Friday, September 22, 2017

Education and updates on substance-use disorders, treatment and policy scheduled at University of Pikeville Tuesday, Oct. 3

Shaping Our Appalachian Region's Healthy Communities program and the University of Pikeville will host a substance-use disorder education event Tuesday, Oct. 3 from 11 a.m. to 5 p.m. at the university's Kentucky College of Optometry (Health Professionals Education Building). The meeting is for "health professionals and stakeholders who share the vision of reducing the scope and impact of substance use disorder and related consequences through education, awareness, prevention, and access to services," SOAR said in a news release. The event is free, but space is limited, so registration is required.

Speakers at the event will provide guidelines based on evidence, "discuss how to integrate prevention and management into practice in a rural setting, and provide resources and tools to help current and future providers in Appalachia turn the tide on the substance use epidemic," the release says. 

The special circumstances of addiction in pregnant women and their children will be discussed by Dr. Connie White, deputy director of the state Department for Public Health; Dr. Allen Brenzel of the Department for Behavioral Health, Development and Intellectual Disabilities; and Jill Martin, of the Hazard Primary Care Centers and Mountain Comprehensive Care Clinic.
The event will include personal stories of addiction and recovery from former basketball star Rex Chapman and others. The audience will hear legislative and regulatory updates from UK HealthCare officials Mark Birdwhistell, Douglas Oyler and Dr. John O’Brien Jr.

“We are facing an opioid crisis in Eastern Kentucky that is threatening our livelihood and way of life,” said Dr. Joshua Crum, associate dean of clinical affairs at the university's Kentucky College of Osteopathic Medicine. “KYCOM is meeting the challenge put forth by Governor Bevin to fight this epidemic through an inter-professional and collaborative approach known as the Kentucky Addiction Prevention Education program. Partners include the University of Kentucky and the University of Louisville Schools of Medicine and Dentistry.”

SOAR was created to advance the economy of Appalachian Kentucky, but it and the federal Centers for Disease Control and Prevention "have partnered for more than two years to build a more connected network of health-focused organizations, institutions, federal partners, and individuals in Appalachia," the release notes.

“Substance-use disorder is a real issue in every community in the SOAR region,” said Jared Arnett, the group's executive director. “This epidemic has touched every single person in our region in some way, shape, or form. A groundswell of meaningful solutions and best practices has evolved from the work of countless individuals and organizations that are passionate about treating those battling substance-use disorder.”

Thursday, September 21, 2017

In Ky., four people a day die of drug overdoses; lawmakers learn about prevention, treatment, recovery efforts in day-long meeting

By Melissa Patrick
Kentucky Health News

"Recovery is possible. Treatment works."

That was the one consistent message of hope for those with an opioid addiction Sept. 20, as a stream of experts told Kentucky lawmakers that opioids have become a "public health catastrophe" in the state, as one put it.

"Today, there is not a lot of good news," Van Ingram, executive director of the Office of Drug Control Policy, told the members of the Interim Joint Committee on Health and Welfare and Family Services and Medicaid Oversight and Advisory Committee at a joint, all-day meeting in Frankfort.

"When the clock strikes midnight tonight, four Kentuckians will have died of a drug overdose," Ingram said. "When the clock strikes midnight tonight, 140 Americans will have died from a drug overdose. These are all preventable deaths that don't have to happen."

Kentucky saw a 7.4 percent increase in overdose fatalities in 2016, and more than half of the 1,404 deaths involved fentanyl, a synthetic opioid that is up to 50 times more potent than heroin, according to Ingram's office. One-third of the deaths involved heroin. Ingram noted that this trend continues, with fentanyl being present in 53 percent of overdose deaths in the first half of this year.

Throughout the day, more than 20 experts talked about the impact of opioids in the state, including prevention and treatment strategies.

Kentucky Chamber of Commerce President and CEO Dave Adkisson said the epidemic has taken a toll on the state's economic growth and development, especially participation in the labor force.

“The businesses I’ve talked with throughout the state say drug abuse is a key contributor to the problem,” Adkisson said. “Many people actively looking for work cannot pass the drug tests required for employment and many of those who do have jobs are exiting the workforce due to untreated, or undertreated, addictions.”

Dr. Gil Liu, the medical director of the Department for Medicaid Services, said that over the past two years, Kentucky has doubled its behavioral health spending and quadrupled its substance use treatment spending.

He warned that Kentucky has the nation's highest rate of newly diagnosed hepatitis C, which is largely spread when intravenous drug users share needles.

He said the state is working to relax some of its "stringent" rules around who can or cannot be treated for the disease, but warned that the treatment, which can cure the disease, is costly. His PowerPoint presentation said it would cost the state $2.4 billion if all hepatitis C diagnosed recipients received treatment. Now, the state pays around $70 million.

"Those who have entered into treatment and that we have information on represent the tip of the iceberg," he said. "We have a large caseload that has yet to enter into treatment."

Dr. Allen Brenzel, clinical director of the Department of Behavioral Health, Development and Intellectual Disabilities, said addressing children's adverse childhood experiences must be part of the solution to "break the cycle" of addiction. He said 50 percent of drug use and 78 percent of intravenous drug use in adults may be attributed to ACEs.

ACEs are potentially traumatic events in a child's life, like physical abuse or substance misuse in the home, that can have negative, lasting effects on their health and well-being. Kentucky's children have "significantly higher" ACE scores than the rest of the nation.

"If we want healthy adults, we've got to screen for ACEs. we've got to identify them, we've got to address them," he said.

Brenzel and others talked about the importance of medication-assisted treatment for substance abuse.

“If this is something that the individual requires to lead a healthy lifestyle, to work, to have insurance, to raise their kids, then we have to end this stigma that somehow if you’re not off your medication that you’re not in recovery, and I do think we’re progress in that,” Brenzel said.

 “We’ve had a long battle, in my opinion, over the last 10 to 15 years about abstinence-only versus medication-assisted treatment. It’s not versus. It’s that individual assessment that leads to the individual, most appropriate treatment for that person.”

Dr. Molly Rutherford, vice-president of the Kentucky Academy of Family Physicians, said it's time to move beyond the stigma of addiction and the stigma of treating people with MAT.

"Stop arguing over the right treatment," she said. "The right treatment is different for every individual and is the treatment that prevents his or her death."

Dr. Lana Davenport, medical director of The Infinity Center in Ashland, said medication-assisted treatment is probably the best treatment for rural people with substance-use disorders, because abstinence-only programs require ancillary services, such as Alcoholics Anonymous or Narcotics Anonymous, and they often don't exist in rural areas.

Several groups shared how their programs help pregnant women with substance-use disorders and their infants, who are often born with neonatal abstinence syndrome. In Kentucky, one out of every 50 newborns has NAS.

Jennifer Hancock, president of the Volunteers of America chapter in Louisville, which runs Freedom House, a program that serves pregnant women with an addiction for up to two years after the child's birth, said the average cost of an NAS case is about $100,000. She said every 10 healthy babies represents a $1 million savings to the state, because most of the cost of these babies falls to the Medicaid program. She called the state's opioid problem "a public-health catastrophe."

Brenzel wrapped up the meeting by noting that Kentucky received $10.5 million from the federal 21st Century CURES Act, and will spend this money on a combination of evidence-based projects that focus on prevention, treatment and harm reduction.

One of the projects will create "bridge clinics" at the University of Kentucky, the University of Louisville and the Saint Elizabeth hospitals in Northern Kentucky that will allow them to become the first point of treatment for people with addictions.

The hospitals' emergency rooms will be staffed with a peer-support specialist who, with permission, will connect with the patient in the emergency room and then will regularly follow up with them after discharge. If the patient wants to start treatment immediately, the emergency rooms will have a protocol to assess the patient and do that, if appropriate.

The hope is to increase those getting treatment from 10 percent to upwards of 70 percent, Brenzel said.

Ingram said, "We're going to beat this. It's just going to take time."

Wednesday, September 20, 2017

Obamacare boosted Ky. hospitals, but bad debts are rising again due to high-deductible plans, and the law's future is uncertain

Baptist Health Richmond is among hospitals featured in the story.
Kentucky's expansion of Medicaid under the Patient Protection and Affordable Care Act turned out better for the state's hospitals than they expected, but they worry about its future, Josh Shepherd writes for The Lane Report, a Lexington-based business magazine.

While two Kentucky hospitals closed soon after the expansion began in 2014, "Elizabeth Cobb, vice president for health policy at the Kentucky Hospital Association, points out that there have been no hospital closures in the past several years and revenue from Medicaid expansion has stabilized several community hospitals that were considered financially at risk in 2014," Shepherd reports.

Cobb told Shepherd that Kentucky's health-care industry is much more stable now than it was earlier in this decade. "Medicaid expansion is partially responsible because residents who gained insurance coverage sought care and created a revenue surge," Shepherd writes. "More importantly, she said, provider systems have shifted away from over-reliance on inpatient hospitalization to generate income."

When Kentucky expanded Medicaid, "Hospital administrators worried that expanding eligibility to families with incomes up to 138 percent above federal poverty guidelines would negatively affect their payer mix by shifting patients from commercial insurance to Medicaid, which pays less reimbursement for services," Shepherd notes. But KHA found that the 103 percent increase in the Medicaid population was mostly from people who didn't have insurance and would have otherwise been treated as charity cases. Hospitals reported significant decreases in bad debt.

"The increase in Medicaid enrollment has produced a significant net gain in most hospital revenues across the commonwealth," Shepherd writes. "According to the Kentucky Hospital Association, rural hospitals have been helped tremendously by providing a federal payer where there once was just mounting bad debt owed by private payers." However, more individual patients now have high-deductible plans that are putting them in debt to hospitals, Shepherd reports.

The Medicaid expansion is in doubt because of a last-ditch attempt by Republicans in Congress to repeal the reform law. Even if that fails, federal officials are expected to approve Gov. Matt Bevin's request for a waiver of rules allowing changes that would tamp down enrollment and introduce "deductibles for recipients as an incentive to 'avoid unnecessary care'," Shepherd notes.

Friday, September 15, 2017

Kentucky's share of people with health insurance goes up again, giving state most-improved status, but future remains uncertain

By Melissa Patrick
Kentucky Health News

In the third full year since the Patient Protection and Affordable Care Act was implemented, the percentage of Kentuckians without health insurance continued to shrink, giving the Bluegrass State a larger drop in its uninsured rate than any other state.  So says a new report from the U.S. Census Bureau, with data from its year-round American Community Survey.

Census Bureau map; click on it to view a larger version
Kentucky's uninsured rate dropped to 5.1 percent in 2016, down from 6.1 percent in 2015 and 8.1 percent in 2014. In 2013, the year before the ACA was implemented, the rate was 14.3 percent.

Put another way, 95 percent of Kentuckians had health insurance in 2016, compared to 86 percent in 2013.

That gain came mainly because then-Gov. Steve Beshear expanded Medicaid under the ACA to those who earn up to 138 percent of the federal poverty line, adding about 470,000 Kentuckians to the free health-insurance program.

“It’s clear beyond a shadow of a doubt the Affordable Care Act is working. It has helped Kentuckians get the care they need to improve their health, work and take care of their families. It has created jobs in our state and kept many more Kentuckians from being an illness or accident away from financial ruin,” Kenny Colston, communications director for the liberal-leaning Kentucky Center for Economic Policy, said in a news release.

The survey also found that 96.7 percent of Kentucky's children had health insurance in 2016, up from 93.6 percent in 2013. Kentucky Youth Advocates estimates this represented an increase of 37,000 children. Children are covered by the Children's Health Insurance Program, a program similar to Medicaid in which the federal government pays most of the cost. Kentucky calls its part of the program K-CHIP.

Medicaid and K-CHIP funding uncertain 

The recent gains aren't guaranteed to continue, with changes looming on both the state and federal level for both the adult and children's insurance programs.

Gov. Matt Bevin has submitted a proposal to overhaul the state's Medicaid program that largely targets "able-bodied" adults without dependents who qualify for Medicaid under the expansion. Bevin says the state can't afford to pay for this expanded population; the state's share is 5 percent this year, rising in annual steps to the ACA's 10 percent limit in 2020.

Bevin's plan is designed to encourage participants to have a higher level of involvement in their care through premiums and work or volunteer requirements. If approved, the state estimates that 95,000 fewer Kentuckians will be on Medicaid in five years than if the proposal is not accepted by federal officials. They are expected to approve Bevin's request, and perhaps allow other changes.

The Bevin administration has said that the goal is for these able-bodied adults without dependents to move to higher-paying jobs that offer employer-provided health insurance. Opponents of the plan say these higher-paying jobs are scarce in Kentucky, and note that many in this group already work at low-paying jobs that don't offer health insurance -- or if it's offered, it's not affordable.

KYA Executive Director Terry Brooks said some of the recent changes in Bevin's proposal could create "very real barriers to coverage" for adults, which research shows could result in fewer children being covered. "We also know that kids are more likely to have health insurance when their parents do," he said in a prepared statement.

Bevin spokesman Woody Maglinger told The Associated Press, "It may be a fact of life in Terry Brooks' alternate universe, but it is not a fact in Kentucky," Maglinger said. He noted that Bevin's plan would not change Medicaid eligibility requirements for children.

Last-ditch ACA repeal pushed; Bevin favors, Paul opposes

In Congress, Republican Sens. Bill Cassidy of Louisiana and Lindsey Graham of South Carolina are pushing a last-ditch effort to repeal the ACA and redistribute its funding from states that expanded Medicaid to states that did not, Sarah Kliff of Vox reports.

The bill would block-grant Medicaid money but would not allow states to re-enroll people now covered by the Medicaid expansion, reports Ed Kilgore of New York magazine: "They’d have to cover them some other way, presumably via private insurance."

The bill would reduce federal funding of Medicaid in Kentucky by more than $3 billion over the next 10 years, but Graham told Fox News that Bevin has endorsed his bill.

Graham also said Senate Majority Leader Mitch McConnell "needs to be as committed to repealing Obamacare as [Democratic predecessor] Harry Reid was to passing Obamacare, and Harry Reid had us in on Christmas Eve on Obamacare passage. . . . We had a lot of time off in August when we should have been here, repealing and replacing Obamacare."

McConnell told Kentucky Health News that the bill will come to the floor if there are 50 votes for it, which would put Vice President Mike Pence in position to break the 50-50 tie and pass it. "There’s a lot of discussion, but the time is running on that," McConnell said Thursday afternoon. "It could well come up. If we have 50 votes, we’ll go to it." The deadline to pass the bill with 50 votes, under budget-reconciliation rules, is Sept. 30.

Cassidy told The Washington Post that the bill has "48 or 49" votes, but it has not been vetted for passage under reconciliation, and the Congressional Budget Office has not said how the bill would affect the federal budget or the insurance-coverage rate. McConnell has asked the CBO to "quickly score" the bill, the Washington Examiner reports.

The Examiner adds: "Sen. Rand Paul, R-Ky., announced he would not be in favor of the legislation, which he called 'Obamacare lite'." Graham said on Fox that he would tell Paul that he should trust Bevin to provide "state-run health care." Paul was among the 49 votes for McConnell's last repeal-and-replace bill.

Congress also faces a Sept. 30 deadline to extend funding for CHIP, which provides health coverage for roughly 9 million children. The Senate Finance Committee has agreed on a plan to extend the program for five years, but phase out federal funding in 2021.

Two flu cases reported in Kentucky; CDC recommends everyone over 6 months old get a flu vaccination

Two confirmed cases of influenza have been reported in Jefferson County, signaling the coming start of the flu season in Kentucky.

The federal Centers for Disease Control recommends that every American over six months of age get a flu vaccination, and especially encourages people who may be at higher risk for complications or negative consequences:

• Children aged six months through 59 months;
• Women who are or will be pregnant during the influenza season;
• Persons who are 50 years of age or older;
• Extremely obese persons, those with a Body Mass Index of 40 or greater;
• Persons with chronic health problems;
• Residents of nursing homes and other long-term care facilities;
• Household contacts (including children) and caregivers of children younger than 5, particularly contacts of children younger than 6 months and adults 50 or over;
• Household contacts and caregivers or people who live with a person at high-risk for
complications from the flu; and
• Health-care workers, including students who have contact with patients.

Adequate supplies of flu vaccine are expected to be available for this year’s flu season, the state Department for Public Health said in a news release. "Only injectable influenza vaccine formulations will be distributed in the United States," the release said. "Vaccination can be given any time during the flu season."

"Getting the flu can be debilitating and sometimes life-threatening. Vaccination is the best tool we have to prevent the flu," state Health Commissioner Hiram Polk said. “It’s also extremely important to take simple preventive steps to avoid the flu. You should also follow the advice your parents gave you to prevent flu and other illnesses that tend to circulate at this time of year – wash your hands frequently, cover your mouth when you cough or sneeze and stay home when you’re sick.”

The flu can be very contagious, and can cause fever, headache, cough, sore throat, runny nose, sneezing and body aches. For more information on influenza or the availability of flu vaccine, Kentuckians should contact their primary-care provider or local health department. Information is also available online at https://www.cdc.gov/flu/index.htm.

State panels to hold a full-day meeting on heroin, other opioids

By Melissa Patrick
Kentucky Health News

State officials will hold what amounts to a symposium on heroin and other opioids, at an all-day meeting of two committees in Frankfort on Wednesday, Sept. 20.

The Interim Joint Committee on Health and Welfare and Family Services and the Medicaid Oversight and Advisory Committee will meet jointly from 10 a.m. to 3:30 p.m. in Room 154 of the Capitol Annex. The meeting also includes an invitation-only working luncheon that will be televised in rooms 149 and 154 for those who would like to listen to the panel discussion.

Kentucky has the third highest drug-overdose rate in the country. The Kentucky Office of Drug Control Policy reported a 7.4 percent increase in overdose deaths in 2016, and of the 1,404 overdose deaths in the state, more than half involved fentanyl, a synthetic opioid that is up to 50 times more potent than heroin, and one-third involved heroin. The National Institute on Drug Abuse reports that 80 percent of heroin use starts with a prescription opioid.

The number of Kentuckians who know someone who uses heroin or abuses prescription drugs in the state is growing.

The latest Kentucky Health Issues Poll on this topic found that 17 percent of Kentucky adults know someone who is using heroin, up from 9 percent in 2013 and 13 percent in 2015. It also found that 27 percent of Kentucky adults say they know someone who has abused prescription pain medications.

The House Health and Family Services Committee chair, Rep. Addia Wuchner, told Don Weber of Spectrum News that she has been evaluating treatment centers in Kentucky and surrounding states to see which model might best serve the state's growing addiction crisis.

"Some are good, some maybe not so good," said Wuchner, a Republican from Florence. "We’re putting a lot of money into it, you know; families are paying money, Medicaid is paying money, insurance companies are paying money, but what are the best practices?" she asked.

Wuchner, who is also a nurse, told Weber that the Sept. 20 meeting will look for "smart and effective" solutions, adding, "It will be a full day committee committed to just this issue."

The agenda shows a host of experts speaking throughout the day on the status and overall impact of the heroin and opioid crisis in Kentucky, including awareness and prevention programs, harm reduction programs, treatment and recovery options, and programs that affect special populations, like pregnant mothers and their infants and the justice populations. The day-long program will wrap up with a look at the progress that has been made and the work that lies ahead.

The luncheon panel includes Dr. Phillip Chang, chief medical officer at the University of Kentucky, who will discuss hospital-based efforts; Dr. Kelly Conrad, medical science director for Addiction Alkermes, who will discuss neuropsychology and opioid use disorder; and Dr. Michael Sprintz, founder and CEO of Sprintz Center for Pain and Recovery, Cellerian Health, who will discuss a physician's journey from addiction to recovery.

Here is the agenda for the main part of the meeting:

OPIOIDS IN KENTUCKY
Awareness, Prevention, and Treatment of Heroin and Opioid Use, Misuse, and Abuse

I. Overview of the Epidemic and Scope of the Crisis: Introductory Remarks (10 minutes): Reps. Addia Wuchner, R-Florence, and Kimberly Moser, R-Taylor Mill

II. OPIOIDS IN KENTUCKY MORNING PANEL I (30 minutes): Status and Overall Impact of the Heroin and Opioid Crisis
a.  Status of Heroin and Opioid Crisis: Van Ingram, Executive Director, Office of Drug Control Policy
b.  Health-care Impact: Dr. Gil Liu, Medical Director, Department for Medicaid Services
c Employment and Economic Impact: Dave Adkisson, President and CEO, Kentucky Chamber of Commerce

III. OPIOIDS IN KENTUCKY MORNING PANEL II (20 minutes): Awareness and Prevention
a. Children and Youth and the Impact of Adverse Childhood Experiences: Dr. Allen Brenzel, clinical director, state Department for Behavioral Health, Developmental and Intellectual Disabilities
b. Core-Life: Bonnie Hedrick, program manager/liaison, Northern Kentucky Office of Drug Control Policy

IV. OPIOIDS IN KENTUCKY MORNING PANEL III (40 minutes): Special Populations Part I: Pregnant/Parenting Women and Infants
Video: "Katie’s Story"
Jennifer Hancock, president and CEO, Volunteers of America Mid-States Freedom House
Teri Wilde, nurse manager, Baby Steps Program, St. Elizabeth Healthcare
Dr. Henrietta Bada, University of Kentucky

V. Harm Reduction: Safe Drug Disposal (15 minutes)
Sen. Alice Forgy Kerr, R-Lexington

VI OPIOIDS IN KENTUCKY AFTERNOON PANEL I (20 minutes): Treatment and Recovery Options, Part I: Medication Assisted Treatment
Dr. Mark Jorrisch, president, Kentucky Chapter of the American Society of Addiction Medicine
Dr. Molly Rutherford, founder, Bluegrass Family Wellness
Dr. Allen Brenzel, clinical director, Department for Behavioral Health

VII. OPIOIDS IN KENTUCKY AFTERNOON PANEL II (25 minutes): Special Populations, Part II: Justice Population
a. Quick Response Teams: Linny Cloyd, deputy, Quick Response Team Coordinator, Boone County Sheriff’s Office; Independence Fire Chief Scott Breeze
b. Angel Initiatives: Mike Ward, Chief, Alexandria Police Department
c Jail Substance Abuse Program: Jason Merrick, Director of Addiction Services, Kenton County Detention Center

VIII. OPIOIDS IN KENTUCKY AFTERNOON PANEL III (45 minutes): Treatment and Recovery Options, Part II
a. Outpatient Treatment: David Hayden, Vice President of Clinical Operations, SelfRefind; William Carter II, CEO, The Infinity Center
b. Long-Acting Injections: Steve Cummings, Our Lady of Peace; Chris Harlow, St. Matthew’s Pharmacy
c. Residential Treatment: Mike Cox, president, Isaiah House; Tim Robinson, founder and CEO, Addiction Recovery Care
d. Comprehensive Approaches: Nancy Hale, president and CEO, Operation UNITE

IX. The Progress Made and the Work Ahead (15 minutes)
a. Current Initiatives in the Department for Behavioral Health, Developmental and Intellectual Disabilities: Dr. Allen Brenzel, clinical director
b. Closing Remarks: Reps. Addia Wuchner and Kimberly Moser

Thursday, September 14, 2017

Study finds SNAP not enough for healthy diet, as budget plans call for cuts in program on which Ky. is more reliant than most

By Melissa Patrick
Kentucky Health News

The Supplemental Nutrition Assistance Program, formerly known as food stamps, only covers 43 to 60 percent of the cost of the federal nutrition guidelines, according to a study by researchers who say policymakers should consider that as they propose deep cuts to the program.

“Even though SNAP is not designed to cover all of the cost of food – it’s meant to be a supplemental food program – this study makes it clear that there would be many low-income households that would not be able to cover the gap needed to eat a diet consistent with federal dietary guidelines,” Lindsey Haynes-Maslow, co-author of the study, said in a news release.

The report notes that the average gross income for all SNAP participants is $786 a month, and the expectation is that "SNAP households are expected to spend about 30 percent of their resources on food," says the U.S. Department of Agriculture.

The study, published in the Journal of Nutrition Education and Behavior, estimated how much it would cost to fulfill the USDA's MyPlate guidelines, which recommend filling half your plate with vegetables and fruits, the other with a lean protein and grains, along with a serving of low-fat dairy. Then it estimated the additional costs needed by SNAP recipients to adhere to it.

The researchers concluded that SNAP benefits are sufficient to meet the needs of children under the age of 8 and women over the age of 51, but are insufficient for older children, younger women, and men of any age.

It found that while the average monthly SNAP benefit is $254 per household, the cost of feeding a family of four according to the MyPlate guidelines is between $1,000 and $1,200 per month, depending on the number and age of children in the home.

The study used average monthly SNAP benefits for 2015 and monthly retail price data from the USDA to determine food costs. The calculations also took into account the time it takes to shop for and prepare the food, citing previous studies that show that in addition to food costs, the time it takes to prepare nutritious foods is a barrier to eating healthy.

“Even without including labor costs, a household of four would need to spend approximately $200 to $300 in addition to their SNAP benefits to follow the dietary guidelines," said Haynes-Maslow, who is also an assistant professor of agricultural and human sciences at North Carolina State University.

SNAP funding based on guidelines that were replaced in 2010

The researchers pointed out that SNAP funding is based on the 2005 Food Pyramid nutrition guidelines, which MyPlate replaced in 2010. They encouraged policy makers to use current information on "the true costs of healthy eating" as they consider cuts to the program. They say proposed cuts to SNAP would "decrease the amount of benefits available for food purchases, and fewer people would have access to the program."

President Trump's 2018 budget proposal calls for $191 billion in cuts to the SNAP program over 10 years, a cut of more than 25 percent. The cuts would largely come from requiring a "state-match" that would shift 25 percent of the cost of the program to states by 2023, while giving them flexibility to cut benefits.

The U.S. House of Representatives' 2018 budget proposal calls for even deeper cuts, which are "$4.87 billion below last year's level and $2.6 million below the president's budget request," the House Appropriations Committee said in a June 27 news release. The Senate has no budget proposal yet.

“This research highlights how modest these benefits really are, which is something a lot of people, including many policymakers, probably don't realize. In Kentucky, it's just $1.36 per person per meal," Ashley Spalding, research and policy associate for the Kentucky Center for Economic Policy, said in a telephone interview. “And so with benefits already this modest, the recently proposed federal cuts would be devastating for our state.”

As of February, 651,889 Kentuckians received SNAP benefits. Of those, 41 percent were children, 25 percent were elderly or disabled, 52 percent lived in a rural county, and about 36 percent were working, Spalding wrote for the Ky Policy Blog, which details the impacts of the proposed SNAP cuts on Kentucky.
Kentucky Center for Economic Policy table 
Spalding notes that Eastern Kentucky would have the most to lose from cuts, because the state's 5th Congressional District has the sixth largest number of households on the program.

She also cites studies that show how SNAP lifts people out of poverty, and that people who receive SNAP when they are children have improved academic achievements, are more likely to graduate from high school, and ultimately have better long-term health outcomes.

Spalding said Kentucky is in no position to take on additional funding responsibilities for SNAP, as proposed in the Trump budget. The state ended the 2017 fiscal year on June 30 with a $138 million shortfall, and is projected to end the 2018 fiscal year with another $200 million shortfall. Gov. Matt Bevin recently ordered a 17 percent budget cut across most state agencies.

The Kentucky Association of Food Banks, representing seven food banks, distributed the equivalent of 58 million meals last year, which doesn't even meet the demand, Tamara Sandberg, the executive director of the Kentucky Association of Food Banks, said in a Lexington Herald-Leader op-ed .

"Despite the large volume of food distributed by our network each year, we struggle to keep pace with the demand because of the high need for food assistance in Kentucky," she wrote.

Sandberg urged the Kentucky congressional delegation to oppose any budget cuts to SNAP and other poverty-reduction programs. She noted that 65 percent of households served by the food banks also receive SNAP benefits.

She said, "Despite our best efforts to meet the need for food assistance among our neighbors, Kentucky’s food banks could never make up the difference if SNAP was cut."

Counties sue painkiller distributors, giving them part of the blame for the opioid epidemic that is costing taxpayers

At least 19 Kentucky counties are suing wholesale distributors of pain-killing drugs, alleging that they have contributed to the state's opioid epidemic, and a lawyer says more lawsuits are coming.

The lawsuits claim AmerisourceBergen Drug Corp.Cardinal Health Inc. and McKesson Corp. “unlawfully sold millions of prescription opioids,” leading to "diversion of the drugs to the black market and creating a public health and safety crisis" that has cost the counties millions of dollars, the Lexington Herald-Leader reports.

“It’s just close to breaking down the system,” Middlesboro attorney Mike Bowling, who is helping coordinate the suits, told the newspaper. He "said it’s likely that 90 or more of the state’s 120 counties will eventually file," the paper reports.

The counties that had filed by Sept. 13 were Anderson, Bell, Boyle, Carlisle, Franklin, Fleming, Garrard, Harlan, Henry, Knox, Leslie, Lincoln, Madison, Nicholas, Pendleton, Shelby, Spencer, Union and Whitley.

"AmerisourceBergen operates distribution centers in Louisville and, until recently, in Paducah, according to the lawsuits. Cardinal Health. has distribution operations through a Radcliff call center, and McKesson operates a distribution center in Louisville," the Herald-Leader reports. "An executive with the the trade association for pharmaceutical distributors, which includes the three companies as members (among others), said the allegations in the federal lawsuits are misplaced."

“As distributors, we understand the tragic impact the opioid epidemic has on communities across the country,” said John Parker, senior vice president of the Healthcare Distribution Alliance. “We are deeply engaged in the issue and are taking our own steps to be part of the solution, but we aren’t willing to be scapegoats. We are ready to have a serious conversation about solving a complex problem and are eager to work with political leaders and all stakeholders in finding forward-looking solutions.”

The Herald-Leader notes that McKesson, in a civil case filed by the U.S. Justice Department, "agreed earlier this year to pay a $150 million penalty to the federal government for alleged violations of federal drug law."

Bowling said a consortium of law firms is handling the lawsuits and paying the costs of the litigation, so it won’t cost counties anything, Bowling told the newspaper. "If the counties are able to prove the drug distributors are liable and win damages, 70 percent of the money would go to counties and 30 percent to the firms, Bowling said."

Similar suits have been filed by state and local governments against drug makers, distributors and pharmacy chains.

Parker, the industry spokesman, said “Distributors are logistics companies that arrange for the safe and secure storage, transport and delivery of medicines from manufacturers to pharmacies, hospitals, long-term care facilities and others based on prescriptions from licensed physicians. We don’t make medicines, market medicines, prescribe medicines or dispense them to consumers.”

University of Kentucky law professor Richard Ausness, who teaches product-liability litigation, "said the companies have a statutory duty to monitor the distribution of the painkillers," the Herald-Leader reports. “I think the counties can make a strong case that distributors had a duty to do a better job than they did, and this breach of duty caused this harm to them, to the counties,” he told th newspaper.

In June, a federal appeals court upheld the Drug Enforcement Agency’s "authority to take prescription drug companies to task for failing to investigate, stop and report painkillers that were diverted to the black market," the paper notes.

Kentucky had 1,404 drug overdose deaths in 2016, and "a recent study found that the rate of deaths from poisoning — which primarily means drug overdoses — in Kentucky’s Appalachian counties was 141 percent higher than the national figure," note reporters Greg Kocher and Bill Estep. But so far, half of the Kentucky suits have come from Appalachian counties.

Nonprofit hospital firm in Northern Ky. gives UK $2.5 million for scholarships for students at new med school going up in area

St. Elizabeth Healthcare has given the University of Kentucky $2.5 million for a tuition scholarship program at the medical school UK plans to open in Northern Kentucky two years from now. The nonprofit health-care firm is part of the effort to create the school, which will also be affiliated with Northern Kentucky University.

“In providing these scholarships, we are making an enormous investment in the future of the health of our community,” Garren Colvin, president and CEO of St. Elizabeth, said in a UK news release. “With our partnership with the University of Kentucky, we will be able to provide additional benefits to both organizations as well as the region and commonwealth by directly assisting in medical school support and recruitment for the Northern Kentucky campus.”

The scholarships will be go to medical students who remain enrolled full-time at the Northern Kentucky campus, meet the college’s financial need requirements and remain in good academic standing and progress toward completion of the M.D. degree.

“This scholarship program, seeds sown in ground made fertile by a willingness to care for others, will ripple through many generations of health practitioners,” UK President Eli Capilouto said in the release. “We are grateful to St. Elizabeth’s leadership and the donors who support this remarkable gift, one that will directly support medical students, and ultimately the patients whose names the donors may never know. That is the highest form of giving, and it is the highest honor we can receive as a partner in this endeavor.”

Wednesday, September 13, 2017

Kaiser foundation sets briefing for news media on its 2017 Employer Health Benefits Survey for Tuesday, Sept. 19

The Kaiser Family Foundation and the Health Research & Educational Trust will hold a web briefing for the news media Tuesday, Sept. 19 at 12:30 p.m. ET, to release their 2017 Employer Health Benefits Survey.

The 19th annual survey takes a detailed look at the state of employer-based coverage and trends in private health insurance for both large and small firms. Among other things, the survey examines average premiums and their rate of increase, average deductibles and drug co-payments and other cost sharing.

Participants will be Drew Altman, president and CEO of the foundation; long-time study director Gary Claxton, a Kaiser vice president; and Matthew Rae, a study co-author and Kaiser senior policy analyst. Click here to register.

Tuesday, September 12, 2017

Appalachian Ky. is short of most types of health-care providers, though it has the poorest health of any region in the state

Appalachian Kentucky has fewer dentists, primary-care providers and specialty physicians than the rest of the state. It has more mental-health providers than the rest of Kentucky, but that number still may not be enough to meet the region's mental-health needs.

So says a comprehensive report sponsored by the Foundation for a Healthy Kentucky, the Appalachian Regional Commission, and the Robert Wood Johnson Foundation.

"This report shows some clear gaps that need to be filled in the eastern portion of the commonwealth," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release.

Overall, the "Health Disparities in Appalachia" report found that Appalachian health continues to fall behind the rest of the nation, and the part of the region dominated by Kentucky has the poorest health statistics -- and one of the region's many challenges is access to care.

The report found that while the proportion of mental-health providers in Appalachian Kentucky was 6 percent higher than the rest of the state (according to population), it was still about 7 percent below the national average. Thus, there still may not be enough providers to meet the needs of a region where residents report feeling mentally unhealthy about 25 percent more often than the nation as a whole, and about 15 percent more often than the rest of the state.

"There remain long waiting lists for mental-health professionals in Appalachian Kentucky and, while Appalachian women have some of the highest rates of depression, they are among the least likely to access mental health care," Fran Feltner, director of the University of Kentucky's Center for Excellence in Rural Health, said in the release.

The report also points out that the number of health-care providers, specialists and dentists are proportionally lower in the region, compared to the nation as a whole and also when compared to the rest of the state.

On the basis of population, there were 26 percent fewer primary-care physicians in the region, compared to the rest of the nation, and 21 percent fewer when compared to the state; 59 percent fewer specialists compared to the nation, and 60 percent fewer than the state; and 37 percent fewer dentists compared to the nation, and 42 percent fewer than the state.

Sunday, September 10, 2017

2017 sees a sharp drop in the number of Kentucky school districts implementing 100 percent tobacco-free school policies

By Melissa Patrick
Kentucky Health News

Only two school districts have passed 100 percent smoke-free school policies in Kentucky this year, compared to 16 in 2016, perhaps because they are waiting to see if the state will require such action.

"Sometimes when the state legislature takes things on, local officials kind of wait and see if the state's going to do it," Ellen Hahn, director of the Kentucky Center for Smoke-free Policy, said in an interview. "We've noticed that, actually, with local smoke-free ordinances, that when the state took it on, people just kind of waited. So, that could be why."

A bill in the 2016 legislative session would have required all Kentucky schools to be 100 percent tobacco-free. It passed quickly out of the Senate, but couldn't garner enough support in the House to bring it to a floor vote.

Sen. Ralph Alvarado of Winchester, who sponsored the legislation, said in an e-mail that he plans to sponsor the bill again in the upcoming session and anticipates that a similar one will be introduced in the House, where his fellow Republicans gained control this year.

"Kentucky has the worst youth smoking rate in the country," Alvarado said in an email. "With all of our current research, everyone is now keenly aware of the devastating health impacts and societal cost of tobacco use. If we hope to reduce the financial burden and promote the healthiest lifestyles for our children, it will have to begin by setting the best examples in our schools."

Almost 17 percent of Kentucky's high-school students are smokers and 23 percent of the report using electronic cigarettes, according to the Campaign for Tobacco-Free Kids. The organization also reports that 3,200 children become new daily smokers each year.

Elizabeth Anderson-Hoagland, a youth tobacco policy specialist with the state Department for Public Health, said she encourages local school districts to pass 100 percent tobacco-free school policies, regardless of what happens at the state level.

"When school districts work on tobacco-free policies at the local level, they can increase community engagement, create buy-in with parents and families, and ultimately help with policy compliance," she said in an email. "A 100% Tobacco-Free School policy is an important way for school districts to protect youth from the effects of secondhand smoke while role modeling smoke-free lifestyles."

Schools are considered 100 percent tobacco-free if they don't allow tobacco products, including vapor products and alternative nicotine products, by staff, students and visitors at any time on school owned property and during school sponsored events.

As of July 2017, just over half of Kentucky's public school students were in school districts with tobacco-free policies: 64 of the 173 districts, covering 681 Kentucky schools. Many districts still need to update their policy to meet new standards for vapor products and e-cigarettes.

Owen County just passed what looks like a 100 percent tobacco-free school policy, but it is still in the process of being verified.

"We want our community to be healthier, and if we all agree that being 100 percent tobacco-free starting in schools, where we have children who are looking at adults and sometimes doing what adults do -- that with education, hopefully, we can prevent that tobacco use from becoming an issue," Owen County Schools Director of District Wide Programs Joretta Crowe told The News-Herald of Owenton.

Most Kentuckians support such policies. According to the 2015 Kentucky Health Issues Poll, 85 percent of Kentucky adults favor tobacco-free schools.

Hoagland said the 100 Percent Tobacco Free School website offers resources for school districts interested in implementing such policies, including success stories from Warren County and Russell County.

"These success stories show that tobacco-free is possible no matter how large or small your school district," she said. "Additionally, support from your local health department will really make a difference, such as trainings for school personnel on the impact of secondhand smoke exposure to smoking cessation classes for interested staff."