Annual health policy forum set Sept. 28 in Bowling Green

This year's annual Howard L. Bost Health Policy Forum "will offer new insights and opportunities from a range of civic sectors for a shared vision, policies, and actions for community health," says its lead sponsor, the Foundation for a Healthy Kentucky.

"Local, regional, and national speakers will share their knowledge and experiences in building healthy communities, with a focus on transportation and housing, education, food systems and policy, and employers and workplaces," the foundation says. "TED style" speakers will make presentations on each of the forum's four focus areas: education, food systems and policy, employer/workplace, and transportation/housing.

The forum will be held at the Sloan Convention Center in Bowling Green on Monday, Sept. 28. For the registration website, click here.

University of Kentucky rural health expert, Ty Borders, appointed to national advisory committee on rural health

University of Kentucky College of Public Health Professor Ty Borders was recently appointed to the National Advisory Committee on Rural Health and Human Services.

Ty Borders

This committee is part of the Health Resources and Services Administration and includes a 21-member panel of nationally recognized rural health experts that is responsible for making recommendations to the Department of Health and Human Services on issues related to rural health. Borders's appointment will continue until April 2019.

“This appointment is an honor not only for Dr. Borders and his family, but also for Kentucky,” Rep. Andy Barr, R-Ky., said in a UK news release. “Dr. Borders possesses a broad and deep understanding of the health care challenges facing rural Kentucky and America. His unique insight about evidence-based strategies that could improve rural health and health care delivery will greatly benefit the committee.”

Borders is the chair of the Department of Health Services Management and the Foundation for a Healthy Kentucky endowed chair in Rural Health Policy. He also serves as a founding co-director of the UK Institute for Rural Health Policy and is the editor of the Journal of Rural Health, an academic publication devoted to rural health research.

Electronic cigarettes are 'high on every school system's radar right now,' Western Ky. school official tells Henderson newspaper

This story has been updated to reflect recent data about teens and e-cigarette use.

School officials in northwestern Kentucky are trying deal with an increase in the use of electronic cigarettes by students, Erin Schmitt reports for The Gleaner in Henderson.

Union County Schools spokeswoman Malinda Beauchamp told Schmitt there had been 16 discipline referrals of students using e-cigarettes at Union County High School and 26 at Union County Middle School this year. There is no data from previous years for comparison, but school officials "have noticed the rise" and want to be proactive in preventing more usage, Beauchamp said.

Schmitt reported on e-cigarette usage at other schools in the region and found 15 to 20 incidents at Henderson County High, but only a few incidents in North Middle School, South Middle School and Central Academy, according to Julie Wischer, public information officer for Henderson County Schools.

The Webster County Schools did not have exact numbers of incidents of usage, but has e-cigarettes listed under its policy as a tobacco product or paraphernalia, Todd Marshall, Webster’s director of pupil personnel, told Schmidt. Though it’s a new issue, Marshall said, “It’s high on every school system’s radar right now.”

A recent report by the Centers for Disease Control and Prevention found that the number of high school students who tried e-cigarettes has tripled in one year, to more than 13 percent, while smoking of traditional cigarettes dropped to 9.2 percent from more than 13 percent, CBS News reports.

“Many users of marijuana prefer e-cigs or vapes because it’s smokeless, odorless and easy to hide or conceal,” Henderson County Supt. Patricia Sheffer told Schmitt. “This ‘vaping’ is a concern in our schools and elsewhere among youth, because it can produce a nearly instant ‘high’ with little or no detection."

The preventive measures include: a Facebook message to parents and students from her about the dangers of e-cigarettes, which not only involves nicotine usage, but also marijuana, alcohol and other drugs that can be ingested through the device; updating policies, procedures and the student code of conduct to include prohibitions on e-cigs and vapor devices on school property; a commitment to find out how the student got access to the device; and a required drug and alcohol screening if caught, with parent-paid counseling if the screen is positive.

Chain restaurants, theaters, amusement parks and grocery delis must post calorie counts in a year, to fight obesity

McDonald's already posts calorie content on its menus

In an effort to combat the country's obesity epidemic, the Food and Drug Administration issued final regulations Tuesday that will require chains with 20 or more restaurants, movie theaters and pizza parlors to post calorie counts on menus.

"The rules will have broad implications for public health," Sabrina Tavernise and Stephanie Strom report for The New York Times. "As much as a third of the calories that Americans consume come from outside the home, and many health experts believe that increasingly large portion sizes and unhealthy ingredients have been significant contributors to obesity in the United States."

“This is one of the most important public health nutrition policies ever to be passed nationally,” Margo Wootan, director of nutrition policy at the Center for Science in the Public Interest, told the authors. “Right now, you are totally guessing at what you are getting. This rule will change that.”

The numbers "could be a pretty big wake-up call," writes Jason Millman of The Washington Post. "The FDA rules are more comprehensive than expected, given the strong industry pushback since the menu labeling provision was included in the 2010 health-care law." The FDA proposed a rule in 2011, but heavy lobbying has delayed its finalization.

"Do people eat healthier when they can see calorie counts?" Milliman asks. "The evidence so far seems mixed. The impact seems to be greater when the calorie count is much higher than what consumers expect. What does seem clear from past studies is that people really are terrible judges of how many calories they consume when they dine out [and] are especially bad judges of the calorie content of the least healthy foods commonly found of restaurant menus."

The rules also cover food in vending machines, amusement parks, alcohol if it is on the menu or a menu board, and some prepared foods in supermarkets. Chain restaurants are defined as food establishments with 20 or more outlets.

The policy will take effect a year from now, "and seems likely to face legal and political challenges from some parts of the food industry, including grocery and convenience stores that sell prepared foods for takeout," the Times reports.

The National Grocers Association told the paper, “Grocery stores are not chain restaurants, which is why Congress did not initially include them in the law. We are disappointed that the FDA's final rules will capture grocery stores, and impose such a large and costly regulatory burden on our members.”

Daren Bakst, a research fellow in agricultural policy at the conservative Heritage Foundation, told the authors that the FDA interpreted the law too broadly. “If Congress wanted to cover any establishment that sells prepared foods, they would have said that,” he said. “No reasonable person is about to confuse a grocery store, convenience store or movie theater with a restaurant.” But retiring Democratic Sen. Tom Harkin of Iowa, who helped create the labeling requirement, said the rule “closely mirrors congressional intent.”

The FDA offered some concessions to grocers, convenience stores, pizza chains and vending-machine owners. For example, pizzerias can define their serving sizes and list calories by the slice, and vending machine owners have been given an extra year to comply.

Medicaid expansion has been more popular than expected, but that raises a question of whether it will really pay for itself

Kentucky officials say the state’s Medicaid expansion under the federal health-reform law has enrolled more residents and created more jobs than expected, but a study will see whether the expansion will pay for itself, as an earlier study and Gov. Steve Beshear predicted.

Eric Friedlander, deputy secretary of the Cabinet for Health and Family Services, reported both a larger-than-expected Medicaid enrollment in every county and an increase of 17,000 jobs in Kentucky from Medicaid expansion at Monday's meeting of the legislature's Interim Joint Committee on Appropriations and Revenue.

Friedlander also discussed other benefits of Medicaid expansion, saying Kentucky health-care providers had received $892,973,500 in reimbursements from January to October of 2014, reports Brad Bowman of The State Journal in Frankfort.

Cabinet Secretary Audrey Haynes told Kentucky Health News on Tuesday that on the previous Friday, the cabinet had passed $1 billion in payments of federal money to health-care providers for treatment of people newly eligible for Medicaid: those with household incomes between 69 percent and 138 percent of the federal poverty level. About half the money has gone to hospitals, she said.

Still, many providers, particularly in rural areas, have reported cash-flow problems caused by delays in payment from Medicaid managed-care companies, lower-than-cost reimbursements and increased administrative burdens.

Also, some legislators have expressed concern about the cost of expanding Medicaid rolls, which grew more than predicted by a study that Beshear cited in his expansion decision. As the law outlines, the federal government will pay 100 percent of the costs until Jan. 1, 2017, when the state will begin paying a small share rising to the law's limit of 10 percent in 2020.

Republican Sen. Chris McDaniel of Taylor Mill, who is running for lieutenant governor on the gubernatorial slate headed by Agriculture Commissioner James Comer, asked Friedlander what Kentucky’s financial obligations would be because of the expansion in the next few years. He said that is uncertain.

Under initial estimates, based on the study by PriceWaterhouse Coopers, expansion was expected to cost the state only about $150 million a year when it was paying 10 percent of the cost. But the study only forecast that fewer than 300,000 newly eligible Kentuckians would sign up for Medicaid in the first year, but about 337,419 did.

To get updated cost projections, Beshear has contracted for a second analysis by an independent agency, which Friedlander said should be completed by mid-January, reports Ronnie Ellis of CNHI News Service.

The governor said the new study will speak for itself, reports Tom Loftus of The Courier-Journal. "I was confident after that initial report that we could certainly afford down the road over the next eight years to expand Medicaid and stay within our budget. I'm still confident," Beshear said.

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.'"

Study shows tailored advocacy for local smoking bans in rural Kentucky gets results

Local smoking bans are only possible if the community is ready for this change, Ellen Hahn, director of the Kentucky Center for Smoke-free Policy, writes in a report of a five-year study she conducted in rural Kentucky.

Readiness for change can be developed in rural communities that participate in smoke-free policy initiatives tailored to their community, Hahn writes in The Journal of Rural Health. The study evaluated six stages of readiness to determine if a community was ready to support smoke-free policy, and then tailored interventions based on how ready the community was.

The study was conducted in 37 rural Kentucky counties that were randomly selected from those without smoking ordinances or regulations. Nineteen of the communities received policy-intervention strategies, tailored to their readiness, from a trained community adviser. The remaining 18 were used for comparison. Data were collected annually and policy outcomes were tracked over five years.

Nearly one-third of the counties that were the target of interventions adopted smoking bans covering restaurants, bars, and all workplaces, while none of the comparison counties did.

Rural, tobacco-growing areas were chosen because they are "disproportionately affected by tobacco use, secondhand smoke, and weak tobacco control policies," Hahn writes in the study, "A Controlled Community-Based Trial to Promote Smoke-Free Policy in Rural Communities."

Free, day-long forum Sept. 16 in Louisville will explore doing health care differently; registration almost full

A free one-day conference will be held Tuesday, Sept. 16, in Louisville to explore policy opportunities and challenges related to doing health care differently for a healthier Kentucky. The focus will be on the shift to a population-health approach, which emphasizes prevention and integration of services while treating the whole person within the context of their community.

This edition of the Foundation for a Healthy Kentucky's annual Howard L. Bost Memorial Health Policy Forum, Doing Care Differently: Journey to a Healthier Kentucky, will have experts on:

• Changing the health-care workforce 
• information-technology applications in health care;
• Measuring, and improving, quality 
• Payment changes that drive care-delivery changes

The keynote speaker will be Dr. Jason Hwang, chief medical officer and one of the founders of PolkaDoc, an "extremely affordable primary care" telehealth company. Other speakers include Dr. Craig Blakely, dean of the University of Louisville School of Public Health and Information Sciences; Brent Wright of the U of L School of Medicine; David Bolt of the Kentucky Primary Care Association; Travis Burgett of KentuckyOne Health; Mark Carter of Passport Health Plan; Fran Feltner, director of the University of Kentucky Center for Excellence in Rural Health; Dr. John Langefeld of the state Cabinet for Health and Family Services; Dr. Raynor Mullins of the UK College of Dentistry; Polly Mullins-Bentley of the Governor's Office of Electronic Health Information; Sheila Schuster, chair of the Kentucky Mental Health Coalition; and Connie White of the state Department for Public Health.

The conference is free to the public, but seating is limited and registration is nearly full. For more information click here; for an agenda, here; to register, here.

Women leading Kentucky health: State health commissioner sees 'stars aligned' for Kentucky to finally get healthier

Health Commissioner Stephanie Mayfield Gibson

This is the third in a series of stories about four high-ranking female state officials who have guided the state's embrace of the Patient Protection and Affordable Care Act.

By Melissa Patrick

Kentucky Health News

“The stars have aligned” and Kentucky has at last “created an infrastructure” to make the state healthier, says Dr. Stephanie Mayfield Gibson, commissioner of the state Department for Public Health.

“What a great time to be in my position,” Mayfield said in an interview, in which she enthusiastically ticked off a list of aligned stars:

• Her bosses, including the governor and lieutenant governor, who are “extraordinarily supportive of health care;”
• The expansion of the federal-state Medicaid program to households with incomes up to 138 percent of the federal poverty level;
• The Kentucky Health Benefits Exchange, branded as Kynect, where Kentuckians sign up for Medicaid or subsidized private insurance;
• The Kentucky Health Information Exchange, an electronic network that makes a wide range of health information easily available; and
• Programs that enhance the quality of care to get better outcomes and decrease costs, such as the programs to stop over-use of emergency rooms.

Mayfield says her top priority is to decrease exposure to tobacco, because so many of Kentucky’s health issues are related to its most famous crop. About 28 percent of Kentuckians smoke, and “The single most important factor that negatively impacts the health of the commonwealth . . . is exposure to tobacco smoke,” Mayfield said. “I want people well.”

She said Kentucky must also address the epidemic of painkiller abuse, which has made it one of the top three states in deaths related to abuse of opioids; and obesity, which is connected to cancer, diabetes and cardiovascular disease. Kentucky ranks in the top five in each of those diseases, and is in the top 10 for child and adult obesity.  

“Who wants the reputation for being number one in cancer deaths?” Mayfield asked. “We know we can do better. These are winnable battles.”

These and other issues are included in Kentucky Health Now, a plan Gov. Steve Beshear has set forth to improve the health of Kentuckians, with specific goals to be reached by 2019, the end of the next gubernatorial term. Beshear’s term ends in December 2015.

Mayfield is vice-chair of the team overseeing the effort, led by Lt. Gov. Jerry Abramson.  She seems to have the full confidence of Audrey Haynes, the secretary of the Cabinet for Health and Family Services, who lit up when asked about her, but Haynes said she had to make sure that Mayfield, a pathologist who ran the state health lab for seven years, was cut out to be the state’s top doctor.

“It’s a job where … you have to kind of have a better understanding of politics,” Haynes said.  “But I wanted her to rise above all that because she is the public health commissioner. Hers is more about the science.  I need her to be honest and tell the truth.”

Haynes said she told Mayfield, “You are going to tell people what they don’t want to hear sometimes, but always stick with science.  You have to rise above the rhetoric, no matter what.”

“And so I recommended her to the governor and they also fell in love with her.” She became commissioner on Oct. 1, 2012.

Kentucky’s health problems have mounted for decades, but Mayfield is optimistic that they can be overcome because of the Medicaid expansion and increased access to health insurance under the federal health-reform law. Thousands of people have sought care for problems that went untreated because they had little or no money or no insurance.

The federal government is paying the entire cost of those newly eligible for Medicaid until 2017, when the state will begin paying 3 percent, rising to the law’s cap of 20 percent in 2020.  Republican legislators and candidates for governor have voiced concern about the state’s ability to pay its Medicaid bills.

Mayfield said the state is working on controlling costs, through the managed-care system that began in 2011.  One target of cost control is the “super-utilizers” of emergency rooms, or those who come to hospital emergency departments 10 or more times per month.

Mayfield, who was put in charge of finding a way to reduce super-utilizers, said 80 percent of them have mental-health issues, so she is working on the problem with Medicare, the state Department of Behavioral Health and Kentucky’s three medical schools. Kentucky is one of six states accepted into the National Governors Association Policy Academy to address super-utilization.

Dr. William Hacker, who preceded Mayfield as commissioner, said her broad training and deep experience in the department uniquely qualified her to succeed Dr. Steve Davis, who was interim commissioner after Hacker retired.

“She is multidisciplinary and thinks beyond the public-health world,” Hacker said. “She has done an excellent job.”

Mayfield, who has been nationally recognized for her contributions to the state’s electronic health information exchange, also stresses the importance of using technology to improve the health of Kentuckians – especially those who live in rural areas, far from specialists.

Mayfield describes her style of leadership as one of action.  “If we say we are going to do something, then let’s build that infrastructure and let’s get it done,” she said.

Hacker said, “Dr. Mayfield is a thoroughbred.  She is on the go at 90 miles per hour.  She is focused on accomplishing goals.”

Haynes said Mayfield “led massive change at the lab” and knows “how to cajole and support and lead” – and when to be firm. “There are times you have to stick to your guns. You have to choose sort of your poison and you have to say ‘I’ll give you this, but I’m not giving this.’ I needed somebody that didn’t feel the political pressure to give in, and that would stick with it. And really just be a great public face of public health.  And she is all of that.”