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."

Beshear is Communicator of the Year for efforts with Kynect

Governor Steve Beshear ​has been named 2014 Communicator of the Year by ​the Public Relations Society of America's Thoroughbred chapter.

He received the award for his communication to Kentucky residents about Kynect, the state's online healthcare marketplace created under federal health-care reform.

More than half a million Kentuckians have gotten coverage through Kynect, most of them through Medicaid, which Beshear expanded under the federal law.

Baptist Health is first stand-alone health provider to become founding partner of Shaping our Appalachian Region effort

Baptist Health has become the first stand-alone health-care provider to sign on as a founding partner in Shaping Our Appalachian Region, an initiative to improve the economy of Eastern Kentucky.

Baptist will work with SOAR to develop and implement health and education initiatives for residents of Appalachian Kentucky and has committed $150,000 to the initiative over the next three years, the organizations said in a press release.

“Baptist Health understands Eastern Kentucky because we have a proven and time-honored commitment to the health and well-being of our people,” Stephen C. Hanson, chief executive officer of Baptist Health, said in the press release. “Our participation in SOAR reflects this pledge. Besides Richmond, we’ve also got hospitals in Corbin and Lexington, along with outpatient facilities, doctors’ offices and other services all over Eastern Kentucky, the rest of the commonwealth and indeed throughout the region."

The University of Kentucky was the first founding sponsor of SOAR, pledging $300,000 over the next three years and winning the right to use the UK HealthCare brand on SOAR materials as well as the university's general logo.

Gov. Steve Beshear and Congressman Hal Rogers formed SOAR in the fall of 2013 to create strategic plans to improve Eastern Kentucky's economy and quality of life.

“Our primary objective is creating and maintaining jobs across eastern Kentucky, and in order to do that, we need a healthy and well-educated workforce,” Beshear said in the release. “I’m pleased that Baptist Health understands the key connections among our efforts and the critical role that health will play in the future of this region."

Beshear says Ky. rural hospitals 'have a positive cash flow' but he can't prove it; industry says it sees 'some improvement'

By Al Cross
Kentucky Health News

FRANKFORT, Ky. -- Gov. Steve Beshear says Kentucky's rural hospitals are profitable again, thanks to his expansion of Medicaid, but he offers little evidence to support his claim, and the hospital industry disputes it.

In a long, joint interview with Colorado Gov. John Hickenlooper at the Brookings Institution in Washington, D.C., Feb. 20, Beshear said, “Our rural hospitals have a positive cash flow for the first time in a long time, so it’s working, it’s going to work, and my job is just to get it so embedded that nobody can do anything about it.”

Kentucky Health News asked Beshear's office for evidence of rural Kentucky hospitals’ positive cash flow, but the office cited only a news story about Carroll County Memorial Hospital in Carrollton, which said it turned a small profit in 2013 (thanks to federal health-reform grants for digitizing medical records) and a much larger one in 2014.

"Some of them have improved and some of them have not," said Mike Rust, president of the Kentucky Hospital Association. As a result of Medicaid expansion, he said, "Some have benefited greatly but others are still struggling."

The association's vice president of health policy, Elizabeth Cobb, said, "In general we’re seeing some improvement in rural hospital finances," largely from a decline in the number of charity cases as a result of previous patients having coverage. "We were already taking care of most of those," she said.

State figures show Medicaid payments to rural hospitals rose 20 percent in the state fiscal year that ended June 30, 2013, but only 6 percent in the next year, when the Medicaid expansion began; and that the payments to urban hospitals rose 4 percent and 10 percent the last two years.

Based on claims from July through September, the state forecasts that Medicaid payments to rural hospitals in the current fiscal year will increase 26 percent, and payments to urban hospitals will rise 15 percent. (The state has estimates for each hospital.)

Cobb said the expansion hasn't generated as many new patients as might be expected for rural hospitals because of the shortage of primary-care physicians who admit patients: "We're not seeing a huge expansion of utilization as a result of Medicaid expansion."

That keeps patients coming to hospital emergency rooms for care, some of which is deemed non-emergency by managed-care organizations, the insurance-company subsidiaries that have overseen the care of Medicaid beneficiaries since 2011. Two MCOs pay only a $50 "triage fee" in such cases, regardless of what diagnostic tests the hospital performs; that was the topic of a legislative hearing last week.

And that is just one part of hospitals' problems with the MCOs. "What we're seeing generally is that while hospitals are receiving payment for some patients who may have been uninsured previously and are now insured by Medicaid, we're still seeing the challenges of hospitals being paid by managed-care organizations," Cobb said. "There's an increase in the administrative burden for small hospitals to work with five different MCO plans that all have very different rules and criteria."

Clinton County Hospital Administrator J.D. Mullins cited MCO problems is explaining his facility's decision to file for bankruptcy last year, mainly to restructure payments on the federal loan for a $14.7 million addition completed a few years ago, the Clinton County News reported.

"These companies’ polices have restricted access to the hospital’s services and reduced our reimbursement even more," Mullins told the Albany paper. "When the idea of a new hospital facility was first proposed, no one could have foreseen the condition of health care today."

The hospital is in the district of Sen. Max Wise, R-Campbellsville, who told fellow members of the Senate Health and Welfare Committee Feb. 26, "I would love to take the governor's report to the six of my seven counties out in rural Kentucky that are struggling right now in their hospitals. . . . What I'm hearing from them is the system is broken and it continues to be broken."

Wsie was referring to Beshear's recent report that Medicaid expansion is generating more money, jobs and tax revenue than forecast. Another committee member, Sen. Ralph Alvarado, R-Winchester, said, "Almost every senator here has received letters that say: This stinks, we are not getting paid, we are going under."

Cobb said some rural hospitals are reporting cuts in jobs and services. That is probably reflected in U.S. Bureau of Labor Statistics data compiled by Paul Coomes, emeritus economics professor at the University of Louisville. It shows hospital employment trending down while other health-care jobs have been going up.

While Carroll County and others are benefiting from federal digitization grants, "That funding’s going to go away," Cobb said, and "Every year you've got to pay for upgrades, and the requirements continue to increase at the federal level." Federal officials say digitization should make hospitals more efficient.

Of the Carrollton hospital, Cobb said, "That’s a special situation. That’s not a typical one." She said the facility "put in place a lot of measures to try to improve their management" and has partnered with larger hospitals to offer more services, such as cardiology, "and that’s breathed some life back in."

Rural hospitals in Nicholas and Fulton counties have closed in the last year, and state Auditor Adam Edelen, who is preparing to issue a report on rural hospitals, has warned that others are in danger, threatening to put new obstacles between rural Kentuckians and health care. "Not acknowledging the looming access issue is a disservice to the low-income and elderly Kentuckians who are depending on an intact provider network,” Edelen spokeswoman Stephenie Hoelscher said.

Highly anticipated report on first year of Medicaid expansion says Kentucky can afford it even with higher-than-expected enrollment

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Kentucky's decision to expand Medicaid under federal health reform is a better deal than previously projected and will more than pay for itself, Gov. Steve Beshear said as he unveiled a top consulting and accounting firm's study of the expansion's first year and projections for the next seven.

"For all the naysayers who claimed that expanding Medicaid was a budget-busting boondoggle, take a look at the facts. It's working, and it's literally paying off. The state is saving money, hospitals are earning more, and our people are getting healthier," Beshear said.

The report was conducted by Deloitte Consulting and the University of Louisville's Urban Studies Institute and cost $140,000, which was paid from Medicaid's administrative budget, half state funds and half federal.

Beshear said a study from Deloitte is "about as reliable as any study can be" and conclusively, with "an avalanche of facts," informs the critics that Kentucky can afford to pay for Medicaid expansion.

"Kentucky can indeed take care of its people, In fact, we can't afford not to do so," he said.

The report says that through 2021, Medicaid expansion will add 40,000 new jobs with an average annual salary of $41,000, putting $30 billion into the state's economy, and adding nearly $820 million to state and local budgets.

That, the report says, will cover the estimated cost of the matching funds that the state will have to pay for care of the newly eligible enrollees, those between 69 percent and 138 percent of the federal poverty level. The match will start at 5 percent of the cost in 2017 and rise to the law's cap of 10 percent in 2020.

For the next two budget years, from July 2016 to June 2018, the report estimates Kentucky will pay $74.4 million and $173.2 million, respectively. The report says this will be offset by $511.8 million of General Fund savings and tax revenues expected from the increased economic activity resulting from additional health care spending.

"These are conservative estimates," Beshear said, without any estimated savings from better health that he said will result from more people getting health care.

A Gallup poll released this summer said that Kentucky saw the second largest decrease of any state in its uninsured rate, dropping to 12 percent from 20 percent.

The study's projections were more favorable than those in a study by the PriceWaterhouseCoopers accounting and consulting firm, which Beshear cited when he announced in May 2013 that he would expand Medicaid. That study estimated the expansion would create 7,600 new jobs in 2014, but Beshear said the actual number was more than 12,000, including 5,400 in health care. Pricewaterhouse estimated 17,000 new jobs through 2021, well under Deloitte's forecast of more than 40,000.

Pricewaterhouse also underestimated the enrollment in Medicaid. In the first year, more than 375,000 people enrolled, about double the number that the firm estimated would enroll by 2020. That means the cost of the state's match will be higher than expected, but covered by jobs and taxes resulting from the higher enrollment.

“People can have whatever opinion they want, but they aren’t entitled to their own facts,” Beshear said. “It’s one thing just not to like [Medicaid expansion] because the president has his name on it, and if that’s the reason they want to take health care away from 500,000 Kentuckians, then that’s their opinion and people oughta know that. This report answers the questions, will it work, and yes it is working in Kentucky, and can we afford it, and yes we can."

The report is online at Governor.ky.gov. For county-by-county data, go to http://governor.ky.gov/healthierky/Documents/medicaid/Medicaid_Hospital_Report.pdf.

Clinton, Beshear, Humana chief and others discuss Medicaid expansion, other changes in health systems, and chronic illness

By Melissa Patrick and Al Cross
Kentucky Health News

The economic advantages from expanding Medicaid under federal health reform should outweigh any ideology that is holding states back from participating in it.

At least that was the consensus of a panel discussion about economics and health care led by former President Bill Clinton on Jan. 27, the last day of the Clinton Foundation's fourth annual Health Matters Activation Summit in Coachella Valley, Calif.

Gov. Steve Beshear, the leadoff panelist, said the Patient Protection and Affordable Care Act is a "transformative tool" to help change the dire health statistics in Kentucky, and while the decision to expand the Medicaid program to people with incomes up to 138 percent of the federal poverty level was "morally the right thing to do," it was economically the right thing to do, too.

Citing figures from a PriceWaterhouse Coopers study that predicted Medicaid expansion would bring money and jobs to Kentucky by expanding health care, he also said it would help create a healthier workforce to compete for jobs and this would give Kentucky an economic advantage over the surrounding states that didn't expand Medicaid.

"We are going to go past them pretty fast, from an economic standpoint," the governor said.

The study Beshear cited is being replicated to give a fresh forecast of the expansion's economic impact now that the state has a year's experience -- a year in which Medicaid enrolled more people than the first study said would enroll by 2020, and two-thirds as many health jobs were created as the predicted number for 2020. Republicans have voiced doubt that the expansion will pay for itself once the state has to pay for part of it: 5 percent in 2017, rising to the law's cap of 10 percent in 2020.

Clinton, a Democrat, said Republican-run states that had used Republican consultants for their Medicaid studies had found that expansion would pay for itself. Laughing, Clinton said the reports weren't well read because they didn't say what the Republicans had wanted them to say, and the consultants replied that "Yes, they were Republicans, but they also believed in arithmetic."

Trevor Fetter, president and CEO of Texas-based Tenet Healthcare, said that as a provider and member of the Texas business community, "It is a big mistake not to expand Medicaid, not to offer this access." He said many in Texas are "trapped" because the state hasn't expanded Medicaid and they make too much to qualify for it and too little to qualify for the federal subsidies for private insurance.

Meredith Rosenthal, professor of health economics and policy at the Harvard School of Public Health, said, "The most compelling argument for those who resist coverage expansion is an economic one," especially because health care is the largest employer in most communities.

The most talkative panelist was Bruce Broussard, president and CEO of Louisville-based insurer Humana Inc. He said expansion "is a good thing" because it allows access to insurance for people as they move or change jobs, decreases the burden of stress on the under-served and will save businesses money because it costs less to take care of healthy people than sick ones.

In discussing the health-care industry's new focus on patient outcomes, Broussard said outcomes will improve as the U.S. shifts from model built around treating episodic conditions to one that treats chronic conditions.

"It's not about the insurance, it's not about the treatment. It's how do we help people stay healthy no matter where they are in their journey," he said to a round of applause.

Experts say rising levels of chronic disease among baby boomers are a major concern. Clinton asked the panel to name the one thing we need to do that isn't being done now to deal with chronic conditions like diabetes.

Broussard said yearly health assessments "would help people make better health decisions." It is important to tell them what their current health is, relative to where it should be. "When people know their numbers, they make more effective decisions," he said.

Rosenthal said, to a room full of applause, "The biggest thing you could do to prevent diabetes in this country is to look at the agriculture policy." Clinton suggested working directly with all of the stakeholders involved in food production and distribution to create change.

The discussion shifted to the role of transparency and interoperability (different systems working together) in health-care finance as a way to improve health outcomes and decrease costs. Michael Peterson, president of the Peter G. Peterson Foundation, said "We are spending 3 trillion dollars a year without any regard to cost or quality."

Broussard said, "I think interoperability will bring transparency, better data analytics and will empower the consumer."

Beshear said Kentucky has already shifted to a pay-for-performance model by switching Medicaid to managed care, in which insurance companies are paid a flat fee per person as an incentive to limit costs.

"We want people to learn how to take care of themselves and to take responsibility for themselves and stay well," he said. "And if we are successful in doing that, we will bend this cost curve."

As for the reform law, Beshear said that while there is still work to do, "We've got to get past this talk of we're going to throw the whole baby out with the bath water" and make it work.

"The ACA is not going anywhere as far as I'm concerned," he said. "It is going to stay and we are going to implement it and we are going to better the lives of our people."

Advocates must sell reform as political winds blow, Luallen says

By Melissa Patrick
Kentucky Health News

Advocates of health reform must arm themselves with information about its success in Kentucky to fight back against its critics as the 2015 gubernatorial election looms, Lt. Gov. Crit Luallen told them at the Kentucky Voices for Health annual meeting Jan. 12.

Lt. Gov. Crit Luallen

"Improving our state's health is not a task that can be accomplished in months. It doesn't fit with the cycles of gubernatorial administrations," Luallen said, alluding to the upcoming election and those for the legislature in 2016.

"I have seen time and again that Kentucky fails to remain on course for the sustained commitment that it takes to successfully tackle our toughest challenges. Too often in the past, we've let political posturing derail our efforts, too often we take the easy course when faced with difficult decisions."

She added, "We have the opportunity to truly change the future of Kentucky if we can cement these reforms in a way that has lasting and sustainable impact. But the key to that sustained commitment is your voices being strong when the political winds make staying strong during the course difficult."

Luallen, who has worked for six Kentucky governors, said governors often slow down during their last year of service, but she said this might be Gov. Steve Beshear's "most important year" as he works to keep his health initiatives moving forward.

She listed many of the results: increased health coverage for children and low-income working families, expanded mental health and substance abuse treatments, increased cancer screenings, 114,000 people already signed up for health coverage in the second enrollment period, and 12,000 new jobs created in Kentucky health care because expansion of Medicaid and subsidies for private coverage have expanded the health-care industry.

In the longer term, she said, "The meaningful reforms we have implemented will lead to a higher quality of life, better attendance at school, a stronger work record and less chance of bankruptcy due to illness or disease, but only if we stay the course."

Luallen reminded the advocates, many of who are paid lobbyists, to also talk about the challenges that remain with the Patient Protection and Affordable Care Act.

One of the biggest concerns critics have about the law is that Kentucky won't be able to pay for its share the care for newly eligible Medicaid patients, which will start in 2017 and reach the law's limit of 10 percent in 2020.

Beshear says the expansion will pay for itself, based on a study by the Pricewaterhouse Coopers accounting firm and the University of Louisville's Urban Studies Institute. However, the newly-eligible Medicaid enrollment last year was more than double the original projection, nearing levels that had been predicted would not be seen until 2020, and the 12,000 jobs are about two-thirds of the total projected by that time.

Beshear has ordered up a new study, using a year's experience, which Luallen said is to be completed by the end of January. She said that the economic impact of the law could be higher than first expected "because we have seen more people sign up, especially in the Medicaid arena, which means more federal dollars flowing to the state."

Luallen said that when critics say, "We can't afford to do it," advocates should say, "Yes we can!"

By virtue of her office, to which Beshear appointed her when Jerry Abramson resigned to take a White House job, Luallen heads Kyhealthnow, an aggressive plan to improve Kentuckians' health, with seven measurable goals, over the next five years. "We will be looking for partners as we work to transition Kyhealthnow's mission beyond this administration," she said.

On perhaps the most pressing health issue of the moment, a proposed statewide smoking ban, Luallen said there is increased interest in the House and more support in the Republican-controlled Senate, where the ban has never even made it out of committee. "We believe that this truly has a chance of passing this session," she said, "if we can all speak with one voice and get behind it and make the case that there is not a single thing we can do that would have bigger impact in this state's health statistics than to lower the rate of smoking and exposure to secondhand smoke."

Luallen is a colon cancer survivor and has lost her mother, two brothers, two aunts and an uncle to cancer. She said that her personal experience gives her a unique perspective in understanding the devastating effects of cancer in Kentucky and has contributed to her passion for health policy. Kentucky ranks first for cancer and cancer deaths.

She said, “I often say that people in Kentucky fall into one of two groups, those who have been touched by cancer and those who have not been touched yet.”

Beshear: Improving health means progress on other issues

Gov. Steve Beshear gave his eighth and final State of the Commonwealth address Wednesday night touting the many accomplishments Kentucky has made in the past seven years under his leadership, but he also said there is work to do, including improving the health of Kentuckians, which is related to so many of the state's problems.

Associated Press photo by David Stephenson

While Kentucky has led the way on many health fronts with the implementation of electronic health records, expansion of Medicaid under federal health reform and a "nation-leading health benefit exchange," Beshear said, it still ranks "among the worst, if not the worst, in almost every major health category."

He said those issues are broader than people think: "There is a direct line from poor health to almost every core challenge Kentucky faces, whether that's poverty, unemployment, low education attainment, substance abuse or crime."

Almost 30 percent of the governor's speech was spent talking about health related issues and the success of the Affordable Care Act in Kentucky.

Beshear reiterated his support for a comprehensive,statewide smoke-free ban and encouraged lawmakers to pass this ban about mid-way through the speech, spending a little over two minutes giving facts about the ill effects of smoking to our state. He noted that the state leads the nation in smoking "and when it comes to preventable illnesses and deaths, every single study concludes that nothing is as devastating to Kentucky as smoking and tobacco use."

A new poll shows that 66 percent of Kentucky adults favor a statewide smoking ban and 29 percent oppose it, but it has never come to a vote on the floor of either chamber of the legislature. However, on Monday, House Speaker Greg Stumbo said the time had come for a floor vote in the House.

Terry Brooks, executive director of  Kentucky Youth Advocates said in a prepared statement after the speech, "A comprehensive statewide smoke-free law will protect children today and, by protecting pregnant women from secondhand smoke, that law will protect unborn babies as well."

Another big health issue in Kentucky is heroin,"and it's getting worse every day," Beshear said.

"In 2011, 5 percent of people who died from drug overdoses in Kentucky had heroin in their bloodstream. In 2013, that had risen to 32 percent," he said. He also cited that the number of heroin cases sent to the Kentucky State Police crime lab for analysis had increased by 340 percent in the last five years.

In response to this epidemic, Beshear asked for legislation to expand access to drugs that immediately reverse the effects of overdoses, saying that such drugs will protect law enforcement and health care workers from needle sticks and will expand access to treatment.

He also asked for legislation that will enhance penalties for major traffickers and will protect users from minor drug charges when they call 911 to help an overdose victim. "No single change in the law is enough," he said. An anti-heroin bill failed last year because each chamber wanted the measure to do something the other chamber didn't want.

On other issues related to health, Beshear asked for legislation to increase the age and weight requirement for booster seats and to create an expansion of court protective orders for dating partners.

Beshear closed by asking the lawmakers to put aside things like "partisan bickering, pending elections and Twitter-feed rhetoric" and to ""Join with me in continuing to improve our health, our workforce, our families and our economy."

Most Kentuckians who bought health insurance on Kynect will pay higher premiums next year

Most premiums for private health insurance purchased through Kentucky's health insurance exchange, Kynect, will increase in 2015.

Most of the people who have used Kynect have been added to Medicaid, the government health insurance program for the poor and disabled. Only about 85,000 Kentuckians used the site to purchase private plans.

Health insurance companies have filed their rate requests for 2015, and the state Department of Insurance has approved most of them, reports Adam Beam of The Associated Press.

Officials have approved a 15 percent average rate increase for the Kentucky Health Cooperative, which sold 75 percent of private plans on the exchange.

Humana and Anthem Blue Cross Blue Shield each sold 12.5 percent of the private plans on Kynect. Humana's premiums will rose an average of 12.8 percent, but rates for Anthem will go down an average of 4.3 percent, Beam reports. Rates apparently have not been set for two new companies that will join the exchange, CareSource and WellCare.

"Rates off the exchange are increasing, too, in both the small group and individual markets," writes Beam. For example, Time Insurance Co.'s individual rates will go up an average of 15 percent, and the small group rates for Time, Bluegrass Family Health and John Alden Life Insurance Co. will rise an average of 5 percent.

Department of Insurance spokeswoman Ronda Sloan told Beam that rates for large group plans were not available yet. The rate certification process will be finalized before open enrollment, which begins on November 15, 2014 and runs through February 15, 2015.

The averages can be misleading because that Kynect offers approximately 70,000 different rates, which vary depending on numerous variables, such as the type of plan, where people live, how old they are and whether they smoke.

Kynect was one of the few online health insurance portals that actually functioned when Obamacare launched a year ago. An estimated 521,000 Kentuckians have obtained insurance through the website, reducing the state's uninsured rate from 20 percent to 12 percent, Democratic Gov. Steve Beshear said in a recent video update.

Beshear said this sharp reduction in the uninsured proves that Kynect is working. Republicans say higher insurance premiums and difficulty finding doctors prove it isn't.

Beshear bans use of tobacco products and e-cigarettes on or near buildings and property the state owns or leases

Gov. Steve Beshear issued an executive order Sept, 4 that soon ban all tobacco products and e-cigarettes from more than 26.4 million square feet of executive branch buildings and grounds on Nov. 20.

All executive-branch buildings are smoke-free inside, but the new ban extends to the use of all tobacco products and e-cigarettes in state-owned or -leased buildings, in state-owned vehicles and on state property.

“Tobacco products have a deadly grip on thousands of Kentuckians. Smoking and tobacco use are the single-biggest causes of preventable illness and death in our state,” Beshear said in a news release. “This policy will protect non-smokers from the effects of secondhand smoke and encourage tobacco users to seek help in quitting.”

Kentucky is only the fifth state to institute such a policy. The release notes that more than 28 percent of adults smoke, leading to 8,000 Kentucky deaths each year from tobacco-related illnesses.

Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, said Beshear's move "sends a clear signal that Kentucky is serious about curbing the negative health consequences of smoking, and committed to improving the health of Kentuckians,” said Zepeda. She noted that polls have shown a clear majority of Kentucky adults favor a statewide smoking ban.

The release from Beshear's office said expanding tobacco-free policies to more executive-branch property is aimed at helping achieve his kyhealthnow goal of reducing smoking rates by 10 percent by 2019. Beshear supports a statewide smoking ban and encourages all state and local government facilities, public and private school districts, universities, and businesses to consider limiting use of tobacco products on their properties.

Amy Barkley, Chair of Smoke-free Kentucky, said in the release, “We are hopeful that this policy will motivate the legislature to pass a comprehensive, statewide, smoke-free law that will protect the rest of Kentucky workers from secondhand smoke exposure in all other indoor workplaces.”

More information about the policy, as well as links to tools to stop tobacco use, are available at http://tobacco-free.ky.gov.

Beshear says that even if Republicans take over, they won't be willing or able to reverse his Medicaid expansion

By Al Cross
Kentucky Health News

Democratic Gov. Steve Beshear may be succeeded by a Republican next year, and the state legislature may even sooner be controlled by Republicans who have objected to his expansion of Medicaid, but he says they won't be willing or able to reduce or eliminate the coverage or the subsidies for private insurance under the federal health-reform law.

"We now have 421,000 Kentuckians who are also voters signed up for the law and liking what they are getting," Beshear told BBC reporter Claire Bolderson. He said Republicans "want to be critical of the president and his administration, but at the same time they want those 421,000 votes, so they're not going to take away that coverage from those folks."

State Senate President Robert Stivers, R-Manchester, "unlike many of his Republican colleagues in Kentucky and Washington . . . is not calling for outright repeal of Obamacare," the BBC reports, quoting him: "What we are looking for is a reasonable alternative.".

"That includes rolling back the expanded Medicaid coverage and subsidies, and eliminating all the mandates," Bolderson reports.

Stivers claimed that "They've caused more people to lose their insurance than they helped gain," but that is not true, even if those who had to get more expensive policies are counted as losing their insurance.

Agriculture Commissioner James Comer, who is expected to enter the Republican primary for governor soon, indicated at a Kentucky Chamber of Commerce forum Tuesday that he expects to pay for Beshear's expansion of Medicaid if elected.

"We're going to have to not point the finger. If it's not repealed in the next year, we're going to have to pay for it," he said. If so, he said, eligibility criteria should be tightened and "We need to privatize every service we can possibly privatize" and reduce the state workforce to get the money.

Former Louisville Metro Councilman Hal Heiner, who is already in the primary, didn't address Medicaid in detail but said the state should seek federal waivers to create incentives for healthier behavior by Medicaid recipients. He and Comer both said they did not accept studies cited by Beshear which predicted that expansion of the program would create so many jobs in health care and so much more tax revenue that the expansion would pay for itself.

Attorney General Jack Conway, the only announced Democratic candidate, pulled out of the forum a few days before it. Democrat Adam Edelen, who passed up the governor's race to run for re-election as auditor, indicated more faith in the studies, saying that in the long term it is better to have people insured than not, to improve the state's health.

Beshear issues executive order funding insurance exchange with fees on insurers, originally used to fund high-risk pool

Gov. Steve Beshear has filed another executive order to continue the state health-insurance exchange he created under federal health reform, "again sidestepping state lawmakers who have blasted Beshear for moving forward without their approval," Matt Young writes for the Lexington Herald-Leader.

"This year's directive says the exchange will generate enough revenue to fund itself beginning Jan. 1, 2015, when federal funds to create the exchange run out," Young reports. "In 2015, the exchange will operate on about $27 million garnered from a 1 percent assessment placed on insurance companies participating in Kynect," the brand name of the exchange.

The General Assembly originally approved the fees to finance the Kentucky Access program, a high-risk insurance pool that was made moot by the Patient Protection and Affordable Care Act, which requires insurers to accept people with pre-existing conditions. Beshear's order, using his broad reorganization powers, makes Kentucky Access a division in a new Kentucky Health Care Improvement Authority to handle the money.

The General Assembly barred the use of state General Fund money to continue the exchange, but the fees go into restricted agency accounts, not the General Fund, Cabinet for Health and Family Services spokeswoman Gwenda Bond told Young.

"Senate Republicans were aware of the governor's plan to use the fees to pay for Kynect throughout the budget process this spring," Young writes. "In 2013, the Republican-led Senate passed two bills that would have required the governor to get legislative approval before expanding Medicaid or establishing a health exchange in Kentucky, but neither bill passed the Democratic-led House."

Senate Republican Floor Leader Damon Thayer of Georgetown told Young, "Governor Beshear continues to bypass the legislature and, like his good friend President Obama, use the executive order process to run Obamacare in Kentucky."

Young notes that Franklin Circuit Judge Phillip Shepherd ruled in 2013 that Beshear has the authority to create offices in the executive branch to fulfill a federal law. The ruling was affirmed by the Court of Appeals; the state Supreme Court has not decided whether to hear the appeal.