Sunday, June 25, 2017

Study finds women aged 25 to 44 are driving the increase in opioid-related emergency room and hospital stays in Kentucky

By Melissa Patrick
Kentucky Health News

Kentucky is a national leader in yet another measurement of the painkiller epidemic: the number of opioid-related emergency-room visits and inpatient hospital stays. That was established by a study which found that the numbers are largely driven by women between 25 and 44.

Kentucky ranks eighth in the rate of opioid-related emergency room visits for both men and women. For opioid-related inpatient stays, it is 10th among women and 16th among men.

The study, released by the federal Agency for Healthcare Research and Quality, analyzed inpatient data for 44 states and the District of Columbia and emergency room data for 30 states, both for 2014, the latest year for which full data are available for all states.

Among all the states studied, there was a 64 percent increase for opioid-related inpatient care and a 99 percent increase for emergency-room treatment since 2005.

The study placed Kentucky women in the top quarter of states for both opioid-related emergency room visits and opioid-related inpatient stays. The rates were 304 women per 100,000 people for hospital stays and 209 per 100,000 for emergency-room visits.

The study found that nationally, women are now as likely as men to be admitted to a hospital for opioid-related inpatient care. In 2005, men were more likely, but since then there has been a steady increase in the rate of inpatient stays for both men and women and they are now hospitalized at about the same rate. In Kentucky, women's inpatient hospital stays have been higher than men's since 2008.
(Click on the image to view larger versions of these charts)
Men are still more likely to be treated in the emergency room for opioid abuse than women, both nationally and in Kentucky, but both sexes have shown steady increases and are rising faster than inpatient stays, the study found.

Nationally, patients aged 25 to 44 had the highest rates for both opioid-related inpatient stays and opioid-related emergency-room visits, though patients aged 45 to 64 numbers had nearly identical rates as the 25 to 44 age group for inpatient stays. The report notes that both opioid-related hospital stays and emergency room visits have increased in all age groups since 2005.

In Kentucky, the 25-44 age group also led for both opioid-related inpatient stays (768 per 100,000 in the first three quarters of 2016) and opioid-related emergency-room visits (642 in per 100,000 in 2015).
(Click on the image to view larger versions of these charts)
These rankings should come as no surprise, since Kentucky has some of the highest rates of prescription drug use in the nation, which is one of the main contributors to opioid addiction. It also has one of the highest overdose death rates in the nation.

In 2015, the rate of drug-overdose deaths in Kentucky was just over 30 per 100,000, compared to 16 per 100,000 nationally, according to the Centers for Disease Control and Prevention. Put another way, 1,297 Kentuckians died from an overdose in 2015.

State Rep. Kim Moser told Kentucky Health News in March that there were 3.5 billion doses of opioids prescribed in Kentucky last year which, "enough for 79 pills per man, woman and child." She was describing a new state law that increases drug penalties and limits the prescribing of pain killers to three days for acute pain.

While speaking at a Kentucky Health News health-journalism workshop in November, Van Ingram, executive director of the Kentucky Office of Drug Control Policy, said 56 percent of people who died from an overdose in 2015 had an opioid prescription written in the prior 6 months to their death, 33 percent had a current opioid prescription, and 21 percent had an overlapping opioid or benzodiazepine prescription at the time of their death.

Friday, June 23, 2017

Legal battle over Kentucky's only abortion clinic widens; state imposes emergency rules, Planned Parenthood joins suit

State officials have filed emergency regulations "that some abortion providers say are designed to shut them down," The Associated Press reports. The emergency designation means the rules took effect as soon as the Cabinet for Health and Family Services filed them June 15.

"State law requires abortion clinics to have agreements with hospitals and ambulance services to transfer patients in case of a medical emergency," AP notes. "The new regulations say those agreements have to be a legal contract with a hospital within a 20-minute drive of the clinic."

The administration of Gov. Matt Bevin said the regulations are needed to minimize risks in an emergency. But an attorney for Kentucky's only abortion clinic, EMW Women's Surgical Center in Louisville, said the rules are intended to shut it down.

The state and EMW are already in a legal battle over the clinic's status. On Friday, a federal judge allowed Planned Parenthood of Indiana and Kentucky to join the case EMW filed against the state. Planned Parenthood claimed  the state will use its rules "to prevent any abortion facility from operating in the Commonwealth of Kentucky. No medical facility could ever keep up with the ever-shifting and undisclosed terms of the requirements."

Deborah Yetter of The Courier-Journal  reports,"Kentucky officials last year denied a license to Planned Parenthood to provide abortions at the clinic it opened in December 2015 in downtown Louisville, citing alleged deficiencies in its agreements with a hospital and ambulance service."

Thursday, June 22, 2017

McConnell would phase out Medicaid expansion funds by 2024, cut old Medicaid after that; bill short of votes; Paul not on board

By Melissa Patrick and Al Cross
Kentucky Health News

Senate Republicans' bill to repeal and replace the Patient Protection and Affordable Care Act delivered few surprises but drew deadly opposition, putting Kentucky's senators on opposite sides.

Journalists mobbed McConnell. (Photo: Doug Mills, New York Times)
“I’m pleased that we were able to arrive at a draft that incorporates input from so many different members, who represent so many different constituents, who are facing so many different challenges," Majority Leader Mitch McConnell, who directed drafting of the bill by Republicans in secret, said in a floor speech.

Republicans hold 52 of the 100 Senate seats, so McConnell can afford to lose only two votes in his own party, and four Republicans -- including Rand Paul of Kentucky -- announced that they are opposed to the current version.

“Currently, for a variety of reasons, we are not ready to vote for this bill, but we are open to negotiation," the senators said in a statement. "There are provisions in this draft that represent an improvement to our current health-care system, but it does not appear this draft as written will accomplish the most important promise that we made to Americans: to repeal Obamacare and lower their health care costs.”

Senators joining Paul were Ted Cruz of Texas, Ron Johnson of Wisconsin and Mike Lee of Utah. There was some doubt about the strength of the opposition from Cruz and Johnson, but then Sen. Dean Heller, R-Nev., said he couldn't be for the bill as written because of what it would do to Medicaid. President Trump said the bill "is going to be negotiated."

Sen. Rand Paul
Paul told Kelsey Snell of The Washington Post, "The bill looks like we are going to keep all of the Obamacare subsidies — in fact, we may well exceed the Obamacare subsidies. That’s a problem. The bill establishes new money — about $130 billion — for what they call a 'stabilization fund.' That money is going to go to insurance companies that make a $15 billion profit. I find it unconscionable that we’re going to give money to insurance companies that make a $15 billion profit. Those two things don’t look like repeal to me."

If the bill passes the Senate and House and is signed by Trump, two of the biggest impacts in Kentucky would be a phasing out of special funding for the state's 2014 Medicaid expansion by 2024, followed by cuts to traditional Medicaid in 2025.

Kentucky is one of 31 states that expanded Medicaid to anyone with household income up to 138 percent of the federal poverty line, $12,060 for an individual and about $33,000 for a family of four. Medicaid covers 1.4 million Kentuckians, 470,000 of them through the expansion.

Under a repeal-and-replace bill passed by the House, the extra money for Medicaid expansion would end in 2020. Under the Senate bill, it would remain the same until 2021, but would be cut back to the traditional Medicaid level over the following three years.

Then, federal support for traditional Medicaid would decrease, because it would have spending limits based on population rather than reimbursing a state a percentage of whatever it spends, based on a formula that gives poorer states more money. In Kentucky, the federal government pays about 70 percent of costs for traditional Medicaid recipients and 90 to 95 percent for expansion members.

"The cap imposed by the House would grow more slowly than Medicaid spending has, but the Senate’s cap would grow even more slowly than the House’s," Julie Rovner reports for Kaiser Health News. "That would leave states with few options, other than raising taxes, cutting eligibility, or cutting benefits in order to maintain their programs."

Kentuckians who buy private, subsidized health insurance on the federal exchange would also be affected by the Senate bill. During the 2017 open enrollment period, 81,155 Kentuckians enrolled for coverage through the exchange and four out of five of them received a subsidy to help pay for their premiums, according to the Kentucky Center for Economic Policy.

The 142-page bill would lower the qualifying level for people to get subsidies, starting in 2020, to 350 percent of the poverty line from 400 percent (about $94,000 for a family of four).

The bill also eliminates billions of dollars in taxes, mostly for the wealthy and the health-care industry, that are being used to pay the subsidies and the cost of the Medicaid expansion. The proposed tax cuts drew fire from Democrats.

Rep. John Yarmuth
“As the Senate proved again today, Trumpcare’s core mission is not to provide health care to Americans, but to give millionaires tax breaks and fundamentally end Medicaid as we know it," Democratic U.S. Rep. John Yarmuth of Louisville, said in a statement. "The results would be devastating for families: millions of Americans would lose coverage, key health-care protections would be taken away, and crucial services for seniors needing long-term care, children with disabilities, people struggling with addiction, and low-income families would be eliminated."

Jason Bailey, executive director of the Kentucky Center for Economic Policy, said in a statement: "No state has more to lose from this bill than Kentucky because no state has achieved more health and coverage gains in the last few years thanks to the Affordable Care Act. The bill would reduce Kentuckians’ health, harm the state’s most vulnerable and set us further back on fighting Kentucky’s opioid crisis. It will result in less coverage at higher cost, especially for poorer, older and sicker people. It will also lead to substantial job loss at hospitals and doctors’ offices and weaken Kentucky’s rural economies in particular."

In his floor speech, McConnell cited increases in premiums for Obamacare policies and said the 2010 law isn't working. "More Americans are going to get hurt unless we do something," he said. "American families deserve better than its failing status quo — they deserve better care."

The Senate bill would keep the Obamacare provision allowing children to stay on their parents' insurance policies until they turn 26. It would also keep the requirement for insurers to cover those with pre-existing conditions and charge them the same regardless of health history. However, it would allow states to waive some consumer protections such as the 10 essential health benefits, like maternity care and mental health treatment, that Obamacare requires in all insurance plans.

"This would allow insurers to offer less comprehensive policies, so those with pre-existing conditions may not have all of their treatments covered," CNN reports. It could "completely reshape the private insurance market," Danny Vinik of Politico reports. The bill also allows states to apply for federal waivers to eliminate the Obamacare mandate that barred insurers from setting a lifetime limit on an individual's benefits, The New York Times reports.

The bill would repeal the individual and employee mandates for buying health insurance. It would allow insurers to charge older people five times as much as younger ones; the current limit is three times. It would de-fund Planned Parenthood for one year.

For an update from The Washington Post, with a side-by-side comparison of the two bills and the 2010 law, click here.

Grant County coalition wins passage of 'complete street' policies to improve the health of its citizens

Grant County High School student Brookynn Scudder urged
the Crittenden City Council to adopt a complete-streets policy.
A Grant County coalition has embraced a policy to make future streets in the county safer for all potential users, and one city's effort to enact such policies involved the county's youth.

The Fitness for Life Around Grant County coalition partnered with the Foundation for a Healthy Kentucky to adopt "complete streets" policies that ensures future projects are planned and designed around not only automobiles, but also pedestrians, bikers, motorists and transit riders of all ages and abilities.

Grant County is the first in Kentucky to enact a county-wide complete street policy, and such policies have also been enacted in its four towns: Corinth, Crittenden, Dry Ridge and the county seat of Williamstown.

Ben Chandler, president and CEO of the foundation, called complete-street rules "pro-health policies" that make it easier for community members to make healthier choices.

"People are more likely to forgo their cars when they have convenient, well-lit and well-maintained sidewalks, walking paths and bicycling lanes," he said in a news release. "And one of the best arguments for complete streets laws is they don't require a large up-front appropriation, because they guide future planning efforts and maintenance priorities."

Grant County's coalition is part of the foundation's "Investing in Kentucky's Future" initiative, a five-year, $3 million program, that provided matching grants and training to seven multi-sector community health coalitions across the state to address children's health issues. FFLAG selected childhood obesity as one of its issues to address under the foundation grant.

"The Foundation grant requirements, training and other support for changing systems and policy really spurred us to look at how we could improve walkability in our communities," Elizabeth Steffer, a health educator with the Northern Kentucky Health Department, which is a member of the FFLAG coalition, said in the release. "These new policies will lead to behavior changes that will long outlive the grant."
Example of the Grant County High School students' walkability assessment
presented to the Crittenden City Council to promote complete-street policies
Grant County youth played an active role in getting the policy passed in Crittenden, the most recent city in Grant County to pass the policy. Under Steffer's leadership, youth from Grant County High School worked with the coalition and the Step It Up Kentucky! campaign to get the policy passed.

The effort involved eight students who did a walkability assessment of Crittenden and then compiled their observations and photographs into a presentation to the Crittenden City Council in May, asking members to adopt the complete street policy, which they did on June 6.

"The students told council members that they had the power to make Crittenden healthier, and their presentation made all the difference in getting the ordinance passed," Steffer said.

Student Blake White said in the release that his work on the project was meaningful because it would help ensure the safety of his younger brother, who loves to ride his bike around the community.

The 2016 Kentucky Health Issues Poll found that one in four Kentucky adults rated their neighborhoods only a fair or poor as a place to walk, jog or bike. Two in 10 said their neighborhood was either somewhat unsafe or not at all safe for exercise.

"In addition to encouraging physical activity, enhancing community walkability attracts business investment and increases small business revenue," Chandler said.

Taylor Mill and Independence in Northern Kentucky have also passed complete-street policies.

Attorney General Beshear joins multi-state effort to investigate role of drug manufacturers in opioid crisis

By Melissa Patrick
Kentucky Health News

Attorney General Andy Beshear announced June 21 that he is working with attorneys general from across the nation to investigate whether drug manufacturers contributed to the opioid epidemic by illegally marketing and selling opioids, according to a news release.

Through May 2016, 1,248 Kentuckians had died from a drug overdose, according to the Kentucky Office of Drug Control Policy. This five-month death toll was almost as many as all of the overdose deaths in Kentucky in 2015: 1,297.

"We know that we had 3.5 billion doses of opioids prescribed in Kentucky last year and that is enough for 79 pills per man, woman and child. That's huge," Rep. Kim Moser, R-Taylor Mill, told Kentucky Health News in March.

Moser was explaining House Bill 333, which imposed harsher drug penalties and limited painkiller prescriptions to a three-day supply if prescribed for acute pain. Moser, sponsor of the bill, is the director of the Northern Kentucky Office of Drug Control Policy.

“The single greatest threat to Kentucky is our drug epidemic,” Beshear said in a news release. “The crisis is killing our family and friends – it is the main source of crime in our communities and it is preventing job and economic growth. This is the crisis of our times, and finding a solution requires everyone working together.”

The announcement was made following a lawsuit filed in Ohio earlier this year against Purdue Pharma, Endo Health Solutions, Janssen Pharmaceuticals, Cephalon and Allergan. The suit accuses the drug manufacturers of "misrepresenting the risks of prescription opioids and helping to fuel an addiction epidemic," NPR reports in an interview with Ohio's attorney general.

Beshear's office previously settled a lawsuit, filed by predecessor Greg Stumbo, against Purdue Pharma over OxyContin. The $8 million settlement was given directly to 15 substance-abuse treatment centers throughout Kentucky.

From a different drug-company settlement, Beshear's office allocated $2 million to expand and enhance Rocket Docket programs that expedite drug cases and allow select defendants rapid access to substance abuse treatment.

Beshear has also joined a multi-state lawsuit alleging the maker of Suboxone, a drug used for treating opioid addiction, tried to monopolize the market.

Bevin declines to join bipartisan group of governors' call for continuation of formula used to fund state Medicaid programs

By Al Cross and Melissa Patrick
Kentucky Health News

A bipartisan group of governors, including Kentucky Gov. Matt Bevin, is asking Congress not to shift health-care costs to the states, a real prospect as the Senate prepares to vote on a bill to repeal and replace the Patient Protection and Affordable Care Act.

However, Bevin declined to join the group's request to maintain federal funding rates for Medicaid, the program that covers 1.4 million Kentuckians and is in for big changes if Senate Republicans' health bill becomes law.

Bevin and Kentucky are part of the Governors' Bipartisan Health Reform Learning Network, organized by the National Governors Association Center for Best Practices. It has six Republican and seven Democratic governors from California, Delaware, Kentucky, Minnesota, Montana, Pennsylvania, South Dakota, Tennessee, Utah, Vermont, Virginia, Washington and Wyoming.

The governors summarized their priorities Wednesday, as details of the Senate bill were leaking out. It would end the Medicaid expansion later than a bill passed by the House, but would use a less generous formula for funding state Medicaid programs, beginning in 2025.

statement of "shared priorities" from the 13 governors in the network says, "It is critical that Congress . . . not shift costs to states. Significant cuts to Medicaid will impact coverage for millions of low-income individuals and could impede state efforts to address the underlying factors driving health care costs."

It also said, "For the majority of the network states that expanded Medicaid, maintaining coverage for those populations at the federal matching rate under current law is of critical importance. (With the exception of Kentucky which does not agree with this statement)."

Bevin's predecessor, Democrat Steve Beshear, expanded Medicaid to people in households with annual incomes up to 138 percent of the federal poverty level. The federal government paid the full cost of the expansion until this year. It is now paying 95 percent, which will drop in annual steps to the current law's floor of 90 percent in 2020.

For traditional Medicaid patients, the federal government pays about 70 percent of the costs, based on a formula that gives poorer states higher reimbursement rates.

The governor's office didn't immediately respond to a request for comment on why Bevin declined to support this part of the statement. During his 2015 campaign, Bevin initially said he would abolish the expansion, and even after dropping that idea, said federal money shouldn't be accepted just because it is available, because it is taxpayer money.

Under the bill to be revealed Thursday, Medicaid funding would use "an even slower growth index than the one used in the House bill," reports Paige Winfield Cunningham of The Washington Post. "That move could prompt states to reduce the size of their Medicaid programs."

Wednesday, June 21, 2017

Senate GOP health bill would dramatically roll back Medicaid

Kentucky Health News

The health bill that Senate Republicans will unveil Thursday "would reshape a big piece of the U.S. health-care system by dramatically rolling back Medicaid while providing a softer landing to Americans who stand to lose coverage gained under the Affordable Care Act," Paige Winfield Cunningham reports for The Washington Post.

As Kentucky Health News indicated Tuesday, the bill would "cut off Medicaid expansion more gradually than the House bill, but would enact deeper long-term cuts to the health-care program for low-income Americans," Cunningham reports. It also would keep Obamacare's income-based subsidies for private insurance, but scale them back.

"Subsidies are currently available to Americans earning up to 400 percent of the federal poverty level," Cunningham writes. "Starting in 2020, that threshold would be lowered to 350 percent under the Senate bill -- but anyone below that line could get the subsidies if they’re not eligible for Medicaid."

The House bill would end the Medicaid expansion, which serves 470,000 Kentuckians, in 2020. The Senate bill is expected to phase out the expansion over a longer period, but it would cut scale back the overall Medicaid program farther in the long run. "In 2025, the measure would tie federal spending on the program to an even slower growth index than the one used in the House bill," Cunningham writes. "That move could prompt states to reduce the size of their Medicaid programs."

That would be the biggest change in Medicaid since a heavily Democratic Congress created it in 1965, and would perhaps reflect the different attitude that Republicans have toward the program. "Republicans view Medicaid as a form of welfare, and pretty much everyone else views it as a government insurance program," Drew Altman of the Kaiser Family Foundation writes for Axios.

"Perceptions of Medicaid as welfare don't seem bothered much by facts, such as, for example, that two thirds of Medicaid spending goes for the low-income elderly and disabled who don't fit the Ronald Reagan era image of the welfare king or queen. But it's not the majority view in any case. A little less than a third of voters identify as Republicans today, and about half of them see Medicaid as welfare," Altman writes. "It's this group and their perceptions of the program, and elected officials who share their views, that seem to be driving debate about Medicaid today." About 1.3 million Kentuckians are on Medicaid.

Louisville senator hopes third time is charm for his bill to allow marijuana to be used to alleviate suffering of the terminally ill

Kentucky should join the states that have authorized marijuana for medical use, and allow it to be used to relieve suffering of the terminally ill, a Democratic legislator from Louisville told a House-Senate committee Wednesday.

McGarvey after the meeting (C-J photo by Deborah Yetter)
"It's 2017," Sen. Morgan McGarvey told the Health and Welfare Committee. "I think it's time we had a conversation about medical marijuana without snickering."

"Members of the committee took no action on legislation McGarvey is proposing for the 2018 legislative session, but no one spoke against the proposal and some committee members spoke in favor of the measure that went nowhere in the past two legislative sessions," Deborah Yetter reports for The Courier-Journal, quoting Sen. Tom Buford, R-Nicholasville: "This is an issue that's got to be dealt with some way."

McGarvey, who has "sponsored similar, unsuccessful measures in the last two sessions of the General Assembly," said public attitudes are moving toward medical marijuana "in some circumstances," Yetter reports. "And he said he doesn't believe support breaks down on partisan lines."

"Everyone has someone in their life who has suffered from cancer or a debilitating illness," McGarvey said. "What we're hearing from Democrats and Republicans is that we need to provide some relief."

McGarvey told the panel that 26 states already allow medical use of marijuana "and said he sees no reason Kentucky should wait any longer," Yetter reports. McGarvey said,"If you're last, you're last and Kentucky shouldn't be the last state to do this." He said it would not be a "back door" to recreational use of marijuana, as some states have done. "That's an argument made out of fear and not out of fact," he said. "It's not a back door to anything."

Yetter writes, "Several supporters of medical marijuana who attended the hearing said they don't think McGarvey's bill goes far enough, that it should allow broader medical use than just for those who are terminally ill. Among them was Dr. Don Stacy, a Louisville cancer doctor who said he has seen dramatic improvements in patients who acknowledge using marijuana 'behind closed doors' to ease pain and nausea from treatments including chemotherapy and radiation."

Tuesday, June 20, 2017

Ky. leads nation in opioid-addiction diagnoses for privately insured people, and in the rate of doctors prescribing medication for it

By Melissa Patrick
Kentucky Health News

Kentucky doctors diagnosed more cases of opioid addiction for privately insured people than in any other state in the nation last year, and the state had the nation's highest rate of medication-assisted treatment for addiction.

The findings are in a study, "America's Opioid Epidemic: Data on the Privately Insured Population," by Amino, a health-care transparency company that uses large sets of data to help people find low-cost care.

Looking only at privately insured patients "shows how pervasive this crisis has become" and that opioid use isn't just a problem for people on Medicaid, the report says.

Nationwide, the researchers found a six-fold increase in the number of patients diagnosed with opioid-use disorder between 2012 and 2016, rising from 241,000 to 1.4 million.

The American Society of Addiction Medicine estimated that in 2015, "about 2 million people in the U.S. had a substance use disorder with prescription painkillers and about 591,000 had a heroin-use disorder," Terry DeMio reports for The Cincinnati Enquirer.

The Amino report said its estimates were probably low, especially among the privately insured, because people are hesitant to get treated for addiction and physicians are hesitant to make the diagnosis because of the stigma attached to it, especially for those who get insurance through their employer.

Dr. Will Lopez, a senior medical director in Cigna's behavioral-health business, told DeMio that opioid-use disorders increased after doctors started prescribing more painkillers in the 1990s, when pain level started being considered a fifth vital sign.

"From the start of this problem, it went across all economical statuses," Lopez said.

Treatment with buprenorphine is highest in Kentucky

Addiction is often treated with substitute drugs, and Kentucky has the highest share of physicians prescribing medication-assisted treatment.

MAT medications include buprenorphine, methadone and naltrexone, which are prescribed along with counseling and behavioral therapies to treat opioid-use disorders and to prevent overdoses.

Click on table to view a larger version
Kentucky has nine of the top 10 counties in the nation for doctors using MAT to treat opioid-use disorder. They include Breathitt, Lee, Wolfe, Perry, Boyle, Floyd, Menifee, Bourbon and Rowan counties. All but Boyle and Bourbon counties are in Eastern Kentucky.

DeMio notes that the Northern Kentucky counties of Boone, Campbell and Kenton were not among the counties with high rates of physicians prescribing MATs, though these counties have been "hit hard by the heroin epidemic."

That could indicate illicit trade in MAT drugs in Eastern Kentucky, but there are other possible causes. Dr. Mina "Mike" Kalfas, a certified addiction expert at Christ Hospital's outpatient clinic in Fort Wright, told DeMio that this was because the region has too few MAT providers, leaving many who need the medication unable to get it here. This is a problem nationwide.

The federal Substance Abuse and Mental Health Services Administration reported in 2016 that "Half the people who could use treatment are not able to get it, in large part because they can't afford it or can't find providers." SAMHSA offers a burprenorphine physician-finder online.

The report adds that opioid-use disorders are linked to many serious health conditions. It found that patients with opioid addictions were nine times more likely to have hepatitis C and almost six times more likely to have chronic pain. They were also eight times more likely than people without addiction to have alcoholism, almost seven times as likely to have contemplated suicide, and were more than twice as likely to have anxiety and depression.

Kalfas told DeMio that many of these dual diagnoses make sense because of what heroin and synthetic opiates do to a user's brain. "The depression, suicidal thoughts, loss of joy, are consequences of chronic opioid use, because they experience a decrease in endorphins over time," Kalfas said. Endorphins are natural hormones that activate the body's opiate receptors.

Hepatitis C is linked to intravenous drug use because it is spread through the sharing of syringes. Kentucky has passed legislation for syringe-exchange programs that allow IV drug users to swap their dirty needles for clean ones to decrease the spread of diseases like hepatitis and HIV. As of June 16, the state had 24 operating syringe exchanges and nine that are approved, but not yet operational, according to the Cabinet for Health and Family Services website.

As for chronic pain, DeMio writes, "When states cracked down on the prescription of addictive painkillers, or opioids, used in an attempt to conquer chronic pain, drug cartels moved heroin into the market, and people who'd been cut off prescriptions along with others who'd been using the drugs sold on the streets started using heroin."

Senate health bill expected Thur., McConnell says; could stretch Medicaid expansion but then cut program more than House bill

By Al Cross and Melissa Patrick
Kentucky Health News

Senate Republicans plan to make their repeal-and-replace-Obamacare bill public on Thursday, Majority Leader Mitch McConnell of Kentucky told reporters Tuesday.

The bill is likely to continue the Medicaid expansion, which serves 470,000 Kentuckians, longer than the bill passed by the House, but could make deeper cuts to Medicaid in the long run.

McConnell talked and gestured as Republican Policy Committee
Chair John Barrasso of Wyoming, left, and Conference Chair
John Thune of South Dakota listened, while Republican Whip John
Cornyn of Texas looked away. (Associated Press photo : J. Scott Applewhite)
McConnell's announcement indicated that the bill is being analyzed by the Congressional Budget Office, which would clear it for debate, votes and perhaps passage on the Senate floor next week, meeting McConnell's goal of action before the July 4 week recess that begins Friday, June 30.

"I expect to have a discussion draft on Thursday, and we will go to the bill once we get a CBO score, probably next week," McConnell told reporters. Asked how long the Senate will have to review the bill, McConnell said "plenty of time."

On the floor Monday, Minority Leader Chuck Schumer of New York asked McConnell if the Senate would have more than 10 hours to debate the bill and McConnell wouldn't answer the question, saying only, "We'll have ample opportunity to read and amend the bill."

Schumer and other Democrats have been shut out of negotiations in the bill, which Republicans can pass with no Democratic votes because they are invoking budget rules that preclude a filibuster and bypass the 60-vote requirement to pass legislation.

McConnell said of Democrats, "They've made it clear they are not interested in helping" repeal Obamacare. Republicans plan no committee hearings on the bill, and note that Democrats passed Obamacare with only their own votes.

"No transparency would have been added by having hearings in which Democrats would have offered endless single-payer-system amendments," McConnell said. "That is not what this Senate was sent here to do."

McConnell's office is writing the bill, Republican Sen. Bob Corker of Tennessee told The Washington Times Monday: “The leader is really writing this bill. You can say the Finance Committee is, you could say the Budget Committee is, you could say the Health Committee is — but the leader’s office is writing the bill. And what they’re trying to do is sort of try to attempt hit the sweet spot between those differences that exist, which are natural when you have people from different states. I haven’t seen what that is yet, and to my knowledge no one has seen that yet.”

The Times reports, "Republican negotiators are still fine-tuning how make tax credits in their plan generous enough for certain cohorts, including the needy and older Americans who aren’t yet eligible for Medicare. Yet Sen. Rand Paul, Kentucky Republican, suggested his colleagues want to dole out more taxpayer assistance than the 2010 law they’re trying to scrap."

“One of the key things when it comes out, when we get a copy, is: Are there more subsidies in our bill than Obamacare?” Paul said. “That, to me, really is a non-starter.”

That could depend on what Paul calls a "subsidy." The word generally refers to tax credits and cost sharing for private insurance policies, but could also be applied to the heavy financial support that the 2010 health-reform law gives to states' expansion of the Medicaid program.

McConnell has suggested phasing out the Medicaid expansion through 2023, instead of ending it in 2020, but The Hill reports that the Senate bill could make deeper cuts to Medicaid in the long run: "According to lobbyists and aides, the proposal would start out the growth rate for a new cap on Medicaid spending at the same levels as the House bill, but then drop to a lower growth rate that would cut spending more."

That risks losing the votes of Republican senators such as Rob Portman of Ohio and Dean Heller of Nevada, and McConnell has only two votes to spare. If the vote is 50 to 50, Vice President Mike Pence can break the tie in favor of the Republicans.

"It may be too late to rally support . . . if reports coming out of a meeting of Republican senators are accurate, Rob Garver and Eric Pianin of The Fiscal Times report. "Sen.John Thune of South Dakota and Majority Whip John Cornyn [of Texas] exited a meeting of the Senate GOP caucus Tuesday afternoon and told reporters that there is currently no consensus among members on what the final version of the bill ought to look like." The writers add, "McConnell is the shrewdest politician on Capitol Hill and it would be a serious mistake to underestimate his ability to pull victory from the jaws of defeat."

McConnell "stopped short of guaranteeing that the bill would get the 50 Republican votes it would need to pass it when he brings it to the floor," notes Tierney Sneed of Talking Points Memo. McConnell replied, “We are going to make every effort to pass the bill that dramatically changes the current health-care law.”

The House Freedom Caucus, an ardently conservative group generally aligned with Paul, sent McConnell a letter warning him not to make bill too moderate. McConnell told reporters that the bill will be "a profound, positive improvement over the status quo."

Meanwhile, some lobbying groups expressed frustration at the inability to meet with McConnell. “It is deeply disturbing,” Erika Sward, assistant vice president of the American Lung Association, told the Los Angeles Times. “Patients groups like ours need to make sure that our patients’ needs for healthcare will be met. … We can’t do that if we can’t see what is being proposed.”

"Major physician groups, hospitals, consumer advocates and organizations representing millions of patients with cancer, diabetes, heart disease and other serious illnesses have been pleading with Republican leaders for months to open up the process and listen to their concerns," report Noam Levey and Lisa Mascaro of the Times. "This week, a group of more than 15 patients' groups . . . asked McConnell’s office to meet with them next week, proposing any time between Friday and June 22.

"A representative from McConnell’s office told them staff schedules were too busy, according to representatives of several of the organizations. McConnell spokesman Don Stewart said the majority leader’s schedule is full. 'Numerous meetings are already booked well in advance,' he said."

A group of 120 lobbies for consumer and health-care providers wrote McConnell a letter asking for the preservation of Medicaid, and the American Hospital Association said the Medicaid cuts being considered would have "serious negative consequences for communities across America."

Mike Rust, president and CEO of the Kentucky Hospital Association, told Kentucky Health News that the group has long taken two consistent positions: "Keep the expansion and if they repeal it, restore the cuts to Medicare" reimbursements, which were made when Medicaid was expanded.

Don Ritchie, historian emeritus of the Senate, told the Times that the Senate had not taken such a partisan, secretive approach to major legislation since said not since the years before World War I. That's when "Senate Democrats, at the urging of President Woodrow Wilson, drew up major tariff reforms while shutting out Republicans. But when Democratic leaders tried that again when they had large majorities during the Great Depression, rank-and-file senators revolted. It hasn’t happened since, he said."

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Post's chief fact-checker gives McConnell an upside-down Pinocchio for a flip-flop the senator won't acknowledge

"It has become a regular feature of the U.S. political system that the politicians in the minority accuse the politicians in power of cutting deals behind closed doors to advance controversial legislation — only to engage in similar tactics once they regain power," writes Glenn Kessler, who runs The Fact Checker column for The Washington Post.

And so it goes with Senate Majority Leader Mitch McConnell and Senate Republicans' health bill, says Kessler as he compares McConnell's recent remarks with those he made in 2009 and 2010 as Democrats were passing the Patient Protection and Affordable Care Act, better known as Obamacare. Kessler, a Cincinnati native, normally gives politicians one to four Pinocchios, depending on how far they stray from the truth; in this case, he gives the Kentuckian one upside-down Pinocchio "for statements that represent a clear but unacknowledged 'flip-flop' from a previously-held position." Here's a video version:

Monday, June 19, 2017

Study finds dog owners walk 22 more minutes per day, at a pace that improves health; Ky. seniors rank very low for physical activity

WebMD photo
By Melissa Patrick
Kentucky Health News

Dog owners walk on average 22 more minutes per day compared to people who don't own a dog, says a recent study.

"Not only did we see an increase in exercise, but also the exercise was at a moderate pace," study author Daniel Mills of the University of Lincoln, in the United Kingdom, told Allison Aubrey of NPR.

The study, published in the journal BMC Public Health, found at times the dog owners walked around 3 miles per hour, which the Centers for Disease Control and Prevention considers moderate intensity.

"Prior studies have shown that moderate-intensity walking is just as effective as running in lowering the risk of high blood pressure, high cholesterol, Type 2 diabetes and other conditions," Aubrey reports.

The study included men and women aged 65 and older who agreed to wear an activPAL monitor, which measure speed, distance and other factors 24 hours a day. Participants also self-recorded information about their own and their dog's demographics, daily responsibilities and sleep/wake times. The study started with 43 pairs of dog owners and non-dog owners.

And in addition to the additional 22 minutes of walking at a brisk pace, the study said participants added almost 3,000 additional steps per day and sat less often, though the total time spent sitting didn't vary much.

"The national physical-activity guidelines call for 150 minutes a week of moderate-intensity exercise, and that's what they got in this study," Robert Sallis, a family physician with Kaiser Permanente in California, told Aubrey about the study. Sallis was not involved in the research.

"If you look at studies on pet ownership, people who own pets seem to live longer than those who don't own them," Sallis said. He added that it's not just the increased activity that improves a persons health, but is also the companionship that pets provide which can lead to lower rates of depression and stress.

Kentucky's seniors are ranked third in the nation for physical inactivity, according to America's Health Rankings. They also ranked last in health outcomes, which measured things like self-reported health status, premature deaths and frequent mental distress.

Harvard Medical School also touts the many health benefits of having a pet, but cautions that they can be expensive to care for, require a lot of work, can pose sanitary risks and that they can sometimes pose a health hazard for older adults.

"If you have problems with gait and stability and your pet can get under your feet or jump up and knock you over, then falls and broken bones are a real danger," psychiatrist Dr. Greg Fricchione, director of the Harvard-affiliated Benson-Henry Institute for Mind-Body Medicine, said in the article.

For a fee, the medical school has published a special health report called "Get Healthy, Get a Dog," that offers advice on how to choose the best pet to suit your lifestyle, as well as the role of service dogs.