Saturday, August 29, 2015

Beshear keeps up defense of Obamacare, McConnell gives only a short rebuttal at State Fair breakfast

Democratic Gov. Steve Beshear and Republican U.S. Sen. Mitch McConnell traded views on health-care reform at the Kentucky Farm Bureau's country-ham breakfast at the Kentucky State Fair, but McConnell made much less of the issue than he had in previous years.

"The governor and I have debated Obamacare at this breakfast the last two or three years," McConnell said, well into his 11-minute speech, which followed Beshear's. "I’ll spare you my rebuttal other than to say higher premiums, higher co-payments, higher deductibles, lost jobs and a big bill coming to state government for Medicaid expansion in a couple of years."

Earlier, Beshear won applause from Thursday's crowd of 1,500 when he pointed out that the share of Kentuckians has been reduced by 56 percent through "our aggressive embrace of federal health reform." He added, "And we’ve done so without jeopardizing our budget. Oh, I know, I know the political rhetoric you hear from health-reform opponents who say it’s costing us thousands of jobs and we’re gonna bankrupt our state. Well, as I’ve said a lot of times, everybody is entitled to their own opinion but nobody is entitled to their own facts."

Beshear cited the state-funded study by Deloitte Consulting, which found that "Kentucky actually created 12,000 new jobs in the first full year of health-care reform, and it’s predicted to create over 40,000 new jobs by 2021." Those figures do not reflect job losses at hospitals, which blame Medicaid managed-care companies and health reform for layoffs.

"Instead of bankrupting our state, Deloitte’s report predicts a positive 820-million-dollar impact over eight years on state and local governments," Beshear said. That prediction is based on the belief that the Medicaid expansion is increasing health-care payrolls and generating more tax revenue; in 2021, the last year for which Deloitte made predictions, it said the expansion would cost more than it brings in.

Beshear expanded Medicaid eligibility to households with incomes up to 138 percent of the federal poverty level. The federal government is paying the entire cost of the newly eligible through 2016; in 2017 states will begin paying 5 percent of that cost, rising in steps to the law's limit of 10 percent in 2020.

Defending his decision, Beshear said, "There is a direct line from poor health to almost every challenge that Kentucky faces: whether that's poverty, unemployment, lags in educational attainment, substance abuse or crime. Our aggressive embrace of federal health reform has brought health-care coverage to over a half a million more Kentuckians, including many farm families."

Alluding to the Nov. 3 election that will choose his successor, Beshear said, "There is no doubt that we are headed in the right direction at a very rapid pace. And we need to accelerate that momentum, for all of our sakes, instead of going back to the Dark Ages. Now, some people refused to acknowledges these accomplishments, or they try to put partisan spin on them. As we know this is the silly season, campaign season, and some people can’t help themselves. But the fact is, Kentucky is back."

(McConnell, Beshear and Louisville Mayor Greg Fischer agreed on at least one thing: Agriculture Commissioner James Comer, who lost the Republican gubernatorial primary by 83 votes to Matt Bevin, has done a great job. "You inherited a mess, and you cleaned it up, and you ran an outstanding department," McConnell said.)

In his weekly commentary the next day, Beshear noted the big increase in preventive screenings of Medicaid clients: "No longer are their medical choices limited to emergency-room or charity medical visits."

Friday, August 28, 2015

Republican senator suggests expanding Kynect to other states to help pay state's coming share of Medicaid expansion

By Melissa Patrick
Kentucky Health News

While the Republican nominee for governor says he would dismantle the state health-insurance exchange branded as Kynect, a GOP senator is talking about not only keeping it, but expanding it to other states to pay for the other big feature of federal health reform: expanded Medicaid.

Sen. Ralph Alvarado of Winchester made the suggestion at a legislative committee meeting where Kynect Director Carrie Banahan said it would be "disastrous" to move Kentuckians to the federal Obamacare exchange, as Republican gubernatorial nominee Matt Bevin has said he will do if elected.

Sen. Ralph Alvarado
Alvarado, a physician, said his concerns about Obamacare in Kentucky are mostly monetary because the state will have to start paying 5 percent of the Medicaid expansion costs in 2017, rising to the reform law's limit of 10 percent in 2020.

"We are looking at about a little over one billion dollars to find between 2017 and 2021, and we are going to have to find a way to pay for that," Alvarado said, noting that around $250 million will be needed in the two-year budget that begins July 1, 2016. "I'd like to find a way that we are going to pay for that."

Democratic Gov. Steve Beshear, who expanded the Medicaid eligbility ceiling to 138 percent of the federal poverty level, cites the prediction in a state-funded study by Deloitte Consulting that the expansion will add a net $820 million to the budget through 2021 by adding more patients to the health-care system, generating jobs and tax revenue. Republicans remain skeptical.

Alvarado suggested that Kynect become a regional exchange and charge other states for its services, using the profit to pay for the expansion.

"There are states that want a good state exchange, but haven't been able to run one. And there are several that are about to expand Medicaid and are looking at the federal exchange," he said. "So my thought was, why not approach those states that are going to expand Medicaid, offer to do the same services that a federal exchange would do, and run the exchange for them for a fee?"

Alvarado said that he is "not a supporter of Obamacare" or the way Beshear implemented it without legislative involvement, but "The Supreme Court has made its decision, it is going to be here," so he said that as a member of the Senate and its budget committee, he would offer his concept and move forward.

"I've been encouraged that there has been bipartisan approval of all this so far," Alvarado said. "I haven't had anyone say, that is a bad idea." He said Beshear Chief of Staff Larry Bond had called it a "novel idea."

Banahan said of the idea, "It took lots of planning and discussion for us to create this state-based exchange and to determine whether we should embark on creating a regional exchange is not as simple as it seems. It is not something we could move on quickly." There are no regional exchanges, but the law provides for them.

Rep. David Watkins, D-Henderson, said, "I think that his proposition surely should be looked at, but I think it would be looked at much more favorably in the context of our new governor intending to keep Kynect, rather than dismantling it."

Alvarado raised the idea at the Thursday, Aug. 27 meeting of the Budget Review Subcommittee on Human Resources, where Banahan, executive director of the Kentucky Health Benefit Exchange, gave a presentation.

Her advice: "Do not dismantle Kynect. We have one of the best exchanges in the nation. We have received all kinds of awards. Other states seek our advice. Even the federal exchange calls us for advice. Other states are utilizing or want to utilize our IT code . . . and we are self-sustaining. It would be disastrous for Kentuckians if we moved to the federal exchange."

Understanding Kynect

Under the Patient Protection and Affordable Care Act, states were given the choice of joining the federal exchange, creating a state-based exchange or using hybrid options to create an online marketplace to shop for health insurance.

Kentucky chose to create its own exchange on the advice of hospitals, insurance companies and other business interests, Banahan told the panel. "Kynect is an exchange built by Kentuckians, for Kentuckians," she said in a telephone interview. "Kynect was developed with a wide range of stakeholders. Early on we engaged advocates, insurers, agents, health care providers and businesses, and with their input, tailored our exchange to meet their needs."

Banahan's presentation described the federal exchange as generic and inflexible, and Kynect as tailored and flexible. "With a federal exchange, it's a one size fits all approach with no flexibility," she said.

She noted that because of Kynect's autonomy, "We are able to customize for Kentuckians our website and system functionalities, our outreach and education programs, (our) marketing (and our) call-center services.

"As a federal exchange, Kentucky would lose its authority and control to make decisions that impact Kentuckians. . . . Once you lose your authority and control you lose the ability to be informed about what is going on. We would also no longer be unable to intervene or assist individuals and insurers with enrollment problems or issues."

Banahan also noted that funding for kynectors, people who help individuals learn about their health-insurance options, would be reduced by 75 percent if Kentucky moved to the federal exchange. Kynectors held more than 3,000 enrollment, education and outreach events in 2014, she said.

"We don't believe they would provide the statewide services that we have today," Banahan said. With the state based exchange, "We have kynectors in all 120 counties."

Banahan said both agents and insurers are happy with Kynect, and the unique "dashboard" that it offers agents has helped them grow their business by 30 percent -- and the eight insurers that have signed up with Kynect in 2016 have said they would not follow Kentucky to the federal exchange.

Show us the money

Federal money helped start Kynect, but the exchange was set up to be self-sustaining, and is now funded entirely through a 1 percent assessment on insurance policies that the companies pass on to customers. The federal exchange charges a 3.5 percent assessment.

Kynect's budget for the current fiscal year is $26.9 million, according to the presentation.

Banahan said no state has dismantled a "working and successful" exchange, but four failed ones were decommissioned at costs ranging from $5 million to $22 million.

"While the total cost of dismantling Kynect is unknown, vendors have projected that it will cost $23 million for IT work alone, Banahan said. "Once we started to decommission Kynect, we believe that cost would be significantly higher."

Alvarado said he was disappointed that Banahan's presentation didn't include information about what it would cost Kentucky annually to participate in the federal exchange, because he had requested that information when he called the meeting.

"For the second time, they could not provide me an answer to that," he said, referring to the Joint Health and Welfare Committee meeting in July, when he said he had pushed Beth Jurek, executive director of the Cabinet for Health and Family Services' budget and policy office, for the same information.

Asked if she had this information, Banahan said, "The governor made an early decision to establish the state exchange; therefore, we did not develop any cost for the federal exchange." She added later, "We never contemplated that we would be part of the federal exchange so we never developed any type of cost, so those numbers aren't available."

Non-profit hospitals in Flemingsburg and Horse Cave become part of larger groups in order to stay open

Two more rural Kentucky hospitals, Caverna Memorial Hospital in Horse Cave and Fleming County Hospital in Flemingsburg, are merging with larger hospital groups in an effort to make ends meet.

“Significant regulatory changes brought about by the Affordable Care Act and payment reform at the federal and state level make it increasingly difficult for small rural hospitals to remain independent,” Caverna CEO Alan Alexander said in a news release.

In a merger expected to be complete by year's end, not-for-profit Caverna will join not-for-profit Commonwealth Health Corp., the parent company of The Medical Center at Bowling Green and will change its name to The Medical Center at Caverna, Alyssa Harvey reports for the Bowling Green Daily News.

Commonwealth will then operate five acute-care hospitals in Southern Kentucky, including The Medical Center at Franklin, The Medical Center at Scottsville and the Commonwealth Regional Specialty Hospital in Bowling Green.

Caverna, a 25-bed, critical-access hospital, was named one of 15 rural hospitals in "poor financial health" by State Auditor Adam Edelen in a report last year.

The report said rural hospitals struggle with high administrative costs associated with Medicaid managed care, higher-than-average penalties from Medicare for readmitting patients within 30 days, managed-care policies related to emergency room visits that often didn't cover the cost of care, and ongoing complaints of slow, low or denied payments from the managed-care organizations.

MCOs in Kentucky signed new contracts with the state this year that addressed many of these issues, but these new contracts only went into effect July 1.

Edelen's report said that to survive, some hospitals would have to change their business models, and merging with larger hospitals could be an option.

Rural hospitals in Nicholas and Fulton counties have closed in the last year.

"I see it as a trend. The industry is going through some very rapid and massive changes," Alan Palmer, director of marketing at TriStar Greenview Regional Hospital, told Harvey for a separate article. "A lot of pressures are being put on smaller or rural facilities. It's a matter of survival and these smaller communities believe they deserve to have a health care facility in their communities."

Palmer noted that HCA, Greenview's parent company, has a spinoff company called LifePoint Health that owns rural hospitals.

LifePoint announced earlier this month that it had acquired Fleming County Hospital, which had been listed in "fair financial health" in Edelen's report.

Fleming County Judge-Executive Larry Foxworthy, who sits on the hospital board as a non-voting member, told Christy Hoots of The Ledger Independent in Maysville that the facility had struggled since it was built in 2008.

"Reserves are down," Foxworthy said. "Unless something is done, the hospital may go bankrupt. We don't want to see that happen. We need to make sure the hospital stays open and has a presence in Fleming County."

LifePoint owns nine other Kentucky hospitals: Bluegrass Community Hospital in Versailles; Bourbon Community Hospital in Paris; Clark Regional Medical Center in Winchester; Georgetown Community Hospital in Georgetown; Jackson Purchase Medical Center in Mayfield; Lake Cumberland Regional Hospital in Somerset; Logan Memorial Hospital in Russellville; Meadowview Regional Medical Center in Maysville; and Spring View Hospital in Lebanon.

The Daily News reported that T.J. Samson Community Hospital in Glasgow, a nonprofit that has chosen to not merge with a larger hospital, has cut between 39 and 49 employees and made salary adjustments in all departments in 2014. It also offered about 45 employees early retirement, of which about 24 people, including then-CEO Bill Kindred, accepted.

Thursday, August 27, 2015

Health care industry ranks first, by far, in legislative lobbying since '93; insurance second, tobacco third; drugmakers' rank a mystery

By far, health-care interests have spent the most on lobbying the General Assembly since the Legislative Ethics Commission was created 22 years ago, Jonathan Meador of Insider Louisville discovered among many other things as he crunched the data filed by lobbying interests over the years.

"The most dominant industries in Kentucky in terms of lobbying dollars have been, by far, the health care and health insurance sectors, comprised primarily of for-profit HMOs and to a lesser extent hospitals, many of which are listed in their own category within the larger dataset," Meador reports.

Health care accounted for almost 23 percent of lobbying expenses categorized by Meador, while insurance totaled 11 percent. Tobacco, the cause of many of Kentucky's health problems, ranked third, just behind insurance. Most of the tobacco lobbying in Kentucky is done by Altria Group, parent firm of Philip Morris Cos., makers of Marlboro and other cigarettes. It has lobbied against a statewide smoking ban with the help of the Kentucky Farm Bureau Federation, a big insurance interest.

One other major category, "pharmaceutical issues," made the Insider Louisville pie chart, at 6.8 percent. It would have been much larger had it included advertising by the Consumer Healthcare Products Association, which ran radio ads before and during legislative sessions encouraging listeners to ask legislators to vote against bills to limit the sales of pseudoephedrine, a key ingredient in making methamphetamine. At the time, such advertising did not have to be reported; now it does.

Meador notes that the "nonprofit" designation "can include everything from conservative anti-abortion groups to the progressive Kentuckians for the Commonwealth, and even well-heeled professional membership organizations like the Kentucky Medical Association." While KMA is a health-care organization, doctors and health-care businesses don't always agree on issues.

Meador also notes that "Chamber of Commerce" in the chart includes local chambers as well as the Kentucky Chamber of Commerce, which usually spends more than any other particular lobbying organization. The figures do not include lobbying of the executive branch, which is monitored by the Executive Branch Ethics Commission.

Study finds that teens who use e-cigarettes are more than twice as likely as non-using teens to start smoking tobacco products

Teens who use electronic cigarettes may be more than twice as likely to start smoking tobacco than those who have never used the devices, according to a study at the University of Southern California.

“Recreational e-cigarette use is becoming increasingly popular among teens who have never smoked tobacco," Adam M. Leventhal, lead author of the study, said in a news release. "Adolescents who enjoy the experience of inhaling nicotine via e-cigarettes could be more apt to experiment with other nicotine products, including smokeable tobacco.”

E-cigarettes are battery-powered devices that deliver nicotine through a vapor by heating a solution of propylene glycol or vegetable glycerin, flavoring and other additives.

The study, published in the Journal of the American Medical Association, followed a group of about 2,500 Los Angeles ninth graders at 10 public high schools and surveyed them about their tobacco and e-cigarette use three times in a year. At the start of the study, 222 of the students had used e-cigs, but not traditional cigarettes, and 2,308 had smoked neither.

The study found that e-cigarette users were almost four times more likely than those who had never tried them to have smoked combustible tobaccos, such as cigarettes, cigars and hookahs, within six months (30.7 percent vs 8.1 percent, respectively) and more than twice as likely in 12 months (25.2 percent vs 9.3 percent, respectively).

The findings are important because teen e-cigarette use tripled between 2013 to 2014, surpassing teen use of all tobacco products. Nationwide, 13.4 percent of high-school students reported smoking e-cigs and 3.9 percent of middle-school students in 2014, according to a report by the Centers for Disease Control and Prevention.

“While teen tobacco use has fallen in recent years, this study confirms that we should continue to vigilantly watch teen smoking patterns,” Nora D. Volkow, director of the National Institute on Drug Abuse, said in the press release. “Parents and teens should recognize that although e-cigarettes might not have the same carcinogenic effects of regular cigarettes, they do carry a risk of addiction.”

The researchers acknowledge that their study doesn't prove that e-cigarettes cause teens to start smoking cigarettes, but they say that it is a possibility, and further research is needed to confirm their findings.

In a separate JAMA editorial, Nancy A. Rigotti, an author of the study, calls for prompt marketing regulations by the U.S. Food and Drug Administration to stop e-cigarettes from being marketed in ways that appeal to children and adolescents. "A rational approach is to extend to e-cigarettes the same sales, marketing, and use restrictions that apply to combustible cigarettes," she writes.

The FDA has been working on regulations for e-cigarettes since April 2014.

Wednesday, August 26, 2015

Legislative leaders debate future of Medicaid expansion

"There’s no doubt that health care remains a significant issue for politicians and voters in the commonwealth. While thousands of Kentuckians have health insurance for the first time, Frankfort continues to debate questions about the quality and affordability of medical services provided under the Affordable Care Act and the cost of expanded Medicaid coverage."

That's how Kentucky Educational Television summed up the health-care discussion among the General Assembly's top leaders on the Aug. 24 episode of "Kentucky Tonight," the state network's weekly issue-oriented discussion show:

The biggest health-care question for the legislature and the new governor will be whether to continue or change the state's expansion of eligibility for the federal-state Medicaid program under federal health reform. The federal government is paying the entire cost of the expansion, which covers about 400,000 people, but the state will have to start paying 5 percent of the cost in 2017, rising to the law's limit of 10 percent by 2020.

House Speaker Greg Stumbo, D-Prestonsburg, said on "Kentucky Tonight" that the question will need close scrutiny, especially because many more people enrolled in Medicaid more quickly than expected, but under the current law, the state needs to keep the current system.

“The economy is good in Kentucky right now,” Stumbo said. “We can afford to provide this insurance, we can afford to continue to make sure that Kentuckians have it, we just have to monitor it and make sure we’re doing it efficiently.”

House Minority Leader Jeff Hoover, R-Jamestown, said he is concerned that the system isn't sustainable because more people are seeking care and providers are facing reductions in Medicaid reimbursements.

“There are a lot of rural hospitals, particularly in my area and I think in other areas of the state, that are struggling financially now as much or more than any time in many, many years,” Hoover said. He said they are “constantly having to fight for every service that’s provided with the insurance companies [and] the managed-care companies,” which oversee the care of Medicaid clients much like private insurance does.

Senate Minority Leader Ray Jones, D-Pikeville, said he hasn’t heard such concerns, and noted that his wife is a primary-care physician in Pike County. He said he worries about proposals by Matt Bevin, the Republican nominee for governor.

“If you do away with Kynect and you roll back the Medicaid expansion, not only are those people going to be hurt, but the local health-care providers that are going to have to continue to treat these people if they show up in the emergency room and they don’t have a way to pay for it, then . . . you’re going to see an increase in charity care.”

Senate President Robert Stivers, R-Manchester, said a recent visit to Manchester Memorial Hospital "reinforced for him the need to dissuade the newly insured from using emergency rooms as source for primary care," KET reports.

Stivers repeated his suggestion, first made to Kentucky Health News a month earlier, that Kentucky consider a Medicaid system more like that in Indiana, "which provides incentives for Medicaid patients to see their family doctor or go to an urgent care clinic rather than going to an ER for non-emergency concerns," KET reports.

After Stivers made that suggestion, Bevin backed off his earlier statement that he would end the expansion immediately if elected, and said he favors a modified plan based on the experience of other states such as Indiana.

Attorney General Jack Conway, the Democratic nominee for governor, and Drew Curtis, the independent candidate, have said they favor the Medicaid expansion, but Conway has said it would have to be scaled back if it doesn't pay for itself by adding health-care jobs and creating tax revenue, as a state-funded study by Deloitte Consulting predicted in February.

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

Kentucky will get money to increase colon cancer screenings in Louisville and Appalachia, which lag behind recent success

By Melissa Patrick
Kentucky Health News

Kentucky will receive about $2.6 million in federal money over five years to help fight colon cancer by encouraging people to be screened for it, with a focus on populations in Louisville and Appalachia.

"Those regions have large numbers of underserved, underscreened residents," Gov. Steve Beshear said at a press conference. Screening rates are lower among African Americans, men, the poor and the less educated.

Lt. Gov. Crit Luallen, a colon-cancer survivor, said "Colon cancer is the one cancer we can prevent through early screening and detection. And if it is caught early, it can be treated effectively."

According to the federal Centers for Disease Control and Prevention, the five-year survival rate for colon cancer is 90 percent when it is found and treated early. In 2013, the last year for which data are available, Kentucky ranked first in colon cancer and fourth in colon-cancer deaths, according to the Colon Cancer Prevention Project.

This Kentucky Cancer Consortium graph shows the
deaths from cancers with evidence-based prevention
or early detection methods in Kentucky in 2005-09.
Kentucky has both the highest rate of new cancers and deaths from cancer in the nation, many of them preventable through early screening and detection. But preventive screening among those who have recently gotten insurance for the first time and those without insurance is not the norm, partly because people who have been accustomed to getting health care only when something seems wrong often don't understand the importance of preventive screening or that these services are provided free of charge if they have Medicaid or private insurance.

recently reported CDC study found that Americans with insurance or with higher incomes were up to three times more likely than those without coverage or with lower incomes to receive preventive screenings and services, which has certainly been the case with Kentucky's expanded Medicaid population.

A Department for Medicaid Services report found that preventive screenings rose sharply in 2014 among Medicaid recipients in Kentucky: colorectal cancer screenings rose 108 percent to 35,633; breast cancer screenings rose 111 percent to 51,292; cervical cancer screenings rose 88 percent to 78,281;cholesterol screenings rose 111 percent to 170,514; preventive dental services rose 116 percent to 159,508, to name a few. This increase in preventive care is expected to improve the future health outcomes of Kentuckians and to help decrease future cost by catching problems earlier.

Kentucky has made great strides in fighting colon cancer.

In 2002, the Kentucky Cancer Consortium began an initiative that brought more than 60 different agencies and organizations together to fight colon cancer. At the time, Kentucky's colorectal-cancer screening rate was next to lowest in the nation, said Dr. Tom Tucker, senior director for cancer surveillance at the University of Kentucky's Markey Cancer Center and director of the Kentucky Cancer Registry.

Seven years later, the screening rate rose from one-third of the eligible population (those are 50 or older) having ever been screened to nearly two-thirds. This caused a 24 percent decrease in the incidence of colorectal cancer and a 28 percent drop in deaths from the disease, Tucker said.

"A 24 percent decrease in incidence means that each year 230 Kentucky residents who would have been diagnosed with colorectal cancer no longer get the disease," he said.

"This is a remarkable public-health accomplishment," Tucker said. "But we are clearly not done," since the state still ranks first in colon cancer. "The new grant just announced by the governor will be an essential resource in helping us reach this last one-third of the eligible Kentucky population with lifesaving colorectal screening."

Since 2012, Kentucky has also provided colorectal screenings to the uninsured through a partnership with the nonprofit Kentucky Cancer Foundation, which matched $1 million in state funds in both 2012 and 2014 to pay for the program.

This year, the legislature passed a law to make sure doctors are coding colonoscopies as screening and not diagnostic, to make sure patients are not charged for the procedure.

Another effort to combat cancer in Kentucky is through the Horses and Hope Program, led by First Lady Jane Beshear, who, along with the Kentucky Cancer Program, Kentucky One Health and the University of Louisville's James Graham Brown Cancer Center, is working to raise $1 million for a mobile cancer screening unit which will provide free or reduced-cost cancer screenings across Kentucky.

“Kentucky has transformed into the state with the broadest number of colon-cancer screening options and the lowest barriers for colon-cancer screening,” said Dr. Whitney Jones, founder of the Colon Cancer Prevention Project and co-founder of the Kentucky Cancer Foundation. "Hopefully, we will be one of the first Southern states, if not the first state, to screen 80 percent of our population by 2018."

Tuesday, August 25, 2015

Writer considers salad a wasteful luxury, and not all that nutritious

Salads should be considered a "resource-hungry luxury" instead of a staple because they offer little nutritional value, require "precious crop acreage" to grow, requires fossil fuel and refrigeration to ship, is the top source for food waste and a top transporter of food born illnesses, Tamar Haspel writes for The Washington Post .

"As the world population grows, we have a pressing need to eat better and farm better," Haspel writes.

Haspel notes that while she has pointed out problematic foods such as almonds, for their water use; corn, for the monoculture it encourages; and beef, for greenhouse gases from cattle, "none of them is a clear-cut villain," unlike salad, which "has almost nothing going for it." She backs up her claim with these arguments:

Salad is mostly water: Haspel writes that a nutrient quality index that rates foods based on how much of 27 nutrients they contain per 100 calories found "four of the five lowest-ranking foods (by serving size) are salad ingredients: cucumbers, radishes, lettuce and celery. (The fifth is eggplant.)" This is because they are 95 to 97 percent water, unlike other more nutritious vegetables like the sweet potato, which is only 77 percent water. "A head of iceberg lettuce has the same water content as a bottle of Evian (1-liter size: 96 percent water, 4 percent bottle) and is only marginally more nutritious."

Salad fixings are expensive, with little nutrition: "The makings of a green salad — say, a head of lettuce, a cucumber and a bunch of radishes — cost about $3 at my supermarket," she writes. "For that, I could buy more than two pounds of broccoli, sweet potatoes or just about any frozen vegetable going, any of which would make for a much more nutritious side dish to my roast chicken."

Eating less salad saves the planet: "When we switch to vegetables that are twice as nutritious — like those collards or tomatoes or green beans — not only do we free up half the acres now growing lettuce, we cut back on the fossil fuels and other resources needed for transport and storage."

Salad add-ins can make you fat: "Lots of what passes for salad in restaurants is just the same as the rest of the calorie-dense diabolically palatable food that’s making us fat, but with a few lettuce leaves tossed in. I won’t be the first to point out that items labeled 'salad' at chain restaurants are often as bad, if not worse, than pastas or sandwiches or burgers when it comes to calories."

"Take Applebee’s, where the Oriental Chicken Salad clocks in at 1,400 calories, and the grilled version is only 110 calories lighter. Even the Grilled Chicken Caesar, the least calorific of the salads on the regular menu, is 800 calories. Of course, salad isn’t always a bad choice, and Applebee’s has a selection of special menu items under 550 calories (many chain restaurants have a similar menu category)."

Lettuce is the top source of vegetable food waste and food borne illnesses: "It’s the top source of food waste, vegetable division, becoming more than 1 billion pounds of uneaten salad every year," and "According to the Centers for Disease Control (and Prevention), green leafies accounted for 22 percent of all food-borne illnesses from 1998-2008." (Leafy vegetables also include cabbage, spinach and other kinds of greens.)

Haspel says she loves a good salad as much as anyone, and recognizes that as a filler it has kept her from eating too much calorie-dense food, but she concludes, "As we look for ways to rejigger our food supply to grow crops responsibly and feed people nutritiously, maybe we should stop thinking about salad as a wholesome staple, and start thinking about it as a resource-hungry luxury."

Sunday, August 23, 2015

Free workshop on health coverage in Louisville Sept. 21; free lodging available to registrants who need to come the night before

Journalists covering health issues in Kentucky, from drug abuse to health reform, have a chance to immerse themselves in the subject at a free one-day workshop in Louisville on Sept. 21.

The workshop is sponsored by the Foundation for a Healthy Kentucky, which is also offering free hotel lodging to registrants whose distance from Louisville would make it inconvenient for them to get there by 9 a.m. EDT, when the workshop will begin.

The workshop is designed to help journalists cover health in ways that your readers, viewers and listeners will appreciate. It will feature a collection of America’s and Kentucky’s top health experts and health journalists. The program should yield terrific stories at the same time it helps you see how to make health coverage a more central part of what your newsroom does every day. The speakers will be:
  • Dr. Nora Volkow, head of the National Institute on Drug Abuse, to talk about the opiate epidemic nationwide, why it's even worse in Kentucky, and specific stories you could and should be doing but probably aren’t.
  • Bill Wagner, head of Louisville's Family Health Centers, to discuss the state of health reform in Kentucky and obstacles that remain.
  • A patient of Wagner's clinic who is newly insured, to talk about what works with the reforms and what needs further reform.
  • Abby Goodnough, national health reporter for The New York Times, to talk about her award-winning series on health reform that focused on Kentucky and lessons it holds for you.
  • Laura Ungar, health reporter for USA Today and The Courier-Journal, to talk about what stories she'd do based on that day's session, and how to sell editors on health stories and a health beat.
  • Mary Meehan, health reporter at the Lexington Herald-Leader who just began a Nieman fellowship at Harvard University, will talk about how to bring new life to the medical beat at media outlets that increasingly are stretched thin.
  • Al Cross, director of the Institute for Rural Journalism and Community Issues, to discuss where the reform law works, where it needs fixing, and what to ask gubernatorial candidates in the upcoming election.
  • Larry Tye, author and former reporter at The C-J and The Boston Globe, will moderate the sessions to keep the focus on making these issues resonate with your readers and listeners. He runs a Boston-based health reporting fellowship that Mary and Laura did, and where Nora and Abby were speakers.
"Larry Tye assembled what we think is a first-rate line-up of health officials and medical journalists to help you think about how to make health stories resonate with your editors and your readers," Cross said. "If you agree, sign up now because there's limited space and a growing list of registrants. Our speakers are the stars, but you will be the focus of the day's program."

Register for the free workshop and lodging at Questions can be directed to Angela Koch at

Saturday, August 22, 2015

Stanford doctor starts local 'Get Healthy Lincoln County' program, plans to take it statewide via Kentucky Medical Association

Part of the effort: A weekend workout group in Stanford
A Stanford physician who started a local movement for a healthier community plans to promote it statewide through the Kentucky Medical Association’s Commission on Public Health.

"Dr. Naren James said in the next year, under the Affordable Care Act, health insurance rates will be affected by the overall health of a community," Abigail Whitehouse reports for The Interior Journal. “Having a healthier community will actually have a tangible impact on people’s health insurance rate,” James told her.

James said he was motivated to start the program when he realized that that Kentucky ranks very high in childhood obesity, "which ultimately effects the future of a community," Whitehouse notes. Much of the program's focus is on increasing residents' physical activity.

“The reason why we did ‘Get Healthy Lincoln County’ was to make a model that could be used statewide,” James told her. She writes, "His goal is to promote the movement so that every community in Kentucky can find a coalition of people interested in health to create that 'get healthy' community."

“It has to be from the ground up, not from the top down,” James said. “When you deal with health, people have to make the choice. It has to be educational.”

In June, the program conducted several activities, "many of which were successful," Whitehouse reports. "Now that the 'Get Healthy Lincoln County' movement has been approved as an annual effort, James said a committee has already begun planning for next year by determining what did and didn’t work well this time around.

For example, a history walk around Stanford, Kentucky's second oldest town, "had a great turnout," James said. Also successful were "a Saturday morning of exercise" in a local park and "Dinner with a Doctor," Linda Carney of Texas, "who provided the crowd with a plant-based diet and spoke about the benefits of such diets," Whitehouse reports.

"What’s for Dinner Stanford?," a project of the local extension office, "invited the public to participate in a plant-based cooking class using local produce," Whitehouse writes. "James said that the cooking class has done well and will continue throughout the year, but it was realized that programs which require more commitment require more of a push."

For example, a program called "Eight Weeks to Wellness" needed "more events to sell it," James said. "Anything you’re going to do for several weeks, you have to sell it. . . . We need to sell it to people’s individual needs. They have to understand why health is impacting them personally."

"In a broader sense, James said people leading the 'get healthy' movement have to learn to speak the right language," Whitehouse reports. “The language about health is immediately negative,” he said. “It’s a cultural shift. Speaking about health positively is so important, which we tried to do with the Get Healthy program and I think overall it came across positively. Even the things that are negative can be turned into positive.”

Friday, August 21, 2015

Medicaid manager Passport gives $25,000 to Democratic group that has given heavily to committee backing Conway for governor

Passport Health Plan, which manages Medicaid care for hundreds of thousands of Kentuckians, gave $25,000 this year to the Democratic Governors Association, "which already this year has given $600,000 to a Democratic super PAC supporting the election of Attorney General Jack Conway as governor," Tom Loftus reports for The Courier-Journal.

"Beshear’s office and Passport Chief Executive Mark Carter both said the $25,000 was not a political contribution but a sponsorship for a one-day policy conference co-hosted by the DGA in Louisville last spring," Loftus reports. "But Senate Republican Leader Damon Thayer of Georgetown said, 'Of course the DGA wanted to do a, quote unquote, policy conference in Louisville because Kentucky is the site of the only competitive governor’s race in the country this year.'" Passport is based in Louisville.

Loftus notes that the money was requested by Democratic Gov. Steve Beshear, who objected in 2010 to Passport's "spending of Medicaid funds on things like lobbying, travel, public relations, donations and sponsorships." Beshear said it should “cease spending a single taxpayer dollar that is not absolutely necessary to provide quality health-care services to Medicaid-eligible recipients.”

Thayer said the donation was a political contribution because the DGA exists to elect Democratic governors, as it says on its website. "An agenda shows the conference involved three one-hour policy discussions on the morning of May 21 at the Galt House," Loftus reports. "Participants included Beshear, Conway and a few other Democratic governors and Democratic candidates for governor from other states." No attendance numbers were given.

In 2010, then-state Auditor Crit Luallen "questioned more than $423,000 in sponsorships and donations — many of which did not seem to advance Passport’s mission of improving the health care of Medicaid recipients. Luallen's report resulted in sweeping reforms," Loftus writes. "Carter said criticism of spending on sponsorships was valid in 2010 when Passport had an exclusive state contract to manage Medicaid in the Louisville region," but now it has to "compete with four other, very large, for-profit plans," Carter said. "Things that are inappropriate when you area sole-source contractor, like sponsorships, are almost necessities to be able to compete with Humana, Anthem and others."

Loftus reports, "Two of the big private insurance companies that hold managed care contracts in Kentucky — which unlike Passport function in many states and offer products other beyond Medicaid managed care — are listed in the report as giving more to the DGA during the first half of this year: Humana, of Louisville, is listed as having given $80,000; Anthem, of Cincinnati, gave $325,000."

Passport expanded its operations after Beshear used federal health-reform money to expand eligibility for Medicaid, increasing the program's rolls by half. Conway supports the expansion but Republican candidate Matt Bevin says it needs to be scaled back. The reform law calls for the state to start paying 5 percent of the expansion cost in 2017, rising to the law's limit of 10 percent in 2020. Beshear, citing a state-funded study; says the expansion will pay for itself; Bevin scoffs at that.

Bevin and Conway to speak, answer questions about health policy at rural-health group's meeting Sept. 18 in Bowling Green

The Kentucky Rural Health Association is hosting a "Candidates Forum on Health" Friday, Sept. 18 in Bowling Green, after the conclusion of its annual conference. All of the candidates running for all offices in November have been invited, KRHA said, but the focus will be on the two major-party candidates for governor, who will speak and answer questions in separate, back-to-back sessions.

"I hope this forum will help us have a better understanding of what the candidates' views are on health care and what their approach will be," KRHA President Dr. Brent Wright said in an interview.

Republican Matt Bevin is scheduled to speak and answer questions from 1:15 to 2 p.m., and Democratic Attorney General Jack Conway is scheduled to do likewise from 2:15 to 3 p.m. Bowling Green is on Central Time. Candidates for governor and other statewide offices will have a meet-and-greet session at 11:30 a.m., before lunch.

Wright said he was looking for candidates' views on the Patient Protection and Affordable Care Act and rural health care, "especially after the auditor put forth his report on hospitals that face financial challenges throughout the state."

Independent candidate Drew Curtis said he was not invited but would seek an invitation.

Wright said the forum offers a unique opportunity for KRHA stakeholders, who represent many different areas of health care around the state, to find out what the candidates are saying about health and get their questions answered.

"We are a group that is about advocacy and education for rural health care," Wright said. "We want to convey that rural health matters and that our membership has a voice and that our concerns need to be heard."

The public is invited to the forum. Lunch will be provided free of charge to attendees, but registration is required. Click here to register.

The forum is co-sponsored by the Foundation for a Healthy Kentucky, the Friedell Committee, the Kentucky Academy of Family Physicians, the Kentucky Coalition of Nurse Practitioners & Nurse Midwives, the Kentucky Hospital Association, the Kentucky Medical Association, the Kentucky Primary Care Association and Kentucky Voices for Health.

The Sept. 17-18 KRHA conference and the Sept. 18 forum will be held at Western Kentucky University's Knicely Center on Nashville Road, with lodging at the adjacent Staybridge Suites on Campbell Lane and the new Hyatt Place, next to the WKU campus on Center Street (with shuttle service). The registration fees until Sept. 3 are $125 for KRHA members, $200 for non-members and $45 for student members. For the draft agenda, registration form and hotel information, in a PDF, click here.