Friday, January 19, 2018

Bevin tells PBS requiring Medicaid enrollees to work will build character; foe says he's lowballed number who will lose coverage

By Melissa Patrick
Kentucky Health News

In a national television interview, Gov. Matt Bevin reiterated his assertion that the work requirements for some in Kentucky's newly approved Medicaid program will provide them with an opportunity to have more "dignity and self-respect" by allowing them to be more engaged in their health care.

"So what is it we’re looking to change is, we simply want, for those that are able to be engaged in their own health outcomes, we want them to be, because there’s dignity and self-respect that is offered to people through the ability for people to do for themselves," he told PBS NewsHour host Judy Woodruff Jan. 15.

The new program, called Kentucky HEALTH (Helping to Engage and Achieve Long-Term Health), requires "able-bodied" Kentuckians on Medicaid to work 80 hours a month and document their participation requirement on a monthly basis. The program will be phased in regionally starting July 1, and Medicaid members will get 90 days notice when it applies to them. Kentucky is the first state to establish such requirements, under a new policy of the Trump administration.

The "community engagement" requirements will be phased in with the first phase starting in July and the full program expected to be rolled out by the end of the year, Beth Kuhn, commissioner of the Department of Workforce Investment, told Kentucky Health News.

The work requirements will mostly affect the 480,000 or so Kentuckians who are on Medicaid through the 2014 expansion of the program under the Patient Protection and Affordable Care Act to those who earn up to 138 percent of the federal poverty level: $16,643 for a single person and about $34,000 for a family of four. Pregnant women, full-time students, and the medically frail will be exempted.

The requirements can be filled by doing a number of things besides working at a job, such as looking for work, volunteering, getting job training, going to school, or caring for an elderly or disabled family member.

Bevin didn't answer Woodruff's question about how the state will determine who is medically frail, or who will qualify as caregivers. Instead, he again explained who would be exempt and how the work requirement could be filled, stressing the value of community engagement on a person's well being.

"The key is to have them engaged in their communities, because it is through that engagement that people have healthier outcomes. They have an interaction with people. They become a part of the fabric of their community. It’s better for them, and their health, and for their children and their families as well," he said. He added that the program isn't designed to find "big savings," but to "create opportunity for people to pursue the American dream."

Woodruff noted that the Kaiser Family Foundation reported that in 2016, 60 percent of "able-bodied adults" on Medicaid were already working. She asked what percentage he thought should be working, and Bevin said 100 percent, adding that there are 200,000 available jobs right now in Kentucky "waiting for somebody to fill them." He added, "Why should somebody have to go to work every day and pay taxes to provide something to someone who could do the same thing, but chooses not to? That’s very un-American."

Woodruff told Bevin it sounded as if his "underlying assumption" is that "many, many" of the able-bodied people on Medicaid are really trying to avoid work, and asked him if that assumption was true. Bevin said, "No, I think, again, this will be a very small subset. . . . This is for those who are not working and maybe want the opportunity. . . . Human beings want to be treated with dignity and respect. They do. And we’re going to give them that opportunity."

Opponents of the program say it is so complicated that it will create "barriers to care" that will result in low-income Kentuckians losing coverage merely for failing to report or pay small, income-based premiums, the other major facet of the program.

The Bevin administration has estimated that the number of people on Medicaid will be 95,000 fewer in five years than without the program, partly because of "non-compliance."

Judith Solomon, vice president for health policy at the left-leaning Center on Budget and Policy Priorities, writes that she expects the number will be much larger than 95,000 because the state doesn't account for those who will experience gaps in coverage "due to the lock-outs for failing to meet work requirements, pay premiums, or report changes or renew coverage in a timely manner."

Solomon says there is a "robust body of research" that shows premium requirements will reduce enrollment. She notes that in Indiana, the model for Kentucky's program, 55 percent of the affected enrollees either never made a first payment or missed a payment while enrolled.

Under Kentucky's new plan, missing payments -- along with failing to meet work requirements, not reporting changes in work status or not renewing coverage appropriately -- would result in a six-month lock-out for those with incomes above the poverty level. Those below that level will be being placed in a different plan that requires co-payments. Those above the poverty level allowed to re-enroll if they pay their past-due premiums and take a financial- or health-literacy course.

Recognizing that there are exemptions to the work requirements for those who are medically frail, Solomon says this is not a fail-proof safeguard, because many with disabilities won't meet the strict medically frail definition, creating yet another opportunity for people to lose their coverage.

Thursday, January 18, 2018

Senate health committee recommends $1 increase in cigarette tax; doctors say it would increase state revenue and save lives

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – What started as an information-only hearing about the benefits of raising tobacco taxes in tobacco-friendly Kentucky ended with an unexpected vote of recommendation by the Senate health committee to raise the state's cigarette tax by $1 a pack, to $1.60.

Sen. Julie Raque Adams, chair of the Senate Health and Welfare Committee, opened the Jan. 17 meeting by making clear that the hearing on the idea was meant to "open the conversation" about what it would mean for the state, since Gov. Matt Bevin has said tax reform will be considered in 2018 – meaning a special session if not in the current, regular session.

But after compelling testimony and a long list of statistics about how smoking-related illnesses plague the health and economics of the state – which the legislators said they'd heard many times before – Sen. Alice Kerr, a Republican from Lexington, moved  that the committee recommend a $1 "health-care assessment" on cigarettes, the concept proposed by Sen. Stephen Meredith, R-Leitchfield.

Adams, R-Louisville, initially declined to call a vote on the motion, but after several members said they would second it, she allowed the vote for recommendation, and it passed without dissent. The action has no legislative effect but could be an indicator of increasing support for the tax.

Dr. Jason Chesney, the director of the University of Louisville James Graham Brown Cancer Center, told the committee that while he was against raising taxes in general, he considered increasing the cigarette tax by $1 a "health-care policy."

"It's been proven in state after state that if you raise the cigarette tax by $1, then you will reduce youth smoking . . . and in turn that will lead to less adults smoking," he said. The proposal would make similar increases in state taxes on other tobacco products.

Kentucky has some of the highest smoking rates in the nation for both adults and teens, 24.5 percent and 14.3 percent, respectively.

Dr. Mark Evers, director of the University of Kentucky Markey Cancer Center, told the committee that estimates from the American Cancer Society and the Campaign for Tobacco-Free Kids show that raising the cigarette tax by $1 will keep approximately 23,000 of Kentucky's youth now under 18 from becoming adult smokers, and would reduce the current number of youth smokers by 4,800.

Chesney noted that Kentucky leads the nation in the number of people with cancer and the number of deaths from it, and that 34 percent of those cancer deaths are due to smoking.

He said that even though he cares for thousands of cancer patients every year, and has developed anti-cancer drugs, "I can say with confidence that this initiative is more important than anything I'll do in my life."

Evers concurred: "Senators, I'm here to tell you that given this information, raising the tobacco tax by at least $1 may be the single most important, significant policy measure you can take in your lifetime, and certainly as Dr. Chesney said, in my lifetime to improve the health of Kentuckians."

Ashli Watts, senior vice president of public affairs for the Kentucky Chamber of Commerce, told the committee that over 90 percent its members favor the $1 increase, and she noted a recent statewide poll that shows over 70 percent of Kentuckians support it, regardless of political affiliation.

Watts said smoking costs the state nearly $2 billion annually in health-care costs, with almost $600 million of that for Medicaid – which are taxpayer dollars. She added that lost worker productivity caused by smoking in the state totals more than $2.3 billion.

"Kentucky business leaders know that increasing the cigarette tax will improve our companies bottom line, help us attract new businesses and workers, produce a more productive workforce and most importantly save lives," she said.

Meredith said he is looking for a House sponsor for his legislation because revenue-raising measures must originate in the House. A retired hospital CEO, he told the committee that he had worked in health care for more than 40 years and that when it comes to smoking and the poor health of Kentuckians, nothing has changed.

"It's time to stop having this conversation and start action," he forcefully told the committee.

Sen. Max Wise, R-Campbellsville, asked the panel and the committee about the "slippery slope" that this type of tax presents, asking, "What's next? . . . Is it a war on Twinkies?"

Watts responded by saying that the Chamber members have drawn a pretty clear line on this issue because, "When you smoke, everyone in that room also inhales that smoke as well. When you drink a soda, the person sitting next to you is not going to be affected. So that is where we have kind of drawn the line."

Other statistics shared by the panel included:

Health impacts of smoking in Kentucky
  • 3,000 Kentucky kids will start smoking this year
  • Smoking doesn't just cause lung cancer, it can also cause bladder cancer, heart disease, emphysema, bronchitis, asthma and congenital birth defects
  • Smoking kills more people in Kentucky than alcohol, HIV/AIDES, car crashes, illegal drugs, murders and suicides combined
  • Smoking related diseases make up six times the number of deaths in Kentucky, compared to deaths from the opioid epidemic
Economic impacts of smoking in Kentucky
  • Smoking cost every tax payer in Kentucky about $1,100 each year
Raising the cigarette tax by $1 would:
  • Would lead 29,400 current adult smokers to quit
  • Prevent 14,800 premature deaths
  • Reduce the number of smoking affected pregnancies and births by nearly 6,000 in 5 years
Health-care cost savings from a $1 cigarette tax increase:
  • $5.3 million over 5 years in the cost of treating lung cancer
  • $14.7 million over 5 years for the cost of treating pregnancies and births affected by smoking
  • $11.6 million over 5 years for treating smoking related heart attacks and strokes
  • $6 million over 5 years in Medicaid spending for smoking related costs

Wednesday, January 17, 2018

Analysts think Medicaid work requirements pose little political risk

Bevin and President Trump (AP photo)
"Kentucky is one of the poorest states in America, and its residents are among the sickest. Yet the governor's decision to force Medicaid recipients to meet a work requirement — something that could take health coverage away from 100,000 people — is unlikely to carry any political repercussions for the GOP in this deeply red state." Tony Pugh reports for McClatchy Newspapers' Washington bureau.

Pugh notes that 2017 Kaiser Family Foundation poll found that 70 percent of Americans support work requirements for Medicaid recipients, and that Republican Gov. Matt Bevin is betting Kentucky feels the same way.

Kaiser Family Foundation graphic.
Click on it to enlarge. Click here for more information.  

Read more here: http://www.mcclatchydc.com/news/politics-government/article194990909.html#storylink=cpy
In Kentucky and other states with many low-income residents, people who work but often struggle to pay for health care tend to resent those who get government-subsidized health care, according to Al Cross, director of the University of Kentucky's Institute for Rural Journalism and Community Issues, which publishes Kentucky Health News. "If you can say, 'All we’re doing is requiring people to be more active participants in their health care and require some work-related activities,' I think the general population looks at that and says, 'What’s the matter with that?'" Cross told Pugh.

"Supporters say the Medicaid work policy will cut government dependency, weed out people who don’t really need the assistance and build work ethic among low-income enrollees," Pugh reports. "Critics say the requirement will be expensive to administer, provide an unnecessary barrier to coverage and penalize people who can’t work due to undiagnosed medical problems." Kentucky's new policy estimates nearly 100,000 fewer Kentuckians will have health coverage in five years, than if the policy were not implemented.

Eight other states with Republican governors (Arkansas, Arizona, Indiana, Kansas, Maine, New Hampshire, Utah and Wisconsin) and one state with a Democratic governor (North Carolina) have asked the Trump administration for the green light to enact similar requirements. Several of those states could be battlegrounds in statewide and congressional elections in November. But the Medicaid work requirements aren't likely to be a problem for most Kentucky Republicans, since there are no statewide races this year.

The traditionally lower turnout among low-income voters who would be affected by the measure could also help protect Republicans, Cross said. And it's worth noting that the Kentucky counties with the highest Medicaid rates backed Bevin in 2014, mostly because of social issues such as religion, abortion and anti-Obama sentiment.

But the political dynamics at play in Kentucky may not apply in other states. "It may depend on rival Democrats making a linkage between Medicaid and overall concerns about health care and insurance," Pugh writes. Democrats are likely to emphasize health coverage in elections this year, since 3.2 million Americans lost health coverage in 2017 and it's an issue that most people care about. A poll by Hart Research Associates last week showed that voters cared about health care more than the economy, taxes, immigration, or terrorism in the 2018 congressional elections.

Tuesday, January 16, 2018

State-UK partnership creates system to track drug overdoses

Kentucky has been hit hard by the opioid epidemic, but the state is trying to fight it with innovative efforts to gather more specific data about overdose deaths. The Kentucky Injury Prevention and Research Center, a partnership between the state Department for Public Health and the University of Kentucky College of Public Health, built a "drug-overdose fatality surveillance system" that combines information sources like death-certificate information, post-mortem toxicology analysis, and victims' prescription history to get a better picture of which drugs are killing people and under what circumstances.

"The efforts that KIPRC and the state have made to improve this data have led to crucial findings, including that Kentucky’s crisis isn’t one crisis, but many," Kathryn Casteel reports for FiveThirtyEight. "Different parts of the state are afflicted with different drugs. Northern Kentucky, for example, has a high prevalence of heroin and fentanyl — a synthetic opioid that is more deadly than heroin and other types of opioids — while in the eastern part of the state, prescription opioids are still the main concern.
KIPRC chart; click on the image to enlarge it.
"We’re not doing this for the sake of research," Svetla Slavova, a biostatistician with KIPRC, told Casteel. "We provide actionable data for policymaking, treatment and prevention. We’re trying to be responsive and provide data that will help make these decisions." Because of KIPRC's research, Van Ingram, the executive director of the Kentucky Office of Drug Control Policy, said he was able to push legislation increasing the availability of the anti-overdose drug naloxone.

One of KIPRC's biggest efforts is to make death-certificate information more uniform across the state, because "even the smallest differences in language can leave overdose deaths uncounted," Casteel reports. Sarah Hargrove, a data management analyst for KIPRC and former autopsy technician for the state, is spearheading the effort. It's tough going, since some coroners in the state's 120 counties, many of them small, have limited resources and funding, and many have little medical experience.

But KIPRC is making headway. "Researchers were able to determine the specific drugs that were involved in 97 percent of drug overdose fatalities in 2016; that’s compared with 82 percent using death certificates alone," Casteel reports. The also used the surveillance system "to find which drugs were most commonly involved in deaths linked to a combination of substances, as well as which drugs were involved in overdose deaths among people of different age groups and genders."

Monday, January 15, 2018

State health plan says online service has saved it $2.5 million

The state says it has saved $2.5 million in the last two and a half years through a health-and-wellness service that allows 300,000 state employees, teachers and others in the state health plan to get doctor consultations and care online.

The “LiveHealth Online Medical + Behavorial Health” initiative, started in June 2015, will continue to expand its services, the state Personnel Cabinet said in a news release. For example, psychiatric “virtual visits” began this month.

“This service is incredibly user-friendly,” Personnel Secretary Tom Stephens said. “It lets you talk face-to-face with a doctor through your mobile device or a computer with a webcam. It’s faster, easier and more convenient than a visit to an urgent care center. . . . There are no appointments, no waiting and no sitting in traffic. It’s quick, easy and connects you to a doctor of your choice in minutes.”

The state plan is Kentucky's largest self-insured health plan, "with benefits designed in partnership with multiple vendors to provide greater access to quality healthcare with increased customer service," the release says. "The Kentucky Executive Branch is the state’s largest employer, with over 30,000 employees."

Sunday, January 14, 2018

HIV cases among N.Ky. drug users jump, sparking fear of an outbreak; health officials renew calls for syringe exchanges

Health officials in Northern Kentucky have renewed their cry for syringe exchanges following a huge surge in cases of the human immunodeficiency virus among intravenous drug users in Kenton and Campbell counties.

"HIV cases were up nearly 50 percent to 37 in 2017; the HIV cases among drug users rose 260 percent to 18," reports Terry DeMio, who covers drug abuse for the Cincinnati Enquirer.

The 50 percent increase in the two counties was mirrored across the Ohio River, where Hamilton County, which includes Cincinnati, reported a 50 percent jump in HIV cases.

Local health officials asked the federal Centers for Disease Control and Prevention to determine whether the increase amounted to an outbreak of HIV, like those they and the CDC have predicted. One expert says an outbreak in Appalachian Kentucky is only a matter of time.

Dr. Jeffrey Howard, Kentucky's acting health commissioner, told Terry DeMio of the Cincinnati Enquirer, "We do not want to give the impression of widespread community risk for HIV in Northern Kentucky." However, local officials and advocates were not so sanguine.

Dr. Lynne Saddler, director of the Northern Kentucky Health Department, "cautioned that 2017's rise in reported cases may only be the tip of the iceberg, since many people aren't tested for HIV and injection drug users generally don't the proper health care," the Enquirer reports. "Kimberly Wright, leader of the private Facebook group Kentucky Parents Against Heroin, said the threat isn't just to injection drug users or health and safety workers."

"We're all at risk now," Wright told DeMio. "Here's the thing I think people don't get about users: We have males and females who are prostituting out here. …You know, we have strip clubs where these girls are going to dance to earn their money. We have married men going into these places that are leaving with them."

Advocates and health officials redoubled their calls for syringe exchanges where IV drug users can get clean needles, preventing the spread of infection and providing an opportunities to recruit them into treatment. Local officials, feeling political pressure from both sides, have dithered.

"Kenton County commissioners have approved an exchange there, but Covington has resisted unless a neighboring county gets an exchange, too," DeMio notes. "Campbell County gave a thumbs up, but Newport hasn't acted on the issue."

Approval is required from the county government and the city where an exchange is placed. At a news conference, advocates and heath officials turned up the heat on politicians.

"We must act immediately," Garren Colvin, president and CEO of St. Elizabeth Hospital, said at a news conference with other health officials. "More than ever, Northern Kentucky now needs comprehensive syringe access-exchange programs."

Brent Cooper, president and CEO of the Northern Kentucky Chamber of Commerce, said "It's about lowering our collective health-care costs, improving the health of our community and attracting and retaining workers and business." The chamber "has been at the forefront of fighting the heroin epidemic for more than five years," DeMio notes.

Opponents of syringe exchanges say they enable drug use, but research has debunked that notion.

Saturday, January 13, 2018

Bill requiring sex-ed classes to teach abstinence until marriage clears first committee; critics want comprehensive curriculum

A bill requiring sex education classes in Kentucky to include abstinence until marriage passed out of a Senate committee, despite the pleas of four women who urged the legislators to create a more comprehensive bill.

Atherton High School senior Sophia Letson-Ettin told the Education Committee Jan. 11 that she had no objections to abstinence and monogamy being part of the curriculum, but said it should also be required to include discussions about sexual abuse, consent, contraception and healthy relationships, Deborah Yetter reports for the Courier Journal.

"I hope you will join us in support of a comprehensive sex education program," said Letson-Ettin, 18.

Sen. Steve Meredith
The bill, sponsored by Sen. Stephen Meredith, a Leitchfield Republican, says that sex education classes in Kentucky would be required to teach: "Abstinence from sexual activity outside of marriage is the expected standard for all school-age children."

Meredith argued that his bill does not say schools can't teach a comprehensive sex-ed program, only that it must teach this component. The bill passed on a 7-2 vote, with seven men on the committee voting for it.

The only woman at the hearing, Sen. Julie Raque Adams, R-Louisville, voted no. She said after the meeting that she had been assured that abstinence was already being taught in these classes.

Sen. Reginald Thomas, D-Lexington, voted no, and said a better bill would be one that offers a comprehensive set of sex-ed guidelines for the state. Sen. Gerald Neal, D-Louisville, passed, saying the panel needed more information about the current requirements and what is already being taught.

State law currently has no requirements for sex education, and curriculum on the topic is determined by each school-based decision-making council. A representative from the state Department of Education told the committee that it is working on guidelines for such classes.

Sen. Danny Carroll, a Paducah Republican who voted for the bill, said teaching abstinence and monogamy until marriage is important, "arguing that societies that don't set standards are doomed to fail," Yetter reports.

Critics of the bill said it doesn't take into account the realities of modern society.

Sara Choate, a Louisville sex educator who works with students, pointed out that most high-school students have had sexual relations by their senior year, and many have been sexually abused, Yetter reports: "Lecturing them to abstain from sex does not provide the help or information they need, she said."

Rev. Lauren Jones Mayfield, a pastor at Highlands Baptist Church in Louisville, added that the bill doesn't account for people with different faiths and sexual orientations or those who have different views about sex outside of marriage. "This assumes sex is between a married man and woman in a Christian home," she said.

Several foes of the bill noted that efforts to promote abstinence and monogamy often end up shaming or blaming women for engaging in sex, without the same consequences for their male partners.

Men on the committee said the bill was not intended to shame anyone. Mayfield said this concern is likely something the men on the panel don't understand.

"As four women sitting here saying shame is very much a part of this, you as men are so confident saying that's not the intent," she said, drawing applause from the audience. "I feel like our realities are different from yours because that hasn't been your experience."

Friday, January 12, 2018

Federal officials approve Gov. Bevin's plan for work requirements, premiums and penalties in Medicaid; changes start July 1

Bevin makes the announcement.
(Photo: Alex Slitz, Lexington Herald-Leader)
By Al Cross
Kentucky Health News

Some Kentuckians on Medicaid will have to work, perform community service or take job training to keep their health-care benefits, under a plan proposed by Gov. Matt Bevin and approved by federal officials. It would also require some to pay small, income-based premiums and co-payments.

Bevin announced the approval Friday, saying the changes would be "transformational." Kentucky is the first state to establish requirements for work-related activities, under a new policy of the Trump administration.

"I am excited by the fact that Kentucky will now lead the nation," Bevin said at a Capitol news conference. "We're ready to show America how this can and will be done." Critics predicted legal action, saying federal law doesn't allow work requirements.

The plan is called Kentucky HEALTH, for "Helping to Engage and Achieve Long Term Health." It mainly affects the 480,000 or so Kentuckians who are on Medicaid by virtue of its 2014 expansion, under the Patient Protection and Affordable Care Act, to people in households with incomes up to 138 percent of the federal poverty level: $16,643 for a single person and about $34,000 for a family of four.

The plan requires beneficiaries to spend a total of 80 hours a month working, looking for work, doing volunteer work, taking job training, going to school, or taking care of someone with a disabling health condition. The rule would not apply to pregnant women, the chronically homeless or the "medically frail," which includes people with a substance-abuse disorder.

“There is dignity associated with earning the value of something that you receive,” Bevin said. “The vast majority of men and women, able-bodied men and women … they want the dignity associated with being able to earn and have engagement.”

Nationally, most beneficiaries of Medicaid work, mostly in low-wage jobs that don't offer health insurance, according to the Kaiser Family Foundation. Kentucky figures indicate likewise for the state.

Medicaid covers about 1.4 million Kentuckians. A list of enrollment by type and county in June 2017 is at http://www.uky.edu/comminfostudies/irjci/MedicaidenrollmentbycountyJune%202017.xlsx.

Premiums and co-payments

A bigger and broader change is that most Kentuckians on Medicaid will be required to pay small monthly premiums, initially $1 per person to $15 per family, depending on income. People with disabilities, pregnant women, children, caregivers and former foster children under age 26 won't have to pay.

Failure to pay premiums would result in suspension of benefits for those above the poverty line; those with less income would be required to make co-payments. When Indiana implemented such a program, 55 percent of those affected missed at least one premium payment in the first 21 months.

The financial part of the plan would go into effect July 1, but the work requirements are to be phased in, starting in areas where more jobs are available. Medicaid members are to get 90 days advance notice that the new requirement applies to them.

Members will be required to report changes in their income, employment or community-service status within 10 days, and failure to do so would result in a six-month disqualification. Disenrolled members could re-enroll earlier if they complete a financial- or health-literacy course, unless they have defrauded Medicaid.

Details of the program are at https://kentuckyhealth.ky.gov/Pages/Parts.aspx.

Critics and politics

One of the most-criticized aspects of the plan is its removal of dental and vision benefits from the basic benefit package for people in the Medicaid expansion. They could qualify for coverage by getting preventive physical, dental or vision exams. State oral-health leaders have said the change would cost more money than it would save.

Another major criticism of the plan is that many Medicaid members will find the reporting requirements hard to meet, be dropped from the program and be discouraged from re-enrolling.

The Bevin administration estimated in its proposal that with it, the Medicaid rolls in five years will have 95,000 fewer people than without it. It gives two reasons: "program non-compliance" and "participants are expected to transition to commercial coverage," but doesn't explain how they will be able to afford that.

Bevin has said the state can't afford to pay its share of the expansion, which is is gradually rising to the health-reform law's limit of 10 percent in 2020. The program was expanded by his predecessor, Democrat Steve Beshear.

Friday, Bevin downplayed the possible cost savings and said the plan is needed to improve the health of Kentuckians because the four-year-old expansion of Medicaid hasn't improved the state's health status. Four years ago, officials said that would take longer than four years.

When he was seeking the Republican nomination for governor, Bevin said he would do away with the expansion, but after being nominated said he would seek approval for a plan like Indiana's. The Indiana plan was drafted by Seema Verma, now director of the Centers for Medicare and Medicaid Services, which approved Bevin's plan as a waiver from federal rules under Section 1115 of the 1965 law that created Medicare and Medicaid.

Bevin proposed the plan when Barack Obama was president, and said that if it wasn't approved, he would end the expansion. While the Donald Trump administration welcomed the plan, it might run into trouble in court, and Bevin's press release referred to that possibility and renewed his threat.

"Gov. Bevin has consistently said since submitting the 1115 application that these are the terms under which Kentucky is able to maintain expanded Medicaid," the release said. "Accordingly, Gov. Bevin has signed an executive order directing the commissioner of Medicaid to take necessary actions to terminate Kentucky’s Medicaid expansion in the event that a court decision prohibits one or more of the components of the Section 1115 waiver from being implemented."

Insure Kentucky, a coalition of groups favoring health reform and opposing the waiver, said such waivers are supposed to "demonstrate that a state can expand coverage, improve access and provide better, more efficient care than under standard federal rules." It noted what it called "overwhelming" objections from citizens and groups.

Senate Majority Leader Mitch McConnell said in a press release, “I applaud CMS and Gov. Bevin for recognizing the unaffordable mess left behind by his predecessor and responding with innovative, common-sense steps to engage patients, improve health, and reduce the burden on Kentucky taxpayers. Today’s announcement by CMS is a step toward taking the power out of Washington and sending it back to the state while also ensuring the long term fiscal sustainability of the Medicaid program.”

Democratic U.S. Rep. John Yarmuth of Louisville said, “During the campaign, Bevin pledged to end Kentucky’s highly successful Medicaid expansion, but as governor, he did not have the courage to do it. Instead he is sabotaging it by raising premiums for families who can’t afford them and creating new barriers to coverage that will—by the governor’s own admission—force tens of thousands of Kentuckians to lose access to life-saving health care. Make no mistake: people will die because of this. Thousands of Kentucky families will face financial ruin. Gov. Bevin and President Trump are creating an entirely unnecessary crisis in our commonwealth for entirely political reasons.”

Health department reports first flu deaths of children this season, continues to urge vaccinations; disease widespread across U.S.

A flu patient in Escondido, Calif. (Photo: Gregory Bull, AP)
At least 36 Kentuckians have died from influenza this season, and the number includes two children, who died in the past few weeks, according to the state Department for Public Health. The average age of the adults who died is 75, health officials said in their weekly flu report. They did not release other information about the two children, citing privacy reasons.

“We extend our deepest sympathies to the families. These personal losses are a reminder for all of us that flu can be a serious illness, for young and old alike,” said Dr. Jeffrey D. Howard, the acting health commissioner. “We strongly encourage people to protect themselves, particularly children 6 months and older and those people at high risk for complications related to the flu. Stay at home if they have the flu or flu-like symptoms and avoid contact with others.”

The department reports that there have been 49 outbreaks of flu in Kentucky nursing homes and other long-term care facilities.

Flu is widespread across the continental U.S., the first time that has happened in the 13 years of the current national tracking system. "Officials said that this flu season is shaping up to be one of the worst in recent years," Helen Branswell reports for Stat, the health-and-science news site of The Boston Globe. "The rate of flu hospitalizations nearly doubled last week." But officials said this flu season still isn't as bad as the one in 2014-15.

This point on the calendar is typically the peak of flu season, but it extends well into the spring, and health officials still urge those who haven't had a flu shot to get one. The vaccination takes about two weeks to generate immunity. Meanwhile, they recommend these precautions:
·        Try to avoid close contact with sick people.
·        While sick, limit contact with others as much as possible to keep from infecting them.
·        If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone for 24 hours without the use of a fever-reducing medicine).
·        Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
·        Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
·        Avoid touching your eyes, nose and mouth. 
·        Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.

Foundation for a Healthy Ky. gave out almost $900,000 in 2017, with 40% of it going to initiatives to reduce exposure to tobacco

The Foundation for a Healthy Kentucky says it awarded grants in 2017 totaling almost $900,000, with more than $361,000 of it on efforts to reduce tobacco use and secondhand-smoke exposure.That brought the foundation's total investments to nearly $27.4 million since it was created in 2001.


For example, the foundation gave a total of $126,400 to Kentucky Voices for Health, the Kentucky Center for Smoke-Free Policy, the Kentucky Equal Justice Center and Kentucky Youth Advocates. That was 43 percent of the $291,700 of the total grants given for health-policy advocacy.

Nearly $35,000 in foundation grants and sponsorships supported educational conferences about tobacco-related policy changes, including a proposal to increase the tax on cigarettes by $1. The rest of the foundation's tobacco-use reduction funding was dedicated to the launch of the new Coalition for a Smoke-Free Tomorrow, which the foundation staffs.

"We're climbing uphill against an industry that spends an estimated $250 million marketing its products in the commonwealth," Ben Chandler, president and CEO of the foundation, said in the news release. "Advocates can't fight dollar-for-dollar against that kind of consumer influence, so we have focused our efforts on policy changes that research shows will have the broadest impact possible. . . . Kentucky's greatest health gains are going to come at the county and statewide policy levels when elected officials enact policies that have been shown over and over to reduce tobacco use and improve health across entire population groups."

In addition to tobacco-reduction grants, the foundation gave slightly more than $323,000 to seven local health coalitions across Kentucky that are working to improve the health of school-age children in their communities.

The foundation also invested $128,000 in research in 2017, including its annual Kentucky Health Issues Poll, educational events such as its Health for a Change training webinars and workshops , the biennial Data Forum and its annual Howard L. Bost Memorial Health Policy Forum, and obtaining and reporting data valuable to understanding health policy implications.

The foundation also invested nearly $103,000 in grants to expand health journalism in Kentucky, $35,000 of which went to the Institute for Rural Journalism and Community Issues at the University of Kentucky, to publish independent journalism in Kentucky Health News.

The foundation was created in 2001 from the charitable assets of Anthem Inc., recovered in a lawsuit by Chandler when he was state attorney general after the company converted from a mutual insurance firm to a stock company. Under the settlement, the $45 million was invested and only earnings from it may be spent.

Thursday, January 11, 2018

Federal government paves the way for Kentucky to impose Medicaid work requirements; approval expected soon

By Melissa Patrick
Kentucky Health News

The Trump administration announced a new policy Jan. 11 that allows states to establish the first work requirements for Medicaid beneficiaries, paving the way for Gov. Matt Bevin's plan for the Kentucky program.

The Centers for Medicaid and Medicare Services policy guidance authorizes work and community engagement among able-bodied adults who are not pregnant, elderly, disabled or medically frail, and Bevin's request for a waiver from the usual rules requests exactly that.

The Bevin administration calls its plan Kentucky HEALTH (Helping to Engage and Achieve Long Term Health) and says is designed to encourage participants to have what Bevin calls "skin in the game" through co-payments, premiums and a higher level of involvement in their care.

A key component of the plan is a requirement for able-bodied adults who are not primary caregivers to work or volunteer 20 hours a week to get the free health insurance -- a requirement that has never been part of any state's Medicaid program, but is now specifically authorized.

Medicaid boss Stephen Miller
“We are excited about the new guidance issued by CMS to allow states the flexibility to pursue innovative approaches to improve the health and well-being of Medicaid beneficiaries," state Medicaid Commissioner Stephen Miller said in a statement. "This guidance is a critical step to moving the Kentucky HEALTH program forward and we eagerly anticipate a quick approval."

The plan will largely affect the 478,000 Kentuckians who are covered by the expansion of Medicaid under the Patient Protection and Affordable Care Act to those who earn up to 138 percent of the federal poverty level.

Medicaid covers about 1.4 million Kentuckians. A list of enrollment by county in June 2017 is at http://www.uky.edu/comminfostudies/irjci/MedicaidenrollmentbycountyJune%202017.xlsx.

If implemented, the proposal estimates there will be 95,000 fewer Kentuckians on Medicaid in five years than there would be otherwise. The Bevin administration has said this will be a result of people moving to better-paying jobs that offer employer health insurance, but critics say the new requirements create barriers to access that will cause people to lose coverage

U.S. Rep. John Yarmuth, a Louisville Democrat and a vocal supporter of the Affordable Care Act, said in a press release, "Work requirements do not make it more likely low-income individuals will find employment, but they will result in struggling families becoming poorer and sicker. . . . My only hope is that the chaos caused by this policy and the desperation of the Kentucky families who will soon lose their only access to health coverage will force Gov. Bevin to demonstrate some level of compassion and reverse this disgraceful policy."

Despite obstacles, more Kentuckians enrolled in Obamacare health insurance this year; many were automatically re-enrolled

Despite an open enrollment period that was half as long as last year's, 9,000 more Kentuckians signed up for federally subsidized health insurance under the Patient Protection and Affordable Care Act, commonly called Obamacare.

Kentucky enrollment for the 2018 open enrollment period, which ended Dec. 15, was 90,625, compared to 81,155 for 2017. That was an increase of 12 percent, the highest of any state, Dustin Pugel reports on the blog of the left-leaning Kentucky Center for Economic Policy.

Pugel, an analyst for the center, said the increase was likely due, in part, to Kentuckians being re-enrolled into either the same health plan or a similar one if they already had a plan and didn't pick a new one, compared to last year's full re-enrollment process.

"While more detailed data will become available later this year, it is very likely that auto-enrollment heavily contributed to the 43,000 signups in the final week of open enrollment, putting this year’s total above last year’s – though still below two of the three years when Kentucky used the Kynect," he wrote.

Kynect was Kentucky's state-based exchange, which lost its name in 2016 after the state moved to a hybrid exchange facilitated through healthcare.gov, the federal Obamacare website. For 2014, the first year of the exchanges, 82,792 Kentuckians signed up for health insurance through Kynect. That number increased to 109,377 for 2015 and dropped to 93,666 for 2016.

Pugel calls Kentucky's move to the federal exchange was a "setback" for enrollment because healthcare.gov doesn't allow states to extend enrollment periods, as state-based exchanges allow. He reports that nine states and Washington D.C., with their own exchanges, extended open enrollment periods.

Pugel also says more people in Kentucky and the nation would have purchased coverage through the federal exchange if it hadn't been for efforts by the Trump administration that discouraged enrollment.

They include: an open enrollment period that was cut to seven weeks from 14; a 90 percent cut in the national marketing budget; a 40 percent cut in the budget for navigators, who help people with the system; ending contracts with two outreach firms and other organizations that helped identify people who needed coverage and get them sign up; federal field staff being told to not attend outreach events; closing down the federal exchange for 12 hours every Sunday for maintenance; and the creation of 23 videos attacking the ACA.

Pugel adds that the executive order directing agencies to ease some of the insurance restrictions and the confusion caused by the numerous attempts to repeal the ACA also likely contributed to lower enrollment. In addition, he says the end of the individual mandate will likely lead to a 10 percent increase in premiums next year, "further undermining the individual insurance market."

"The robustness of the marketplace in Kentucky suggests that people continue to need and value the coverage offered through to the ACA," he concludes. "But despite this year’s success, the intentional and unintentional degradation of the individual insurance market may put an even greater damper on coverage in the future."