chance that she would eventually have to have it again to motivate a 250-pound, 40-year-old Kentucky woman with a list of health issues to decide to lose 100 pounds — and she says if she was able to do it, then so can you.

Liz Hopkins, a registered nurse from Owenton who works in Lexington, told Molly Haines of the The News-Herald in Owenton that she had struggled with her weight since she was a teen, but it wasn't until her 30s that her unhealthy eating habits and sedentary lifestyle caught up with her.

“I had developed high blood pressure; I had osteoarthritis in both of my knees, but the back surgery really scared me,” she told Haines. “That was rock bottom.”

Hopkins had her back surgery for a herniated disk February 2017 and told Haines that her surgeon told her that if she didn't lose "a significant amount of weight," she had a 96 percent chance of having to repeat it.

“But [the surgeon] also said she didn’t think I could lose the weight,” Hopkins said. “She didn’t mean that in a nasty way, she just meant, 'I don’t think you’ll be able to lose the amount that you need to lose not to have chronic issues.'”

Fast forward to June 1: Hopkins is 100 pounds lighter.

How did she do it? In addition to resisting the urge to pull into one of the 32 fast-food restaurants that she passes daily between Owenton and her job in Lexington every day, Hopkins told Haines that she joined her local gym and started exercising every morning from 5 to 6 a.m., with 30 minutes focused on cardio and 30 minutes on weightlifting.

Hopkins said she was encouraged by a friend to join the gym and said that while she was initially "intimidated" and worried that she would be harshly judged, what she found was the opposite.

“When I started I was welcomed by everyone,” she told Haines. “The atmosphere is so positive, and I’ve made some really good friends since joining because everyone wants everyone to succeed. There’s no competition, we all want each other to succeed — whatever success looks like for you individually.”

Hopkins noted that getting her workout in early works for her because it doesn't take time away from her family or work, and also helps her to make better food choices throughout the day.

“I have committed my life to taking care of other people, but somewhere along the way I forgot to take care of Liz,” Hopkins said.

Since beginning her weight-loss journey, Hopkins told Haines that she finds herself taking 15-minute walks after nearly every meal, even at work, and also attends a Zumba class on weeknights when her schedule allows.

“I feel like I have come back to life,” she said. “Before I had no energy, I had high blood pressure; I had to take Zantac for indigestion and heartburn at least twice a day. I had to take Ibuprofen and Tylenol for knee pain, back pain — my back hurt, I didn’t feel like doing anything. I came home and sat in a recliner, that was my life. Now, I have so much energy, and I feel like not only am I better at my job, I’m more active physically at work and at home.”

With the weight gone, Hopkins told Haines that she no longer needs her blood-pressure medicine or the over-the-counter medicines for her aches and pains. She added that her goal is to maintain the weight loss while continuing to strengthen and tone her body.

“The other thing I’m looking forward to is rollercoasters again,” she told Haines. “I had gotten so huge that it was a struggle for me to get strapped into the seat, so this summer I’m looking forward to riding rollercoasters because I’ll be able to fit in them a little bit easier. Just being more active, feeling good, being a good wife and mom and trying to continue to be an inspiration for anyone that’s interested in it, and thinks that they can’t. I know it’s cliche, but if I can do it, anyone can do it.”

Hopkins' story of being overweight, with a long list of health issues, could be told over and over in Kentucky, where 68 percent of adults are overweight and 34 percent of those are obese. The difference is that she did something about it, and her story can serve as an example and an inspiration.

Beshear sues Walgreens, alleging it worsened opioid epidemic by not reporting unusually large drug shipments top Kentucky

Attorney General Andy Beshear is suing Walgreens for "allegedly failing to legally monitor its own operations that shipped and dispensed large quantities of opioids through its more than 70 locations statewide . . . directly contributing to the state's drug epidemic," his office said in a press release.

Walgreens is not only the nation's second-largest pharmacy chain, it is also a distributor of pharmaceuticals, "a unique positon," the release said. The lawsuit, filed June 14, involves both roles. It accuses Walgreens for "failing to legally report to state and federal authorities the suspiciously large orders it received for prescription opioids," the release says.

The suit alleges, "Walgreens pharmacies filled so many opioid prescriptions, that the numbers of opioids dispensed by Walgreens pharmacies were unreasonable on their face. Acting as a distributor, Walgreens received orders for those opioids from its own stores. Upon information and belief, those opioid orders were suspicious on their face due to the unreasonable numbers of opioids being dispensed at the store level, but were nevertheless shipped, rather than flagged, halted and reported."

The company declined to comment, according to several news-media reports. 

Beshear said he filed the suit in in Boone County because of the large number of Kentuckians who have died from overdoses in Northern Kentucky. He has filed five similar suits.

The release said Beshear is working with CVS Health, the nation's largest pharmacy chain, to created places for safe disposal of drugs at pharmacies in Elizabethtown, Frankfort, Georgetown, Lexington, Louisville and Paducah.

New clinical trial at UK takes personalized approach for rare type of Lou Gehrig's Disease in Appalachian Kentucky

http://uknow.uky.edu/research/new-clinical-trial-takes-personalized-approach-rare-type-als-appalachia

People with positive attitudes about aging live longer and have better health; Kentucky seniors' health is ranked 48th in nation

How you think about growing old can influence how well you age, says a growing body of scientific research and global data collected and analyzed by nonprofit journalism organization Orb Media. That's especially relevant in Kentucky, where seniors' health ranks 48th among the 50 states, according to America's Health Rankings.

"Individuals with a positive attitude towards old age are likely to live longer and in better health than those with a negative attitude. And those with a negative view of aging are more likely to suffer a heart attack, a stroke or die several years sooner," Jim Rendon and Olufemi Terry write for Orb. "Older people in countries with low levels of respect for the elderly are at risk for worse mental and physical health and higher levels of poverty."

Projected percentage of country population over 65 in 2050. Source: United
Nations World Population Prospects. (Orb Media graphic)

Why does it matter?

Orb reports that if population trends continue, by 2050 nearly one of six people in the world will be over 65, and close to half a billion will be older than 80. In 2050, seniors would make up nearly 16 percent of the world's population, compared to today's 8 percent.

In the U.S., the Census Bureau estimates that one in five people will be over the age of 65 by 2030, and by 2035, seniors will outnumber children younger than 18.

Those are the basic figures, reflecting quantity, but what about quality of life for those people? Research shows that a simple shift in attitude can make a difference in how well we age, especially in a world that often has negative views about growing older.

A World Health Organization analysis found that 60 percent of people surveyed across 57 countries reported relatively low levels of respect for older people. A separate Orb analysis found that the level of respect for seniors varied "significantly from country to country."

Of the 58 countries ranked in the Orb study -- in order of how they respect their elderly, with 1 being "very low" and 5 being "very high" -- the United States ranked 50th, scoring 3.29.

Becca Levy, a professor of epidemiology at the Yale School of Public Health, and a leading researcher in the field, has found "Those with positive views about old age live longer and age better," Orb reports. "They are less likely to be depressed or anxious, and they show increased well-being and recover more quickly from disability. They also are less likely to develop dementia and the markers of Alzheimer’s disease."

"In one study, Levy found that Americans with more positive views on aging who were tracked over decades lived 7.5 years longer than those with negative views," Orb reports, adding that studies in Germany and Australia have found similar results. In addition, other studies have shown that "the cells of those who have more positive views of the elderly actually aged more slowly than those who had negative views."

Levy told Orb that people with negative views of aging have higher levels of stress, which has been linked to a range of health problems. She added that those with more positive views of aging are also more likely to exercise, eat a balanced diet and go to the doctor. She also said people can decide for themselves how they think about aging, and that her research has found that people who who watch less TV, participate less in social media, and have more resistant personalities are more likely to hold more positive views of aging.

McConnell gets hemp in Farm Bill, after argument with Iowa senator about inclusion of cannabinoids, including CBD oil

McConnell at the meeting (Associated Press photo by Jacquelyn Martin)

The Senate version of the Farm Bill contains Majority Leader Mitch McConnell's legalization of industrial hemp, but not without a dissent from another powerful senator who says it goes too far on a health-care issue.

The Senate Agriculture Committee passed the bill 20-1, and McConnell vowed to bring it to the Senate floor before July 4. The lone "no" vote came from Judiciary Committee Chair Charles Grassley of Iowa.

"Grassley’s objections to the farm bill appeared to be largely based on its language around industrial hemp," reports Marianne Goodland of Colorado Politics. Grassley "said he believed any language around industrial hemp ought not be included in the Farm Bill, but rather belongs in another bill that would go through his committee."

At issue is McConnell's language defining hemp, which includes cannabinoids, including CBD oil, which is used for a variety of medical conditions, especially in epileptic children. "However, the Food and Drug Administration has not approved those uses," Goodland notes. "Grassley argued that CBD oil is not an industrial hemp product."

The bill would let “any snake oil salesman” sell CBD without safety assurances, putting children at risk, Grassley argued. McConnell "said the bill incorporated suggestions made by the Judiciary Committee, the FDA and the Justice Department, including that the agriculture secretary could consult with the attorney general on state plans for hemp production. The bill, McConnell added, does not make hemp a legal commodity, and it also improves the integrity of the hemp program, to ensure that states and Indian tribes conduct proper oversight over their own hemp programs."

McConnell, making a rare appearance as a member of the committee, "said hemp could fill the market niche left when farmers in his state stopped growing tobacco," AgWeek reports, quoting him: “Younger farmers in my state are particularly interested in going in this direction, so I think it’s time for America.”

Newspaper editor writes about dealing with depression

By Jesse Jones

The Eagle Post

Don’t read this alone in the dark. That thing under your bed might get anxious. The monsters that come to life when the lights go out would know. The dead-eyed woman on the ceiling above you might get angry.

Here goes anyway: There are things in this world far scarier than an imagination’s creations.

I slept in the same bed as my mother until I was 9 years old. Nothing terrified me more than unexplained noises, the bleak emptiness of my dark room and the creatures my mind imagined lived there.

In middle school I got punched in the face for the first time. I remember it, clear as day. The kid in front of me in math class warned me, said I had better quit bumping his chair or else. I forgot his warning. He didn’t.

The thing about getting really hit for the first time is that it dispels the anticipation. Before, you worry. Will it hurt? Would I black out, and everyone make fun of me forever?

I rubbed my cheek for a couple days, but I lost the fear of being hit. It wasn’t as bad as I imagined.

There was no blow to take to get rid of my fear of the dark. Goosebumps would raise on my skin at the thought, and a little shiver would make its way down my spine. The things I imagined lived in that blackness terrified me. I grew up, I learned to sleep in my own bed. I knew there wasn’t really anything awaiting me just beyond my vision. The fear, however, took longer to go away.

In my first house out on my own, the air conditioning flipped off for whatever reason six times a week. Turning it back on meant a trip down to the unfinished basement to the circuit breaker. There were no windows. Weird noises were commonplace. It was a nightmare’s playground.

I would have been OK, except every single light was set up to be turned off down there. There were no switches at the top of the stairs. It was a horror movie opening credits death waiting to happen. I was in my early 20s, but it didn’t stop the dread. It didn’t stop me from flicking the switch and racing up the stairs in pitch blackness as fast as my dignity would allow.

I don’t fear the darkness anymore. It’s comfortable, it’s quiet. Wanna know my secret to not being afraid of the things that go bump in the night?

Depression.

It’s hard to talk about. It was tough to write that word. There’s a stigma that’s associated with people who have had it. However, it seems someone famous is killing themselves every other day. It’s not talked about, but it happens just as much in the southern Pennyrile.

I hope you’re reading these words. Bad times can overcome anyone. I remember the first time I sat alone in the dark and wishing, hoping that there was a boogeyman just around the corner. I was struggling with an emptiness inside, a feeling of worthlessness and terrifying thoughts about the bottle of pills in my lap. I was more afraid of being inside my own head than the supernatural. I remember taking a nighttime walk on a poorly-lit street and seeing a car that didn’t see me at first veer into the lane I was walking in. I didn’t move. In some ways that still haunt me, I wanted it to hit me. I never thought about the fantastical things my head used to imagine would have been on that road.

I don’t write this for you to feel sorry for me. Depression is an incredibly common ailment many of us struggle with. Like cancer, it doesn’t care what color you are, what kind of car you own or how successful you are. It takes away who you are.

I don’t know you. But these feelings you have, you’re not alone in them. There is no small victory that can make that go away. I’m sorry.

Even if you have no one to talk to, though, remember that there are options. There are people to help. Before you take that final step, please call 1-800-273-8255. Personally, I used their online, anonymous chat to talk through the worst of my times. Depression isn’t a competition, but I know if I can survive, there’s hope for you too. You don’t have to be afraid of the darkness, even if it’s just the darkness inside your own head. That’s this week’s small victory.

Jesse Jones is editor of The Eagle Post, the Army newspaper for Fort Campbell.

Interior Department official met with coal industry lobbyists before canceling study on health effects of surface mining in Appalachia

A top official in the Department of the Interior met repeatedly with coal-industry lobbyists shortly before canceling a study on the public health effects of surface mining, Jimmy Tobias reports for the Pacific Standard.

Katharine MacGregor

Katharine MacGregor, the principal deputy assistant secretary for land and minerals management, oversees the Office of Surface Mining Reclamation and Enforcement. OSM hired the National Academies of Science, Engineering and Medicine to do the study, but Interior abruptly suspended it last August, as researchers were about to hold their final public meetings on it. The meetings were held, and researchers said they expected to continue after a budget review that Interior had cited as the reason for the suspension, but then Ken Ward Jr. of the Charleston Gazette-Mail revealed that the study was the only one suspended. Later, the contract was canceled and the research committee disbanded.

Tobias writes: "Emails obtained through a FOIA request show that Katharine MacGregor had a hand in ensuring the health study's cancellation. Indeed, she appears to have been keenly interested in the matter." She wrote the OSM director Aug. 17: I thought you told me on the phone that this was postponed?" The next day, OSM suspended the work.

“This is the very essence of what we mean when we describe Appalachia as a sacrifice zone,” said Bob Kincaid, president of Coal River Mountain Watch, a group fighting mountaintop-removal mining. Bo Webb, coordinator of the Appalachian Community Health Emergency campaign, which helped prompt West Virginia officials to ask for the study, said in the same press release, "It’s clear now that canceling this study was a gift to the coal industry.."

Tobias reports that "in the months leading up to the cancellation," MacGregor's calendar "shows that she had no fewer than six meetings with the most powerful mining players in the country. In both April and May of 2017, she met with the National Mining Association. In March and June, meanwhile, she met with Arch Coal, a long-time practitioner of mountaintop removal mining in Appalachia."

The evidence is circumstantial, but Tobias sees a broader trend in MacGregor's calendars: "At the same time she held a mere handful of meetings—fewer than 10, according to my tally—with conservation organizations like The Wilderness Society and Sportsmen for the Boundary Waters." The calendar sshow that she "appears to have a habit of meeting repeatedly with industries and organizations that later receive favorable treatment from agencies she helps oversee," Tobias writes. An Interior spokesperson told him MacGregor is "happy to make time to meet with whomever requests a meeting," including conservation groups. "We have always welcomed input from all citizens and will continue to listen to ideas and concerns from anyone interested in sharing them."

McConnell says whole Senate backs continued coverage of pre-existing conditions, contrary to Justice Dept. stance in lawsuit

Sen. Mitch McConnell (NBC News image)

Senate Majority Leader Mitch McConnell of Kentucky says "Everybody that I know in the Senate is in favor of maintaining coverage for preexisting conditions," even though the Trump administration is arguing in court against the Obamacare law that requires such coverage. “There is no difference of opinion about that whatsoever,” McConnell said Tuesday, June 12, when asked about the case.

Senate health committee Chairman Lamar Alexander of Tennessee said the Department of Justice's stance in a federal lawsuit in Texas is “as far-fetched as any I've ever heard.” In a prepared statement, the Tennessee senator said, “There’s no way Congress is going to repeal protections for people with pre-existing conditions who want to buy health insurance. 

Alexander "rejected the notion that Republican lawmakers intended a broader swipe at the law when they repealed the individual mandate" in Obamacare, Inside Health Policy reports.

On June 7, the department declined to fully defend the law from a suit by 20 Republican-led states and asked the judge "to invalidate the preexisting-conditions ban as of Jan. 1, 2019, when the individual mandate penalty goes away," IHP reports.

Health and Human Services Secretary Alex Azar said earlier Tuesday, during a Senate hearing, that the Justice Department has taken “constitutional and legal position, not a policy position,” Anna Edney and Steven T. Dennis report for Bloomberg News: "Still, the distinction is political. Republicans were quick to blame Democrats for failing to vote for an Obamacare stabilization package earlier this year that started off as bipartisan but ended up including restrictions on abortion coverage that scuttled the deal."

Democrats' reaction to McConnell's comments ranged from bemused to skeptical to outraged. “Lie of the year. Hands down,” said Brad Woodhouse, campaign director for Protect Our Care, a pro-Obamacare group.

Sen. Patty Murray of Washington, ranking Democrat on the health committee, said, “If every Republican now supports protecting preexisting conditions, that’s news to very sick patients across the country who fought back again and again as Republicans tried to go back to the days when a preexisting condition meant you might not be eligible for insurance, or could be priced out completely -- especially since many Republicans continue to want to pass harmful bills to do exactly that.”