Saturday, January 21, 2017

Did Medicaid expansion make people move from non-expansion states to Kentucky? A study suggests it did not

When Kentucky expanded Medicaid and Tennessee and Virginia didn't, did that prompt some people to move from Tennessee and Virginia to Kentucky? A study suggests that it did not.

There is "little to no evidence" that Medicaid expansion under the Patient Protection and Affordable Care Act in 2014 encouraged migration to expansion states from non-expansion states in that year, says the author of a study published in the Journal of Policy Analysis and Management.

"Migration from non-expansion states to expansion states, among those who I classify as being potentially Medicaid-eligible, did not increase relative to migration in the reverse direction," University of Maryland Ph.D. student Lucas Goodman said in a JPAM interview about his study. He noted that the possibility of in-migration and additional taxpayer expense "were often cited by non-expanding states as a reason why they should not expand."

Goodman said he was surprised at his finding, because "Medicaid expenditures in 2014 for the newly-eligible population averaged about $5,500, which is a large amount relative to income for the typical newly-eligible individual. Yet, individuals were apparently not willing to migrate in order to gain access to these benefits."

He added, "The big question is whether migration effects will increase in the longer term, either as individuals in non-expansion states learn about the presence of the expansion in other states or states’ expansion/non-expansion decisions appear to be more set in stone." However, the reform law and Medicaid likely to undergo major changes under President Donald Trump and the Republican Congress.

Friday, January 20, 2017

Health boards support legislative agenda to change how public health is delivered and paid for, to make Kentucky healthier

By Melissa Patrick
Kentucky Health News

At their first-ever statewide meeting, Kentucky's local boards of health voted for their state association to adopt a legislative platform aimed at modernizing the state's public health systems in order to improve Kentucky's overall health.

The "Kentucky's Public Health 3.0" plan calls for local health departments to demonstrate measurable outcomes, a supportive framework of state laws, and secure funding for all the services the law requires them to provide. The goals match the recently launched national Public Health 3.0 initiative.

During the online meeting Jan. 12, former Pendleton County judge-executive Henry Bertram, the president of the Kentucky Association of Local Boards of Health, implored board members to support the plan as a way to improve the health of Kentuckians and to better use taxpayer dollars: "We’re not spending our money correctly.”

"It's a call to action," said Bertram, who has been a member of his local health board for 16 years. He added, “The biggest voice in Kentucky for public health is the board members. . . . And I say that because many of you are elected officials that sit on those boards of health. You're county judges, you're magistrates," and medical professionals. "You've got a voice in your community.”

Bertram went on to say that while Kentucky has some excellent local health directors, "Many of us who sit on local boards of health don’t know what our responsibilities are." He said that when he became judge-executive, he didn’t even know that he was on the health board by virtue of his office.

He said it is the responsibility of health board members to fully understand why Kentucky's health is so poor and be able to explain why change is necessary.

“We’ve got to step up; we’ve got a challenge in front of us and we’ve got to hit it head-on," he said.

The plan has also been endorsed by the Kentucky Public Health Association and the Kentucky Health Department Association.

What exactly is Public Health 3.0?

Georgia Heise, health director for the Three Rivers District Health Department in Northern Kentucky, opened the meeting by stressing that Public Health 3.0 is She said PH 3.0 is a "grass-roots initiative" meant to improve the health of Kentuckians, not part of "Obamacare." She said in a telephone interview that such a false perception could cause some people, including legislators, to not even listen to the proposal.

“We have to separate population health, the health of our citizens, from politics. We have to. We cannot continue to do the same old, same old thing and expect different results," said Heise, who is also the president of the National Association of County and City Health Officials.

Graphic from Kentucky Health Departments Association presentation
Heise people must first realize that "public health is not clinical, medical care," but is grounded in prevention through population-health initiatives.

"The work that has already been done with this initiative can be explained and it can be defended and that is what we need you board of health members to help us do with our legislators," she said.

Dr. Karen DeSalvo, acting secretary for health in the U.S. Department of Health and Human Services, appeared via video recording and commended Kentucky for leading the way with this initiative. She focused her comments on the plans call for health departments to join forces with community stakeholders to address the social determinants of health, because "We know that health is more than health care. . . . Our goal is to change the conversation in this country and get every sector involved in improving health and well-being."

For example, health department officials should be included in planning and zoning meetings to make sure newly developed properties include sidewalks, said Allison Adams, director of the Buffalo Trace District Health Department and the KHDA president. Health officials should advocate for "health in all policies," she said.

Adams noted that social and economic factors, such as education, employment, income, family and social supports, and community safety, contribute to 40 percent of a typical person's health, and "none of those things happen inside the walls of the health department. . . . But it's our job to be conveners of bringing these groups that affect these health factors together and letting them know . . . decisions they make and the things they do, how that influences health and the opportunity to be healthy."

The plan also calls for public-health leaders to be the chief health strategists in their communities; encourages health departments to work toward national accreditation; and calls for increased county-level health data so they can make more informed decisions.

What state law requires each Kentucky health department to do
(Click on image to view a larger version)
At the state level, the plan calls for "enhanced and substantially modified funding" for public health. Adams said it is largely funded programmatically, but departments get "very little funding" for their statutory requirements, the things that state law requires them to do. She estimated a $40 million gap between funding and what it costs to meet the requirements.

"There’s no doubt about it, our funding needs to be modified," Adams said. "We need to figure out a way to spend $1 that affects 10 people, instead of $1 that only affects one person." But she acknowledged, "Change is never easy. There will be difficult decisions to make."

But as she described Kentucky's dismal health statistics, noting that the state ranks 45th for health, she said it's time to do something differently, because what we've been doing isn't working.

"My goal is for us across the state of Kentucky to get as angry about the fact that we are 45th in the nation as we would when our basketball teams fall out of the top 25," Adams said. "I think if we could all get angry about that, we could move mountains here in the state of Kentucky."

Wednesday, January 18, 2017

McConnell: 'If the goal was to expand Medicaid, that could have been done alone.' But he won't say what's next for it

U.S. Sen. Mitch McConnell "has a particularly thorny road" in guiding Republicans' repeal and replacement of Obamacare because of the program's success in Kentucky, David Lightman of McClatchy Newspapers writes after a 20-minute interview with the Senate majority leader.

But McConnell challenged Lightman's premise. Asked why "he would want to undo a successful program," as Lightman put it, McConnell replied, “It depends on how you define success,” and noted “higher premiums and co-payments and higher deductibles and chaos in the private health-insurance market.”

McConnell added, “If the goal was to expand Medicaid, that could have been done alone. . . . This overreach tried to turn the private health insurance market into a regulated utility.”

McConnell has declined to reveal his plans generally for health-care legislation or specifically for Medicaid, the expansion of which in Kentucky has added 440,000 people to the program and cut by more than half the number of Kentuckians without health coverage. He "will have lots more to say about this issue in the coming weeks," McConnell spokesman Robert Steurer said Jan. 10.

In state Trump won in a landslide after pledging Obamacare repeal, fewer than 1 in 5 said they feared losing coverage

By Melissa Patrick
Kentucky Health News

Fewer than one in five Kentucky adults who have health insurance were concerned about losing their coverage in the weeks after Gov. Matt Bevin proposed changes to the state's Medicaid program and Donald Trump pledged to repeal the Patient Protection and Affordable Care Act, according to the latest Kentucky Health Issues Poll.

Ninety percent of those polled Sept. 11 through Oct. 19 said they had health insurance. They were asked, "Are you concerned that you may lose your coverage within the next 12 months?"

The poll found that 80 percent weren't concerned about losing their health coverage, but responses varied with health status. Almost one-third, or 32 percent, of those who were concerned about losing their coverage said they were in fair or poor health; 11 percent of them said they were in excellent or very good health; and 20 percent said they were in good health.

"The vast majority of Kentuckians just weren't worried about having their health insurance coverage taken away, despite the debate about the potential for repealing the ACA in the months preceding the election," said former U.S. Rep. Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsors the poll. "Kentucky, like the nation, remains deeply divided on the health-care law."

Trump got 62.5 percent of Kentucky's vote. An article by Sarah Kliff and Byrd Pinkerton of Vox could help illustrate why many Kentuckians said they weren't concerned about losing their coverage. They went to Whitley County, which had a 60 percent drop in uninsured people due to the law, but is heavily Republican and gave 82 percent of its votes to Trump.

They report that "many" in Whitley County voted for Trump because they didn't believe he would "repeal a law that had done so much good for them." Those interviewed also expressed anger over increasing premiums and deductibles, fewer plan choices and a narrowing network of providers, though they had a "persistent belief that Trump would fix these problems and make Obamacare work better," with some even saying they hoped the expansion of Medicaid might include more people, "offering more of the working poor a chance at the same coverage the very poor receive."

Republicans are pursuing their promise to repeal Obamacare, with the U.S. Senate and House voting last week for a budget resolution, largely along party lines in each chamber, as the first step. Trump recently promised "insurance for everybody" but also endorsed funding Medicaid through block grants to the states and giving the states more leeway to set its rules.

The Washington Post reports that at least 18 million people would lose health insurance in the first year if Republicans repeal the ACA without a replacement plan, according to a report from the nonpartisan Congressional Budget Office. However, President-elect Trump, and others, have said they don't want to see a repeal without a replacement plan in place.

The poll also found that Kentucky adults remain divided on their opinion of the reform law, with 46 percent saying they had an unfavorable opinion of it and 40 percent saying their opinion was favorable, about the same as last year. Those figures were just outside the poll's error margin of plus or minus 2.5 percentage points.

Among the 46 percent who said the law had affected their family personally, half said it had affected them positively and half said it had affected them negatively, the same as last year.

"More than 600,000 Kentuckians have gained health coverage under the ACA, and our own research shows that it has greatly increased the use of important health measures such as cancer and dental screenings, preventive care services and substance use treatment," Chandler said. "Yet nearly half of Kentuckians continue to oppose it."

Under the law, the previous state administration expanded Medicaid to people in households earning up to 138 percent of the federal poverty line. This added about 440,000 Kentuckians, most of them in low-paying jobs that don't offer health insurance. The federal government paid the full cost through 2016, but the state is now paying 5 percent, which will rise in annual steps to the law's limit of 10 percent in 2020 unless the law is changed.

Bevin says Kentucky can't afford to pay the bill and has submitted a plan for a waiver from federal rules, to make "able-bodied adults" pay small monthly premiums depending on income and either work or volunteer to get their benefits, among other changes. It is expected to be approved.

The poll was conducted by the Institute for Policy Research at the University of Cincinnati for the foundation and Interact for Health, a Cincinnati-area health foundation. It surveyed a random sample of 1,580 Kentucky adults via landlines and cellphones.

Tuesday, January 17, 2017

Study of Ohio's Medicaid expansion: Enrollees have better health, more financial security, and say it's easier to keep or find work

By Melissa Patrick
Kentucky Health News

Ohio's Medicaid expansion enrollees say having health coverage made it easier for them to keep or find work, and most said it gave them better health and financial security.

Their experience is part of a report Ohio's legislature ordered to evaluate the impact of Gov. John Kasich's 2014 decision under federal health reform to cover those who earn up to 138 percent of the federal poverty level. Previously, only Ohioans who fell under 90 percent of the poverty line qualified for Medicaid, unless they were disabled or pregnant.

Kentucky, under then-Gov. Steve Beshear, also expanded Medicaid, from a previous threshold of 69 percent of poverty. That added 440,000 people to the program; Ohio added 702,000.

That was the main factor in reducing from 21 percent to 8 percent the share of Kentuckians without health insurance. Among low-income, working-age people, the rate dropped from 38 percent to 13 percent. The Ohio report noted that the state's uninsured rate dropped to its lowest rate ever, 14.1 percent.

Ohio's expansion enrollees "overwhelmingly reported that access to medical care had become easier since enrolling in Medicaid," with 43 percent saying they had fewer unmet health-care needs, the report said.

Group VIII is the Medicaid expansion population. Graphic is from the Ohio report.
The report also found that Medicaid expansion enrollees used hospital emergency rooms less often because they were "better integrated into the health care system." According to the report, 34 percent said they used the emergency department less often, and Medicaid claims data proved it.

Nearly half of expansion enrollees reported that their health had improved; only 3.5 percent that said their health had worsened. Just over a fourth said they had been diagnosed with at least one chronic health condition after obtaining coverage. They also showed fewer instances of high blood pressure and high cholesterol.

"Because they were able to obtain treatment for previously untreated conditions, several of the enrollees stated that they did not think they would be alive today if Medicaid expansion had not occurred," the report said.

Enrollment in Medicaid also made it easier for its participants to work and to seek work, with 75 percent of those who were unemployed but looking for work reporting that Medicaid made it easier to seek employment. And 52 percent of those who were currently employed said having Medicaid made it easier to keep working.

They also reported that having Medicaid made it easier to meet other basic needs, like food (59 percent) or paying the rent (48 percent) or to pay off other debts (44 percent). Also, the share of expansion enrollees with medical debt fell by nearly half since they enrolled in Medicaid, from 56 percent to 31 percent.

In conclusion, the report said,"These results suggest that Medicaid expansion has and will continue to improve the health of low-income Ohioans enrolled."

The assessment was independently developed and carried out by a partnership of the Ohio Colleges of Medicine Government Resource Center, The Ohio State University College of Public Health, Ohio University, and RTI International. The data in the report came from a 7,508-person telephone survey, biometric screenings, medical-records reviews, analysis of Medicaid records, and interviews with Medicaid enrollees and stakeholders.

Sunday, January 15, 2017

Health officials say flu is widespread, urge a vaccination

Photo illustration: affiniahealthcare.org
The state Department for Public Health has raised the state's influenza level from "regional" to "widespread," the highest level of flu activity. The widespread level indicates increased outbreaks or flu symptoms in at least half of the state's regions.

The flu virus can cause fever, headache, cough, sore throat, runny nose, sneezing and body aches and can be extremely contagious.

"With widespread flu activity reported in Kentucky, now is a good time to protect yourself and your family by getting a flu shot," Dr. Hiram Polk, public health commissioner, said in a news release. "We urge anyone who hasn’t received a flu vaccine, particularly those at high risk for complications related to the flu, to check with local health departments or other providers."

The federal Centers for Disease Control and Prevention recommends the flu vaccine for everyone six months of age and older. The CDC strongly encourages certain high-risk groups to get vaccination, including children age 6 months to 5 years and their caregivers, women who are or might be pregnant during flu season, people age 50 and older and their caregivers, obese people, those with chronic health problems, residents of long-term care facilities and health care workers.

Vaccinations can be given at any time during flu season, according to DPH. Flu activity levels are tracked weekly as part of the CDC's nationwide flu surveillance system.

"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," Vickie Yates Brown Glisson, secretary of the Cabinet for Health and Family Services, said in a news release.

For more information on the state's flu levels and what they mean, click here.

Supporters of Obamacare rally in Ky. and protest repeal plans

"The event was billed as a public forum on the consequences of repealing the [Patient Protection and] Affordable Care Act and Kentucky Medicaid expansion. But at times it seemed more like a political rally," Andrew Wolfson reports for The Courier-Journal. "Several hundred people turned out for the session hosted by U.S. Rep. John Yarmuth, D-Louisville, at the Louisville Central Community Center." Protests were also held in Lexington and around the nation, WKYT-TV reports.

State Rep. Attica Scott, state Sen. Morgan McGarvey and U.S.
Rep. John Yarmuth (Courier-Journal photo by Marty Pearl)
State Rep. Darryl Owens, D-Louisville, claimed President-elect Donald Trump is “hell-bent on destroying the lives of Kentuckians and Americans,” and state Rep. Jim Wayne, "another Democrat who has worked 40 years as a psychotherapist, went further, describing the soon-to-be president as 'evil' for vowing to repeal the Affordable Care Act and return to a competitive system for health care that 'didn’t maintain our country’s health'," Wolfson reports. "Yarmuth said Republicans want to dismember the law that has provided health care to 22 million Americans without offering any details on how they will replace it."

“They say they want a free market system, which sounds to me ominously like what we had before the Affordable Care Act – when insurance companies decided who lived and who died,” Yarmuth said. Wolfson notes, "Critics of the Affordable Care Act say it is too expensive and that the requirement to get coverage is an intrusion on individual liberty."

Yarmuth said he expects federal officials to approve the Medicaid waiver requested by Republican Gov. Matt Bevin, which would charge small premiums based on income and the require work, school or similar activities by able-bodied adults who aren't primary caregivers.

The future of the Medicaid expansion, and the rest of the law, are in doubt because there has been no agreement on a plan to replace the law but retain certain core elements such as coverage of pre-existing conditions, which Trump has said he wants to keep. Experts say that requires a mandate to buy insurance, a provision Republicans don't like.

"Speakers beseeched Trump and Republican leaders to replace the law immediately and to keep the features that Yarmuth said provide 'health security' for all Americans," Wolfson reports.

Drug-addicted babies more than twice as likely in Kentucky as in rest of nation, but few facilities accept addicted pregnant women

Amy Kalber of Louisville strokes her infant son, Marty Barkley,
in a family gathering. Her first two children were born addicted,
but the last two were born healthy during her recovery, described
by The Courier-Journal's Laura Ungar (C-J photo: Sam Upshaw)
A baby born in Kentucky is more than twice as likely to be addicted as a typical baby born elsewhere in the United States.

In 2013, the last year for which comparative figures are available, Kentucky had 15.1 cases of addiction per 1,000 live births; the national rate was 7.3, according to a research letter in the journal JAMA Pediatrics.

"Both were up substantially from five years earlier, and Kentucky’s rate jumped another 40 percent the following year," reports Laura Ungar of The Courier-Journal.

“We have mothers who are addicted throughout pregnancy and their addiction is more or less passed down to their babies,” researcher Joshua Brown, of the Institute for Pharmaceutical Outcomes and Policy at the University of Kentucky, told Ungar. “The trend just keeps going up and up and up.”

Addicted babies are one product of the state's issues with drugs, legal and illegal. “We’ve had one of the country’s worst prescription drug problems,” institute director Jeffrey Talbert told Ungar. “We need more treatment providers and more access to care.”

Especially for addicted mothers or mothers-to-be: "Only 30 of the 123 substance-abuse treatment facilities in Kentucky accept pregnant or post-partum women," Ungar reports. "Only eight are long-term residential programs."

"There are signs of progress," Ungar reports. "In 2015, Kentucky became one of 11 states to receive up to $3 million in federal grants to provide expanded treatment to pregnant addicts. That was in addition to $1 million in state funds for transitional care and other services that came from an appropriation in the anti-heroin bill passed that year. And on Wednesday, state officials announced they will apply for up to $10 million in federal ... funding to fight the opioid epidemic, and one of their priorities if they get it will be to help pregnant addicts."

A law co-sponsored by Senate Majority Leader Mitch McConnell of Kentucky "calls for, among other things, spreading proven practices to prevent and treat maternal opioid abuse and recommendations for treating drug-dependent infants," Ungar notes

U.S. Sen. Rand Paul suggests that if Kentucky wants to keep its Medicaid expansion, it should raise taxes to pay for it

U.S. Sen. Rand Paul suggested Sunday that Kentucky and other states that expanded Medicaid under federal health reform should have to raise taxes to keep it expanded and not rely on the federal government to continue the benefit.

Paul appeared on CNN's "State of the Union" to discuss his plan for replacing the law, which he said should be replaced the same day it is repealed. "Paul's plan did not directly address the future of states that signed on for expanded Medicaid offered as part of Obamacare," Gregory Kreig reports for CNN.

"That's the big question," Paul told host Jake Tapper. "And I don't think that's going to be in the replacement aspect."



He added, according to The Hill, "If Kentucky or Tennessee or Ohio wants to expand Medicaid, and they say, 'You have a lot of people struggling,' we're willing to help them, that's fine. . . . But we have no money in Washington. . . . So I'd say that if you want to have more Medicaid you should say we're going to have to have higher taxes to pay for it."

Those taxes could be considerable. Under the law, federal funds covered all the expansion cost through 2016. States are now paying 5 percent, and the law calls for that will rise in annual steps to its limit of 10 percent in 2020. Kentucky's share for 2017 and the first half of 2018 is estimated at $257 million.

The expansion covers people in households with incomes up to 138 percent of the federal poverty level (about $33,000 a year for a family of four). It added about 44,000 Kentuckians to the program and was largely responsible for cutting by more than half the percentage of Kentuckians without health insurance.

A spokesman for Senate Majority Leader Mitch McConnell, Kentucky's other senator, asked to reveal McConnell's plans for the Medicaid expansion, said in an email, "Sen. McConnell will have lots more to say about this issue in the coming weeks."

Paul said his replacement plan would allow health-insurance companies to offer cheaper plans with less coverage. "We're going to legalize the sale of inexpensive insurance," he said. "That means getting rid of the Obamacare mandates on what you can buy. We are going to help people save through health savings accounts, as well as a tax credit."

"Under Paul's program, the bargaining power created by the state and federal exchanges would be replaced with a provision that allows individuals and associations like small businesses to create their own markets," Kreig reports. "He added that those negotiations with insurance companies could also be used to guarantee the availability of policies that "can't cancel you and guarantees the issue of the insurance even if you get sick."

Paul told Tapper, "Our goal is to insure the most amount of people, give access to the most amount of people, at least the amount of cost."

However, Paul is just one of 100 senators, and President-elect Donald Trump says he has he own plan, which will have "insurance for everybody." Kreig notes, "Republicans have been at loggerheads over the timing and execution of their promise to repeal Obamacare and replace it with a cheaper alternative that will not disrupt the insurance market and leave millions of Americans without coverage."

Saturday, January 14, 2017

Massie joins Paul in voting against bill to start Obamacare repeal; McConnell won't say what he has in mind for Medicaid expansion

Kentucky Health News

One Kentucky congressman was among the nine House Republicans who voted against a budget resolution that is the new Congress's first step toward repealing the Patient Protection and Affordable Care Act.

Massie (Breitbart.com photo)
Rep. Thomas Massie of Vanceburg "said he voted against the budget resolution because of the estimated $9.7 trillion it would add to the national debt," Lindsey McPherson reports for The Hill. "He said his fiscal conservative colleagues who voted 'yes' because they only saw the budget as a vehicle to get to Obamacare repeal will regret it."

"We got a Category 5 hurricane coming when you have to reduce to practice the differences between Donald Trump’s agenda and [House Speaker] Paul Ryan’s agenda," he said. "I think there are going to be some very confusing votes in here.”

The resolution passed 227-198, with all Democrats opposed. The Republicans against it were "a mixed bag," The Hill reports: "four members of the moderate Tuesday Group --  Charlie Dent and Brian Fitzpatrick of Pennsylvania, John Katko of New York and Tom MacArthur of New Jersey, and two members of the hard-right House Freedom Caucus, Justin Amash of Michigan and Raul Labrador of Idaho." The others were Massie, North Carolina Rep. Walter B. Jones and California Rep. Tom McClintock, "all of whom are conservatives but not members of the Freedom Caucus."

When the session opened with the vote for speaker, Massie was the only member who voted for Amash, who is chair of their libertarian-oriented Liberty Caucus. Amash called the resolution "the worst budget we've had since I've been in Congress. . . .  We can put together a good budget and also repeal Obamacare."

The resolution is not binding but provides a vehicle for Senate Majority Leader Mitch McConnell to prevent a Democratic filibuster against repealing parts of the health-reform law that relate to spending and taxes. It takes 60 votes to stop a filibuster and Republicans have 52 senators.

Massie, Amash and Paul (Photo via imgdex.com)
Sen. Rand Paul, R-Ky., was the only Republican senator to vote against the resolution, citing concerns similar to Massie's and saying it would add $9.7 trillion to the national debt over the next decade. He unsuccessfully pressed the House Freedom Caucus to stand against it.

After that meeting, Massie challenged Republican leaders' argument that the resolution is merely a vehicle to repeal Obamacare: “If they want to tell us these are pretend numbers, then why do your pretend numbers not even balance?”

Massie told Bridget Bowman of Roll Call that the episode showed why he opposes Ryan and other leaders. “We’re given a lose-lose proposition,” he said. “You either vote to keep Obamacare or you vote to add $10 trillion to the budget when in fact it would be so easy to have a conservative budget that repeals Obamacare.”

Mike DeBonis of The Washington Post writes, "It will now only get harder for Republicans," DeBonis writes. "They must assemble a viable replacement for a law that has expanded health insurance coverage to roughly 20 million Americans and eliminated unpopular insurance industry practices, such as lifetime coverage caps and widespread refusal to cover already-sick individuals. Republican leaders have instead focused on the Affordable Care Act’s flaws — rising premiums for plans sold in state marketplaces, high deductibles and burdensome taxes. GOP lawmakers are set to gather in Philadelphia later this month to hash out a more complete alternative."

Several senators from states that expanded the Medicaid program with federal money through the reform law want to see its replacement before voting on the repeal. Kentucky is one of the states that has benefited most from the law, adding more than 400,000 people to Medicaid and cutting by more than half the percentage of Kentuckians without health insurance.

McConnell, in a news release after the Senate vote, mentioned various problems with private insurance under Obamacare but said nothing about Medicaid. Asked what he plans to do with the Medicaid expansion, his spokesman, Robert Steurer, replied via email, "Sen. McConnell will have lots more to say about this issue in the coming weeks."

Ky. has 25 approved syringe exchanges to reduce risk of HIV and hepatitis C outbreaks; other counties debate proposals

By Melissa Patrick
Kentucky Health News

A minister, a nurse and a physician assistant joined forces in Powell County to educate its citizens about a syringe-exchange program, which should open up this month -- but the decision to support an exchange didn't come easily for any of them, Mary Meehan reports for Ohio Valley ReSource, a regional journalism collaborative of public broadcasters.

Van Ingram, executive director of the Kentucky Office of Drug Control Policy, told Meehan that rural counties like Powell are leading the way in changing the perception of how addiction is perceived in the state, shifting the focus toward treatment and public health initiatives and away from the criminal justice system. So far, syringe exchanges have been approved in 25 of the state's 120 counties; several others are having debates like the one that went on in Powell County.

Pastor Brad Epperson of the Clay City First Church of God, who also drives a school bus, told Meehan that the many funerals he has officiated for people too young to die, and the stories he hears from the children on his bus, made him realize that something had to change. He now considers syringe exchanges the first place for addicts to get the help they need.

Nurse Mandy Watson
(Photo by Mary Meehan)
Mandy Watson, a nurse for the Powell County Board of Health, told Meehan that she changed her mind about syringe exchanges after realizing what an HIV or hepatitis C outbreak could do to the community.

The federal Centers for Disease Control and Prevention ranks Powell County 15th in the U.S. for risk of an HIV or hepatitis C outbreak from IV drug use, and the county borders Wolfe County, which is ranked No. 1 in the nation.

"Almost anybody you ask has some kind of family member who does use or (has) some type of trouble with addiction," Watson said of the county, where 13,000 people live.

Physician assistant Troy Brooks, who is on the county health board, initially opposed a syringe exchange. "He said it seemed like a way to let addicts keep using their drug of choice without consequence," Meehan reports. But then local police showed him how bad the problems is by taking him to the Clay City playground, where they collected 41 dirty needles, and he saw the need to protect children and first responders.

The state legislature authorized syringe exchanges in the 2015 anti-heroin bill, but in an effort to decrease the spread of HIV and hepatitis C, which are commonly spread by the sharing of needles among intravenous drug users. They require both local approval and funding.

Six of the 25 syringe exchanges approved so far aren't operational yet. Thirteen are in counties deemed most vulnerable counties by the CDC, which identified 54 Kentucky counties as among the 220 most vulnerable in the nation to a rapid spread of HIV and hepatitis C infection among persons who inject drugs. Sixteen of the state's counties ranked in the nation's top 25.

Cabinet for Health and Family Services map; updates at http://chfs.ky.gov/dph/epi/HIVAIDS/prevention.htm
The Madison County Board of Health supports a syringe exchange, but was met with "mixed feelings" about the program at the August fiscal court meeting, with some members concerned that the program condoned intravenous drug use, Ricki Barker reports for The Richmond Register.

The county will host several forums to educate local citizens about the cost and benefits of the program and answer any questions that the public may have about it. Health officials told Barker that the department sees about eight to 10 patients a day with hepatitis C.

Woodford County has received a $6,860 grant from the Kentucky Agency for Substance Abuse Policy that will be used to seed a syringe exchange program if approved by the local governments.

Securing a needle exchange in Northern Kentucky continues to depend on what Campbell County decides to do, Chris Mayhew reports for Cincinnati.com.

The Northern Kentucky Health Department wants to put a needle exchange program in the Campbell County Health Center in Newport, but Newport hasn't yet approved an exchange, despite a strong push from health officials since 2015 to do so. Mayor Jerry Rex Peluso, who supports an exchange, told Mayhew that the four city commissioners remain divided on this issue.

Intravenous drug use is so bad in Northern Kentucky that the health department created a "story map" to utilize "big data" to help combat the heroin epidemic in the area, noting that one person in Northern Kentucky died from a drug overdose every 40 hours last year. The map shows the areas with the highest number of opioid-related arrests since 2011, opioid related medical runs and where naloxone was administered; where you can get naloxone, among other things, Jay Warren reports for WCPO-TV in Cincinnati.

Several exchanges are newly approved or just getting started

Boyle and Whitley counties started their syringe exchanges Jan. 13.

Boyle County's program is open 1 to 3 p.m. Fridays in the basement of the health department in Danville, Kerry Steinhofer reports for The Advocate-Messenger. The program is initially being funded by a $20,000 ASAP grant, which will pay for supplies, but not salaries. Health officials said the hope is that the city and county will eventually fund the program.

Whitley County's exchange is open from 2 to 4 p.m. Fridays at the health department's main office in Williamsburg. Whitley County is ranked the 14th most vulnerable county in the nation for a rapid outbreak of HIV or hepatitis C infections, Mark White reports for the News Journal, the local weekly newspaper.

“Needle exchanges are the only thing they have shown that truly decreases hepatitis. Hepatitis C has become the number one killer in the state,” Public Health Director Martha Steele told White.

Mike James of The Daily Independent in Ashland reports that Greenup County recently approved a syringe exchange. The program will cost about $8,000 per year, including materials and will be funded by the local health department and a grant from Pathways Inc., a behavioral-health nonprofit. The program will be operated out of the health department one day a week for three hours a day. James reports that "users also will get counseling from a Pathways Inc. professional."

Floyd County will also begin offering its program in January as well, Andrea Saddler reports for The Floyd County Times. The county health department is conducting a survey to determine the best day to operate its exchange.

Nelson County approved its program in December, but it's not operating yet, Jim Brooks reports for the Nelson County Gazette. This exchange will be one-for-one and will be funded by the health department.

Warren County's excahnge opened in September and reports that it is off to a good start, seeing about a dozen people each week, Alyssa Harvey reports for the Bowling Green Daily News. It is open Thursdays from noon to 4 p.m. at the Barren River District Health Department.

Brad Stacy of The Morehead News reports that "the city, county and board of health approved a harm-reduction program that focuses on limiting the risks and harms associated with unsafe drug use, including needle exchange" after a standing-room-only crowd at a community forum discussed the heroin problem in the county.

Click here for a list of operating needle exchanges and their hours of operation.

Louisville's program grows, make case against one-for-one rule

The Louisville syringe exchange opened its fourth location in December at the Redeemer Lutheran Church in the Shawnee neighborhood. It will be open every Tuesday from 9 a.m. to noon, Joe Sonka reports for Insider Louisville.

"Statistics provided to Insider Louisville by the city health department show that from the program’s inception through the end of this October, a total of 5,347 individual clients have received 454,989 free syringes, with 267,746 used syringes returned," Sonka reports. He also notes that 295 clients in the exchange have been referred to drug treatment programs, two have tested positive for HIV and 182 have tested positive for hepatitis C.

Sonka reports that Louisville's exchange is the only one in Kentucky that uses a needs-based model, which is considered best practice by leading health experts to prevent the spread of disease. Other programs in the state place some limits or follow a one-for-one policy, as the state is requiring for exchanges that get state grants.

Stat, the science-and-medicine supplement to The Boston Globe, reports, "Needle exchanges, once met with fierce resistance, are working" and notes that public-health experts say that one of the challenges in decreasing infections is "that exchanges do not provide as many clean syringes as people who use drugs need."

Friday, January 13, 2017

Jan. 31 is last day to sign up for insurance on HealthCare.gov if you didn't have a 2016 health plan on Kynect; March 1 if you did

By Melissa Patrick
Kentucky Health News

Jan. 31 is the deadline for Kentuckians who did not have health insurance through Kynect last year to sign up for health insurance through the federal exchange, now being used for enrollment instead of Kynect. If you do not have health insurance, you face a steep penalty when it comes time to file your tax returns.

Kentuckians who had a health insurance plan through Kynect in 2016, with coverage ending Dec. 31, have been granted an extension and can sign up on HealthCare.gov until March 1, with coverage beginning April 1. In order to qualify for the extension, applicants must check the "loss of qualifying coverage" box on the HealthCare.gov application, and provide the last date of coverage.

This is the first year Kentuckians have signed up for health insurance on the federal exchange. Gov. Matt Bevin largely dismantled Kynect prior to the 2017 enrollment period, calling it redundant, but it still has a website that can be used to find insurance agents or application assisters, formerly called Kynectors.

The Cabinet for Health and Family Services told Kentucky Health News in October that application assisters were available in every county to help people sign up for coverage.

You can find an assister in your area by clicking on the "kynectors/Application Assisters" tab on the Kynect site or calling Kynect's call center (855-459-6328), which is also available to help you sign up for coverage. The HealthCare.gov customer service call center (800-318-2596) can also help and is open 24 hours a day, seven days a week.

The Patient Protection and Affordable Care Act requires most people to have health insurance, or pay a penalty. For 2017, the penalty for not having health insurance is 2.5 percent of your income or $695 per adult and $347.50 per child, with a maximum of $2,085 per household, whichever is higher.

There are a few exemptions, including:certain hardships, membership in some groups, some life-changing events, incarceration, if health coverage is considered unaffordable, or if household income is below the threshold for filing a tax return, according to HealthCare.gov.

If you miss the deadlines, the only way to buy health insurance on the federal exchange is if you have a major life event, like marriage or a change of employment. Those who qualify for Medicaid can apply year round.

Kentucky had 70,542 people sign up for individual health plans on the federal exchange during the regular 2017 open enrollment period, which ran Nov. 1 through Dec. 31, according to the Centers for Medicare & Medicaid Services.

Last year at the same time, 68,319 Kentuckians had signed up for private plans through Kynect. Overall, around 82,000 people were enrolled in private plans in Kentucky last year, according to the Cabinet for Health and Family Services.

A separate CMS report said that between Nov. 1 and Christmas, 78 percent of the 67,915 Kentuckians who had signed up for coverage on the federal exchange received a tax credit to help pay for their policy, and the average credit was $275.