Sunday, August 31, 2014

Appalachian Kentucky has much of what it needs to improve its poor health status, key federal officials agree

By Al Cross
Kentucky Health News

Appalachian Kentucky has the enthusiasm, creativity, people and facilities needed to greatly improve its dismal health status, two high-ranking federal officials said after looking at the problem on a recent tour.

Dr. Thomas Frieden, Rep. Hal Rogers
"I want to stir up our people to get involved in a grass-roots effort," U.S. Rep. Harold "Hal" Rogers, R-Somerset, who hosted Dr. Thomas Frieden, director of the federal Centers for Disease Control and Prevention, on a four-stop tour of his Fifth Congressional District in early August.

Rogers and Frieden were guests on KET's "One to One" Sunday afternoon, in a program recorded right after they returned from their trip, where Frieden said he saw much creativity and enthusiasm.

Using one of Rogers's favorite sayings, Frieden said, "If you plan your work and work your plan, you may very well have tremendous success."

Rogers said what struck him most about the trip was "the infrastructure we already have in place," including hospitals, health departments, doctors and other health providers, and he wants to "talk about enhancing them.

Rogers is in a position to do that with federal money, because he is chairman of the House Appropriations Committee. He is also co-founder, with Democratic Gov. Steve Beshear, of Shaping Our Appalachian Region, an initiative to improve the economy of Eastern Kentucky.

Asked by "One to One" moderator Bill Goodman where the role of government begins and personal responsibility for health begins, Frieden said, in an apparent reference to smoking bans, "You don't want to go to your job and get cancer as a result."

"We don't tell people what to do" at the CDC, he said, but offer communities choices from a list of proven programs. Earlier, he said smoke-free laws not only reduce smoking, but heart attacks among non-smokers.

Rogers said he asked Frieden what one thing he would recommend for improving personal health in the region, and the doctor replied, "Walk."

Frieden said walking is an especially good option for Kentuckians because they have such a beautiful state. However, many rural areas in the state lack sidewalks or other easily accessible places to walk.

"Physical activity is the closest thing we have to a wonder drug" for all sorts of ailments, Frieden said, "but you have to do something you love to do" in order to stick with it. He said it also helps children be good students: "The more physical activity they get, the better their minds will work."

That point was made a few days before the two men's trip, at the Kentucky Summit on Childhood Obesity and Physical Activity at the University of Kentucky.

As nurse practitioners enjoy their new, state-granted authority, The Paducah Sun looks at the issue in far Western Kentucky

Kentucky law has expanded the rights of nurse practitioners, Laurel Black notes for The Paducah Sun: "Local practitioners say the move will provide patients with better access to care, but not everyone in the medical community embraces the idea."

The new law "gives nurse practitioners who have worked with a physician for four years the right to prescribe routine medications, such as those used to treat diabetes and blood pressure, without a doctor's involvement," Black writes. But nurse practitioners want it to go farther.

The American Association of Nurse Practitioners says "19 states and the District of Columbia allow nurse practitioners full autonomy. This means they're allowed to evaluate patients, order and interpret diagnostic tests, and initiate and manage treatments, including prescribing medications," Black reports. "As the population in the United States grows and ages, providers worry over a physician shortage -- as many as 130,600 by 2025, according to the Association of American Medical Colleges -- and some providers believe nurse practitioners could fill that gap if granted more independence."

"We want to be as independent as we can, because that gives better access to patients," said Amy Fennel, a nurse practitioner at the Paducah Neurosurgical Center, told Black.

"But the idea has met with opposition from organizations such as the American Medical Association," Black notes. "The AMA argues in support of physician-led teams, stating that nurse practitioners lack the education and training to practice on their own."

Black writes, "Local practitioners say their roles are different from those of physicians, and that practicing independently is well within the scope of their training. Elizabeth Scheidler, a nurse practitioner with Mercy Primary Care in Lyon County, who was a nurse for 12 years, told Black that her training was more patient-focused.

"That makes them a good fit for the current health care climate, where primary care physicians are at a premium, particularly in rural areas," Black writes. "Kentucky's law addresses only prescription of non-scheduled medications; controlled substances still require a collaborating physician. And there's still a ways to go before nurse practitioners are able to practice with complete autonomy in the state. For the time being, Scheidler says, the new law 'is a good compromise'." The legislature wrestled with the issue for years before passing the compromise this year. (Read more; subscription required)

Saturday, August 30, 2014

School nutrition beat keeps busy: Ketchup returns to Anderson County, more students eating at school in Allen County

School meal programs continue to make news, as schools, students and parents adjust to the latest round of federal guidelines to combat childhood obesity and make sure no child goes hungry.

The second and third Kentucky counties in the alphabetical list were two of the latest in the news.
In Allen County, expansion of a free-meals program means that almost all children are getting breakfast at school.

Following parental complaints in Anderson County, the schools are again offering ketchup, which had been removed because of its high salt content, Shelley Spillman reports for The Anderson News.

The problem, Food Service Director Ronnie Fields told Spillman, was the unavailability of low-sodium ketchup. All the cafeteria offerings had been configured with it, but there wasn't any available. Regular ketchup pushed the allowable sodium limits too high, so it was removed.

Signs were posted to explain, but this didn't set too well with the parents, who "flooded the Anderson County Schools' office and The Anderson News with questions," Spillman writes.

“They’re micromanaging our children,” Paul Coffey, who has grandchildren in the schools, told Spillman. “A parent knows what’s good for their child and ketchup is not going to hurt them.”

Low-sodium ketchup packets are 10 calories and contain 25 mg of sodium. Regular ketchup packets are 11 calories and 85 mg of sodium, Spillman reports.A teaspoon of salt has 2,300 mg. of sodium, according to the American Heart Association. It adds up quickly, with all the added salt in processed foods, so lunches and breakfasts for middle-school students are supposed to have less than 1,360 mg and 600 mg, respectively. Limits for elementary- and high-school students are slightly lower and higher, respectively.

“A lot people don’t realize how it’s this complicated to feed kids,” Fields told Spillman. There were rumors that the schools wouldn't let students bring their own lunches or condiments. “We’d never ban that,” Fields said. “Kids are always welcome to bring their own lunches and condiments.”

Meanwhile, Allen County reports "promising statistics" in after its elementary and middle schools joined the free-meal program offered by U.S. Department of Agriculture, Rachel Herrington reports for The Citizen-Times of Scottsville.

Of the 1,600 students enrolled in both centers, 95 percent are eating breakfast this year, compared to around 60 percent last year, Food Services Director Mary Hobdy told Herrington.

Hobdy said unclaimed breakfast food does not go to waste. Non-perishable foods are kept in elementary classrooms for students to eat during breaks, and are placed in the Family Resource Center for middle-school students who need extra food during the day. Leftover food is donated to the center's backpack program, which sends easy-to-prepare food home with needy kids on Fridays.

Students in Allen County are allowed to refuse meals if they have eaten breakfast or have brought their lunch.

Henderson County Schools post videos to explain changes in meals, snacks and school fund-raisers involving food

Student Nibre Fortune chose food items at Henderson's
Jefferson Elementary School last April. (Gleaner photo
by Mike Lawrence)
To help parents and students understand the federally mandated changes in school lunches, the Henderson County Schools have posted three videos on YouTube, Erin Schmitt reports for The Gleaner.

“We decided a video would reach a wider audience and actually show parents what has changed,” Child Nutrition Director Sabrina Jewell told Schmitt. “The biggest challenge with this has been with side items of what we would typically see as a la carte items,” which were affected by the last round of changes. The "Smart Snacks" rules also apply to vending machine sales, Jewell said.

"School fundraisers involving food must also meet the federal requirements," Schmitt reports. "The Kentucky Department of Education has not given any waivers for fundraisers, Jewell said."

“We are working with the schools to meet these requirements without causing undue hardships on the various programs,” Jewell told Schmitt. “This section is very much a learning process.”

Schmitt lays out the changes in her story, which begins, "There has been less ice cream and more brussels sprouts served in school cafeterias nationwide since a federal child nutrition act was passed." To see the videos, visit and click the YouTube icon.

Friday, August 29, 2014

Medicare ratings for nursing homes rely heavily on self-reported data; recent inspection data are available elsewhere

Next time you look at Medicare's ratings for nursing homes, be aware that most of the information used to make the ranking is based on self-reported data and is not verified by the government.

Consumers and investors make critical decisions based on these misleading "gold standards" that are doled out by Medicare, Katie Thomas reports for The New York Times.

"Only one of the three criteria used to determine the star ratings - the results of the annual health inspections — relies on assessments from independent reviewers," Thomas writes. "The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value."

ProPublica, the nonprofit, investigative journalism enterprise, offers a program, Nursing Home Inspect, that allows consumers to search and analyze the details of recent nursing home inspections, featuring tools the federal government's Nursing Home Compare doesn't have, including the ability to search using any keywords and the ability to sort results based on the severity of the violation and by state. (Read more)

The Medicare ratings also do not account for fines and other enforcement actions by state, rather than federal, authorities,Thomas reports, or complaints filed by consumers with state agencies.

Starting this year, Medicare will use this same type of rating system not only in nursing homes, but also in hospitals, dialysis centers and home-health-care agencies, Thomas writes. And federal officials told Thomas that "while the rating system can be improved — and that they are working to make it better — it gives nursing homes incentives to get better." They cite the homes' reduced use of physical restraints, and fewer reports of bedsores, as examples of improvement.

But current and former nursing home employees, lawyers and advocacy groups say some nursing homes have "learned how to game the rating system," Thomas writes. Nursing home ratings have risen steadily since the program began, she notes. "In 2009, when the program began, 37 percent of them received four- or five-star ratings. By 2013, nearly half did."

The Times analysis also shows that even if a nursing home has a history of poor care, it self-reports better. "Of more than 50 nursing homes on a federal watch list for quality, nearly two-thirds hold four- or five-star ratings for their staff levels and quality statistics," Thomas writes. These same homes received one or two stars for the health inspection, which is conducted by state workers.

“These are among the very worst facilities, and yet they are self-reporting data that gives them very high staffing and very high quality measures,” Toby S. Edelman, a senior policy lawyer with the Center for Medicare Advocacy,told Thomas. “It seems implausible.”

Pediatricians say middle and high schools shouldn't start class before 8:30 a.m., as a way to help sleep-deprived teenagers

The American Academy of Pediatrics recently recommended that middle and high schools not start of classes until 8:30 a.m. at the earliest.

An estimated 40 percent of high schools in the U.S. start classes before 8 a.m.; only 15 percent start at 8:30 a.m. or later. The median middle-school start time is 8 a.m., and more than 20 percent of middle schools start at 7:45 a.m. or earlier, according to the AAP release. The Kentucky Department of Education doesn't track school start times, but those are locally available.

When children become adolescents, their sleep-wake cycles begin to shift up to two hours later, meaning their bodies naturally want to go to bed and get up two hours later than before puberty hit, says the release. This makes it hard for teens to fall asleep before 11 p.m., and even more difficult to get to class by 7:30 or earlier the next day.

“The research is clear that adolescents who get enough sleep have a reduced risk of being overweight or suffering depression, are less likely to be involved in automobile accidents, and have better grades, higher standardized test scores and an overall better quality of life,” said Judith Owens, pediatrician and lead author of the AAP policy statement. “Studies have shown that delaying early school start times is one key factor that can help adolescents get the sleep they need to grow and learn.”

Pediatricians "urge middle and high schools to aim for start times that allow students to receive 8.5 to 9.5 hours of sleep a night," the group says. In most cases, that means a school start time of 8:30 a.m. or later, depending on average commuting times and other local factors.

Many studies have documented that "the average adolescent in the U.S. is "chronically sleep-deprived and pathologically sleepy." Reasons listed for this lack of sleep include homework, extracurricular activities, after-school jobs and use of technology that can keep them up late on weeknights.

And while students, parents, and all those involved need to learn about healthy sleep habits for adolescents and about the biological and environmental factors that contribute to insufficient sleep, schools should also adjust their start times, AAP said, citing studies showing that a too-early start time "is a critical contributor to chronic sleep deprivation among American adolescents."

“By advocating for later school start times for middle and high school students, the AAP is both promoting the compelling scientific evidence that supports school start time delay as an important public health measure, and providing support and encouragement to those school districts around the country contemplating that change," Owens said in the release.

Thursday, August 28, 2014

Mental-health coverage now required, but access is limited; Medicaid share of all new Ky. enrollments is 85 percent

More people in Kentucky and the nation have access to mental-health care than ever, because of the Patient Protection and Affordable Care Act, but that doesn't mean the care is quick or abundant, especially for those on Medicaid, Abby Goodnough reports for The New York Times.

In the latest of a series of stories Goodnough is doing about health reform from the Louisville area, she gives a new figure for the share of Medicaid patients in the rolls of the 521,000 newly insured Kentuckians: 85 percent. When the regular enrollment period for private insurance ended this spring, the figure was 75 percent, but Medicaid enrollment is open year-round.

The reform law requires mental-health treatment to be covered by Medicaid and every private plan sold through the state's online insurance marketplace, The intent of that, Advocates told Goodnough, is to not only reduce suffering, but also to reduce other health problems and the resulting expense and lost productivity.

Kentucky recently allowed private psychologists and social workers to accept Medicaid patients, adding more than 1,000 private mental health providers to the Medicaid list, state officials told Goodnough. Previously, only "quasi-governmental agencies" were approved to treat Medicaid patients in Kentucky.

"But shortfalls in care persist," Goodnough writes, telling several stories of the successes and challenges that people on Medicaid in the Louisville area who now have mental health coverage are facing. One of the people she interviewed is Terri Hall.

Hall suffers from depression and anxiety that "often consumed her," Goodnough writes. Since she got Medicaid coverage, she is now getting therapy for the first time, but she "just wished she could go more often." She tells Goonough that she has had to wait up to seven weeks between appointments at Seven Counties Services. This is a common story among the people Goodnough interviewed.

Another challenge to mental-health access is that many private therapists, like some of their physician counterparts, refuse to accept Medicaid. Medicaid pays, on average, about 66 percent of what Medicare does, and some therapists say "the paperwork takes too much time and the poor — who often experience more violence and trauma than those who are better off — are too challenging to treat," Goodnough reports.

In addition to low reimbursement, private providers struggle when they take on Medicaid patients because they have to wait to be approved by the managed care companies that provide benefits to Medicaid recipients, Goodnough writes.

With nearly one in five Americans having a diagnosable mental illness, according to the Department of Health and Human Services, but most getting no treatment, Goodnough writes, the new health law offers "a big opportunity for mental health providers to reach more people of all income levels," especially the poor in states that have expanded Medicaid.

Wednesday, August 27, 2014

Health-board smoking bans that Supreme Court struck down are still being obeyed: 'Everybody loves it,' advocate says

By Melissa Patrick
Kentucky Health News

Three counties in Kentucky with unenforceable smoking bans continue to be smoke-free by the people’s choice.

Clark, Madison and Woodford counties have smoking bans that can’t be enforced because they are regulations of county health boards, which the Kentucky Supreme Court ruled in June do not have the power to ban smoking in public places. But officials in each county reported that most of the establishments in these counties continue to be smoke-free by choice.

“We are finding, in general, public spaces and restaurants are still complying with regulations as if it is still enforceable,” said Christie Green, public-information officer for the Madison County Health Department. “It seems as if the general public prefers this.”

In Versailles, the city council “hadn’t heard from one single tax-payer who is opposed to it,” recently resigned city council member Sonny Jones said in an interview before his resignation.

Scott Lockard, director of public health in Clark County, said likewise. “The community has remained smoke free. The public has demanded this, ” he said, and as far as he was aware “No businesses have gone backward in this.”

That doesn’t surprise Ellen Hahn, director for the Kentucky Center for Smoke-Free Policy and the state’s leading smoking-ban advocate. “When communities go smoke free, everybody loves it,” she said.

The anti-smoking regulations can’t be enforced, advocates said. “If enforced, a lawsuit might result,” Lockard said. “We have no active enforcement right now in Clark County.”

The court ruled in a case from Bullitt County, where a local judge had blocked enforcement.

Each of the other counties is handling the issue somewhat differently.

Woodford County, out of “respect for the cities” of Midway and Versailles, will let them determine whether they want to reinstate their previously enacted smoking bans before the county fiscal court makes a decision for the unincorporated area of the county, County Attorney Alan George said, “because the bulk of the affected business is in the city.”

Midway passed a new anti-smoking ordinance Aug. 18 and Versailles plans to hold its first reading on one Sept. 2.

Madison County plans second reading and passage of its smoking ordinance for Sept. 9. Berea is scheduled to do likewise Sept. 2.

Clark County has “no forward actions” or “no ordinance drafted” at this time, Lockard said. Asked if officials are waiting on the Nov. 4 election to move forward, he said that “no one had come out and said the election will play a role,” but he noted that the Winchester mayor and the county judge-executive have opponents.

The Supreme Court ruling was a great disappointment to smoke-free advocates. Betsy Janes, coordinator for Smoke Free Kentucky, said several health boards had been ready to implement smoke-free regulations, but were waiting on the Supreme Court. These plans obviously have had to change.

“It was a major blow, but the good thing is that it is very clear who has the authority to do this now,” Janes said. “Fifty-five percent of Kentuckians want to be smoke free. We are losing 1000 Kentuckians a year to second hand smoke,” based on research that has determined its effects.

While Hahn said the decision was a “step backwards for Kentucky,” she also said her center is “busier than ever” working with fiscal courts to create smoke-free laws on the local level. She said there are 35 city or county ordinances in effect, covering 31 percent of Kentuckians.

The Kentucky Chamber of Commerce supports statewide smoking ban, which has never come to a vote in either chamber of the legislature.

“Twenty-four other states have statewide smoke-free laws and we want to not be the last to join them,” said Ashli Watts, the chamber’s public-affairs manager.

While Clark County is not pursuing a smoke-free ordinance now, the health department is actively educating the public about the benefits of such laws and plans to be a strong advocate to get something passed, Lockard said.

“We are finding overwhelming positive response to smoke-free,” he said. “The Board of Health and health department will work in any way possible to get a law on the books.”

Lockard also voiced his hope that school boards will pass smoke-free policies in schools, which he said should be attainable because no legislation is needed.

“There are 174 school districts in Kentucky and less than 40 of them have smoke-free policies on their campuses,” Lockard said. “If we could have all schools smoke-free, that would have a major impact on our communities.”

Lockard reflected on what Tom Frieden, director of the federal Centers for Disease Control and Prevention, said in his recent visit to Kentucky, that the most important changes Kentuckians need to make to improve their health are to stop smoking, decrease secondhand smoke exposure, and to exercise.

Tuesday, August 26, 2014

Logan Co. schools work to keep kids and bus drivers hydrated during hot, humid days; here are tips for dealing with heat

With temperatures soaring into the high 90s and the heat index over 100, the new Logan County school superintendent made sure the students and bus drivers were well hydrated last week, O.J. Stapleton reports for the Russellville News Democrat & Leader.

Dr. Kevin Hub and other members of the central office staff delivered bottled water to all schools for students who would be riding buses in the extreme heat, Stapleton writes.

“I think it’s important to recognize that it’s hot and we do not have air conditioning on our school buses,” Hub told Stapleton. “That makes it hard on our drivers and students. This just falls under the category of ‘a good thing to do’ when it comes to taking care of our students and staff.” He said the gesture was appreciated by both the staff and students.

Signs and symptoms of heat exhaustion, according to the Centers for Disease Control and Prevention, are heavy sweating; weakness; cold pale clammy skin; fast, weak pulse; nausea or vomiting; and fainting. The CDC suggests that if someone has these symptoms they should be moved to a cooler location, lie down and loosen their clothing, apply wet, cool cloths to as much of the body as possible, be offered sips of water and seek medical attention immediately vomiting occurs and continues.

The CDC reports the signs and symptoms of heat stroke, a much more serious condition, as: body temperatures above 103 degree Fahrenheit; hot, red, dry or moist skin; rapid and strong pulse; and possible unconsciousness. These symptoms require immediate medical attention. Call 911 immediately, move the person to a cooler environment, reduce the person's body temperature with cool cloths or even a bath and do NOT give fluids.

Prevention is the best way to avoid these heat-related illnesses, Stapleton reports. He offers some suggestions below on how to protect yourself during these extreme temperatures.

Here are some suggestions to prevent heat stroke:
  • Drink more fluids, regardless of your activity level.
  • Avoid alcoholic beverages and high-sugar beverages as they can cause you to lose more body fluid.
  • Don't wait until you are thirsty to drink.
  • Seek the advice of your doctor if you have fluid restrictions or are on water pills.
  • Avoid very cold drinks as they can cause stomach cramps.
  • Stay indoors in an air-conditioned place if possible.
  • Go to the mall or the library for some air-conditioned relief if you do not have home access.
  • Seek a heat-relief shelter in your area. Contact your local health department for information.
  • Fans do not prevent heat-related illness when the temperatures are in the high 90s.
  • Take a cool shower or bath.
  • Wear lightweight, light-colored, loose-fitting clothes.
  • NEVER leave anyone in a closed, parked vehicle.
Every person is at risk of heat-related illnesses in these extreme temperatures, but some people are at greater risk and need to be checked on regularly, Stapleton writes. High risk adults should be checked on at least twice daily and monitored for signs of heat exhaustion or heat stroke. Infants and children need more frequent watching.

Those at high risk of heat-related illness are:
  • Infants and young children
  • People aged 65 or older
  • People who are ill, especially with heart disease or high blood pressure.
Some advice for being outdoors in the heat:
  • Limit your outdoor activities to the morning and evening hours.
  • Minimize your outdoor exercise.
  • Drink two to four glasses of cool, non-alcoholic fluids each hour if you exercise.
  • Drink sports beverages to replace the salt and minerals you lose in sweat. Consult your doctor about the use of sports drinks if you are on a low-salt diet.
  • Rest often in shady areas.
  • Wear a wide-brimmed hat, sunglasses, and sunscreen.

W. Ky. elementaries use Baptist Health grants to join national program to fight childhood obesity; results encouraging

Two more West Kentucky schools have joined Project Fit America, a fitness program that targets childhood obesity, to help its students become more fit, reports The Paducah Sun.

East Calloway County and Calvert City elementary schools are the seventh and eighth schools in the area to win a $16,500 grant from Baptist Health Paducah for indoor and outdoor fitness equipment, teacher training and curriculum material, all included with the Project Fit America program.

"We believe as educators it is our responsibility to help our young population begin healthy lifestyles that will follow them into adulthood," Kathy Crouch, East Calloway principal, told the Sun.

Kentucky ranks eighth in child obesity, and U.S. adult obesity is expected to grow from 30 percent of the population now to 60 percent by 2030.

Benton Elementary, which joined the program only last year, has already documented improvement in students' fitness, showing a a 27 percent increase in cardiovascular endurance, 18 percent increase in upper body strength, 12 percent increase in abdominal strength and a 38 percent increase in students who could perform pull-ups.

Project Fit America is a national non-profit group that has worked with nearly 900 schools in 45 states to motivate students, parents and faculty to choose fitness over sedentary lifestyle habits. (Read More. This article is behind a pay wall.)

Monday, August 25, 2014

Beshear cites examples of health reform's benefits, while McConnell keeps up criticism, at Farm Bureau's ham breakfast

By Al Cross
Kentucky Health News

Democratic Gov. Steve Beshear and Republican U.S. Sen. Mitch McConnell squared off on health-care reform for the second straight year at the Kentucky Farm Bureau Federation's annual Country Ham Breakfast at the Kentucky State Fair last week.

Beshear, who spoke first, noted that a year earlier he had called for politicians to stop "partisan bickering" about the law and told Kentuckians that they didn't have to "like the president or the Congress" to investigate its benefits. "Over half a million Kentuckians took my advice," he said. "Young and old, black and white, singles, families, Democrats, Republicans, city folks, country folks -- you went looking for the facts, and what you found was high-quality, low-cost health insurance."

Beshear noted that Kentucky is second in the nation in the estimated reduction of uninsured population, and gave the reductions in four counties: Christian, from 17 percent to 12 percent; Montgomery, from 18 to 9.5; Laurel, from 18;7 to 10.1; and heavily Republican Monroe, from 21 to 11.5.

He also cited two individual examples: Casey County farmers Frank and Renee McAninch, who couldn't afford insurance but now pay nothing, who skipped doctor visits, ignored health concerns and paid "outrageous out-of-pocket costs;" and Joe Paul Mattingly of Marion County, a state Farm Bureau director who found "cheaper, better insurance" on the state health-insurance exchange.

Beshear said Frank McAninch had skin cancer removed, and Mattingly is not receiving a subsidy but is paying 20 percent less for coverage than before. "As Joe Paul said, he chose to be part of the solution, not part of the problem," Beshear said, adding that critics of the law should do likewise.

McConnell was having none of it. Noting that Beshear didn't use the word "Obamacare," the senator said, "He just doesn't want to say it, and I don't blame him."

McConnell delivered his usual litany about the law -- its cuts in payments to health-care providers, its taxes on medical devices and insurance policies, and the higher premiums, co-payments and deductibles being paid by many people.

Citing a study by the Congressional Budget Office, McConnell said Obamacare “will cost 2.5 million jobs.” The study says the predicted reduction, through 2024, will come “almost entirely because workers will choose to provide less labor,” not because jobs will be eliminated.

As for the Medicaid expansion that is responsible for about three-fourths of the 521,000 people with Kynect coverage, McConnell said, "I do worry about our state government and its ability to meet these commitments in the future."

Beshear has cited studies predicting that the expansion will pay for itself by expanding the health-care industry and creating jobs. Republicans have said they don't believe those predictions but generally have been unwilling to say that the expansion should be ended, which would leave hundreds of thousands of people without coverage. McConnell has said his criticism of the law is "not connected" to the state insurance exchange.

Sunday, August 24, 2014

Montgomery County board OKs free meals at most schools

In a microcosm of discussions taking place all over Kentucky and much of America, a divided Montgomery County Board of Education decided Aug. 19 to offer free meals to all children in the county's elementary schools and its Early Learning Center.

By another 3-2 vote, the board defeated a motion to offer free meals at those schools and the county's intermediate school, one of the two options recommended by the district's food-services director.

It did not vote on a much more expensive option of offering free meals at all the county's schools, including Montgomery County High School, or on the other recommended option, to offer the meals at only one elementary and the Early Learning Center. Board Member Sharon Smith-Breiner, who supported the program generally, said she couldn't support singling out one elementary, Tom Marshall reports for the Mount Sterling Advocate.

Board Member Kenny Gulley, who opposed all the options, "told fellow board members that he couldn’t support the decision because it provides free meals to students whose parents have been deemed capable of paying and there is no evidence that they are not being fed," Marshall reports.

Board Member Alice Anderson, who voted yes on both motions, "responded that at least this way the board can ensure that they are fed," Marshall writes. "Smith-Breiner cited as one of the advantages of the move being the potential to boost the school attendance rate and test-score improvement."

Under guidelines of the federal National School Lunch Program, the district must commit for a period for four years with the ability to opt out," Marshall notes. "Food services director Julie Tuttle . . . said the board can reevaluate the success of the program next April."