Wednesday, October 22, 2014

In Senate race, McConnell and Grimes differ on health care

By Cheyene Miller
University of Kentucky School of Journalism and Telecommunications
               The U.S. Senate race between Republican Sen. Mitch McConnell and Democrat Alison Lundergan Grimes has seen the candidates focus on several key issues, including the coal industry, the minimum wage and health care.
               The health-care issue has been almost unique among Senate races in that Kentucky is generally seen as a success story for the Patient Protection and Affordable Care Act. In August, Gov. Steve Beshear said 521,000 of Kentucky’s 4.3 million citizens had signed up for health coverage through Kynect, the state’s health insurance marketplace created under the law.
               According to a Gallup-Healthways poll, published in August, Kentucky reduced its percentage of uninsured more than any other state besides Arkansas, and lowered the percentage of uninsured in the state from 20.4 percent to 11.9 percent, thus covering two of every five uninsured Kentuckians.              
In addition to funding the expansion of Medicaid, the law requires Americans to either purchase private health insurance or enroll in some form of government assisted health care like Medicaid; requires insurance companies to cover people with pre-existing conditions and provide 10 elements of coverage in each policy; allows parents to keep their children on their health insurance until they are 26; and requires businesses employing 50 or more full time employees to provide health insurance, a provision that President Obama has suspended for a year.
McConnell says he wants to repeal the law “root and branch,” but has been more lenient toward the idea of keeping Kynect. In the Senate race debate on KET, McConnell suggested that Kynect was merely a website. However, repealing the law could pose issues for the newly insured in Kentucky because private insurance under Kynect uses federal tax credits, and provides free Medicaid coverage to citizens who earn up to 138 percent of the federal poverty level.
According to Douglas McSwain, a Lexington-based litigation attorney who specializes in constitutional and health-care law, the uprooting of the law would result in drastic changes to Kynect.
               McSwain said repealing the ACA “root and branch” would mean cutting the federal tax subsidies that are essential to Kynect’s survival.
“You take the exchange tax credit away, do you think for a minute that the website is going to stand?” McSwain asked.  “Nobody is going to buy policies.”
At a Kentucky Farm Bureau forum in August McConnell said Congress should have passed laws allowing health insurance to be sold across state lines, limiting malpractice lawsuits and making it easier for businesses to form health-insurance groups.
               McSwain said the law allows formation of such groups, and interstate regulation “is conceivable” but “The problem is we don’t have the infrastructure, regulatory-wise, to do that without having reached a compact or an agreement” among the states.
               A study on the effects of malpractice reform, published by the New England Journal of Medicine, found that Texas, Georgia and South Carolina did not see a significant reduction in the amount of doctor-ordered tests and scans after enacting reforms.  A five-person team of doctors performed the study, collecting data from 1997 through 2011.
               Grimes has only publicly discussed health reform on select occasions, taking a similar strategy to many Democrats in the 2014 midterm election because of the unpopularity of “Obamacare” and its namesake.  When she does mention health care, she talks about fixing and streamlining the law, as she did during the KET debate.
“I will not be a senator that rips that insurance from their hand,” Grimes said in reference to the half a million Kentuckians who’ve gained coverage under Kynect.  She said McConnell was in a “fictional fantasyland.”
Grimes has also talked about supporting an extension of Obama’s “grandfathering” of insurance policies that don’t comply with the law after he was criticized for not keeping his campaign promise that Americans could keep their doctor and health plan if they liked them.
               That controversy and other aspects of the law have led to negative feelings among Kentuckians about Obamacare.  A poll by Marist College for NBC News showed Obamacare had a 33 percent approval and 57 percent disapproval rating among Kentuckians, while Kynect had 29 percent approval and a 22 percent disapproval., while 29 percent of those polled said that they had never heard of Kynect and 21 percent were unsure of how to rate it. 
               At last report, about 80,000 Kentuckians had bought private insurance through Kynect and about 440,000 had used it to get on Medicaid – 320,000 of whom were eligible under the new rules and 120,000 under the what state officials call “old Medicaid.” The federal government pays about 71 percent of “old Medicaid” costs and, until the end of 2016, 100 percent of the newly eligibles’ coverage. In 2017, it will pay 95 percent of the new costs, and fall to the reform law's floor of 90 percent in 2020.

Cheyene Miller of London, Ky., wrote this story for “Covering the U.S. Senate Race,” a special course in the University of Kentucky School of Journalism and Telecommunications.

Sunday, October 19, 2014

Medicaid expansion boosts preventive care

More Kentuckians than ever are using preventive care services since the state expanded Medicaid on Jan. 1, reports FamiliesUSA, a lobby for federal health reform that included the expansion.

Recent data from the state Cabinet for Health and Family Services show a 37 percent increase in the use of preventive care services since 2013, report Andrea Callow, a Medicaid policy analyst and Katie Supko, a Medicaid intern for FamiliesUSA. Of particular note is that more Kentuckians are getting screened for diseases that kill so many of us.

In 2013, Kentucky ranked first in cancer deaths and sixth in all premature deaths. It ranked 41st in annual dental visits and 45th in overall health status.

Since the expansion, which has provided coverage to more than 450,000 Kentuckians, the cabinet reports a 30 percent increase in breast cancer screenings, a 3 percent increase in cervical cancer screenings, a 16 percent increase in colorectal cancer screening and a 37 percent increase in adult dental visits.

Screenings and check-ups allow medical providers to identify health issues before they advance, and improves the chance that treatment will be successful. For example, with early detection, the five-year survival rate for breast cancer, the leading cause of cancer death in women, is 90 percent, and the rate for cervical cancer is nearly 100 percent, the writers note. Screenings for colon cancer, the second leading cause of cancer deaths in the U.S., have a five-year survival rate higher than 90 percent if detected early, but only 40 percent of colon-cancer diagnoses are made during this early stage.

At least one study, over two years in Oregon, found no preventive health benefits from expanding Medicaid, but advocates say it will work in the long term. "Medicaid expansion makes preventive care possible," the authors write. "Kentucky’s decision to expand Medicaid will undoubtedly reap the state many benefits, from a drop in the uninsured rate to an increase in economic activity" by expanding health-care jobs. "But the access to critical preventive care services may be the benefit that gives Kentucky a much-needed boost in the health status of its residents."

Saturday, October 18, 2014

Rural Ky. hospitals make sure they are ready for Ebola

Rural hospitals in Kentucky are making sure they are prepared in the event they get a patient with the Ebola virus, Bill Estep reports for the Lexington Herald-Leader.

The risk of Ebola coming to rural Kentucky is low and there have been no cases in the state, according to officials of the state Department of Public Health, but rural hospitals are getting ready just in case, Estep reports.

It's not known where a patient might enter the health care system, so every hospital must be prepared, State Health Commissioner Stephanie Mayfield, told Estep.

Hospital officials all over the state have told Estep that they are making sure they are prepared in case they get an Ebola patient, saying they are reporting up-to-date daily information on dealing with Ebola to their employees; staying apprised of what the state health department and the federal Centers for Disease Control recommend; updating patient-screening processes to help determine the risk of Ebola, reviewing isolation procedures; taking stock of protective gear; and providing staff education.

"The protocol for rural hospitals would be to put an Ebola patient in isolation, then contact the local or state health department for guidance on whether to transfer the patient," Joe Murrell, chief executive officer at the 25-bed Wayne County Hospital in Monticello, told Estep, because "most rural hospitals don't have the resources to treat an Ebola patient for a long period."

But is this level of preparation enough?

Health care workers continue to be concerned because the two nurses in Dallas who were caring for the infected man from Liberia who has since died, and now have Ebola, "reportedly got the virus despite wearing protective gear," Estep writes.

Initially Dr. Tom Frieden, director of the CDC, said any hospital could safely take care of Ebola, Kimberly Leonard reports for U.S. News & World Report. “You need a private room with a private bathroom, and rigorous, meticulous training and materials to make sure that care is done safely so caregivers aren’t at risk,” he said, Leonard writes.

But Linda Greene, an infection prevention manager at Highland Hospital in Rochester, N.Y., and a member of the Professionals in Infection Control and Epidemiology Regulatory Review Panel, told Leonard, "Despite the best efforts, we do know in many hospitals that infection-prevention control measures are under-resourced,” and "There may be need for even more specialization than we initially thought."

But Greene goes on to say that despite these challenges,"Every hospital, however, should be able to screen and identify a patient at risk and immediately put them into isolation as necessary and do the initial triage, Leonard reports.

This is what Kentucky hospitals seem to be doing, despite concerns of some that it might not be enough.

Kevin Kavanagh, a Somerset physician and board member of Health Watch USA, told Estep that there are still "unanswered questions" about care for patients with Ebola, citing "his understanding that the CDC still doesn't know how the Dallas nurses got infected despite wearing protective gear" and "what plans hospitals have to dispose of the medical waste" and the "extent of the knowledge about how the disease spreads."

News media blamed for most of Ebola scare; experts continue to say that risk of infection is low

The reaction of many Americas regarding the Ebola virus has gone beyond what is medically necessary, but is a natural reaction to fear, Maggie Fox reports for NBC News.

Medical experts told Fox that while the federal Centers for Disease Control and state health departments are taking appropriate measures to keep an eye on people who were in direct contact with Ebola patients, some actions "may be excessive," such as Cleveland-area schools closing after a middle-school worker "traveled home from Dallas on Frontier Airlines Tuesday on a different flight, but perhaps the same aircraft" as the Ebola-infected nurse, Fox reports.

“They are taking drastic steps for a risk that is rather remote,” said George Kapalka, professor of psychological counseling at Monmouth University in New Jersey.

Blame for this fear is placed on the news media and politicians, Fox reports. Media are “undoubtedly complicit in stoking this fear, not by covering the story — that’s fine,” risk perception expert David Ropeik told Fox. “They are complicit by burying all the qualifiers about how minimal the risk is.”

So how risky is Ebola?

“The only individuals potentially at risk for Ebola in the United States right now are those who have traveled to affected areas of West Africa or who have been directly involved in treating cases of Ebola or close contacts to a symptomatic patient with Ebola," Stephanie Mayfield, Kentucky's public health commissioner, said in a press release.

Mafudia Suaray, a family physician at Rutgers Robert Wood Johnson Medical Schoolsays the risk of getting Ebola in the U.S. is "very low." She explains that "Ebola is a virus that is spread from person to person through contact with bodily fluids, including saliva, tears, sweat, urine, blood, stool and semen. It is not spread through the air. ... The virus cannot be spread through contact with intact skin and a person must have symptoms of the disease to spread it to others."

Adam Cole of NPR created a visual to show how unlikely an Ebola infection is, based on the reproduction number of the virus, which indicates how many people one person might infect. It says that for every person who has Ebola will infect two others, but direct contact with a bodily fluid is required.


And the reason that officials, including the CDC Director Thomas Frieden, think Ebola will be contained in the U.S. is because our public health system is good and Ebola isn't contagious until symptoms are present, allowing time to isolate those who have come in contact with anyone who has been infected, and thus stopping the spread of the disease, Michaeleen Doucleff reports for NPR.

Suaray reminds us in the release that "common sense prevention measures should always be the priority, whether for Ebola or for more common illnesses such as the cold and flu." Wash your hands, stay home if you have fever, see a health care provider if your fever is high, cover your face with your arm or a tissue when you cough or sneeze and talk to your doctor if you plan on traveling to an infected region.

Friday, October 17, 2014

Nine hospitals in Kentucky get maximum Medicare penalty for readmissions; they blame socioeconomic factors

Article updated 10/20/2014
Nine hospitals in Kentucky, eight of them in Appalachia, have been hit with the highest penalty possible by Medicare for high rates of patient readmission.

This is the third year the program has fined hospitals, under the federal health-reform law, for having too many patients return within 30 days for additional treatment.

This year, the maximum penalty is a 3 percent reduction in Medicare payments for all patient stays in the fiscal year beginning Oct. 1. Last year, the cut was 2 percent. The fines are based on readmissions from July 2010 through June 2013.

Kentucky hospitals fined the maximum amount this year are the Appalachian Regional Healthcare hospitals in Harlan, Whitesburg and Hazard; Memorial Hospital in Manchester; Methodist Hospital in Henderson; Pineville Community Hospital in Bell County; Three Rivers Medical Center in Louisa; Monroe County Medical Center in Tompkinsville; and Westlake Regional Hospital in Columbia. All except Henderson are in Appalachia, and most are in Eastern Kentucky.

“Some of the specific challenges that have faced hospitals in Eastern Kentucky is that they see a greater proportion of patients who have suffered from heart attacks, heart failure and pneumonia,” Elizabeth Cobb, vice president for health policy at the Kentucky Health Association, told Kevin Halpern of the Middlesboro Daily News.

Cobb also said the region has "higher numbers of chronically ill patients, who require a greater amount of hospitalization," and that high rates of obesity and smoking, which affect how well a patient does after discharge, as well as a lack of oupatient services in rural areas, also contribute to readmissions. The formula for calculating readmission penalties does not take such problems into account.

Nationwide, 2,610 hospitals received a readmissions penalty, but only 39 were hit with the full 3 percent. In Kentucky, 63 hospitals, about two-thirds of the state's total, were penalized, with the average penalty being a 1.21 percent reduction in payment, according to an analysis of federal records from Kaiser Health News.

Halpern, citing KHA, reported that Kentucky represented a "disproportionate share of (the) hospitals receiving the maximum penalty, with nine hospitals, representing 23 percent of the total."

KHA supports pending legislation that will require the Centers for Medicare and Medicaid Services to adjust its program to account for socioeconomic conditions that "are beyond a hospital's control," Halpern reports. Opponents say "hospitals that have many readmissions are providing substandard care and should not be let off the hook," Kaiser's Jordan Rau reports.

The penalties have forced hospitals to provide better follow-up care for their patients after discharge in efforts to avoid readmission. The days of handing a patient a written discharge plan and expecting the patient to follow them without follow-up are quickly becoming a thing of the past, Rau reports.

Instead, hospitals are finding ways to ensure patients are not readmitted like ensuring outside doctors monitor discharged patient's recoveries; providing free medication for those who can't afford them; or sending a nurse to a patients home to make sure they are taking care of themselves.

But some hospitals are still struggling with these new guidelines, resisting many such efforts because they aren't paid for these services, Rau reports, and some continue to readmit patients because it has been financially beneficial to the hospital in the past.

Medicare officials estimate that $17 billion of the $26 billion Medicare pays for readmissions is a result of "potentially avoidable readmissions," Rau reports.

Telemedicine helps reduce waits for mental-health patients in ER and provides better health-care access in schools

Health professionals have used telemedicine to help delay Alzheimer's disease and reduce hearing loss in Appalachia, especially among children. Now the new approach is helping students access health care, and mental-health patients to get faster medical attention in emergency rooms.

AMD Global Telemedicine has been establishing telemedicine systems in schools, which allow "providers to care for students on-site with few clinicians to support it," Katie Wike writes for Health IT Outcomes. So far "the Center for Rural Health Innovation in western North Carolina used the technology to support 14 school-based programs and provide care to 4,000 students.

The health-care provider can ask the questions during the exam, and "it doesn't assume the presenter knows the questions to ask," said CRHI Executive Director Amanda Martin. This approach allows one nurse practitioner to provide care to thousands of children. Some Kentucky schools are already using the telemedicine platform, Wike reports.

Sometimes when patients seek mental-health care in emergency rooms, no psychiatric services are available. In this case, hospitals often contact and wait for a provider to arrive or send written evaluations for review, Karla Paris writes for Health IT Outcomes. Now KentuckyOne Health has a telemedicine program that gives faster response times for those requesting mental-health care. For example, patients who visit Louisville's Ss. Mary & Elizabeth Hospital for mental-health care will be able to videoconference with professionals from Our Lady of Peace Hospital. "Patients can then be referred for admission at Our Lady of Peace, another outpatient program or care center," Paris reports.

Thursday, October 16, 2014

2014 Kentucky Rural Health Day observance includes a photography contest; submissions are due by Nov. 7

Part of the 2014 Kentucky Rural Health Day celebration this year is the "Bridges to Rural Health" Photo Contest.

Participants are asked to submit photos that express this year's theme, "Bridges." Whether you depict this with a photograph of one of the many beautiful bridges in Kentucky or creatively (a bridge can be many things) the organizers say to submit pictures that depict what rural means to you.

Only Kentucky residents are eligible to participate in the contest and all photos must have been taken in Kentucky. Submissions are due by 11:59 p.m. Eastern Time on Friday, Nov. 7. Click here for contest details. For more information email chris.salyers@uky.edu or follow the Kentucky Office of Rural Health on Facebook.

Wednesday, October 15, 2014

Boone County school bans all food at school birthday celebrations, partly in an effort to combat childhood obesity

Burlington Elementary School in Boone County has banned all food during birthday celebrations, including ice cream and cake, as part of its new wellness policy, Jessica Brown reports for The Cincinnati Enquirer.

Celebrations are still allowed and can include non-food treats, Brown writes. Burlington is one of very few schools to make this move in efforts to make sure students are getting healthy food at school and to also decrease celebration time, which takes away from classroom time.

"We're finding it's difficult to be the first," Valerie Bailey, who is on the PTA and on the committee that helped craft the policy, told Brown. "Parents say it's not fair. But we hope it sends a message to the parents and kids, especially with the obesity rate being so high, and puts a bug in their ear."

"To be clear, the federal government does not ban birthday cake. Nor does it ban pizza parties or bake sales – all notions that have gotten a lot of attention in recent years," Brown writes.

The Healthy, Hunger-Free Kids Act does require all schools to have a "wellness policy," which is determined by the individual schools and is where some schools have created this type of restriction.

Burlington's main goal when it revised its wellness policy was to address the growing childhood obesity rate, Brown reports.

"About 37 percent of our children are at risk (for obesity) or obese," Kathy Reutman, who is in charge of making sure the wellness policies for Boone County schools meet federal guidelines, told Brown. "It's not up to us to tell parents what to do," she said. "But when children are in our care we make sure that nothing gets in the way of them and their learning. Food allergies or too much sugar get in the way of that."

Students have gotten creative at Burlington to accommodate this change, with one student bringing in jump ropes for the class for a jump rope party to celebrate his birthday, Brown notes.

The Enquirer reports that they have found only one other local school district with a similar rule, Southgate, a one-school district in Campbell County and reports that while rare locally, birthday-cake bans are "springing up elsewhere across the country."

Sunday, October 12, 2014

A close call with his heart helped a 36-year-old man change his life; UK opening cardiovascular unit to help those like him

A lifetime of eating poorly and smoking a pack of cigarettes a day landed one man in the hospital with a heart condition that usually kills half of its victims; but quick thinking, surgery and a complete turn around in his lifestyle will hopefully allow him to reach his goal of walking his daughter down the aisle when she grows up, UKNow reports.

Jarrett Spriggs
Jarrett Spriggs told the University of Kentucky news service that if he skipped breakfast, he typically ate a "fast-food combo meal, plus an extra sandwich and two extra-large sweet teas" for lunch, followed up with only meat and potatoes for dinner and plenty of snacks, often a full-size bag of chips, and sugary drinks in between. Add to that ... a pack of cigarettes a day.

"A recipe for disaster," says the release.

The disaster hit in May when Spriggs, 36, woke up with "terrible chest pains" that "moved from my chest to my left arm," he said in the release. And despite the immediate 911 call, he and his wife Amy thought this would simply be a case of "expensive heartburn."

But instead, Spriggs was experiencing a rare type of a "deadly condition" called ascending aortic hematoma, which occurs when a tear develops in the inner wall of the main artery that carries blood from the heart. His specific condition is known as an aortic dissection and it often causes patients to bleed to death before they can reach a hospital, says the release. This is the same condition actor John Ritter died from in 2003.

Spriggs survived a five-and-a-half-hour hour surgery in which a portion of his diseased aorta was replaced with a tube made of cloth.

“Jarrett is a very lucky man, because the mortality rate for an aortic dissection is 50 percent, and the variant Jarrett experienced is pretty rare,” Dr. Hassan Reda, his UK HealthCare cardiothoracic surgeon, said in the release. “He acted quickly to get help, and he got to the right place.”

Post-surgery, Reda told Amy that Spriggs "had the heart tissue of an 80-year-old man and without some drastic changes, he likely would not live to see his 50th birthday."

This prognosis has led to some drastic changes in Spriggs' life. He told UKNow that it was a "wakeup call from God."  He immediately quit smoking; he now uses a diet and exercise phone app; and has involved the entire family in his efforts. He has lost almost 50 pounds in five months and says his motivation is to be alive to walk his daughter, who in now 10, down the aisle.

The UK Chandler Hospital is opening a new 64-bed cardiovascular unit in December to help patients like Spriggs. It not only incorporates many elements that already exist in the hospital, according to the release, but will add new features to improve patient recovery.

One of these new features is a guided walking path within the unit for patients and visitors to use. "Research demonstrates that when patients begin exercising in the hospital they are more likely to continue that activity at home," says the release.

The unit will also offer a "state-of-the-art interactive TV system in every patients room that will provide patients with information and educational materials about their diagnosis, their care team and their treatment plan." The information will also be available on patients' home computers.

“Cardiovascular disease, smoking, obesity and physical inactivity are the modern plagues of our society,” Dr. Alison Bailey, director of preventive and ambulatory cardiology and cardiac rehab at UK's Gill Heart Institute, said in the release. “The good news is that these are almost always reversible diseases that can be treated, if not cured. The goal of cardiovascular rehabilitation is to help patients shift back into a healthy lifestyle in a safe, fun environment.”

McConnell runs anti-Obamacare ad with doctor who connects pre-existing condition with cancellation of insurance

U.S. Sen. Mitch McConnell is running his first re-election commercial focused on the federal health-reform law, featuring a Somerset physician saying “As a doctor, I see how Obamacare hurts patients’ access to care.” She says McConnell is working for “common-sense health care reforms,” which are not specified, and is leading the fight to repeal the law.

Sandy Schuldheisz adds that her son has diabetes and her plan was “cancelled under Obamacare. Like many, we now pay more for less coverage.” That may cause an incorrect inference. "The Affordable Care Act also prohibits insurance companies from dropping or denying coverage to Kentuckians because they have a pre-existing condition, such as diabetes," notes Joe Sonka of Insider Louisville. Many policies were canceled because they didn't meet the law's requirements.
Sonka, a McConnell critic, reports that he "requested more background information on Schuldheisz’s personal situation from the McConnell campaign — such as her premium rate before and after, and whether she received insurance through her employer or individually," and the campaign has not provided it.

Gov. Steve Beshear told Sonka in a written statement, "We don’t know the specifics of the doctor’s claim about her family’s plan being canceled (although many folks with health insurance policies prior to ACA were allowed to maintain those older plans if they chose to). We do know that she could have shopped for affordable health insurance on kynect, and may have even qualified for a discount. The vast majority of Kentucky families who shopped on kynect qualified for some kind of payment assistance or subsidy. Finally, the ACA required insurers to offer standard, robust benefits such as preventive care and vaccinations, mental health coverage, maternity and infant care, and prescription drugs."

Sonka writes that Schuldheisz's home Pulaski County "ranked among the top fifth in Kentucky counties with the largest estimated decrease in their uninsured rate" as a result of Obamacare. "As of this April’s signup deadline, 8,134 residents in the county had signed up for health care coverage through the state exchange. Based on Kynect estimates that 75 percent of their enrollees did not previously have insurance, this means Pulaski County’s percentage of uninsured residents may have fallen from 18 percent to under 7 percent."

Saturday, October 11, 2014

Ky. Rural Health Assn. gives UK's James Norton the Dan Martin Award for Lifetime Contributions to Rural Health

James Norton of the University of Kentucky is this year's recipient of the Dan Martin Award for Lifelong Contributions to Rural Health, which honors a health care professional who has shown a long-standing commitment to solving health challenges in rural areas across the state, UKNow reports.
James Norton

This year the Kentucky Rural Health Association presented the award, a handmade and locally crafted dulcimer, to Norton prior to the annual conference, since he was traveling abroad during the September conference when it is normally presented. Norton is a past president of the KRHA and has served on the committee that chooses the recipient of this award.

"It's really gratifying," Norton said of receiving the award. "You do this for a long time, and it's nice to have your peers convey to you that they think what you've done has value in the long pull."

Norton is the associate dean for educational engagement at UK College of Medicine; leads the Western Kentucky Initiative, which places third-year medical students in rural clinical sites in Western Kentucky; is the director of CE Central, which manages continuing education for doctors and pharmacists; and serves on state and national boards that include the National Rural Health Association and on groups that are part of the Association of American Medical Colleges.

 "For over 30 years, Dr. Norton has been a major contributor and leader in developing programs directed to developing future health care providers for rural and underserved communities," Linda Asher, chair of the KRHA selection committee, said in the release.

Started in 2003, the award is named after its inaugural honoree Dan Martin of the Trover Foundation in Madisonville.

Kentuckians like Kynect coverage as long as it's not called 'Obamacare,' and some don't like to talk about it

By Molly Burchett
Kentucky Health News

Sticks and stones may break your bones, but words will never hurt you -- unless you're talking about the word "Obamacare" and its impact on the U.S. Senate race in Kentucky, the only Southern state to have both expanded Medicaid and set up its own health-insurance exchange under the federal health-reform law.

"The Affordable Care Act, known as 'Obamacare,' is a lightning rod in Kentucky, even though the state had one of the most successful rollouts in the nation," Al-Jazeera America reports in a five-part series on political issues in the state. The polarizing word is affecting the race between Senate Republican Leader Mitch McConnell and Democrat Alison Lundergan Grimes.

"In a state where 65 percent of registered voters disapprove of President Obama, even those who have signed up for coverage through Kynect don't want to think of it as Obamacare," Libby Casey and Philip Maravilla report.

In May 2013, Democratic Gov. Steve Beshear announced that he would use Obamacare to create the state health-insurance exchange and expand Medicaid rolls to cover Kentuckians earning up to 138 percent of the federal poverty level. That qualified hundreds of thousands of Kentuckians for the federal-state program, including Frank Dixon of Benham in Harlan County.

Dixon's 52-year-old body is damaged from decades working as a mechanic in coal mines where he injured his back, rotator cuff and shoulder. Like many Kentuckians who have worked hard to earn a good living all of their lives but lost jobs due to the mining industry or economic downturn, Dixon is thankful to have medical coverage and food stamps but "kind of ashamed to say it," he told Al-Jazeera:
"When asked if he supports Obamacare, Dixon lets out a long sigh and fidgets in his chair. “I don't know how to answer that,” he said. “Some things are left unsaid.” An NBC/Marist poll conducted in May found 57 percent of Kentuckians surveyed said they disliked Obamacare. But when asked about Kynect, only 22 percent disapproved. And yet they’re basically the same thing."
Republicans have more than taken notice of this sentiment, which may also be the reason Grimes hasn't made Kynect's success part of her campaign unless she is asked about it.

"Obamacare has been demonized by its opponents," Al Cross, director of the Institute for Rural Journalism and Community Issues at the University of Kentucky and publisher of Kentucky Health News, told Al-Jazeera. "And it’s easy to demonize because the first three syllables of the word are a word that most Kentuckians don't like."

Cross said that for Grimes to run on a platform of supporting the law would be risky, but could pay off: "I hope they do engage on the issue of health care because this state in many ways is the least healthy state in the country."

Aside from the questions of demonization and branding, Kentucky's health system has serious challenges, and the influx of Medicaid patients covered by Obamacare has come with new challenges for both patients and doctors, such as delayed approvals and burdensome paperwork from insurance companies.

Facing delays in preauthorization, some newly covered patients like Dixon are questioning the value of their Medicaid coverage. Others are just thankful to finally be able to see a doctor, Casey and Maravilla report.