Aetna to quit selling Ky. Obamacare policies; affects 10 counties in 3 major metros; may relate to feds' suit to block Humana deal

Aetna Inc. will stop selling federally subsidized health-insurance policies in Kentucky and 10 other states, remaining only in Virginia, Delaware, Iowa and Nebraska, it said Aug. 15. The company is "joining other major insurers that have pulled out of the government-run markets in the face of mounting losses," notes Zachary Tracer of Bloomberg News.

"More than 40 payers of various sizes have similarly chosen to stop selling plans in one or more rating areas in the individual public exchanges over the 2015 and 2016 plan years, collectively exiting hundreds of rating areas in more than 30 states," Aetna said in a news release. "As a strong supporter of public exchanges as a means to meet the needs of the uninsured, we regret having to make this decision."

Aetna had filed and received state approval to sell plans for 2017 in Boone, Campbell, Kenton, Fayette, Madison, Jefferson, Oldham, Trimble, Henry and Owen counties.

Nationally, the company said it will sell policies on state and federal insurance exchanges in only 242 counties, down from 778 this year. It will continue to offer individual policies off the exchanges, and thus without federal subsidy, "in the vast majority of counties where it offered individual public exchange products in 2016," the release said.

"The decision is the latest blow to President Barack Obama’s signature domestic policy accomplishment," Tracer reports. "While the Affordable Care Act, known as Obamacare, has brought coverage to millions, the new markets have proven volatile for some of the largest for-profit insurers. Aetna said earlier this year that it expected to lose $300 million on the plans. UnitedHealth Group Inc. and Humana Inc., which Aetna has agreed to buy for $37 billion, are also pulling out after posting hundreds of millions of dollars of losses."

Kevin Counihan, who oversees Obamacare marketplaces for the Centers for Medicare and Medicaid Services, told Bloomberg News, “Aetna’s decision to alter its marketplace participation does not change the fundamental fact that the Health Insurance Marketplace will continue to bring quality coverage to millions of Americans next year.”

Aetna denied that its move had anything to do with the Justice Department's lawsuit to keep it from buying Louisville-based Humana Inc., but "Aetna's announcement . . . was seen by some as payback to the Obama administration," reports Carolyn Y. Johnson of The Washington Post. "After all, in April, Aetna chief executive Mark Bertolini had called selling insurance in the exchanges "a good investment."

"Now, a letter obtained by the Huffington Post through the Freedom of Information Act shows that the company's chief executive clearly explained to Justice Department officials in early July that if the merger were to be challenged or blocked, 'We would need to take immediate actions to mitigate public exchange and ACA small group losses.' Bertolini clearly spells out what that means," Johnson writes. "Aetna would withdraw from many insurance exchanges, limiting its participation to no more than 10 states in 2017, rather than the 20 it had been planning."

Heroin arrests and treatment are up in Appalachia, enlarging threat of HIV and hepatitis C outbreaks from unclean needles

Partly because it's much cheaper than pain pills, heroin is "quickly making inroads in Southern and Eastern Kentucky," the head of an anti-drug organization told Laura Ungar of The Courier-Journal.

Numbers show rank on Centers for Disease Control's national list
of counties at risk for outbreak of HIV or hepatitis C from needles.

Nancy Hale is president and CEO of Operation UNITE (Unlawful Narcotics Investigations, Treatment and Education), which serves 32 Appalachian Kentucky counties and has law-enforcement powers. "Hale said they are arresting more people for small-time heroin offenses and hearing from ERs treating overdose victims," Ungar reports. "One reason, she said, is that the drug provides a relatively cheap high. A hit of heroin in Appalachia costs about $5, compared with around $30 for one pain pill."

Meanwhile, treatment centers in the region "are serving more people seeking to kick heroin and break the cycle of addiction," Ungar reports. "At Hope in the Mountains, a women’s recovery facility in Prestonsburg, 22 of 36 clients are heroin addicts."

Heroin started becoming more common in Kentucky's major metropolitan areas after the legislature cracked down on pain pills in 2012, but took a while to reach rural areas because the supply chain from Mexico runs through major cities, then smaller ones, officials said. Now, in Hazard, "I’m definitely scared about heroin," Police Chief Minor Allen told Ungar. "We already have syringes laying around in playgrounds and neighborhoods. Anything that deals with shooting up is scary."

The federal Centers for Disease Control and Prevention considers the region the most vulnerable in the nation to outbreaks of HIV and hepatitis C from sharing of needles by intravenous drug users, but only four counties in the area, Pike, Carter, Elliott and Knox, have syringe exchanges where users can get clean needles. The exchanges require city and county approval.

FTC warns online marketers about claims of Zika protection

"It appears that some online marketers may be trying to take advantage of consumer concerns" about the Zika virus, so the Federal Trade Commission has sent letters to 10 of them warning that "Zika protection claims must be supported by competent and reliable scientific evidence in the form of well-controlled human clinical testing," the FTC said in a news release this month.

Some mosquito species carry Zika better than others.

"The products of concern include wristbands, patches, and stickers that purportedly can repel the mosquitoes that carry Zika or otherwise protect users from the virus," the FTC said. "The letters also point out that the testing supporting claims of protection from the Zika virus must use the mosquito species that are able to carry the virus, and must be able to demonstrate that the repellent effects last as long as advertised."

The agency "is concerned that some products don't work as advertised," FTC consumer education specialist Aditi Jhaveri wrote on the agency's Consumer Information blog. "To prevent mosquito bites, the Centers for Disease Control and Prevention recommends using skin-applied insect repellents registered with the Environmental Protection Agency with certain active ingredients. The EPA also has registered products to treat clothing and gear. These registered products have been evaluated by the EPA for safety and effectiveness."

The EPA registry is searchable by type of insect, active ingredient, company name and the length of time protection is needed.

"If you’re considering an all-natural repellent — or a wristband or sticker — not registered with the EPA, know that the CDC and EPA don’t speak to their effectiveness," Jhaveri wrote. "And if you’re a parent, know that certain ingredients aren’t safe for children under 3 — even if they’re advertised as all-natural. Here’s more from the EPA on using repellents safely and effectively.

Kentucky leads the nation in cancer deaths, but falls short on policies to prevent cancer, especially when it comes to tobacco

Kentucky ranks first in deaths from cancer and has for several years, but falls short in its fight against cancer when it comes to supporting policies and passing legislation to prevent it, according to an American Cancer Society report released Aug. 11.

The latest edition of "How Do You Measure Up?: A Progress Report on State Legislative Activity to Reduce Cancer Incidence and Mortality" found that Kentucky followed ACS policy recommendations in only two of the 10 issue areas ranked, and showed some progress in two areas, but fell short in six.

How Kentucky measures up.
Red: Falling short  Yellow: Some progress  Green: Doing Well

“We’ve made tremendous progress in the way we diagnose and treat cancer across the country. But to leverage this progress, Kentucky legislators must take advantage of the opportunities to pass evidence-based laws and policies that are proven to save lives and money,” Erica Palmer Smith, Kentucky government relations director at ACS, said in a news release.

The report used a color-coded system to rate states in 10 specific areas of public policy that can help fight cancer, including smoke-free laws, tobacco tax levels, funding for tobacco prevention and cessation programs, cessation coverage, funding for cancer screening programs under Medicaid and restricting indoor tanning to minors.

The report also looked at whether or not a state had increased access to health care by expanding Medicaid under federal health reform to people who earn up to 138 percent of the federal poverty level, had passed laws to increase patient quality of life, had passed laws to ensure oral chemotherapy drugs are covered by insurance the same as intravenous chemotherapy, and whether the state offered a well-balanced approach to pain medications.

Green shows that a state has adopted evidence-based policies and best practices; yellow indicates moderate movement toward the benchmark and red shows where states are falling short.

Kentucky fell short for all four tobacco policy measures in the report.

"Tobacco use remains the number one preventable cause of death, so Kentucky’s biggest opportunity to save lives and reduce health care costs starts with addressing the state’s current tobacco control policies," says the release.

The report found that Kentucky's cigarette tax, at 60 cents per pack, is less than 50 percent of the national average of $1.65 per pack. The report recommends increasing cigarette taxes by at least a $1 per pack, and then to use that money to pay for tobacco prevention and cessation program. It also recommends similar increases for all tobacco products.

"Evidence clearly shows that raising tobacco prices through regular and significant excise tax increases, encourages tobacco users to quit or cut back and helps prevent young people from ever starting to use tobacco," says the report.

Kentucky has also been unable to pass a comprehensive statewide smoke-free law and isn't likely to do so under the leadership of Republican Gov. Matt Bevin, who doesn't support a statewide ban on smoking, saying the issue should be decided locally.

That being said, about a third of Kentucky's population is covered by local comprehensive smoke-free policies, and another 10 percent or so live in places that have ordinances with varying exceptions. Kentucky has one of the nation's highest smoking rates, 26 percent.

American Cancer Society map; click on it for a larger image and a more readable legend

Two-thirds of Kentucky adults support a comprehensive statewide smoking ban, according to the latest Kentucky Health Issues Poll, and have since 2013.

"Smoke-free laws reduce exposure to secondhand smoke, encourage and increase quitting among current smokers and reduce health care, cleaning and lost productivity costs," says the report. "Smoke-free laws also reduce the incidence of cancer, heart disease and other conditions caused by smoking and exposure to tobacco smoke."

Kentucky's tobacco-cessation policies also fell short. The report noted that while all Medicaid programs offer some tobacco-cessation coverage, most have varying restrictions that create barriers, like limits on the length of time a person can use certain services.The report says such barriers reduce utilization.

In addition, the amount of money Kentucky spends on tobacco prevention and cessation programs is only 4.4 percent of the amount recommended by the federal Centers for Disease Control and Prevention. In 2016, Kentucky allocated $2.5 million for tobacco prevention; the CDC recommends the state spend $56.4 million.

"For every $20 Big Tobacco spends on marketing their deadly products, states spend just $1 on programs to reduce tobacco use and save lives," says the report. "States with sustained, well-funded prevention programs have cut youth smoking rates in half or even more, saving lives and reducing state health-care costs."

In Kentucky, high school smoking rates are 56 percent higher than nationwide, and the adult rate is 74 percent higher. The report blames that on lack of "statewide tobacco-control policies" and says the higher rates cost the state more than $2.7 billion a year in health-care costs.

Kentucky also fell short on its control of indoor tanning, ACS said. The report says Kentucky lawmakers missed out on an opportunity in 2016 to pass legislation to protect minors from the dangers of indoor tanning beds. A bill cleared the Senate Health and Welfare Committee, but wasn't heard in the Senate.

The other area in which the state fell short, in ACS's opinion, was state appropriations for breast and cervical cancer screening programs.

Kentucky scored best on policies that centered around access to care. The report said the state has made some progress with its cancer pain control and palliative care policies and was ranked as doing well in the areas of oral chemotherapy fairness and expanding access to care through Medicaid.

Jury awards Corbin man $21.2 million for unnecessary heart surgeries at London hospital

Lexington Herald-Leader photo

A jury said Wednesday that St. Joseph Health System and its parent firm should pay a Corbin milk-truck driver $21.2 million in damages for unnecessary surgeries on his heart at its London hospital. The verdict for Kevin Wells was "the latest blow for Catholic Health Initiatives" in Kentucky, reports Andrew Wolfson of The Courier-Journal.

Two years ago Saint Joseph agreed to pay the federal government $16.5 million "to resolve civil allegations that it submitted false or fraudulent claims to the Medicare and Kentucky Medicaid programs for a variety of medically unnecessary heart procedures" at the hospital, Wolfson notes. "St. Joseph Health System merged with Jewish Hospital and St. Mary’s HealthCare in 2012 to form KentuckyOne Health. The alleged violations covered in the settlement were before the merger," notes Bill Estep of the Lexington Herald-Leader.

Read more here: http://www.kentucky.com/news/state/article95223727.html#storylink=cpy

"Dr. Anis Chalhoub, who implanted the pacemaker in Wells, was indicted in June on criminal fraud charges of implanting the devices into patients without 'sufficient need or justification.' Federal prosecutors said the alleged crimes were related to a scheme for which another cardiologist, Dr. Sandesh Patil, was sentenced to 2½ years in prison in 2013," Wolfson reports. "He was accused of exaggerating the severity of patients' illnesses so he would be paid for treating them."

The jury in the Wells case in Laurel Circuit Court wasn’t told about Chalhoub's indictment or Patil’s conviction, Wells attorney Hans Poppe of Louisville told Wolfson. He told Estep that he expects the hospital chain to appeal.

Wells's lawsuit "was one of hundreds filed by patients who alleged they were the victims of unnecessary surgery and implantation of stents and other devices," Wolfson reports. "Two previous trials resulted in defense verdicts, but this was the first case in which the jury considered claims against the hospital, Poppe said."

"The verdict is the most recent of a series of problems that have plagued CHI and KentuckyOne Health, its Kentucky unit," Wolfson notes. "Triggered by a surgeon's complaint that University of Louisville Hospital, which KentuckyOne manages, is dangerous, a state inspection last month found that deficiencies in nursing services specifically endangered three patients. A dozen nurses and doctors also told state inspectors that nursing and other staff shortages put patients at risk." The company "said the hospital is safe and has made numerous improvements."

Tips to keep off that 'Freshman 15' when going to college

kidshealth.org

While most college freshmen don't gain the fabled "Freshman 15," they do gain an average of about 7 pounds their first year, and then continue gaining gradually throughout their college experience. But with careful planning, they don't have to, says a University of Florida Institute of Food and Agricultural Sciences news release.

Fast food, late-night pizza, dining halls filled with calorie-laden foods and unlimited desserts, limited transportation to grocery stores, lack of exercise, demanding schedules and stress all contribute to this likely weight gain. Experts say it's important to avoid the gain because poor eating habits in college can last a lifetime.

The news release says the share of people aged 12 to 19 who were obese increased from 5 percent to nearly 21 percent from 1980 to 2012, according to the federal Centers for Disease Control and Prevention; almost 19 percent of Kentucky's high-school students are considered obese.

Here are some tips to keep those pounds off:

• Keep fruits,vegetables and high-protein snacks, like nuts and yogurt, on hand for snacking.
• Aim for at least three different food groups on your plate at each meal.
• Fill half of your plate with fruits and vegetables, then add the entrée.
• Plan ahead, think about where your best food options are each day.
• Load up on protein at each meal.
• Invest in a lunch box that fits in your backpack for busy days.
• Learn how to make a few simple, healthy meals.
• Avoid eating when stressed, while studying or while watching TV
• Eat slowly.
• Choose lower-fat options when possible.
• Pay attention to portion size.
• Avoid going back for additional servings.
• Replace empty-calorie soft drinks, alcohol, energy drinks, and high-fat, sugary coffee drinks with water. 
• Exercise at least three days a week.
• Sleep an average of seven to eight hours each night.

2.4% of Kentucky Medicaid's emergency-room costs in 2015, or $9.3 million, were for non-emergency cases

Taxpayers paid nearly $385 million in 2015 for emergency-room visits for Medicaid patients, $9.3 million for cases that were judged not to be emergencies, according to state data gathered by a Louisville television station.

About 36 percent of Medicaid recipients visited an emergency room last year, according to data Eric Flack of WAVE-TV obtained from the Cabinet for Health and Family Services. Of those visits, nearly 200,000 of them were for non-emergencies, "things that could have handled by a regular doctor, saving taxpayers millions," Flack reported.

Kentucky taxes pay about 30 percent of the bills of traditional Medicaid recipients. The federal government pays the rest, and through this year pays the full cost of those in the 2014 expansion of the program.

It's unclear at this point how the 2015 figures stack up to those from 2014, the first year of then-Gov. Steve Beshear's expansion of Medicaid eligibility under federal health reform. That has added about 440,000 Kentuckians to the Medicaid rolls.

Flack's report was based solely on the 2015 figures, with no further context, and he did not mention that the $9.3 million figure was 2.4 percent of the total.

"Taxpayers spent around $300,000 in ER visits for various forms of rhinitis, or runny nose," Flack reported. "Even when it's caused by the family pet. Medicaid users come to the ER for cramps, insect bites, sunburn, acne. They come because they can't quit smoking. They get emergency treatment for a headache after sex."

Why do many Medicaid recipients seek care at an ER for a non-emergency? Lack of information, say people familiar with the program. Medicaid recipients make a co-payment of $8 for ER visits, so if the person seeking care is someone who has never had insurance before and doesn't understand how to choose the most effective outlet for treatment, or has not obtained a primary-care physician, that person may rely on the local ER for non-emergency medical care.

Passport Health Plan and Humana Inc., two of four managed-care organizations that deal directly with Medicaid members, had drastically lower rates of non-emergency visits to the ER than did Aetna and WellCare, according to state data from Flack reported.

Michael Rabkin, communications director for Passport, said that could be because of the company's educational programs and staff. Passport employs embedded case managers who work with patients and doctors to inform patients of alternative options to the ER, such as urgent-care clinics. The case managers also encourage patients to practice preventive care and schedule regular doctor visits to decrease costs and treat health problems before they become critical. The company also offers a free nurse hotline that allows patients to call with medical questions, day or night, seven days a week.

Republican Gov. Matt Bevin's proposed changes to Medicaid are expected to be filed this month. One of his suggested changes is a $75 fee for expansion members who use the ER for non-emergencies. Traditional Medicaid users would not be subject to the fee.

Survey of low-income Kentuckians, Arkansans suggests expansion of eligibility for Medicaid is making them healthier

A survey of people in Kentucky and other states suggests that the 2014 expansion of the Medicaid program under federal health reform is making them healthier.

The telephone survey of more than 8,500 low-income citizens of Kentucky, Arkansas and Texas was part of a Harvard University study published Monday in the medical journal JAMA Internal Medicine. The researchers found that low-income people in Kentucky and Arkansas, which expanded Medicaid eligibility to 138 percent of the federal poverty level, appear to be healthier than their peers in Texas, which did not expand Medicaid access.

The surveys of Medicaid-eligible people found that those in Arkansas and Kentucky were 4.8 percent more likely than their peers in Texas to say they were in excellent health in 2015.

That difference was bigger than the 2.4 percent difference found in the 2013 and 2014 surveys, which is to be expected because "significant impacts of Medicaid expansion may take several years to unfold," the researchers wrote.

"After two years of coverage expansion in Kentucky and Arkansas, compared with Texas’s non-expansion, there were major improvements in access to primary care and medications, affordability of care, utilization of preventive services, care for chronic conditions, and self-reported quality of care and health." But they cautioned, "It remains to be seen whether the modest changes detected in our study will lead to subsequent improvements in objective measures of population health."

Results from surveys of people with incomes below 138 percent of 
federal poverty line. Arkansas expanded Medicaid through private
insurance. Texas has not expanded it. (JAMA Internal Medicine)

The survey also found that people in Kentucky and Arkansas were more likely to have a doctor and a place to go for care than in Texas, Margot Sanger-Katz reports for The New York Times. They said they were more likely to have their chronic disease treated, and that they were more likely to have received screening for high cholesterol or high blood sugar, markers for heart disease and diabetes.

Measuring whether people are healthier may sound simple, "but it’s actually pretty tough," Sanger-Katz writes. While tests can check for high cholesterol or high blood pressure, "a single test may not tell the whole story. It turns out, however, that when you ask people how healthy they are, they do a pretty good job of telling you."Research shows that people who say they are in poor health are more likely to die soon than those who describe their health as good.

Arkansas' expansion works differently than Kentucky's traditional Medicaid expansion in that it helps low-income residents buy private insurance. Either way, greater access to health insurance seems to be creating positive health outcomes.

"What this means is that it doesn’t matter so much how states expand coverage," Benjamin Sommers, primary author of the study and assistant professor of health policy and economics at Harvard's School of Public Health, said in a news release. "What matters is whether they expand at all."

The researchers were quick to warn that the findings were not necessarily generalizable to other states. "Medicaid programs vary widely across states in terms of physician payment, covered benefits, and other features, which means that our results are in some sense a case study of two specific expansion efforts," they wrote.

Even so, Sommers and the other researchers concluded their study with some advice based on their findings: "As Kentucky and Arkansas reconsider the future of their expansions, our study (along with evidence on the financial benefits to these states of expansion) provides support for staying the course." Gov. Matt Bevin is expected to formally propose changes to the federal government this month.

Appalachian Health and Well-Being Forum focused on the positive health initiatives going on in southeastern Kentucky

By Melissa Patrick
Kentucky Health News

Scientists, community leaders and researchers gathered at the Appalachian Health and Well-Being Forum at Whitesburg in July to share information about successful health and disease prevention programs in the region, to explore the role of community in preventing disease and promoting well-beings and to discuss the links between environment and health.

Linda Birnbaum

The forum was prompted by Linda Birnbaum, director of the National Institute of Environmental Health Sciences, part of the National Institutes of Health. She told those at the forum that the mission of her agency is “to discover how the environment affects people in order to promote healthier lives. More and more, we are all realizing that the environment influences our health."

Birnbaum pointed out that many diseases are linked to the environment, including asthma, infertility, lung diseases, Parkinson's, autism, birth defects and many cancers. She stressed the importance of doing research to understand the problem before pushing for solutions, noting community members have used NIEHS research to create healthier communities.

"As I see it, environmental health research is the key to preventing disease because you can’t change your genes, but you can change your environment," she said.

Though Birnbaum did not mention it in her prepared remarks, an ongoing environmental concern in the Appalachian region is the possible link between mountaintop-removal coal mining and health, which the Centers for Disease Control and Prevention, the Environmental Protection Agency, and the Indiana University School of Public Health are researching.

In addition, the federal Office of Surface Mining Reclamation and Enforcement announced recently that it will fund a $1 million study to examine links between surface coal mines in Central Appalachia and increased health risks of residents living near those mines.

Birnbaum was able to talk to local leaders about issues affecting the natural resources in the community during her site visits to the University of Kentucky Center of Excellence in Rural Health in Hazard, the Mountain Comprehensive Health Corp., the Appalshop media center and the Cowan Community Center in Whitesburg, according to a UK news release.

The forum, held at the Letcher County Cooperative Extension Service office, was sponsored by UK and NIEHS, which has provided almost $12 million for health research in Kentucky.

Fran Feltner

Fran Feltner, director of the UK CERH in Hazard, who participated in the forum, mentioned several successful health programs at the Center during a telephone interview, including: the Center's efforts to assess the health-related workforce needs in the region and then finding ways to fill them; working with Kentucky Homeplace, which helps people in the region gain access to medical, social and environmental services; a federal grant program that helps get children in the region signed up for health insurance; and its mobile dental unit that provides dental services to children at local schools.

"It was a positive meeting where we came together as leaders and talked about the things that are happening throughout our region to improve the health of the region," Feltner said.

Along with Birnbaum and Feltner, Dawn Brewer, assistant professor in the UK Department of Dietetics and Human Nutrition in the College of Agriculture, Food and Environment; and L.M. "Mike" Caudill, chief executive officer of Mountain Comprehensive Health Corp., participated in a panel discussion that focused on the role of community in preventing disease and promoting health and well-being.

Brewer described nutrition research that hopes to “make the healthy choice, the easy, or default, choice" and Caudill talked about the importance of place and how it is central to MCHC's efforts to promote health within the region, the news release said.

At table, L-R: Mike Caudill, Fran Feltner, Dawn Brewer, Linda Birnbaum

Feltner talked about how a depressed economy affects the health of a community and expanded on her comments during an interview.

When a person becomes unemployed their "normal living conditions" dramatically change and can affect their health, she said.

"Research supports that economic status has more to do with your health outcomes than any other thing because you risk being homeless, you risk separation from your family and community network, it creates economic and cultural barriers and all of this can be devastating to your health," Feltner said. "And psychologically, I think it is hard to feel your worth when you have been working and all at once you find yourself unemployed, so the mental health aspects play into it as well."

Feltner said while she saw no immediate solution to improve employment in the region, people in the region had to "come together to find solutions to do something different" because they could no longer depend on coal mining.

"I have always believed that communities can work together and that they can come up with solutions," Feltner said. "And sometimes there needs to be just a little bit of help. We can't come in and tell people what to do, but we can listen and help them find solutions."

She added, "The strength that we have in Appalachia is that we have a strong sense of where we are from and where we live and a commitment to our neighbors and friends."

For an audio report on the forum, from WMMT-FM of Whitesburg, click here.

UK entomologist says Ky. not likely to have Zika outbreak this year, but state still sprays around homes of those few with virus

Aedes Aegypti mosquito (CDC photo)

An entomologist from the University of Kentucky encourages Kentuckians to stay calm about the Zika virus because Kentucky does not have many of the mosquitoes known to transmit the disease, and therefore is not likely to have an outbreak.

"Keep calm, don’t overreact and enjoy what’s left of summer. Zika is not likely to cause a mosquito-borne outbreak in Kentucky in 2016," Grayson C. Brown, director of the Public Health Entomology Laboratory at the university, wrote in an op-ed for the Lexington Herald-Leader.

The op-ed comes on the heels of the federal Centers for Disease Control and Prevention reporting that the Zika virus is being locally transmitted between humans and mosquitoes in southern Florida.

Grayson explains that the mosquito that transmits Zika, the Aedes aegypti or yellow-fever mosquito, was common in Kentucky until the mid 1980s. But since, it has been replaced by the Aedes albopictus, or the Asian tiger mosquito. He wrote, "Over the last two years, we have only found four out of over 26,000 mosquitoes caught."

"The significance of Asian tiger mosquitoes replacing yellow-fever mosquitoes here is that Asian tiger mosquitoes either do not transmit Zika or are much less efficient at it," he wrote. "Lacking the principal vector, we do not expect a significant outbreak of Zika in Kentucky this year."

He also noted that mosquito season is coming to an end, which will decrease any further threat of a Zika local outbreak.

Meanwhile, the state Department of Agriculture sprayed an insecticide for adult mosquitoes around the home of an Alexandria resident who contracted the Zika virus while traveling outside the country, Chris Mayhew and Anne Saker report for The Kentucky Enquirer. Mosquitoes can pick up the virus by biting infected people, then transmit it to others.

City officials were upset that they weren't told about the spraying. The Northern Kentucky Health Department cited privacy concerns. “The spraying is done in such a concentrated area, a matter of blocks, around the affected person, that to identify the neighborhood would likely be a violation” of the federal patient- privacy law, said Emily Gresham Wherle, spokeswoman for the department.

Grayson urged Kentuckians to not overreact and to use "common-sense mosquito-avoidance techniques" like using a repellent only when necessary, emptying containers that hold water and to avoid being outdoors between 4 p.m. and 9 p.m., when mosquitoes are most active.

He also reminded Kentuckians that state and local health departments have been preparing for Zika since last October and have developed rapid-response teams to respond to an outbreak if it occurs.

But he also told Kentuckians to stay informed because "next year may well be a different story."

"Zika has proven to be difficult to predict, as it has mutated. It may well jump to another mosquito more common here. If we start seeing significant caseloads in Georgia, for instance, we’ll have to go on alert here," he wrote.

Grayson cautioned travelers to Zika-infected areas, especially pregnant women and women who plan on becoming pregnant, to follow the CDC guidelines for how to prevent mosquito bites and how to practice safe sex both during and after travel.

Madisonville girl provides example of emerging teletherapy that can help overcome shortage of psychiatrists in rural areas

When Ron Gadley searched for a therapist who could help his daughter, Rebecca, with depression near their Madisonville home, he found that their options were shockingly limited.

The few child psychiatrists within driving distance told him that Rebecca would be waiting months for an appointment, and another refused to accept new patients at all, Emma Ockerman reports for Time magazine.

Gadley finally found someone who could see his daughter every week. Even better, the treatment could begin immediately. There was a catch, though: Rebecca and her therapist would be 250 miles apart. She would be able to hear and see her therapist like normal, but her "telehealth" appointments, therapy sessions conducted by video conference, meant that Rebecca might never see her therapist face to face.

Cincinnati Children's Hospital Medical Center
(Photo from theodysseyonline.com)

Gadley, a machinist for Warrior Coal, told Ockerman he had never heard of teletherapy before his daughter’s depression diagnosis. After struggling to find local treatment for her, he learned that his company’s relationship with Cincinnati Children’s Hospital Medical Center meant Rebecca could receive treatment for free.

Mental health advocates hope that teletherapy can ease some of the burden on psychiatrists, especially in rural areas like Rebecca's, which often lack such professionals. A shortage of child psychiatrists is of particular concern. Mental health advocates say the U.S. needs more than 30,000 child and adolescent psychiatrists, but has only 8,300. Advocates and therapists alike have been struggling for years for an answer to the complicated problem.

The American Telemedicine Association reported earlier this year that the number of states requiring private insurers to cover telemedicine in the same way they cover in-person services had doubled in the past four years. Kentucky law requires Medicaid and private insurance to cover "tele-mental health encounters," including appointments with licensed social workers.

As technology has become cheaper and more reliable, teletherapy has emerged as a practical approach to reaching more patients, Ockerman adds. However, teletherapy has its critics, who question whether computer-assisted appointments like Rebecca's are as effective as traditional sessions carried out in person.

A 2013 study in the American Journal of Psychiatry cautioned that video conferencing could affect the natural conversation and bedside manner that would normally occur between mental health provider and patient. The appointment might initially feel impersonal; the therapist might have to make up for that with small talk to encourage “feelings of connectedness in a clinical encounter,” Dr. Jay H. Shore, a Denver psychiatrist and author of the study, writes.

But when it comes to children, they are used to interacting with technology, Dr. Michael Sorter, director of child and adolescent psychiatry at Cincinnati Children’s, told Ockerman. Computers and smartphones are where they maintain relationships with friends. Because of that, Sorter says, it might not be so unusual for them to see a doctor the same way. “They seem like they can easily relate to the TV screen.”

Others take a middle ground, seeing teletherapy as just one promising part of what must be a broader, more comprehensive solution to the shortage of behavioral health care in rural areas.

"It is part of an evolving landscape that has to change to get kids the services they need, and this is one very good part of that,” Dr. Kathleen Myers, program director for telepsychiatry and behavioral health at Seattle Children’s Hospital, told Ockerman. “But if you take a child psychiatrist here and have them practice [telehealth], all you’ve done is redistribute the manpower. We really need more than that.”

For Rebecca's part, she says teletherapy has helped her in her battle against depression. "It helped me put a jumbled-up mess into perspective," she told Ockerman. "The therapy put everything everywhere I needed it to be in my life. I’m getting active, I talk to more people, I’m making more friends."

Ky. still has 300,000 without health coverage; they're more likely to be working, and younger and less educated, than the insured

By Al Cross
Kentucky Health News

The 300,000 Kentuckians who still lacked health coverage at the end of 2015 were more likely to be working but earning low pay. They were also more likely to be young adults, lack any college education, and be of Hispanic or Latino heritage.

So says the latest report on the impact of the Affordable Care Act and Medicaid expansion in Kentucky, done for the Foundation for a Healthy Kentucky.

"We need to understand who the remaining uninsured are to make certain they can get essential health services moving forward, and this report gives us some critical insight," said Susan Zepeda, president and CEO of the foundation. "While traditional and expanded Medicaid programs are providing more than 600,000 working-age Kentucky adults with access to health-care services that will help them lead healthier and more productive lives, there remain 300,000 Kentuckians who . . . likely cannot afford to pay for even basic health care."

The fact that seven of 10 uninsured Kentuckians are working suggests that many of them are unwilling or unable to buy health insurance or sign up for Medicaid, even though 46 percent of them have incomes that qualify for the program. Those with household incomes above 138 percent of the federal poverty threshold can't get Medicaid but are eligible for federally subsidized insurance. However, they may feel they still can't afford the monthly premiums or the high deductibles of policies that have the lowest premiums. Many work for employers that don't offer health insurance.

The higher percentage of uninsured among young adults is one of the pitfalls of the reform law. To make a profit, insurers need a substantial enrollment of healthy people paying premiums and not making many claims to create a balanced enrollment with older, less healthy people.

Of Kentucky's non-elderly adults who had health coverage in the first quarter of 2016, nearly 611,000 were covered by traditional or expansion Medicaid. More than 515,000 Kentucky children were covered by traditional Medicaid and the Kentucky Child Health Insurance Program. "While the Affordable Care Act's coverage expansions primarily target adults, children are more likely to be covered when their parents have health insurance," Zepeda said.

The report said Medicaid covered tens of thousands of screenings and other health services for Kentucky adults aged 19-64 during the first quarter of  this year, including 6,304 colorectal cancer screenings, 5,451 hepatitis C screenings, 9,567 breast cancer screenings, 12,837 substance-use services, 46,668 dental services; and 6,660 births.

"More than three-fourths of those who received dental services were able to get coverage because of Medicaid expansion, pointing out the great need for dental coverage," Zepeda said. Gov. Matt Bevin has proposed removing dental coverage from the basic coverage but creating a rewards program through which Medicaid members could earn access to it.

The report was prepared for the foundation by the State Health Access Data Assistance Center at the University of Minnesota. It is the fifth quarterly snapshot of a study of the impact of the Patient Protection and Affordable Care Act in Kentucky.