Ky. community health centers get $96 million for Covid-19 work

Kentucky's 25 federally qualified health centers, generally known as community health centers, will share more than $96 million in grants from the recent relief-and-stimulus bill, the American Rescue Plan Act.

"The funding will be used to expand Covid-19 services and help ensure preventive and primary care for those at higher risk" for the disease, the Kentucky Primary Care Association said in a press release.

“Community health centers provide essential, high quality, state of the art healthcare to all people, regardless of their ability to pay,” KPCA's CEO, David Bolt, said in the release. “They are located in more than 90 Kentucky counties, including nearly all of the 42 counties that do not have a local hospital. By focusing on the uninsured, the underinsured, homeless, seasonal workers, minority populations, and others who may have barriers to healthcare access, community health centers now treat more than 550,000 Kentucky residents.”

The grants were based on patient counts, with double weight for the uninsured, and a base amount for each clinic. Here's a list from the federal agency:

Ky. ranked 37th in protecting children in pandemic; in top 3 for hunger; 22% of families with kids said they lacked enough to eat

Chart from Page 17 of national report from Save the Children; for a larger version, click on it.

By Melissa Patrick
Kentucky Health News

Kentucky ranks 37th for how well it's protecting children and providing for them during the coronavirus pandemic, and more than one in five Kentucky families with children didn't have enough to eat in December, according to a report from Save the Children, a global children's-rights organization.

The ranking was based on four months of data from a bi-weekly Household Pulse Survey that is conducted by the Census Bureau. The researchers looked at three hardships they say make it harder for children to reach their full potential: hunger, economic hardship and lack of tools for remote learning.

A scan at the end of November and through most of December found that Kentucky was one of the top three states for hunger, and that nearly half of Kentucky families are struggling to pay their bills.

The year-end analysis found that 22 percent of Kentucky families with children under 18 said they didn't have enough to eat in the prior week; that 11% of homes with at least one school-age child lacked internet access a computer for educational purposes; and that 47% found it somewhat or very difficult to pay for usual household expenses in the prior week.

Alissa Taylor, Save the Children's director for Kentucky rural education programs, told the Public News Service that 60% of low-income students regularly logged in for online instruction in the pandemic, compared to 90% of higher-income students.  

Nationwide, the pandemic is hitting the poorest families the hardest and that because of this, "childhood equity gaps are likely to grow," the report says. "They are about 15 times as likely to struggle with hunger as the wealthiest families, four times as likely to lack internet for educational purposes and nine times as likely to have difficulty paying bills." The challenges were even higher for Black and Hispanic families. 

The analysis also found that the number of coronavirus cases and Covid-19 deaths in a state was not predictive of where a state was ranked. It concluded that what mattered more were the resources and protections that each state has, or lacks, to protect children and families.

What's Kentucky doing to address these issues?

In August, the state allocated $8 million from the federal Coronavirus Aid, Relief and Economic Security Act to help reduce the monthly cost for low-income parents to pay for internet access for K-12 children. The program runs through the school year. Kentucky is working on a statewide broadband initiative that could be paid for by the American Rescue Plan, the successor to the CARES Act. 

Kentucky has provided rent and utility assistance as well as unemployment benefits throughout the pandemic, but the unemployment process has been plagued with long waits to get claims resolved and employment is still well below pre-pandemic numbers. 

The Kentucky Center for Economic Policy reports that while the state added 4,300 jobs in February, according to the federal Bureau of Labor Statistics, it still has 90,400 fewer jobs in February 2021, than it did in February 2020, the month before the pandemic hit. 

The state's 857 Family Resource and Youth Service Centers, which serve the 1,200-plus schools that have 20% or more students who are eligible for free and reduced-price lunch, have also been able to help. The centers say they did more than 49,000 home visits during the initial closure of schools from March to June 2020. 

“During the COVID-19 pandemic, the Family Resource and Youth Services Centers across the state met the increased needs for students and their families by adapting service delivery," Melissa Goins, director of the centers said in an e-mail. " Familiar with community needs, our FRYSCs coordinated home visits, porch drop-offs, and virtual platforms to continue connecting with families during this time.”

In survey about their pandemic response in that period, 98% of the FRYSC coordinators said they had provided food assistance, 85% provided non-traditional instruction packets and educational supports, 85% had provided basic needs and essential products, 65% had made family welfare checks, 56% had provided Covid-19 prevention information, and 35% had provided information about unemployment or jobs. 

Another way the state is working to make sure it's kids are getting enough food is participating in the Pandemic Electronic Benefit Transfer program that provides funds through a benefits card to households with children eligible for free or reduced-price school meals to cover the food costs on the days they learn from home. The P-EBT program will run through the school year.

Flap over food aid to parents owing child support

Gov. Andy Beshear also recently vetoed Senate Bill 65, sponsored by Sen. Stephen West, R-Paris, which would reinstate a 2018 policy to disqualify some non-custodial parents from receiving Supplemental Nutrition Assistance Program benefits, formerly food stamps, if they owe child support. 

More broadly, the bill addresses regulations that have been found deficient after review by a legislative committee, and is meant to ensure that the legislature has ultimate control over policymaking decisions and not the governor. Beshear's administration put a halt to the policy in April 2020, citing the pandemic.

West's bill would reinstate the policy and prevent the Cabinet for Health and Family Services from issuing any similar regulation. Beshear said that would hurt more than 6,000 children in the state. 

"It is a cruel bill at any time, but certainly in a once in 100-year pandemic," Beshear said at a news briefing. "It takes food benefits away from children, and that is wrong. . . . SNAP benefits provide crucial help to so many of Kentucky's children. I'll not allow food to be taken away from children's tables simply because of actions of parents." His veto will likely be overridden by Republican supermajorities in both the House and Senate.

An analysis of the bill's effects by the Kentucky Center for Economic Policy found that the policy is ineffective at significantly increasing child-support payments and would worsen food insecurity across the state, including for kids. 

West noted at a February committee meeting that the interim health committee had asked for this policy to be reinstated because it is not fair to reward noncustodial "deadbeat parents" who haven't paid their child support and that this policy will give them an incentive to do so.

Vaccination priority age group now begins at 40; Beshear pushes signups; positive-test, infection rates up; 88 audit deaths added

Map shows Covid-19 death rates by county as of March 20; for a larger version, click on it.

By Bruce Maples
Kentucky Health News

As he reported more than 36 percent of Kentucky adults had been vaccinated for the novel coronavirus, Gov. Andy Beshear announced a further expansion of the program: starting Monday, March 29, anyone 40 and older is now in the priority group to sign up for their "shot of hope."

Beshear said more than 1.25 million shots had been administered, with almost 200,000 in the last week alone. The state is adding three new sites, bringing the total number to 573, but Beshear spent a good part of his news briefing urging Kentuckians to sign up for unfilled vaccination openings.

Where to find sites with vaccine openings on state
kycovid19.ky.gov website; click on it to enlarge.

Saying he was going to do his best to tell people about how to sign up for those, he listed four sites and how to make an appointment, and said the kycovid19.ky.gov website would start listing sites with openings.

He said some people are waiting to be vaccinated with the one-shot Johnson & Johnson vaccine, and said that was not a good idea, since the supply of that vaccine is very limited right now. He speculated that it would take less time to get a two-shot vaccine than wait for a Johnson & Johnson.

Variant outbreak: Health Commissioner Steven Stack gave an update on the outbreak of a variant of the virus at a nursing home, apparently in Morehead. The state has not revealed the location.

Stack said 90% of the residents but only half of the staff had been vaccinated. Of those who were vaccinated and then infected, only 33% had symptoms, while 80% of the unvaccinated and infected had symptoms. Only 4% of the vaccinated were hospitalized, while 19% of the unvaccinated were.

"The take-home message here, more than anything else, is these vaccines are doing what we hoped they would do," Stack said. "They're reducing risk, they're keeping people safe, and they're helping us to get out of this pandemic so we can all get back to our lives, and keep everyone from having the risk to the fullest extent possible of suffering injury, severe illness, or even death from this disease. ... Please get the one that’s available."

Daily numbers: The percentage of Kentuckians testing positive for the virus in the last seven days rose to 2.92%, about where it was Monday and Tuesday before falling to 2.85% Wednesday.

Beshear reported 726 new cases of the virus, which he said were the fewest on a Thursday in at least a month. That reduced the seven-day average by seven, to 614, the lowest since Sept. 14.

He noted that there were no new cases in long-term-care facilities, saying he could not remember when he had last been able to report that. He did note that there was a day last week with no new cases, but it was not a day when he held a briefing.

The statewide rate of new cases rose slightly, to 11.65 per 100,000 residents over the last seven days. Counties with case rates more than double the statewide rate are Simpson, 56.2; Lyon, 52.2; Powell, 42.8; Owsley, 38.8; Knox, 33.0; Whitley, 28.4; Bell, 26.3; and Trimble, 23.6. The state's rate is 30th in the nation, the lowest in many weeks, according to The New York Times data tracker.

Counties with 10 or more new cases were Jefferson, 121; Fayette, 49; Scott, 39; Kenton, 34; Daviess, 22; Simpson, 22; Christian, 15; Warren, 15; Boone, 14; McCracken, 14; Bell, 13; Campbell, 13; Hardin, 12; Montgomery, 12; Oldham, 11; Carter, 10; Harrison, 10; Hopkins, 10; Laurel, 10; and Pike, 10.

Kentucky’s hospitals reported 403 Covid-19 patients, down 35 from Wednesday. Of those, 104 were in intensive care, and 49 were on ventilators. Yesterday's report of ventilated patients, which listed an unusually high number; appears to have been in error. State officials didn't provide an explanation.

Deaths: The state added 19 more deaths to its official list of Covid-19 fatalities, bringing its toll to 5,970. It also added 88 new deaths from the ongoing audit of death certificates, the most added since the audit reports began with 417 a week earlier. The deaths in the two reports overlap.

Four of the regularly reported deaths occurred in March, 13 in February, one in January and one in December. Among the 88 deaths found by audit, two were in February and 30 were in January.

The 19 regularly reported fatalities added to the official list today were a Barren County woman, 79; a Christian County man, 71; a Clark County woman, 67; a Daviess County man, 67; a Fayette County man, 88; a Gallatin County man, 61; a Greenup County woman, 75; a Jackson County woman, 77; three Jefferson County women, 46, 68, and 88, and a Jefferson County man, 95; two Kenton County men, 60 and 62; a Marshall County woman, 90; a Montgomery County woman, 78; a Taylor County man, 79; a Washington County man, 76; and a Woodford County woman, 84.

Mask mandate: The governor was asked if he was going to re-authorize his mask mandate, as other governors are dropping theirs. The questioner noted Indiana, where the mandate will vanish April 6.

Beshear said he would follow the advice of health experts and continue to recommend wearing masks as get more people get vaccinated. "As soon as it's safe, I look forward to lifting it," he said. "We're not going to be wearing these things forever."

In other coronavirus news on Thursday:

• A study of Covid-19 cases and deaths in 175 countries found that pandemic outcomes hinged on how egalitarian the country's culture is. Countries that prioritize the well-being of society in general have fared better over the past year than more individualistic cultures. The study identified two cultural variables that affected death rate: individualism and “power distance” – a measure of power disparities among the citizenry. When both elements are extremely high, as in the U.S., that culture becomes a threat. The average death rate predicted by the model under such conditions is 28.79 per 100,000. When both are extremely low, as in New Zealand, culture helps. The average predicted death rate under such conditions is only 1.89 per 100,000.
• A recent opinion piece in the New York Post asserted that lockdowns to thwart the virus "do not work," and that lockdowns may have caused more deaths than they saved, but that was disputed a fact check published by the American Thoracic Society. "A well-designed study" at the University of California-San Francisco "demonstrated not only that lockdowns were associated with a decrease in all cause mortality, that with relaxing of the lockdowns, mortality rates went up for all communities studied," wrote Dr. David Hotchkin, a pulmonologist. "The preponderance of evidence suggests lockdowns do save lives." 
• Even though persons can develop immunity to a virus by being infected, that immunity is not necessarily enough to protect against getting it again, Jennifer Grier of the University of South Carolina, writes on The Conversation, a site for journalistic reports by academics: "Covid-19 vaccines offer safer and more reliable immunity than natural infection."
• Stack was asked about the Ebola threat that was reported last week. He said the state had identified 15 persons who had recently traveled to the two countries in Africa with Ebola outbreaks, and none had been near the outbreak areas or was at high risk.

Kentucky doctors worry that not enough people in the state will take advantage of vaccines for us to reach herd immunity

"As Covid-19 vaccine rollout continues to break records in Kentucky, there is a concern that interest could peak and the vaccinations could plateau before we reach herd immunity," which is needed to protect people who can't or won't get vaccinated, reports Chad Hedrick of Lexington's WKYT-TV.

"Dr. Ryan Stanton says the latest survey shows around 50 to 55 percent of Kentuckians will get the vaccine when they can," Hedrick reports. "To reach herd immunity, the magic number is 75 to 80 percent. Stanton says we won’t know for sure how short or close we are to those levels until mid-year."

Stanton, an emergency-room physician, and other doctors worry that the lack of herd immunity would lead to "flare-ups of cases year-round and chances for the virus to mutate easier," perhaps into more contagious strains, Hedrick reports.

Because vaccination has been politicized, just like the pandemic as a whole, "Stanton says doctors have had to play myth-busters a lot when it comes to the vaccine," Hedrick says.

“There’s a lot of false narrative and myths and dogmas that are still out there that are simply not true,” Stanton said. “Whether it’s the newness of the vaccines, whether it’s the risk for whatever the perceived association it is with potential risks for them. They just aren’t there and those aren’t factual.”

Stanton made this argument: “If you want to live the way we had to live in 2020, then not getting the vaccine is reasonable, but if you want to move past this, we need to get as many people vaccinated as can be.”

Tax removed from e-cig hardware sold separately from liquid

By Melissa Patrick

Kentucky Health News

The General Assembly has passed legislation to remove the 15 percent wholesale tax on the hardware used in electronic smoking devices when it is sold separately from the e-cigarette liquid. The e-cigarette liquid will continue to be taxed at 15%. 

Atlanta Journal-Constitution photo

That was the intent of the original tax bill, Republican Rep. Jason Petrie of Elkton, sponsor of House Bill 249, an omnibus revenue bill, said at a February committee meeting. He said legislators had been receiving lots of calls about it, and the bill more clearly defines how open "vaping" systems should be taxed. 

Last March, when the Senate Appropriations and Revenue Committee passed a trimmed down version of a House bill to tax e-cigarettes for the first time in Kentucky, Sen. Chris McDaniel, R-Taylor Mill, said the hardware should only be taxed at 6%. Ultimately, the 15% tax on open systems, including both hardware and solution, and a $1.50-per-pod tax on closed vapor cartridges were added to the revenue bill and became law.

A fiscal statement attached to this year's bill notes that Kentucky started taxing vaping products in August 2020 and has generated about $1.5 million per month from the levies. It says about $1.4 million per month comes from taxes on closed systems, like those sold by Juul Labs, and about $185,500 per month on the open systems, which are typically sold in "vape" shops. 

The report says removal of the 15% separate-hardware tax will cost $243,750 in revenue. That's a relatively small amount, but health advocates were not happy with the change. 

“Removing the tax on open vaping system devices reduces tax revenues at a time when Kentucky remains very uncertain about the long-term economic impact of the pandemic," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in an e-mail. "Moreover, these devices will become the sole tobacco product to escape a state excise tax." 

In contrast, Chandler said, "Only 19 of the state’s 61 local health departments will get funding for tobacco prevention and cessation beginning July 1. We urge the governor and lawmakers to work together to address Kentucky’s continuing tobacco and nicotine addiction problem, which appears to have grown during the pandemic." 

The American Cancer Society Cancer Action Network said it was "dismayed" with the removal of this tax and urged Gov. Andy Beshear to veto the bill.  

"Right now, over 26% of our Kentucky high-school students are using e-cigarettes. Eliminating taxes on some e-cigarette products will make them even more appealing to price-sensitive consumers, including youth," said Kristy Young, chief ACS-CAN lobbyist in Kentucky. "All tobacco products, including e-cigarettes, should be taxed at parallel rates to encourage people who use tobacco to quit rather than switching to lower-priced alternatives. As we face skyrocketing youth tobacco use, now is not the time to take steps backward."

Kentucky's positive-test rate for the coronavirus falls to 2.85%

State Dept. for Public Health graph, relabeled by Ky. Health News; for a larger version, click on it.

By Bruce Maples
Kentucky Health News

The percentage of Kentuckians testing positive for the novel coronavirus dropped again Wednesday, to 2.85%, as the state's vaccination program continued to expand.

“Every day, as more Kentuckians are vaccinated, we get closer to our goal of defeating Covid-19,” Gov. Andy Beshear said in a press release. “We’re not just going to meet the president’s goal that every American adult will be able to sign up for vaccination appointments by May 1, we’re going to beat that goal by more than two weeks at least.”

The positive-test rate has generally declined since a high of 12.45% on Jan. 10, but has has had occasional upward blips and plateaus. It was 2.93% Monday and Tuesday. Beshear has cited the decline in recent relaxation of restrictions, such as increased capacity and hours in restaurants and bars.

The state reported 695 new cases of the coronavirus on Wednesday. That brought the seven-day average to 623, down 38 from the day before, when it had risen by 11, only the fourth rise in four weeks.

Kentucky’s seven-day rate of new cases also fell, to 11.58 per 100,000 residents. Counties with case rates more than double the statewide rate are Simpson, 65.4; Lyon, 55.7; Knox, 35.3; Powell, 33.5, Whitley, 31.5; Owsley, 29.1; Trimble, 27; and Jackson, 24.7. The state's rate ranked 25th in the nation, according to the New York Times data tracker.

The state's daily report was the first in some time on which Lyon County, site of outbreaks at state prisons, was not at the top of the list. The Corrections Department's daily report showed active cases in prisons fell to 193 inmates and 21 employees; two days ago, 492 inmates and 35 employees were active cases.

Counties with 10 or more new cases were Jefferson, 95; Fayette, 47; Hardin, 34; Scott, 27; Warren, 21; Boone, 20; Daviess and Kenton, 19; Laurel and Whitley, 17; Pulaski, 15; and Campbell, Christian, Hopkins, Logan, and Simpson, all with 11.

Kentucky’s hospitals reported 438 Covid-19 patients, two more than Tuesday. Of the state's 10 hospital regions had more than 80% of their intensive-care beds in use: Lake Cumberland, at 82%.

The state added 24 more regularly reported Covid-19 deaths to its official toll, bringing it to 5,863. It also added 25 deaths reported as a result of the ongoing audit of death certificates.

The 24 fatalities were two Bell County women, 64 and 69; a Caldwell County woman, 81; a Clay County woman, 90; three Fayette County men, 62, 82, and 87; a Fulton County man, 91; a Graves County woman, 88, and a man, 39; a Hardin County woman, 94; two Johnson County women, 69 and 81, two Johnson County men, 71 and 84; a Magoffin County woman, 85; a Meade County woman, 61; two Perry County women, 84 and 92; a Pike County man, 80; a Russell County woman, 50; two Shelby County women, 69 and 85; and a Washington County man, 87.

In other pandemic news Wednesday:

• Based on daily testing of a group of health-care workers, researchers have concluded that coronavirus reinfection is possible after being fully vaccinated, but that the risk is "minuscule," according to a letter published in the New England Journal of Medicine. Out of more than 28,000 fully vaccinated individuals, 37 tested positive, about a tenth of a percent.
• Noting the spats between Sen. Rand Paul and Dr. Anthony Fauci about the need for mask wearing after vaccination, David Catanese of McClatchy looks at what Paul gets wrong and right on this topic by talking to nine leading public health experts about the future of mask wearing in an increasingly vaccinated world. He says "Fauci’s case for masks is . . . better be safe than sorry."
  
  Read more here: https://www.kentucky.com/news/politics-government/article250172215.html#storylink=cpy
• Becker's Hospital Review's analysis of the Centers for Disease Control and Prevention's data tracker shows that Kentucky ranks 17th in percentage of coronavirus vaccines it has administered, out of those that have been sent to the state. It shows Kentucky has administered 81.9% of its doses. 
• Becker's answers questions about post-acute Covid-19, which is sometimes called "long Covid" or "long-haul Covid-19" or "post-Covid syndrome."

Vaccinations hit new high, but several locations have hundreds of slots open, and the U.S. pandemic plateau may be coming to Ky.

By Melissa Patrick

Kentucky Health News

As Gov. Andy Beshear said Kentucky broke another weekly record for coronavirus shots, he also announced that several vaccination sites have many slots open next week and encouraged people to sign up for one of them. Meanwhile, daily case numbers suggested a pause or plateau in their decline. 

"I'm really excited that this week we again broke another record, 198,447 Kentuckians vaccinated in this last vaccine week. . . . We want to keep that up. We want everybody to get their shot of hope," Beshear said. "We are now, though, seeing some vaccine areas that have extra appointments."

He said the Kentucky Dam Village Convention Center in Gilbertsville has more than 2,000 slots available; Pikeville Medical Center has about 1,000; Carter County has about 750; adjoining Boyd County and King's Daughters Pavilion in Russell have about 900; and Christian County has about 500. 

Go to vaccine.ky.gov for more information on these locations. Sign-ups for Gilbertsville can be made at kyvax.com/kydam or by calling 859-217-4679. Anyone needing help with free or low-cost transportation can check kycovid19.ky.gov for a participating transit agency; they're in 90 counties. 

Beshear urged anyone 50 and older in those areas to sign up for an appointment at one of these locations and said he would announce on social media which locations have vaccination slots that need filling. 

At a news briefing called to discuss bill signings and vetoes, Beshear didn't comment on why so many slots are available. When asked about vaccine hesitancy, especially among Republicans who may not be receptive to a Democratic governor's message, he said they were working on this. He noted that some Republican leaders have been vaccinated publicly, said that he has asked for help from the state's congressional delegation, and that he is continuing to look for help from local leaders.

Beshear gave an example about the value of local leadership. He said at a grants announcement Monday, Hazard's mayor said the city and Perry County appear to have the state's highest vaccination rates. "That's because of hard work that they are doing at that local level to push it out," he said. 

The governor added that health departments were also trusted members of the community and that the state was close to being able to work with employers to get people vaccinated.

For the second day in a row, he suggested that the Centers for Disease Control and Prevention could help with "more guidance about what vaccinated people can do, which would encourage more people who want to do those things to become vaccinated," he said. Those things include travel. 

The Washington Post talked to six experts about whether driving or flying is best for those who choose to travel. Their answers varied between recognizing that both methods come with risk, to one saying it's safe and another saying it's best to be cautious, so driving is best.

Daily numbers: Beshear issued a press release announcing 893 new cases of the novel coronavirus, a bit higher than the last two Tuesdays, when he reported 819 and 880 new cases, respectively. 

The state's seven-day average of new cases rose by 11, to 661. Tuesday was only the fourth day in the last four weeks that the average has risen.

Tuesday also saw a rise in the statewide rate of new cases over the last seven days. It was the second straight day for that, which could be a sign that the state is entering a plateau. 

The rate is 12.27 cases per 100,000 people, and it rose by more than double yesterday's increase, after months of decline. Monday's rate was 12 cases per 100,000; Sunday's was 11.89.

Counties with rates Tuesday rates more than double the statewide rate are Lyon, 146; Simpson, 79.2; Knox, 39.4; Whitley, 28.8; Trimble, 28.7; Estill, 28.4; Jackson, 27.9; Powell, 27.7; and Hopkins, 26.2. 

Beshear said Dr. Anthony Fauci, in a call with governors and the White House Coronavirus Task Force, voiced concern about the national plateau of new cases, but named Kentucky as one of the states on the right trajectory. The state just finished its 10th straight week of declining new-case numbers.

The percentage of Kentuckians testing positive for the virus in the past seven days was the same as Monday: 2.93%. 

Kentucky hospitals reported 436 Covid-19 patients, 93 of them in intensive care; and 48 of those on ventilators. The share of ICU patients on ventilators returned to normal after two days of higher numbers.

The easternmost hospital readiness region, from Lee to Pike counties, and the Lake Cumberland region had, respectively, 80.9% and 84.4% of their intensive care beds in use. 

The state officially listed 11 more deaths from Covid-19, plus four more from an ongoing audit of death certificates going back to October. All four audited deaths were in December; six of Tuesday's 11 happened in March; two in February; two in January; and one in December. The death toll is 5,814.

Tuesday's fatalities were a man from Caldwell County, 61; a woman from Harrison County, 75; a Harrison County man, 70; a Jefferson County woman, 56; five Jefferson County men, 44, 70, 71, 73 and 75; a Johnson County man, 89; and a Martin County man, 63. 

Fourth vaccine? Beshear said Fauci told governors that he believes the Astra Zeneca vaccine is effective and safe, and that the company simply needs to provide the most recent clinical-trial information to the U.S. Food and Drug Administration for review for emergency-use authorization. 

The agency Fauci heads, the National Institute for Allergy and Infectious Diseases, issued a highly unusual statement very early Tuesday morning saying AstraZeneca "may have included outdated information from that trial, which may have provided an incomplete view of the efficacy data."

Beshear also said Fauci told the governors that he anticipates that the U.S. will be able to start coronavirus vaccinations to all high-school students in the fall and to all students by early 2022. 

In other pandemic news Tuesday:

• Counties with more than 10 new cases were Jefferson, 148; Warren, 55; Fayette, 53; Laurel, 49; Scott, 35; Christian, 29; Daviess and Madison, 23; Barren, Knox, and Whitley, 19; Boone, McCracken and Simpson, 17; Oldham, 16; Hopkins, 14; Montgomery and Pike, 13; Allen, Bullitt and Hardin, 12; and Kenton, 11. 
• In long-term care, only one new resident case and five new staff cases were reported to the state, for a total of 73 active resident cases and 81 active staff cases. 
• The Louisville Courier Journal expands on advice for Kentuckians planning to travel for spring break. Louisville's chief health strategist, Dr. Sarah Moyer, said anyone planning to travel should get tested before Wednesday, and to stay home if positive. She recommends that travelers get tested three to five days after returning. 
• The Biden administration plans to use the Christian Broadcasting Network and NASCAR to persuade hesitant conservatives to be vaccinated, The Wall Street Journal reports: “The public-service campaign features videos with a new Willie Nelson recording and athletes representing 13 sports leagues and organizations.”
• Experts say that coronavirus vaccines still work even if you don't experience any side effects after getting a shot, the Lexington Herald-Leader reports. 
• The Robley Rex VA Medical Center in Louisville is offering vaccine to veterans of any age, WDRB reports. Veterans can call 502-287-4426 to request an appointment.
• Sharing pictures of coronavirus vaccination cards on social media could make you a target for scammers, WKYT-TV reports. 
• In his first interview since being confirmed, Health and Human Services Secretary Xavier Becerra said a new federal strategy to get disparate populations vaccinated will include bringing vaccines to people where they are, including farms, construction zones and other work sites. He also talked about the importance of addressing behavioral-health problems exacerbated by the pandemic, and the importance of making health care more available and affordable, The Washington Post reports.
  
  

Supporters of harm-reduction strategy say campaign against e-cigarettes has unintended consequences, many of them not good

Photo of e-cigarette pods by Scott Olson, Getty Images

Billionaire Michael Bloomberg's $160 million, three-year campaign to fight youth use of electronic cigarettes by young people may have had its intended effect, but some experts think it has had unintended effects, including scaring young people away from e-cigarettes and toward traditional tobacco cigarettes.

"Others who have worked for decades to reduce deaths from smoking say the ongoing campaign against e-cigarettes is misguided, built on unsound science and likely to do more harm than good," Marc Gunther writes in Philathropy Today. "Scientists are deeply divided. Each side accuses the other of distorting evidence."

He cites Kenneth Warner and David Mendez of the University of Michigan, who "built a computer model that tracks the U.S. adult population’s smoking status and smoking-related deaths. When they ran data about vaping through the model, they found that under all but the very worst-case assumptions, the benefits of e-cigarettes, which can help smokers quit, exceed their costs in terms of lives saved."

Warner is a founding board member of a campaign to end tobacco use, and has been president of the Society for Research on Nicotine and Tobacco, senior scientific editor of the surgeon general’s 25th-anniversary report on smoking and health, and dean of public health at Michigan. He and others argue thusly:

"E-cigarettes are much less dangerous than smoking. Vaping appeals to smokers who want to quit but need a nicotine fix. Like kids, adult vapers prefer flavors. So while no one wants teenagers to vape, removing flavored e-cigarettes from the market deprives adult smokers of a popular safer alternative," Gunther writes. "Worse, the critics say, by exaggerating the dangers of e-cigarettes, Bloomberg [has] inadvertently given people a reason to smoke. Public opinion polls show that Americans overestimate the risks of vaping."

The critics include Steven Schroeder, former president of the Robert Wood Johnson Foundation, who favors the strategy of harm reduction, which Gunther says "aims to limit the dangers of risky behavior by offering safer, though not entirely safe, alternatives."

Schroeder told Gunther, “The ideal solution for vaping would be to keep it out of the hands of kids and preserve it as a gateway for smokers who want to quit.” Gunther writes, "Laws barring the sale of tobacco products to anyone under 21 should accomplish that. But the age limits are poorly enforced so the anti-tobacco nonprofits are determined to go beyond harm reduction to abolition — for better or worse."

Bloomberg's allies cite studies that show youth who use e-cigarettes are much more likely to become smokers of traditional cigarettes. The other side says the studies show correlation, not causation, and that young e-cig users are "more prone to experimentation or rebellion than their peers," Gunther writes.

Matt Myers, president of the Campaign for Tobacco-Free Kids and Bloomberg's main funding partner, told Gunther, “You can’t understate the significance of the youth-use problem. The level of harm that we have seen to kids far outweighs any benefit to adult smokers that has been actually studied and documented.”

Governor signs 13 health-related bills into law, including one that caps co-payment for insulin at $30/month for an estimated 22,000

Reps. Minter and Bentley, Beshear and interpreter Virginia Moore

By Melissa Patrick

Kentucky Health News

Gov. Andy Beshear signed 13 health bills into law Monday, highlighting one that caps insulin costs for about 30 percent of Kentuckians who need the life-preserving hormone. 

The limit is $30 for a 30-day supply. "This is the right thing to do and it's a game changer for those who rely on insulin to live," Beshear said. "Until now, a single dose of insulin which cost between $2 and $7 to manufacture could sell for an average wholesale price of around $300 per vial."

Beshear noted that in a lawsuit he filed against insulin companies while attorney general over their "unconscionable overpricing," revealed that over 10 years, the price of one insulin product went up 311%, and another rose 285%, including a rise from $325 per package in 2011 to $530 in 2017. 

"While these companies work to increase bottom lines and sustain market shares," he said. "Kentucky families hit hardest by this price gouging can be paying more than $1,000 a month on insulin just to stay alive."

House Bill 95, co-sponsored by Reps. Danny Bentley, R-Russell, and Patti Minter, D-Bowling Green,  will cap the monthly out-of-pocket cost for a 30-day supply of insulin at $30 for Kentuckians covered by state-regulated employer health plans or plans purchased on the marketplace exchange. 

Minter, whose son has Type 1 diabetes, has said the bill will cover about 30% of insulin-dependent Kentuckians. It doesn't cover Medicare, Medicaid or self-funded employer plans except the one for state employees.

"I want to be very clear, this is only a first step," Minter said. "There is much more work to do. . . but today is a very big deal. It will save lives and it will give people hope." She said that for many families, it will make the difference between bankruptcy and keeping a child alive.

In a video, Angela Lautner, Kentucky #insulin4all legislative lead, expressed her gratitude to the lawmakers for the bill, but she too warned that more work needs to be done, saying it will help about 22,000 people. 

"Much more has to be done, but HB 95 is a step forward,” said Lautner, "My chapter is here for insulin for all and that's why we must continue this momentum into the next session with urgency, with priority." 

More than half a million Kentuckians have diabetes, and Kentucky ranks seventh-highest in the U.S. for diabetes prevalence. Lautner said more than one in four insulin-dependent people ration insulin due to cost. 

The price cap will apply regardless of the amount or type of insulin the person with diabetes needs.

In addition to capping the price, HB 95 requires health plans to provide the equipment, supplies and outpatient training and education needed to help diabetics stay healthy, and forbids any reductions from this coverage by others involved in coverage.

The fiscal impact statement attached to the bill says it will increase premiums for health benefit plans, not including the state employee plan, by about 80 cents a month. 

Bentley said that's a small price to pay to make sure diabetics keep getting their insulin, because without it they can suffer amputations, loss of vision, neuropathy, ketoacidosis and even death. "The costs on the medical side is much more than the cost that we're going to have by helping people with insulin," he said. 

Beshear also signed bills addressing these health topics:

Telehealth: HB 140, sponsored by Rep. Deanna Frazier, R-Richmond, will permit telehealth services that were allowed to expand due to the pandemic to remain in place. The bill requires reimbursement for telehealth to be equivalent to reimbursement for the same service provided in person. "I think it's one of the most important bills that have been passed," Beshear said. 

Substance-use disorder: HB 219, sponsored by Bentley, allows pharmacies to sell hypodermic syringes and needles without a prescription. The aim is to increase access to clean supplies for people who inject drugs, which will help to decrease the risk of blood-borne diseases such as hepatitis C and HIV/AIDS.

Medicaid and hospitals: SB 55, sponsored by Sen. Stephen Meredith, R-Leitchfield, abolishes co-payments required by Medicaid.

HB 183, sponsored by Rep. Brandon Reed, R- Hodgenville, will allow Kentucky hospitals to get more money from Medicaid, based on an "average commercial rate" instead of the current Medicaid rate, which is often below that amount. The program would not cost the state anything, because Kentucky's hospitals have agreed to cover the cost. To get the money, hospitals will have to abide by higher quality standards that are still being decided by the Kentucky Hospital Association and the Cabinet for Health and Family Services. The bill is expected to help many of the state's rural hospitals; a recent report shows that 16 of them are at risk of closing. 

Colon cancer and genetic testing: HB 108, sponsored by Melinda Gibbons Prunty, R-Belton (Muhlenberg County), codifies current Medicaid coverage of colorectal cancer, including screenings starting at 45 for most people and genetic cancer-risk testing, to align Medicaid and commercial coverage.

Mental health parity: HB 50, sponsored by Rep. Kim Moser, R-Taylor Mill, will make health-insurance plans comply with a 2008 federal law that requires them to treat mental-health conditions and substance-use disorders the same as physical health. It also requires health insurers to file annual reports with the state to show how they are complying with the federal law.

Workforce: HB 276, sponsored by Moser, allows Kentuckians trained as temporary Covid-19 personal-care attendants under an executive order to apply their supervised training toward their Registered Nurse Aide certification. About 300 personal-care attendants work in Kentucky long-term care facilities, Moser said while presenting the bill to the House in February.

SB 154, by Sen. Tom Buford, R-Nicholasville, lets advanced practice registered nurses and physician assistants prescribe and supervise home-health services, as federal law has allowed them to do in the pandemic. An emergency clause ensures there would be no gap in care if the federal rule ended.

HB 448, sponsored by Rep. Bill Wesley, R-Ravenna, expands the definition of "qualified mental-health professional" so that it fits the state's juvenile code, allowing those who work in private agencies to testify in child-welfare hearings, especially around issues of emotional injury.

Alzheimer's Disease: SB 74, by Sen. Ralph Alvarado, R-Winchester, creates but does not not fund a dementia services coordinator in the heath cabinet to manage the Alzheimer’s Disease and Related Disorders Council, the state plan to address Alzheimer’s in Kentucky, and apply for federal funding.

Living organ donors: HB 75, sponsored by Rep. Shawn McPherson, R-Scottsville, prohibits insurance companies from increasing rates on organ donors or dropping their coverage. It would also encourage the cabinet to develop educational materials relating to organ donation.

Charitable care: SB 163, sponsored by Sen. Alice Forgy Kerr, R-Lexington, expands the definition of "charitable health care provider" to include those that provide invasive or surgical procedures. This change was needed to allow the non-profit surgery program "Surgery on Sunday" in Lexington to be reimbursed for liability insurance premiums. 

 
Beshear also vetoed five bills that would strip power from the governor or the executive branch. None were related to health. 

Beshear blames high Covid-19 case numbers in prisons on testing, but death rate among state prisoners ranks third in U.S.

Marshall Project chart shows virus cases and deaths in state prisons. To enlarge, click on it.

This story has been updated with comments from both sides of the issue.

By Al Cross and Bruce Maples

Kentucky Health News

Gov. Andy Beshear said Monday that Kentucky has more coronavirus cases in state prisons "sometimes look higher than other states" because "We're committed to testing when there's an outbreak" like the one in progress at the Kentucky State Penitentiary.

But Kentucky doesn't just have the second-highest rate of cases. It has the third-highest death rate among state prisoners from Covid-19, according to The Marshall Project, a nonprofit news organization that deals with criminal-justice issues and has tracked prison cases and deaths during the pandemic.

Kentucky's reported rate of 6,418 cases per 10,000 prisoners is second only to that of Michigan, which has a rate of 6,734. Arkansas, South Dakota and Kansas also have rates above 6,000. The Marshall Project says Kentucky prisoners' infection rate is nearly seven times that of all Kentuckians.

The Marshall Project says 46 state-prison inmates in Kentucky have died of Covid-19, a rate of 38 per 10,000. The only higher rates are in New Mexico and Nevada, which each have rounded rates of 43 per 10,000. Kentucky prisoners' Covid-19 death rate is 3.4 times the rate for the state's population.

The governor addressed the subject at a regular news briefing after being asked if he had any update on an virus outbreak at a prison in Lyon County. The county has two prisons, the Kentucky State Penitentiary and the Western Kentucky Correctional Complex, and both have had outbreaks.

Beshear indicated that Cabinet Secretary J. Michael Brown would give an update at a later briefing, but said that the state is using the same control measures it had used in outbreaks at other prisons, "to the extent the facilities allow us, of separating people by groups. I will say, that when you look at numbers in prisons, they sometimes look higher than other states, but I know why that is: We're committed testing when there's an outbreak. Now, I have seen others that have stopped that, but we want to know the full scale of it so that we can try to mitigate it to its fullest extent."

Asked via email how he accounted for the state's high death rate, Beshear's office referred Kentucky Health News to an update Brown gave last week, which did not address the death rate. Brown said then that vaccine shipments for inmates over age 70 were scheduled for this week, and that all state correctional facilities would be distribution centers for the Johnson & Johnson vaccine, with timing of shots depending on supply. When Beshear was asked that day about vaccinating other inmates, especially those over 60, he said those would be vaccinated once the state had received enough of the vaccine.

Later, Beshear's office said in an email, "About 1,881 Kentucky prisoners were eligible for release following four executive orders [the governor] signed in 2020 to reduce overcrowding in state prisons and slow the spread of Covid-19."

Corrections Department spokeswoman Lisa Lamb said in an email Monday that the agency "has taken, and will continue to take, aggressive steps to protect the safety and security of all staff and inmates," including recent installation of ultraviolet-light sanitizers at entrances. "We are working diligently to ensure all interested DOC staff receive a vaccination," and 1,845 employees and contractors have received a shot, or 43% of the total 4,288 employees and contractors, and another 338 are pending.

Aaron Tucek, a legal fellow at the American Civil Liberties Union of Kentucky, said in an email that his group "has called on the state to adequately protect people who live in correctional facilities from the ravages of Covid-19. For the past year the state has failed to do so, and the systemic unwillingness of corrections staff to get vaccinated sadly continues this legacy of neglect and failure. . . . In the face of this suffering, the state fought against a lawsuit seeking to protect medically vulnerable Kentuckians, and has refused any calls to include incarcerated Kentuckians in initial vaccination distribution. It is the moral, ethical, and legal duty of the state to care for those who it incarcerates."

The department reports 496 active cases among inmates and 35 among staff at its prisons, 470 and 22 at the penitentiary and 18 and 8 at the other Lyon County prison. Those numbers have declined in the last few days, but the county still has the nation's highest seven-day rate of new cases, as it has for more than a week, according to The New York Times.

In the state at large, the pandemic continues to wane slowly, but shows signs of entering a plateau. The statewide rate of new cases rose for the first time in weeks, though the increase was small: 0.11, to 12 cases per 100,000 residents.

Counties with rates more than double the statewide rate on the state's daily report are Lyon, 150; Simpson,75.4; Knox, 42.7; Trimble, 32; Hopkins, 28.1; Jackson, 25.7; Whitley, 25.6; and Bell, 25.2.

On the positive side, the percentage of Kentuckians testing positive for the virus in the last seven days dropped .04 percentage point, to 2.93%.

State Dept. for Public Health graph, relabeled by Ky. Health News; to enlarge, click on it.

Beshear announced that the most recently completed official reporting week, Monday through Sunday, was the 10th straight week with declining new-case numbers. He said the decline was longer and slower than other states because his actions in late 2020 made the year-end spike in cases less than elsewhere. 

The state reported 294 new cases, 102 fewer than last Monday. That lowered the state's seven-day average of cases to 650, down 15 from Sunday.

The governor said the state's vaccination programs continue to hit his goal of using at least 90% of the weekly vaccine doses sent to the state, with the latest rate being 93.7%. To date, 1,186,538 Kentuckians have had at least their first shot. Beshear noted that the priority list expanded Monday to cover anyone over 50 and persons with intellectual or developmental disabilities.

Beshear said that for long-term-care facilities, "The vaccine has changed everything." He shared a video from Lexington's Sayre Christian Village showing vaccinated family members visiting with loved ones in person. The video closed with a resident looking into the camera and saying "If you haven’t got the shot, please do. It’s important — especially for older people."

The state added 61 more deaths to its list of Covid-19 fatalities, including 50 from the ongoing audit of death certificates going back to October, bringing its toll to 5,799. Beshear said the good news was that none of the regularly reported and listed deaths occurred this month.

The 11 fatalities were a Carter County woman, 91; a Crittenden County man, 81; two Franklin County men, 67 and 84; a Fulton County woman, 88; a Harrison County man, 82; a Hickman County man, 87; a Kenton County woman, 79; a Letcher County woman, 85; a Marshall County woman, 91; and a Perry County woman, 89.

Kentucky hospitals reported 434 Covid-19 patients, the fewest since August. Of those, 95 were in intensive-care units, and 63, or almost two thirds, were on ventilators. The share of ICU patients who are mechanically ventilated is the highest since Kentucky Health News began tracking it five months ago.

Only one of the state's 10 hospital regions, Lake Cumberland, had more than 80% of its ICU beds in use, and few of that 84% were Covid patients.

In other pandemic news Monday:

• Because too few people are signing up for vaccinations in Lexington, the local health department has made them available to anyone over 18, the department announced. Spokesman Kevin Hall "attributes the waning demand to the state’s influx of immunization sites, many of which have come online this month," the Lexington Herald-Leader reports.
• Beshear said the state is concerned about possible spread of the virus from spring-break revelry in Florida. "If you're not going to be careful, don't send your kid back [to school] right away," but use remote schooling, he said.
• Agriculture Commissioner Ryan Quarles announced that he is vaccinated. Quarles, a Republican who is expected to run for governor in 2023, had turned down an offer of the vaccine from Beshear (who says he wants Republicans to set an example), saying he would get a shot when it was his turn. Quarles, 37, said in a press release, "With food and agriculture being included in the industry groups in Phase 1C, I took the vaccine this weekend. While taking the vaccine is a personal choice, I encourage Kentuckians to take it when their place in line comes."
• Southwest Virginia "has some of the highest coronavirus vaccination rates in the state, despite national surveys showing ­rural Republicans are the most reluctant to receive it," The Washington Post reports. "The area’s robust public health infrastructure, which for years has delivered typical flu vaccines in mass settings, is part of the reason. So was the wake-up call that followed Thanksgiving — a post-holiday surge in cases so high that two hospitals brought in refrigerated trucks because their morgues were overflowing." The story notes that the region is "geographically and culturally closer to Kentucky and Tennessee than to Virginia’s power centers 
  in Richmond and suburban Washington."
• AstraZeneca’s vaccine is 79% effective against symptomatic disease and 100% effective against severe disease and hospitalization, CNN reports. The company plans to apply for emergency-use authorization in the first half of April. UPDATE, 3/23: The National Institute of Allergy and Infectious Diseases, headed by Dr. Anthony Fauci, said early Tuesday that the firm may have left out a week of unfavorable data. "Scientists are describing the reaction as unusual and unprecedented for the agency," The Washington Post reports.

Positive-test rate for novel coronavirus drops below 3% in Ky. as new cases continue their slow decline, but ICU ventilation rises

Twelve of the dozens of images in Hoptown Chronicle's visual, vertical timeline of the pandemic

By Al Cross

Kentucky Health News

The course of the Covid-19 pandemic in Kentucky crossed another threshold Sunday: In the last seven days, fewer than 3 percent of residents tested for the novel coronavirus got a positive result. That continued a general decline for the last month and a half that has brought the positive-test rate to levels not seen since June, the first full month that testing was widely available.

Kentucky Health News graph; for a larger version, click on it.
New-case numbers are based on initial, unadjusted daily reports.

The state reported 316 new cases of the virus, the fewest on any Sunday since Sept. 6. That brought the seven-day rolling average of new cases to 665, virtually the same as it was Sept. 1.

The only sign of increased concern was that Covid-19 patients in intensive care were more likely than ever to be on ventilators. Kentucky hospitals reported 463 Covid-19 patients, six more than Saturday, with an unchanged number of 111 in intensive-care units. But the number of those on ventilators rose by six, to 71, meaning that 64% of ICU Covid-19 patients were mechanically ventilated, the highest share since Kentucky Health News began tracking it in late October.

Kentucky's rate of new cases over the last seven days ranked 22nd in the nation, according to The New York Times. The state's new-case numbers have declined more slowly in the last 10 days than they did the previous 20, but numbers in other states have gone up, improving Kentucky's national ranking.

The state said its rate dropped by .09, to an average of 11.89 daily cases per 100,000 residents. Counties with rates more than double the statewide rate were: Lyon. 148; Simpson, 74.6; Knox, 39; Trimble, 33.7; Hopkins, 27.8; Clay, 27.3; Jackson, 25.7; Powell, 25.4; Bell, 24.7; and Whitley, 24.4.

Counties with five or more new cases Sunday were: Jefferson, 67; Fayette, 32; Warren, 13; Bullitt, 9; Kenton, Lyon and Perry, 8; Madison and Simpson, 7; Henderson, Shelby and Trigg, 6; and Campbell, Daviess, Hardin, Hopkins and Pulaski, 5.

The state added 16 more fatalities to its list of Covid-19 deaths, plus two that it said were found by the ongoing audit of death certificates. Not counting those two, the state has added an average of 23.9 deaths per day to the list over the last two weeks. The daily average for the past month is 25.2.

As usual on a weekend, the state did not issue an itemized list of deaths by county, age, sex and date.

In other pandemic news Sunday:

• Dr. Moncef Slaoui, former chief science adviser for vaccine development in the Trump administration, said on CBS's "Face the Nation" that it is a sign of civility and respect to others to wear a mask even if you have been vaccinated. He was commenting on Sen. Rand Paul's accusation that Dr. Anthony Fauci was engaging in "theater" by wearing a mask. Morgan Watkins of the Courier Journal reports on the dust-up and CJ columnist Joe Gerth says Paul is the one who's being theatrical.
• Arkansas Gov. Asa Hutchinson said on CNN's "State of the Union" that he is abolishing its mask mandate because people in his state have become educated about the need for masks and "Common sense is going to replace mandates." Now, he said, they need education to overcome their hesitancy or resistance to getting vaccinated.
• Former Food and Drug Administration commissioner Dr. Scott Gottlieb said on "Face the Nation" that unless a more potent virus variant emerges, he doesn't expect a true "fourth wave" of cases in the nation because vaccinations are accelerating and millions who haven't gotten a shot have some immunity from being exposed to the virus. "There's not a lot of people left to infect," Gottlieb said. "Maybe we'll see an uptick in certain parts of the country."
• As the Covid-19 pandemic officially entered the second week of its second year, Hoptown Chronicle built a visual, vertical timeline of how it has gone in Kentucky, Christian County and Hopkinsville. It ends with comments solicited from readers on how they have adapted to the new normal.
• The Washington Post interviewed 17 students across the country, from kindergarten through high school, about what they learned about school and life during the pandemic.

Veto-proof budget includes health-departments pension reforms, no money for health-related proposals made by governor

By Melissa Patrick

Kentucky Health News

Kentucky legislators have sent Gov. Andy Beshear a conservative one-year budget, wrapping up the second half of what is normally a two-year spending plan that was adjusted last year out of concern for the looming financial impact of the novel coronavirus pandemic. 

Rep. Jason Petrie discusses the state budget in the House.

The Democratic governor can veto line items in the budget, but the vetoes would likely be overridden by the supermajorities of Republicans in the House and Senate; only a majority is needed to override.

House Bill 192, sponsored by Rep. Jason Petrie, R- Elkton, which holds the budget, passed the Senate 30-0 with six members passing. The House vote was 74-21, largely on party lines. 

The budget does not include money for the many health-related items that were in Beshear's proposal, it does include money for one: pension reform for health departments and quasi-governmental agencies.

The nuts and bolts of the reform are  in HB 8, sponsored by Rep. Jim DuPlessis, R-Elizabethtown. It was delivered to Beshear March 12 after passing both chambers unanimously. A similar bill passed the House last year, but was not heard in the Senate.

HB 8 calls for the agencies to pay only what they owe the Kentucky Employees Retirement System to cover employees' pensions, not the current percentage-of-pay formula. The entities would have 30 years to pay off their unfunded pension liability, using a set cost they can include in their budgets. 

At a February committee meeting, DuPlessis explained that the percentage-of pay formula keeps employers from paying their employers better, reduces services, and encourages employers to hire fewer employees and to instead hire contract workers, which further exacerbates the problem.

Lawmakers froze pension contribution rates for health departments, regional universities and quasi-governmental agencies at 49.47% of payroll, but that rate is set to jump July 1 to 85%, a rate that is not sustainable for many of them; for every dollar an employee is paid, the agency must pay 85 cents in pension cost.

Going forward, health departments and quasi-governmental agencies will make two payments, one based on a fixed amount to cover their past unfunded pension liability and another for their current employees, based on a percentage of payroll, currently around 10%. 

The budget provides about $25 million in state funds to subsidize health-department pension payments. DuPlessis told a Senate committee in March that about six health departments would need to be subsidized to meet their new pension requirement. 

One reason given for such a conservative budget is that the state is expecting to receive $2.4 billion from the American Rescue Plan and detailed guidance on how it can be spent has not been issued. Other federal-relief money will go directly to cities, counties and school districts.

The budget gives the legislature final say on how the relief money is to be spent. HB 405, also sent to Beshear, includes a provision that would fine the state's budget office $902,2000 if Beshear spends any of the federal money without the legislature's approval.

Legislators and Beshear are discussing how the relief money should be spent, and could agree on legislation that could still be passed on the last two days of the legislative session, March 29-30.  

The legislature took very little from Beshear's budget proposal. One example: He proposed adding $100 million to the state's "rainy day fund," a reserve that can be used when revenue falls below expectations, but legislators put more than $600 million, increasing it to more than $1 billion.

Beshear's budget also had additional money for health departments, 76 more social workers and full-time mental health staff at schools, more to help people with intellectual or developmental disabilities and fully fund Medicaid. None of these health-related items were included in the legislature's budget. 

Here are some of the health-related provisions in the budget: 

From the Tobacco Settlement Fund: 

• $500,000 for a rural mental-health and suicide-prevention pilot program
• $900,000 for The Healing Place, an addiction recovery program
• $7 million for the Health Access Nurturing Development Services Program (HANDS)
• $965,000 for Healthy Start initiatives (up from $942,000 this year)
• $965,000 for early childhood mental health (up from $942,000 this year)
• $1,013,200 for early childhood oral health (up from $989,100 this year)
• $2 million for smoking cessation, much less than advocates want

From the General Fund: 

• $1.9 million for the Kentucky Poison Control Center, which operates the Covid-19 hotline. The budget notes that $750,000 has been allocated for the center and says that if federal funds become available for any Covid-19 expenditures, they must be used to do so and any state-budgeted money that is not used would return to the General Fund. 
• $500,000 for the Kentucky Colon Cancer Screening Program
• $2.5 million to the Kentucky Pediatric Cancer Research Trust Fund
• $500,000 for ovarian cancer screening
• $93,700 each for grants to the Brain Injury Association of America, Kentucky Chapter and the Epilepsy Foundation of Kentuckiana to help veterans who have experienced brain trauma.
• $16 million in state funds and $59 million in federal funds for additional Medicaid reimbursement of $29 per day to nursing homes through Dec. 31. This money is intended for coronavirus pandemic relief.