Retired UK professor Dr. Ardis Dee Hoven elected first female chair of World Medical Association

Retired University of Kentucky professor Dr. Ardis Dee Hoven, who was the president of the American Medical Association in 2013-14, was elected the first female chair of the World Medical Association at the organization's 200th council meeting in Oslo, Norway

For the past few years, Hoven was the chair of the AMA's delegation to the WMA and will now serve as the chair of the WMA for a two-year term. WMA represents physicians from 111 national medical associations.

"I feel fortunate to have the opportunity to do this," Hoven said in a UK news release. "I see myself not so much as a woman in this role but as a leader of a global organization of physicians who are working to support their peers around the the world and improve the lives of their patients."

Hoven earned an undergraduate degree in microbiology then a medical degree from UK. She finished her internal medicine and infectious disease training at the University of North Carolina at Chapel Hill. Now she is a member of the American College of Physicians and the Infectious Disease Society of America.

Hoven has received the University of Kentucky College of Medicine Distinguished Alumnus Award and the Kentucky Medical Association Distinguished Service Award, and in 2015, she was inducted into the Hall of Distinguished Alumni for UK. "Hoven hopes for the WMA to raise its profile internationally and increase the impact of its policies and advocacy on behalf of physicians and patients," the release says.

"I want to make our footprint bigger and our voice stronger," Hoven said.

Bevin says he will end all Obamacare programs in Ky., including Medicaid expansion that has added more than 400,000 to rolls

Matt Bevin, the Republican nominee for governor, has made clear that if elected he would end the Medicaid expansion that has provided free health coverage for more than 400,000 poor Kentuckians.

During his primary campaign, Bevin never made that quite plain, saying he would close the state's health-insurance exchange, Kynect, because it would cost "hundreds of millions of dollars." Kynect is paid for by insurance companies, so Bevin was alluding to to the state's projected cost of expanding Medicaid, which enrolls through Kynect.

The Washington-based publication Politico reported on June 10, after interviewing Bevin, that he would not only close Kynect but roll back the Medicaid expansion: “You may or may not have access to Medicaid going forward,” he said. “People are not on it for extended periods of time. It’s not meant to be a lifestyle. It really isn’t. The point of it is to provide for those who truly have need.”

Democratic nominee and Attorney General Jack Conway, with Gov.
Steve Beshear; GOP nominee Matt Bevin (AP photos via Politico)

Gov. Steve Beshear "is furious" about Bevin's plan, Politico reported. “I am not going to allow someone to become governor of this state who wants to take us back to the 19th century,” the governor said in a telephone interview. “For a serious candidate for governor to be advocating a simple repeal of the whole program without offering any kind of alternative which will continue health care for these people is irresponsible.”

Beshear expanded the eligibility rules for Medicaid as part of implementing the Patient Protection and Affordable Care Act, raising the income limit to the law's required 138 percent of the federal poverty level, from the state's previous level of 69 percent.

The federal government is paying the entire cost of the newly eligible Medicaid recipients though next year. In 2017, the state would begin to pay 3 percent, rising to the reform law's cap of 10 percent by 2020. A study by Deloitte Consulting and the Urban Institute at the University of Louisville  — "which Republican critics have rejected as spin," Politico says — has said the expansion more than pays for itself through 2020 by expanding health-care jobs and generating tax revenue.

Jobs are growing as projected by the study, according to the Cabinet for Health and Family Services, which handles Medicaid.

Cabinet spokeswomnan Jill Midkiff said the study estimated that 32,000 jobs would be created through 2015 as a result of the expansion. "U of L projected this growth would primarily be in the areas of retail trade, finance and insurance, administrative services, health and social services, accommodations and food services and other services," Midkiff said. "These sectors were estimated to account for more than 28,000 of the 32,000 jobs created." She said the latest Bureau of Labor Statistics figures show that "these sectors have grown by more than 29,000 jobs from 2013 until April 2015. Therefore, the most recent BLS numbers indicate that UofL’s estimates are on target to meet projections."

Politico says a Bevin victory could "blot an Obamacare bright spot," since Kynect has "worked virtually glitch-free." Through April, 106,000 Kentuckians had obtained tax-subsidized, private insurance coverage through Kynect, which is also the portal for enrolling in Medicaid.

Bevin says he would move those people to the federal exchange, which has been marred by technological issues and charges insurance companies much more to use it than Kynect does. But that plan would not work if the U.S. Supreme Court rules this month that the tax subsidies are not legally available through the federal exchange.

"That doesn’t worry Bevin," Politico reports, quoting him: “You’re worrying about a hypothesis. Let’s let the Supreme Court rule.”

And what about the new Medicaid recipients who would lose their benefits if Bevin wins? He "insists that Obamacare is coverage in name only — that Kentuckians still lack access to high-quality health care, partly because Medicaid pays doctors such low rates, partly because he says too many people rely on emergency rooms," Politico reports, quoting him: “Just having health insurance doesn’t mean you’re going to get health care.”

Attorney General Jack Conway, the Democratic nominee, declined Politico's request for an interview. Campaign spokesman Daniel Kemp said, “Jack wants to make sure that the hundreds of thousands of Kentuckians who now have health insurance through Kynect, especially kids, keep their health insurance — not play politics or push an ideology that’s out of touch with Kentucky’s values.”

Politico observes, "Conway is in the tricky spot of embracing Kynect while trying to keep his distance from Obama and Obamacare, a term that still generates ire among Kentucky residents. A September 2014 Marist [College] poll found that 61 percent of registered Kentucky voters had an unfavorable impression of Obamacare. Only 17 percent had negative feelings about Kynect."

Citing costs, Bevin has said he would shut down Kynect; actually, insurance companies pay for it; Medicaid is another matter

By Molly Burchett and Al Cross
Kentucky Health News

The governor's race between Democrat Jack Conway and Republican Matt Bevin will spotlight the Patient Protection and Affordable Care Act, an issue that affects all Kentuckians at least indirectly.

Conway, in his eighth year as attorney general, says he would have voted for the law. Bevin, who was the most conservative candidate in his primary, has said he would shut down the state's health-insurance exchange, Kynect, that was established under the law, because it will cost the state hundreds of millions of dollars.

Actually, Kynect is paid for by insurance companies that sell policies in Kentucky. Bevin appears to be referring to the projected cost of expanding Medicaid, another Obamacare-related move that Democratic Gov. Steve Beshear made at the same time he created Kynect. It raised the program's income limit to 138 percent of the federal poverty level, from 69 percent.

The federal government is paying the entire cost of the Medicaid expansion for the first three years. In 2017, the state will pay 3 percent, gradually rising to the law's cap of 10 percent in 2020. A study for the state projects that the expansion will pay for itself until 2021 by expanding health-care jobs and generating economic activity and tax revenue.

Bevin has scoffed at those projections. Conway has said the state needs to provide health coverage, but only what it can afford.

As Kentuckians, voters, and consumers of health insurance, you may be asking: What's going on with Obamacare in the state? Are we able to afford it? Who and what should we believe? While the cost of Medicaid expansion is debatable, it's becoming clear that Kynect has avoided the problems plaguing other state-run exchanges.

So far, the Centers for Medicare and Medicaid Services has dispensed more than $4.9 billion in grants to help launch state-run exchanges. Kentucky received $253 million for the initial planning and development phases of Kynect. Now its $28 million annual cost is covered by a fee on insurance companies, state officials say.

Despite federal support and their own revenue sources, many of the 17 state-based exchanges are expecting deficits this year and in the future. Many will continue to rely on leftover federal funds to pay for operations this year, report Darius Tahir and Paul Demko of Modern Healthcare. Hawaii announced this week that it would close its exchange and transfer clients to the federal exchange because of continued funding problems.

Kynect officials say it isn't having such problems because the state has ensured that Kynect is self-supporting through fees on insurance plans.

"The governor committed that the exchange would be self-supporting and would not rely on state General Fund dollars," said Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services. "Kentucky’s sustainability plan employs an existing assessment on insurers that was previously used to fund Kentucky Access, the state’s high-risk pool, which was closed [since] individuals previously enrolled are now eligible to purchase a plan through Kynect."

But to transform Kentucky Access into Kynect, Beshear used executive orders that bypassed the General Assembly, where Republicans control the Senate. They have questioned his use of executive powers but generally have not been critical of Kynect.

The fee on insurers is a 1 percent, broad-based assessment on companies offering plans through the exchange. While insurers don't pass this fee directly to consumers, it almost certainly figures into their calculation of premium calculation and thus is indirectly paid by policyholders. The federal exchange is financed in a similar way, but its fee is 3.5 percent, meaning higher costs for insurers and policyholders.

In most cases, premiums for Kynect policies are reduced by a federal income-tax subsidy that is a key part of Obamacare.

"The vast majority of Kentuckians buying health insurance through Kynect are eligible for some kind of payment assistance or subsidy," Beshear said in commenting on most health-insurance companies recent requests for premium increases. "That cost will vary from family to family, so talking about rate changes in a vacuum isn’t a very effective way to gauge how much those rate fluctuations may affect policyholders or those shopping for insurance."

Bevin says he would move Kynect customers to the federal exchange, but the U.S. Supreme Court could rule this month that the tax subsidies are not supposed to be available through the federal exchange. The plaintiffs in the case cite a passage of the law that opponents say was a drafting error and does not make sense when the law is viewed as a whole.

If the court agrees with the plaintiffs, and Congress doesn't change the law, states using the federal exchanges will see spikes in insurance premiums, and millions of people could be at risk of losing their insurance. Bevin has not said what he would do in case of such a ruling.

Independent Drew Curtis is also running for governor.

Sen. Mitch McConnell faces diverse pressures on the question of repealing the federal health-reform law

Incoming Senate Majority Leader Mitch McConnell says he still wants to get rid of Obamacare, and the Kentuckian is "under rapidly increasing pressure from conservatives to pursue an aggressive path to repealing the landmark health care law," but it won't be easy, Jennifer Haberkorn reports for Politico.

Ardent conservatives are calling for repeated repeal votes under budget reconciliation, which requires only 51 votes, not the 60 usually needed to do significant business in the Senate. But establishment Republicans "barely mentioned Obamacare" the day after the election, Haberkorn notes. McConnell indicated that 60 votes are needed for repeal, and it takes 67 votes to override a presidential veto.

"McConnell has said that he wants to use the Senate appropriations process to starve funding to the law. When asked about his strategy on Wednesday, he said Republicans would be 'addressing that issue in a variety of different ways' and hinted at using reconciliation by saying that 'There are some things we can do with 51 votes'," Haberkorn writes. "Reconciliation is tricky — it would require Congress to pass a budget resolution, which is no easy task, and in the end, even a successful Obamacare repeal bill would just get vetoed anyway. And by the time they’re done, Republicans would have squandered potentially months of their new majority debating health care."

Several Republican sources say that McConnell will all but certainly hold an early, symbolic full repeal vote that is expected to generate support from every Republican and probably no Democrats. It will fail to overcome the 60-vote threshold for a filibuster. Beyond that, the Republican conference will collectively decide the strategy: a full-bore attack on as much of the law as possible, or a selective picking and choosing of the most vulnerable pieces of the law," such as its tax on medical devices and the coming mandate that employers of more than 50 people insure employees who work 30 or more hours a week.

"While Obamacare on the whole remains unpopular, there are pitfalls in any repeal strategy that includes popular parts of the law," Haberkorn notes. "That includes helping people with pre-existing conditions get covered, the subsidies that make insurance more affordable, and the exchanges, which is particularly popular in McConnell’s home state of Kentucky."

Still, "In some quarters, anything other than the full-scale assault is unacceptable," Haberkorn reports. "When McConnell stated on Fox News the other day the simple fact that Republicans couldn’t repeal the whole thing, the backlash was swift. The Senate Conservatives Fund, which backed his Kentucky Tea Party primary opponent, accused him of being insufficiently committed and of 'making excuses for why he won’t deliver on his central campaign promise.' McConnell’s aides had to send out statements restating how much he despised the health law."

Exit poll: Half of voters say Kynect works well, but almost as many say Obamacare went too far; 45% favor pot legalization

An exit poll of voters in Tuesday's election showed that half of them thought the state's health-insurance exchange, Kynect, is working well, but almost as many thought the federal health-reform law went too far.

Asked how Kynect is working, 21 percent of the electorate said it was working very well, and 29 percent said it was working somewhat well. About 13 percent were undecided, while 21 percent said it was not working too well and 15 percent said it was not working well at all.

Asked about the 2010 law that allowed creation of Kynect and subsidizes the health coverage obtained through it, 46 percent said it went too far, 22 percent said it was about right and 26 percent said it didn't go far enough.

The poll was taken primarily for the U.S. Senate race, and CNN cross-tabbed the two sets of results:

In another question that could be health-related, 45 percent of voters said they were in favor of legalizing marijuana in Kentucky while 52 percent opposed it. The poll report on CNN did not give the survey's margin of error.

In Senate race, McConnell and Grimes differ on health care

By Cheyene Miller
University of Kentucky School of Journalism and Telecommunications

               The U.S. Senate race between Republican Sen. Mitch McConnell and Democrat Alison Lundergan Grimes has seen the candidates focus on several key issues, including the coal industry, the minimum wage and health care.

               The health-care issue has been almost unique among Senate races in that Kentucky is generally seen as a success story for the Patient Protection and Affordable Care Act. In August, Gov. Steve Beshear said 521,000 of Kentucky’s 4.3 million citizens had signed up for health coverage through Kynect, the state’s health insurance marketplace created under the law.

               According to a Gallup-Healthways poll, published in August, Kentucky reduced its percentage of uninsured more than any other state besides Arkansas, and lowered the percentage of uninsured in the state from 20.4 percent to 11.9 percent, thus covering two of every five uninsured Kentuckians.              

In addition to funding the expansion of Medicaid, the law requires Americans to either purchase private health insurance or enroll in some form of government assisted health care like Medicaid; requires insurance companies to cover people with pre-existing conditions and provide 10 elements of coverage in each policy; allows parents to keep their children on their health insurance until they are 26; and requires businesses employing 50 or more full time employees to provide health insurance, a provision that President Obama has suspended for a year.

McConnell says he wants to repeal the law “root and branch,” but has been more lenient toward the idea of keeping Kynect. In the Senate race debate on KET, McConnell suggested that Kynect was merely a website. However, repealing the law could pose issues for the newly insured in Kentucky because private insurance under Kynect uses federal tax credits, and provides free Medicaid coverage to citizens who earn up to 138 percent of the federal poverty level.

According to Douglas McSwain, a Lexington-based litigation attorney who specializes in constitutional and health-care law, the uprooting of the law would result in drastic changes to Kynect.

               McSwain said repealing the ACA “root and branch” would mean cutting the federal tax subsidies that are essential to Kynect’s survival.

“You take the exchange tax credit away, do you think for a minute that the website is going to stand?” McSwain asked.  “Nobody is going to buy policies.”

At a Kentucky Farm Bureau forum in August McConnell said Congress should have passed laws allowing health insurance to be sold across state lines, limiting malpractice lawsuits and making it easier for businesses to form health-insurance groups.

               McSwain said the law allows formation of such groups, and interstate regulation “is conceivable” but “The problem is we don’t have the infrastructure, regulatory-wise, to do that without having reached a compact or an agreement” among the states.

               A study on the effects of malpractice reform, published by the New England Journal of Medicine, found that Texas, Georgia and South Carolina did not see a significant reduction in the amount of doctor-ordered tests and scans after enacting reforms.  A five-person team of doctors performed the study, collecting data from 1997 through 2011.

               Grimes has only publicly discussed health reform on select occasions, taking a similar strategy to many Democrats in the 2014 midterm election because of the unpopularity of “Obamacare” and its namesake.  When she does mention health care, she talks about fixing and streamlining the law, as she did during the KET debate.

“I will not be a senator that rips that insurance from their hand,” Grimes said in reference to the half a million Kentuckians who’ve gained coverage under Kynect.  She said McConnell was in a “fictional fantasyland.”

Grimes has also talked about supporting an extension of Obama’s “grandfathering” of insurance policies that don’t comply with the law after he was criticized for not keeping his campaign promise that Americans could keep their doctor and health plan if they liked them.

               That controversy and other aspects of the law have led to negative feelings among Kentuckians about Obamacare.  A poll by Marist College for NBC News showed Obamacare had a 33 percent approval and 57 percent disapproval rating among Kentuckians, while Kynect had 29 percent approval and a 22 percent disapproval., while 29 percent of those polled said that they had never heard of Kynect and 21 percent were unsure of how to rate it. 

               At last report, about 80,000 Kentuckians had bought private insurance through Kynect and about 440,000 had used it to get on Medicaid – 320,000 of whom were eligible under the new rules and 120,000 under the what state officials call “old Medicaid.” The federal government pays about 71 percent of “old Medicaid” costs and, until the end of 2016, 100 percent of the newly eligibles’ coverage. In 2017, it will pay 95 percent of the new costs, and fall to the reform law's floor of 90 percent in 2020.

Cheyene Miller of London, Ky., wrote this story for “Covering the U.S. Senate Race,” a special course in the University of Kentucky School of Journalism and Telecommunications.

McConnell runs anti-Obamacare ad with doctor who connects pre-existing condition with cancellation of insurance

U.S. Sen. Mitch McConnell is running his first re-election commercial focused on the federal health-reform law, featuring a Somerset physician saying “As a doctor, I see how Obamacare hurts patients’ access to care.” She says McConnell is working for “common-sense health care reforms,” which are not specified, and is leading the fight to repeal the law.

Sandy Schuldheisz adds that her son has diabetes and her plan was “cancelled under Obamacare. Like many, we now pay more for less coverage.” That may cause an incorrect inference. "The Affordable Care Act also prohibits insurance companies from dropping or denying coverage to Kentuckians because they have a pre-existing condition, such as diabetes," notes Joe Sonka of Insider Louisville. Many policies were canceled because they didn't meet the law's requirements.
Sonka, a McConnell critic, reports that he "requested more background information on Schuldheisz’s personal situation from the McConnell campaign — such as her premium rate before and after, and whether she received insurance through her employer or individually," and the campaign has not provided it.

Gov. Steve Beshear told Sonka in a written statement, "We don’t know the specifics of the doctor’s claim about her family’s plan being canceled (although many folks with health insurance policies prior to ACA were allowed to maintain those older plans if they chose to). We do know that she could have shopped for affordable health insurance on kynect, and may have even qualified for a discount. The vast majority of Kentucky families who shopped on kynect qualified for some kind of payment assistance or subsidy. Finally, the ACA required insurers to offer standard, robust benefits such as preventive care and vaccinations, mental health coverage, maternity and infant care, and prescription drugs."

Sonka writes that Schuldheisz's home Pulaski County "ranked among the top fifth in Kentucky counties with the largest estimated decrease in their uninsured rate" as a result of Obamacare. "As of this April’s signup deadline, 8,134 residents in the county had signed up for health care coverage through the state exchange. Based on Kynect estimates that 75 percent of their enrollees did not previously have insurance, this means Pulaski County’s percentage of uninsured residents may have fallen from 18 percent to under 7 percent."

Kentuckians like Kynect coverage as long as it's not called 'Obamacare,' and some don't like to talk about it

By Molly Burchett
Kentucky Health News

Sticks and stones may break your bones, but words will never hurt you -- unless you're talking about the word "Obamacare" and its impact on the U.S. Senate race in Kentucky, the only Southern state to have both expanded Medicaid and set up its own health-insurance exchange under the federal health-reform law.

"The Affordable Care Act, known as 'Obamacare,' is a lightning rod in Kentucky, even though the state had one of the most successful rollouts in the nation," Al-Jazeera America reports in a five-part series on political issues in the state. The polarizing word is affecting the race between Senate Republican Leader Mitch McConnell and Democrat Alison Lundergan Grimes.

"In a state where 65 percent of registered voters disapprove of President Obama, even those who have signed up for coverage through Kynect don't want to think of it as Obamacare," Libby Casey and Philip Maravilla report.

In May 2013, Democratic Gov. Steve Beshear announced that he would use Obamacare to create the state health-insurance exchange and expand Medicaid rolls to cover Kentuckians earning up to 138 percent of the federal poverty level. That qualified hundreds of thousands of Kentuckians for the federal-state program, including Frank Dixon of Benham in Harlan County.

Dixon's 52-year-old body is damaged from decades working as a mechanic in coal mines where he injured his back, rotator cuff and shoulder. Like many Kentuckians who have worked hard to earn a good living all of their lives but lost jobs due to the mining industry or economic downturn, Dixon is thankful to have medical coverage and food stamps but "kind of ashamed to say it," he told Al-Jazeera:

"When asked if he supports Obamacare, Dixon lets out a long sigh and fidgets in his chair. “I don't know how to answer that,” he said. “Some things are left unsaid.” An NBC/Marist poll conducted in May found 57 percent of Kentuckians surveyed said they disliked Obamacare. But when asked about Kynect, only 22 percent disapproved. And yet they’re basically the same thing."

Republicans have more than taken notice of this sentiment, which may also be the reason Grimes hasn't made Kynect's success part of her campaign unless she is asked about it.

"Obamacare has been demonized by its opponents," Al Cross, director of the Institute for Rural Journalism and Community Issues at the University of Kentucky and publisher of Kentucky Health News, told Al-Jazeera. "And it’s easy to demonize because the first three syllables of the word are a word that most Kentuckians don't like."

Cross said that for Grimes to run on a platform of supporting the law would be risky, but could pay off: "I hope they do engage on the issue of health care because this state in many ways is the least healthy state in the country."

Aside from the questions of demonization and branding, Kentucky's health system has serious challenges, and the influx of Medicaid patients covered by Obamacare has come with new challenges for both patients and doctors, such as delayed approvals and burdensome paperwork from insurance companies.

Facing delays in preauthorization, some newly covered patients like Dixon are questioning the value of their Medicaid coverage. Others are just thankful to finally be able to see a doctor, Casey and Maravilla report.

Obamacare seems to be no plus for Kentucky Democrats, perhaps mainly because of the word's first three syllables

Though the federal health-reform law has helped cover more than half a million Kentuckians and cut the state's uninsured population by half, "there is little evidence it will help" Kentucky Democrats in the Nov. 4 elections, reports Abby Goodnough of The New York Times, who has been following Obamacare's implementation in the state.

“The campaign by the Affordable Care Act’s critics against it has been very effective in demonizing the phrase Obamacare and anything to do with the president,” Democratic Gov. Steve Beshear told Goodnough. “So I think you find a reluctance on the part of people, even though the law is benefiting them, to publicly acknowledge it.” Beshear noted that President Obama is highly unpopular in the state, and Goodnough notes that no one applauded during the six minutes that he spoke about the law at the Kentucky Farm Bureau's Country Ham Breakfast at the state fair last month.

Interest groups and Republican candidates in Kentucky "have run more than 10,000 broadcast television spots here since January 2013 that mention the law in a negative way, according to Kantar Media’s Campaign Media Analysis Group," Goonough reports. "Kantar found only one positive television ad, from Elisabeth Jensen, the Democrat challenging Rep. Andy Barr in the state’s Sixth Congressional District."

Many Democrats have urged their nominee for the U.S. Senate, Secretary of State Alison Lundergan Grimes, to use the issue, but "far from flaunting Kentucky’s strong enrollment numbers, Democratic candidates — most notably Ms. Grimes — have remained reticent about the law, even its successes."

Republican Sen. Mitch McConnell's re-election campaign hasn't run any advertising lately about the law, but still calls it the worst legislation in American history and says he wants it repealed "root and branch." But he has yet to explain, if that unlikely event happened, what would happen to the state exchange where more than 521,000 people got on Medicaid or bought private insurance policies.

Goodnough says McConnell has "hedged" on that, and links to an earlier story by her Times colleague, Jonathan Martin, who wrote: "When I pressed him about the politics of taking away Medicaid from those individuals that now have it, he suggested that was unlikely – even while still faulting Beshear for the decision. 'I don’t know that it will be taken away from them,' McConnell said of the expanded Medicaid coverage. Speaking about Beshear and Kentucky’s state government, he added: 'They’ve made the decision to expand it; they’re gonna have to pay for it.'"

State won't estimate cost of greater-than-expected Medicaid expansion for 'a few additional months' – after Nov. election

By Al Cross
Kentucky Health News

The Republican-controlled state Senate's budget committee chair wants to know how much Democratic Gov. Steve Beshear's expansion of the Medicaid program will cost, since enrollment in the federal-state program has exceeded the administration's expectations.

Medicaid Commissioner Lawrence Kissner told Sen. Bob Leeper of Paducah in a letter Sept. 8 that the administration won't be able to update the estimates "until a few additional months have passed and more data [are] collected" and "after the newly insured population has stabilized."

That pushes the date for new estimates past the Nov. 4 election, in which Republicans are making issues of the expansion's cost and the federal health-reform law that allowed it. U.S. Sen. Mitch McConnell has mentioned it in attacking "Obamacare," and Republicans trying to take over the state House have done likewise.

When Beshear announced in May 2013 that he would expand Medicaid eligibility to people with incomes up to 138 percent of the federal poverty level, using entirely federal money for the first three calendar years, he said it would cost the state $30 million in the 2016-17 fiscal year and $70 million in the 2017-18 fiscal year.

Those figures were based on an estimate by the Price Waterhouse Coopers accounting firm that 308,000 Kentuckians would become eligible for Medicaid but only 188,000 would enroll by 2017, based on calculations by the Congressional Budget Office. But so far, about 320,000 people have enrolled, more than double the 148,000 that the firm estimated would sign up by June 30.

At last report, about 521,000 people had obtained coverage through the state's Kynect health-insurance exchange. About 80,000 of them bought private insurance, and 120,000 qualified for what state officials call "old Medicaid" for a variety of reasons: they were children, blind, disabled or had income less than 69 percent of the federal poverty level, the old limit for the program.

The federal government pays about 71 percent of "old Medicaid" costs and, until the end of 2016, 100 percent of the newly eligibles' coverage. In 2017, it will pay 95 percent of the new costs, falling to the reform law's floor of 90 percent in 2020.

Kissner told Leeper that the administration needed more experience with the new enrollees, and better estimates of projected employment in 2017-18, other "key economic indicators" and how many Kentucky households will have incomes above or below 138 percent of the federal poverty level.

Leeper could not be reached for comment. For a copy of Kissner's letter and related materials, click here.

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

By Melissa Patrick
Kentucky Health News

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Al Cross
Kentucky Health News

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

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

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

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

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

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

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

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

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

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

Grimes and McConnell lay out differences on health reform

By Al Cross and Megan Ingros
Kentucky Health News

U.S. Sen. Mitch McConnell kept attacking federal health-care reform and challenger Alison Lundergan Grimes gave her strongest defense of it yet as the candidates held the closest thing to a debate Wednesday, Aug. 20, at Kentucky Farm Bureau headquarters in Louisville.

Grimes was the most detailed she has been in a public discussion about health-care reform. Grimes indicated that she supports Kynect, the state health-insurance exchange, created by Gov. Steve Beshear and funded by Obamacare, where people sign up for Medicaid or buy insurance.

“For the first time ever, because of our governor, 500,000 Kentuckians are able to go to the doctor, their kids get checkups before school, and many of them are farm families in rural Kentucky,” she said. “The law isn’t perfect but we have to work to fix it. . . . We have to work to streamline the Affordable Care Act, to make sure there aren’t over-burdensome regulations on our businesses, especially our small businesses.”

Grimes endorsed President Obama’s delay in the law’s employer mandate and suggested that he should also live up to his promise that “If you like your doctor, you can keep it.”

She actually appeared to be referring to keeping old insurance policies, because her next words were, “We should be working to extend that grandfathering clause so we live up to that promise that Washington politicians made to Kentuckians. . . . It requires a senator, though, who doesn’t want to repeal root and branch the access to health care that Kentuckians just got for the first time.”

McConnell answered, “She won’t use the words, but she supports Obamacare, he single worst piece of legislation that’s been passed in the last half-century.”  He said Obamacare is going to cost jobs and it “ought to be pulled out root and branch and we ought to start over.”

McConnell said what should have been done is “truly national competition among health-insurance companies to keep prices down and quality up,” as well as “a national medical malpractice standard to bring some sanity to the litigation lottery that’s confronting every health-care provider in America; and thirdly, we need to allow small businesses to form groups for the purpose of more purchasing power on the open market.”

Citing a study by the Congressional Budget Office, McConnell said the law will only cover 10 million of the 40 million people who were uninsured, and will “cost 2.5 million jobs.” The study says the predicted reduction, through 2024, will come “almost entirely because workers will choose to provide less labor,” not because jobs will be eliminated.

McConnell said Kentucky will not be able to afford its expansion of the Medicaid program, which covers about three-fourths of the newly insured. “She applauds it,” he said. “It’s fine for the governor because the first three years the federal government will pick up 100 percent of the tab, but after that, the state’s going to be in serious financial problems.”

Beshear has cited studies showing that the Medicaid expansion will pay for itself by expanding the health-care industry and creating jobs, but Republicans say they are skeptical of that.

A video of the debate is available on the Farm Bureau website, www.kyfb.com, until Sept 20. The specific site is http://new.livestream.com/accounts/7542430/events/3309694.

Nursing-home industry cited as example of how campaign-funding lobbying interests get what they want from General Assembly

Lobbying groups' political action committees gave almost 40 percent of the money that the campaign committees of the legislature's party caucuses received in the last 18 months, Tom Loftus reports for The Courier-Journal.

"Much of the remaining 60 percent came in contributions from officers of corporations and associations representing highway contractors, nursing homes, coal companies, payday lenders and other interests with an active lobbying presence in the state capital," Loftus writes. "The Senate Republican Caucus got at least $26,000 from about 30 owners or employees of Kentucky nursing homes."

"It's a part of the equation where we can't compete," Bernie Vonderheide, president and founder of Kentuckians for Nursing Home Reform, told Loftus. "The only tool we have to compete with that is to try to make our case to the public and hope." For several sessions of the legislature, the group has lobbied for staffing requirements at nursing homes, to no avail.

The winner of that lobbying battle is the Kentucky Association of Health Care Facilities, which has a generic name but is in fact the main lobby for nursing-home owners. KAHCF President Betsy Johnson sent Loftus this statement: "We support candidates who have consistently supported Kentucky's excellent caregivers, and in particular some of our most pressing issues including medical liability reform."

Loftus reports, "The General Assembly's two top leaders, who have been leading fundraising drives for their caucuses for the past month, say there's no problem." He quotes Senate President Robert Stivers, R-Manchester: "Contributions do not influence policy. ... It's the policy that influences contributions."

House Speaker Greg Stumbo, D-Prestonsburg, told Loftus, "We tell them when we have our fundraisers that this doesn't guarantee anything except that we will promise we will listen to your problems and we'll try to be honest with you." (Read more)