CDC says state spends less than 8% of what it should on preventing use of tobacco; companies spend 13 times as much

Kentucky spends only 7.6 percent of what it should spend on preventing the use of tobacco, the federal Centers for Disease Control and Prevention says in its latest annual report on the subject.

The state spent $4.33 million on tobacco-control programs in 2011, the year covered by the report. The CDC said spending of $57.2 million was called for, since 29 percent of Kentuckians smoked that year. Tobacco-related illnesses are estimated to cost Kentuckians $3.3 billion a year.

South Carolina and Texas, which spent 6.5 percent and 7 percent of the recommended amounts, were also singled out for criticism by the CDC. Nationally, states spend less than 18 percent of what they should, $3.7 billion, in the agency's view. "Only Alaska and North Dakota funded programs at the CDC-recommended levels, $10.7 million and $9.3 million, respectively," Samantha Ehlinger of McClatchy Newspapers reports.

Read more here: http://www.kentucky.com/2015/06/25/3918046/cdc-says-kentucky-isnt-spending.html#storylink=cpy

"States that made larger investments in tobacco prevention and control have seen larger declines in cigarettes sales than the United States as a whole, and the prevalence of smoking has declined faster as spending for tobacco control programs has increased," the CDC report said. "Evidence suggests that funding tobacco prevention and control efforts at the levels recommended . . . could achieve larger and more rapid reductions in tobacco use and associated morbidity and mortality."

In contrast to the state spending of $658 million on tobacco control, tobacco companies spent more than 13 times as much on advertising and promotion in 2011: $8.8 billion, or $24 million per day, the report noted.

"During the same period, more than 3,200 youth younger than 18 years of age smoked their first cigarette and another 2,100 youth and young adults who are occasional smokers progressed to become daily smokers," the report said. "If current rates continue, 5.6 million Americans younger than 18 years of age who are alive today are projected to die prematurely from smoking-related disease. However, the tobacco-use epidemic can be markedly reduced by implementing interventions that are known to work."

For the CDC's latest comprehensive report on tobacco use in Kentucky, with data from 2012, click here. For county-by-county figures on adults smoking in Kentucky in 2011-13, click here.

As session nears end, bills on heroin, dating-violence orders, managed-care appeals and lawsuit review panels are hanging fire

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The General Assembly has sent Gov. Steve Beshear four health-related bills, and several more could reach his desk in the legislative session that ends Wednesday. Legislators will return briefly after 10 days to reconsider any bills Beshear vetoes; they could also pass more bills, but would not be able to override any vetoes.

Here are some of the health-related bills that were pending on Monday; bills with two readings are ready for floor action.

Heroin: tougher penalties and needle exchanges?

Both the Senate and the House have heroin bills and both remain in committee in the other chamber, but hope remains high in both chambers that a compromise can be reached so that a heroin bill will pass this session. Senate Bill 5 is sponsored by Sen. Christian McDaniel, R-Latonia; House Bill 213 is sponsored by Rep. John Tilley. The main differences are how traffickers would be punished and whether to start needle-exchange programs for addicts. The Senate's penalties are tougher and it has opposed needle exchanges, which advocates say prevent disease and death from dirty needles and can lead addicts to treatment.

Now the Senate is moving toward accepting needle exchanges, James Pilcher reports for The Cincinnati Enquirer. Rep. Dennis Keene, D-Wilder, and Sen. Wil Schroder, R-Wilder, said exchanges "are much more likely to be included than when the session started," Pilcher writes. Schroeder told him, "I think there is a real possibility that we could include needle exchanges and then get our tougher penalties." Pilcher reports, "The possible legislative position shift comes as health officials throughout the Tristate have expressed deep concerns about the spread of diseases that can be contracted using dirty needles."

Protective orders for dating violence

House Bill 8, sponsored by Rep. John Tilley, D-Hopkinsville, has received its second reading and is awaiting passage in the Senate. This bill would allow dating partners to petition for interpersonal protective orders if they have been the victim of domestic violence, sexual abuse or stalking. Such orders are now available only to those who are married, live together or have lived together, or an unmarried couple with a child in common.

Kentucky is the only state that offers no protection for such victims. Legislation to do that has stalled in the Senate in earlier sessions, but a Senate committee substitute addresses a key objection, by creating a new chapter in the statutes for the bill, separate from the existing domestic-violence chapter.

Advocates say domestic violence is a health issue not just because of the physical injuries it causes. They say victims are more likely to be depressed, have unplanned and premature pregnancies, go to fewer prenatal visits, and to miss more well-child visits with their children.

Prescription synchronization, managed-care appeals

Senate Bill 44, sponsored by Sen. Julie Raque Adams, R-Louisville, has had its second reading in the House. This bill would allow patients with multiple prescriptions, in consultation with their health-care provider and their pharmacist, to synchronize prescriptions so that they may be picked up at the same time.

House Majority Caucus Chair Johnny Bell, D-Glasgow, has filed a floor amendment on an unrelated issue, to create a state appeals process for health-care providers to appeal decisions of Medicaid managed-care companies. It is the same as or similar to Senate Bill 120, sponsored by Sen. Ralph Alvarado, which has given it a first reading without assigning it to a committee. The Cabinet for Health and Family Services opposes a state appeals process, saying it would have a conflict of interest (successful appeals would cost the state money) and providers have the courts available to them to resolve contractual issues. UPDATE: Bell withdrew his floor amendment to Senate Bill 44 March 9. 

Review panels for suits against health-care providers: Senate Bill 6, filed by Alvarado, remains in the House Judiciary Committee, but a discharge petition was filed March 4 to bring it to the floor, bypassing leaders of the House's Democratic majority. This bill would establish panels of three medical experts, two chosen by each side and the third chosen by the other two, to review suits against health-care providers to determine if the case has merit before the lawsuit can proceed. Panel findings would be admissible in court, but not legally binding. Opponents say that Kentucky already has laws to punish attorneys for filing frivolous cases and that this just adds another barrier for patients seeking justice.

Newborn screenings for fatal disease: Senate Bill 75, sponsored by Sen. Alice Forgy Kerr, R-Lexington, has had two readings. It would require all newborns to be tested for Krabbe disease, a neurological disorder that destroys the protective coating of nerve and brain cells and is fatal once symptoms occur. Treatment with stem cells from an umbilical cord blood transplant is sometimes successful it the infant is treated early enough. The cabinet opposes the bill, saying the screening will cost half a million dollars a year at a time when local health departments are suffering budget cuts.

Spina bifida: Senate Bill 159, sponsored by Sen. Julie Raque Adams, R-Louisville, is in the House and the three-day posting rule has been waived. This bill would require medical providers to supply written, up to date, accurate information to parents when their unborn child is diagnosed with spina bifida so parents can make informed decisions on treatment

Physician assistants: House Bill 258, sponsored by Rep. Denver Butler, D-Louisville, is awaiting Senate passage. This bill allows a physician to supervise up to four physician assistants at the same time, rather than two.

In-home care: House Bill 144, sponsored by Rep. Tom Burch, D-Louisville, is awaiting Senate passage. It would establish a 60-day, hospital-to-home transition program through an approval waiver from the Department for Medicaid Services. The daily cost would have to be less than the average daily nursing home payment allowed by Medicaid. The bill would also provide non-medical support services to the applicant as needed.

BILLS SENT TO THE GOVERNOR

Colorectal cancer screening: Senate Bill 61, sponsored by Sen. Ralph Alvarado, R-Winchester, received final passage in the House March 4. This bill requires that a fecal test to screen for colon cancer, and any follow-up colonoscopy, be considered preventive measures that health insurance is required to cover without imposing additional deductible or co-insurance cost. The bill would apply to health plans issued or renewed on or after Jan. 1, 2016, if it becomes law. A similar measure, House Bill 69, sponsored by Rep. Tom Burch, D-Louisville, is awaiting passage in the Senate with a committee substitute by Sen. Julian Carroll, D-Frankfort, calling for a Medicaid savings study.

Medical order scope of  treatment (MOST) form: Senate Bill 77, sponsored by Sen. Tom Buford, R-Nicholasville, received final passage in the House March 3. This bill creates a medical order scope of treatment (MOST) form that specifically directs the type of treatment a patient would like to have, and how much intervention he or she would like to have, during end-of-life care. It is considered a physician's order, travels with the patient between health care facilities, and must be reviewed annually. The bill clearly defines the order of controlling documents for end-of-life care: the living will first, the MOST form second and the health-care surrogate, which is chosen by the patient and listed on the form, third. The MOST form is already used in 32 states.

Emergency care for strokes: Senate Bill 10, sponsored by Sens. Stan Humphries, R-Cadiz, and David Givens, R-Greensburg, received final passage in the House March 4. The bill requires that a list of all acute stroke-ready hospitals, comprehensive stroke centers and primary stroke centers in Kentucky be posted to the cabinet's website and be made available to all emergency medical services providers, who are required to set their own internal protocols toward assessment, treatment and transport of stroke patients.

Funding for UK cancer research center: House Bill 298, sponsored by Rep. Rick Rand, D-Bedford, received final passage in the Senate March 4. This bill authorizes the state to appropriate $132.5 million, half of the cost, for construction of a new medical research center at the University of Kentucky. The university will raise money to cover the other half. The facility will target prevalent diseases in Kentucky, including cancer, diabetes and cardiovascular disease. The bill required a 60 percent vote in each chamber because it affects the state budget and the legislature is in a non-budget session; it passed the House 83-9 and the Senate 36-1 (Sen. John Schickel, R-Union).

Smoking-ban bills get unfavorable committee assignment in state Senate, but supporters say they'll keep trying to get votes

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The state Senate's Republican leaders have assigned both the Republican and Democratic smoking-ban bills to a committee that appears unlikely to send them to the full Senate.

The Veterans, Military Affairs and Public Protection Committee got House Bill 145, which the House had passed 51-46, and Senate Bill 189, filed by Sen. Julie Raque Adams, R-Louisville.

Adams is chair of the Health and Welfare Committee, and smoke-free advocates had hoped the bills would go there, improving its chances in a Senate that doesn't appear disposed to pass it.

Senate President Robert Stivers defended the assignment, saying the bills relate to public protection. Last year, a smoking-ban bill sponsored by the previous Health and Welfare chair, Republican Julie Denton of Louisville, was sent to the Judiciary Committee and never heard.

Stivers was asked if Adams' bill was sent elsewhere because of her support for it. He acknowledged that it could have been considered a health issue, and "It was a choice." Pushed to answer, he said, "I don't recall anything being made, because we put a lot of bills in chairman's committees that they support whether leadership supports it or not."

Adams did not respond to requests for comment, but Amy Barkley, chair of the Smoke-free Kentucky Coalition, said she had hoped the bill would go to Health and Welfare because it addresses a health issue.

"We hope it gets a hearing in the Senate," Barkley said. "We are hoping that even if those individuals in leadership are not supportive, that they will at least let the bill have a fair hearing and hopefully a vote – and they can vote no if they are not supportive, but we think it deserves to have a vote so we know where people stand."

Sen. Morgan McGarvey, of Louisville, a Democratic co-sponsor of the Senate bill, said he understood how a smoking ban could be perceived as a public-protection matter, but used the assignment as an argument for the legislation.

"There is no bill we can pass this session that would save the state more money than a comprehensive statewide smoking ban," he said. "It will make Kentuckians healthier; it will save the state money."

Advocates' job will be to persuade Republicans, whose policy is not to allow bills to reach the full Senate unless they are favored by a majority of the 26 Republican senators.

The chairman of the Public Protection Committee, Sen. Albert Robinson, R-London, said through his assistant that he wasn't ready to talk about the bills because they had just been assigned to his committee. He told the Lexington Herald-Leader, "I don't know if there is support for it in my committee." He told The Courier-Journal that he opposes the bill.

The legislation has been debated in the legislature for five years. Senate Bill 189 is identical to the original House bill, which was amended. Both bills would prohibit smoking in workplaces and indoor places, and within 15 feet of their entrances, to protect others from secondhand smoke, which is estimated to kill 950 Kentuckians annually.

House Bill 145 passed with three changes: an exemption for cigar bars, cigar clubs, tobacco stores, private clubs and market-research facilities; significantly lower fines for violation; and preservation of any weaker or stronger local bans in effect when the bill would become law, in late June.

The fundamental conflict about the bill, largely along party lines, is whether individual liberties or public health take priority.

Stivers reiterated his stance, siding with those who support individual liberties.

"I do not like smoking. I don't patronize places that smoke. I have allergies," he said. "It costs you money to take your suits to the cleaners and things of that nature, but I just don't think it is the role of government to start telling private businesses what they can and can't do from that perspective."

He suggested that his opposition wasn't decisive. "I am one of 38 [senators] and if you go back and look at respective bills, there have been bills that I haven't voted on that have made it to the floor because they have the support of the body. Actually, I think we voted on one this week or maybe late last week that I did not vote for, but there was support in this chamber for that issue."

Stivers noted that more Republican senators support the ban than last session, mentioning Adams and Sen. Ralph Alvarado, a Winchester physician. Both were elected to the Senate last fall.

Alvarado explained why he values health over liberty on this issue. He said we all have the right to swing punches at another person, but at the point of contact, that person's rights have been violated. "My individual rights to do something ends when it affects the rights of another individual is my perspective, and secondhand smoke is just that," he said.

Alvarado said he continues to talk to senators about why they should support a statewide smoking ban, saying," It would cost nothing to implement and the benefit from a fiscal perspective and lives saved . . . would be tremendous."

As a rookie public official, Alvarado said he still has a "romantic idea" that it is possible to persuade senators to change their positions and "find at least some type of compromise to get more people covered and to reduce (secondhand smoke) exposure."

Sen. Perry Clark of Louisville, a libertarian-oriented Democrat on the Public Protection Committee, said it was too early to say how he might vote on the issue because the bill might be amended. It has been suggested that the bill could pass if local governments could opt out of the ban, but Barkley told The Courier-Journal that would fatally weaken it.

Besides Clark and Robinson, other members of the committee are Republicans C.B. Embry of Beaver Dam, Carroll Gibson of Leitchfield, Ernie Harris of Prospect, Stan Humphries of Cadiz, Chris McDaniel of Taylor Mill, Dan Seum of Louisville, Whitney Westerfield of Hopkinsville, Mike Wilson of Bowling Green and Max Wise of Campbellsville; and Democrats Julian Carroll of Frankfort and Dennis Parrett of Vine Grove.

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.

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.

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.

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.

State gives 5 health departments money for mobile dental-hygiene teams that will examine children at schools; 5 more next year

Using new money in the state budget, the state Department for Public Health has given five local health departments grants to launch mobile dental hygiene programs.

The one-year awards of $160,000 will pay for a full-time dental hygienist and assistant; portable dental equipment to set up two treatment areas; a transport vehicle and transportation costs; and dental supplies.

“Hundreds of thousands of children in this state don’t see a dentist regularly and many not at all,” Gov. Steve Beshear said. “The vast majority of both childhood and adult dental problems could be avoided through routine dental care and other preventive efforts.”

The hygienists and assistants will visit schools for "assessments, age-appropriate cleaning services, fluoride varnishes and dental sealants on permanent teeth for children at the beginning of the school year," says a release from the Kentucky Press News Service. "They can also serve local day care centers and Head Start programs. Hygienists will work with parents to facilitate any needed follow-up care with a local dentist."

The grants went to the Lincoln Trail District Health Department, which serves Hardin, LaRue, Marion, Meade, Nelson and Washington counties; the Purchase District Health Department, which serves Ballard, Carlisle, Fulton, Hickman and McCracken counties; the Pike County Health Department and the departments in Jessamine County, which will also serve Mercer County; and Lawrence County, which will also serve Martin County.

Three health departments – Madison County, the Barren River district, and the Northern Kentucky district – already have dental hygiene programs in place. Five more health departments are to get grants next year two for similar programs.

The legislature appropriated $1.2 million in the current fiscal year and $2.1 million in fiscal 2016 for the grants and other enhancements to the state oral health program, overseen by state dental director Julie W. McKee.

“Placing public health dental hygienists in the community where they can provide front-line support and services to our young people is a great leap forward in terms of not only being able to assess problems, but provide on-site cleanings and dental care,” McKee said.

Improving the oral health of Kentuckians is one of the goals of kyhealthnow, Beshear's plan to improve Kentuckians' health. It aims to reduce the percentage of children with untreated dental decay by 25 percent and increase adult dental visits by 10 percent.

Beshear has been more active on oral health than other recent governors. He launched an effort in 2009 to enroll all eligible children in state health insurance through the Kentucky Children's Health Insurance Program and Medicaid; authorized the "Healthy Smiles Kentucky" initiative, which includes training for general dentists on how to care for young patients; community oral health coalitions; and started the "Smiling Schools" program, which provided free protective tooth varnishes to school children in first through fifth grades in 16 Appalachian counties.

Medicaid expansion has dramatically reduced share of uninsured in most counties; some legislators worry about future cost

The expansion of Medicaid under federal health reform has greatly reduced the number of Kentuckians without health insurance, but state legislators are wary of its future cost.

Medicaid Commissioner Lawrence Kissner dramatically illustrated the impact of the expansion by showing two county-by-county maps to the latest meeting of the Interim Joint Committee on Appropriations and Revenue. They showed the estimated percentage of uninsured under age 65 in each county in 2012 and this year, based on calculations by the Cabinet for Health and Family Services.

The map above is based on the Small Area Health Insurance Estimates by the Bureau of the Census. The map below adds data from the state health-insurance exchange, which asked applicants if they had insurance; 75 percent said they didn't. The map was created by adding 75 percent of the enrollees "to the original data, and recalculating the percentages," cabinet spokeswoman Jill Midkiff said.

“In the Appalachians there, we actually have done a tremendous job through an army of recruiters and ‘Kynectors’ and people to help get the enrollment through,” Kissner said, referring to the peopke paid to help others sign up for coverage on the state health-insurance exchange, branded as Kynect.

Kissner "noted a number of improvements in visits and screenings, such as a 15.8 percent jump in annual dental visits, 36.7 percent hike in preventative services among adults, 20.6 percent increase in cervical cancer screenings and 16.1 percent more colorectal cancer screenings compared to last year," Kevin Wheatley reports for The State Journal in Frankfort.

"Data showing Medicaid reimbursements to hospitals are bittersweet, as some rise while others fall in a short two-year window," Wheatley writes. "Still, one table showed that of 100 hospitals listed, 45 had received more reimbursements from Medicaid expansion in the first six months of 2014 than disproportionate-share payments, which hospitals receive to compensate for treatment given to uninsured or underinsured patients, in all of fiscal year 2013." The so-called DISH payments are to be phased out under the reform law, though implementation of that has been delayed.

Enrollment in Medicaid has been larger than expected, and Kissner said he did not know how much the new enrollees will cost the state when it has to begin paying 3 percent of their cost in 2017, rising to the law's cap of 10 percent in 2020.

"To hear the head of Medicaid say we don’t have any idea whatsoever what we’re going to be paying, that’s, again, very worrisome,” said Sen. Chris McDaniel, R-Taylor Mill. “I mean, we’ve got tons of priorities in this state, and it’s going to be a big number.” (Video from cn/2)


Democratic Gov. Steve Beshear has said the expansion will pay for itself by creating more jobs in, and tax revenue from, health care. "Sen. David Givens, R-Greensburg, asked Kissner how the General Assembly should gauge financial success in the budget-writing process for the 2017-18 biennium," Wheatley reports.

In addition to the studies indicating that expansion would pay for itself, Kissner said, “If you make your population healthier, what happens? What’s the long-term ramification of that? Do they work more? Do they have more working hours?” Kissner asked. “We’re 48th in poor mental health days and 49th in poor physical health days in the country. … Health care is not a zero-sum game. Building a healthy population results in more time at work, more efficient at work, maybe more head in the game at work.”

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.