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.

West Virginia to involve Kentucky in examination of studies that link health problems to mountaintop-removal coal mining

Kentucky Health News

The administration of Democratic Gov. Earl Ray Tomblin of West Virginia "said Tuesday that it would initiate an evaluation of the growing body of studies that have found residents living near mountaintop removal coal-mining operations face increases risks of serious illnesses and premature death," Ken Ward Jr. reports for The Charleston Gazette. Studies have found correlations between mountaintop removal and cancer, birth defects and the endangerment of freshwater species.

Dr. Rahul Gupta, commissioner of the state Bureau for Public Health, "said that his agency would work with the state Department of Environmental Protection to examine the issue and to seek help from various federal scientific and regulatory agencies to review existing research on the subject," Ward writes. “The analysis is something that is needed going forward,” Gupta said. “The bottom line here is to let science speak for itself. It’s time that we attempt to do that.”

"Gupta said that his plan would 'engage surrounding states' such as Kentucky and Virginia to 'evaluate the scientific research being conducted by academia, non-profit groups, and others with an emphasis on peer-reviewed research to better understand the issues,'" Ward writes. "Also, Gupta said, his agency would work with the DEP to ask 'federal partners'—such as the U.S. Environmental Protection Agency, the Centers for Disease Control, and National Institutes of Health, and the federal Office of Surface Mining—to 'seek relevant subject matter expertise allowing for the exploration of a federal-state, multi-agency partnership to conduct analysis of the existing research in the field.'" (Read more)

Bill to give civil protection to victims of dating violence is poised to become law, addressing a serious health issue for women

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Victims of violence between dating partners in Kentucky are about to get a law giving them civil court protection, after years of hitting roadblocks in the state Senate. Most of the argument has been among lawyers, about legal process, but domestic violence is also a major health issue.

"There is a strong association between the experience of victimization and physical and mental health problems," Carol Jordan, executive director of the Office for Policy Studies on Violence Against Women at the University of Kentucky, said in an interview.

Rep. John Tilley

House Bill 8, sponsored by Rep. John Tilley, D-Hopkinsville, would allow a civil protective order for victims of dating violence and stalking. Under current law, this immediate level of protection is only offered to people who are married, have a child in common or who have lived together. Kentucky is the only state that offers no such protections.

As of March 8, the bill was awaiting passage in the Senate after clearing the Judiciary Committee with a substitute version that addresses a key objection by creating a new chapter in the statutes for the bill, separate from the existing domestic-violence chapter.

Senate President Robert Stivers, R-Manchester, had opposed previous bills on grounds that criminal protections exist for victims of dating violence. At the committee hearing, he said the new bill offers a "different tier of protection" and is a "solution that individuals want."

But Stivers added, "I don't want there to be an unjustified belief that a piece of paper will keep someone away" if they are intent on doing harm.

And Sen. Robin Webb, D-Grayson, declined to vote on the bill, saying it would do nothing to stop the abuser. "That perpetrator is really the one that needs some help and really needs to stop the cycle," she said. "Because if he or she can't find another victim, they're going to go create one."

But Marion Brown, director of Sanctuary Inc., a shelter, counseling and court-advocate center for victims of domestic violence in Hopkinsville, told the committee that victims of dating violence have no immediate civil protections if they are not married, don't live with or don't have a child with their abuser. These unprotected victims "walk out of our doors not feeling safe" she said. "Help us help them."

Tilley shared some chilling statistics at the hearing: 638,000 Kentucky women will experience physical violence, rape or stalking by an intimate partner; 345,000 will experience a forcible rape; and 420,000 will be stalked, which, he said, is the highest percentage in the nation.

Also in Kentucky, one in three women will be the victim of domestic violence in her lifetime and the most vulnerable population for this type of violence is females between 16 and 19, according to the Louisville-based Center for Women and Families.

Domestic violence and health

The National Intimate Partner and Sexual Violence Survey by the federal Centers for Disease Control and Prevention has found that victims of domestic violence, both men and women, are "more likely to report frequent headaches, chronic pain, difficulty with sleeping, activity limitations, poor physical health and poor mental health that men and women who had not experienced these forms of violence." It also found that women who had experienced domestic violence were also "more likely to report asthma, irritable bowel syndrome, and diabetes than women who did not experience these forms of violence."

""It is a women's health issue because the way women treat their bodies (is often) dependent on the abuser," Brown said in an interview. "The abuser degrades them so much that they don't maintain their health. Their self-confidence goes down, their self-esteem goes down and as a result, all of their health issues fall to the wayside."

"Domestic violence is a public health crisis of a staggering multitude," Marcia Roth, executive director of The Mary Byron Project, a non-profit that advocates for domestic violence issues, said in a phone interview. "It leads to $4.1 billion for direct medical and mental health services per year."

Jordan, of UK,  said she has been part of research that shows an association between breast cancer and domestic violence – not higher cancer rates, but delayed diagnoses, which can be fatal. "For many battered women, their partners are so controlling they won't let them go to the doctor," she said.

Jordan said that while physical injuries are the most obvious health issue, "it goes well beyond that," to physical stress and mental-health issues.

"There is a lot of research that would suggest that other systems within the body are also very much harmed by the experience of living in that constant fear, constant stress, constant tension that so many battered women do," she said. "Depression begins to sink in" when women feel they have no way out, get repeated messages that they are not worthy, or are in constant fear of harm.

Jordan said the bill will provide another escape outlet for victims. When they show up for help and answer no to these three questions: "Are you married? Are you living together? or Do you have a child together?" and can't get an immediate protective order, she said, their sense of helplessness is confirmed.

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."

Tennessee's Republican governor will use Obamacare Medicaid money to expand coverage

One of the longest and starkest boundaries in health care for the last year has been the border of Kentucky and Tennessee, because the Bluegrass State expanded Medicaid under the federal health-reform law and the Volunteer State did not. That is about to change, because Republican Gov. Bill Haslam of Tennessee will use federal Medicaid money to expand health insurance in his state.

Kentucky, Arkansas and West Virginia expanded Medicaid; Tennessee and Virginia haven't yet.

"Like most other Republican governors who want to take the health-care law's generous federal funding, Haslam is now offering a plan that deviates from the Medicaid expansion envisioned under the Affordable Care Act," writes Jason Milliman of The Washington Post. "Haslam, who made the announcement almost a month after his re-election, said the Obama administration has verbally approved the approach."

The Tennessee plan includes a two-year waiver program with two tracks. "It will offer vouchers to people earning up to 138 percent of the federal poverty level—or about $16,100 for an individual—to help purchase employer coverage they would otherwise struggle to afford," Milliman reports. "Other newly eligible individuals can sign up in health plans modeled after health reimbursement accounts, with people earning above the poverty level required to pay premiums and copays. Haslam's administration didn't immediately offer details about how those payments are structured."

In November the Kaiser Family Foundation estimated that Tennessee has "about 142,000 low-income adults fall into what's known as the coverage gap—people who earn too much to qualify for the existing Medicaid program but not enough to qualify for subsidies to purchase private coverage on the Obamacare health insurance marketplaces," Millman writes.

"Nine Republican governors have expanded Medicaid so far, while Indiana Gov. Mike Pence is still negotiating with the feds on leveraging an existing state program to expand coverage," Millman reports.