Statewide smoking ban passes Kentucky's Democratic House, but its chances don't look good in the Republican Senate

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – A statewide smoking ban passed the Democrat-controlled state House Friday for the first time, but its chances appear grim in the Republican-controlled Senate though a clear majority of Kentuckians support the bill.

House Bill 145, which would prohibit smoking in workplaces and indoor places, passed 51-46 after the narrow defeat of two amendments opposed by its advocates and three changes that may have put it over the top. Nine of the 44 Republicans joined 42 of the 56 Democrats to pass it.

Amendments to the bill added exemptions for cigar bars, cigar clubs, tobacco stores, private clubs and market-research facilities; significantly reduced the fine for violation, to $25 for individuals and $50 for businesses; and would preserve any weaker or stronger local bans that are in effect when the bill would become law, in late June.

House Speaker Greg Stumbo told Tom Loftus of The Courier-Journal that the latter amendment was key to the bill's passage. Rep. Tanya Pullin, D-Greenup, told the House that it won her vote because it creates a "window of opportunity" for localities to enact their own bans. It was proposed by Democratic Caucus Chair Johnny Bell of Glasgow.

The defeated amendments would have exempted electronic cigarettes and well-ventilated adult establishments prominently displaying a "Smoking Establishment" sign. The e-cig amendment, proposed by Republican Caucus Chair Stan Lee, lost 46-49; the other one, offered by freshman Rep. Jim DuPlessis, R-Elizabethtown, lost 44-45. For the roll calls, click here.

"A couple of the amendments are problematic," Amy Barkley, chair of the Smoke-free Kentucky Coalition, said in a phone interview. "The existing laws in these communities may not protect all workers," she said. "And localities can pass weak laws (before this bill becomes law) and have that forever."

Nevertheless, Barkley said, "This is really a historic moment."

More compromise may be necessary to get the bill through the Senate, where Republican Sen. Julie Raque Adams of Louisville filed a similar bill as the House measure was coming up for a vote.

Senate President Robert Stivers told Bruce Schreiner of The Associated Press, "I am personally not a fan of smoking, but I just don't believe it is the government's role to tell [a business] that you cannot have a facility that smoking takes place in — be it a pool hall a bar or restaurant." He added, "I don't see there being that type of support in the Senate to pass a bill like that."

Barkley disagrees. "There is a lot of support in the Senate," she said.

The sponsor of HB 145, Rep. Susan Westrom, D-Lexington, said "I cannot predict what will happen in the Senate. Stivers has said from the beginning that he wouldn't let it have a hearing."

Barkley said advocates are asking Senate leaders to "let your members have the vote and go on record with their position." The next clue to the leaders' attitude will be where they send the bill. If it doesn't go to the Health and Welfare Committee, which Adams chairs, that would be a bad sign for it.

Westrom repeately said that the bill does not ban smoking. "This bill just requests that a smoker step outside 15 feet," she said. "Fifteen feet is not too far to walk to know that 950 people in this state won't die from secondhand smoke related illness." That is the estimated number of deaths each year in Kentucky from secondhand smoke.

Westrom said afterward that she had hoped for a larger margin than five votes, but "I couldn't be happier. This is a historic moment and there is lots to be proud of," referring to the many people and organizations that committed themselves to the cause.

The Kentucky Health Issues Poll last fall found that 66 percent of Kentucky adults favored the ban. It won 57 percent support in last year's Bluegrass Poll for news organizations.

During the House debate, opponents of the bill spoke mainly of private-property rights and individual liberty.

I deplore smoking," said Rep. Brian Linder, R-Dry Ridge, "but my love for liberty is greater than my hate, therefore I vote no."

Earlier, Westrom said, "Our freedoms only extend until they begin to affect others."

Democratic Gov. Steve Beshear hailed the House vote as "an extremely important and significant event," adding, "It sends a very strong statement ... that it is time to move in this direction. It is just such a health problem and health issue in the commonwealth; so many of our chronic conditions relate directly back to smoking."

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.

Thousands of Kentuckians face federal tax penalty for not having health insurance

"Thousands of Kentuckians might face a penalty this tax season for failing to sign up for health insurance during 2014," Mary Meehan reports for the Lexington Herald-Leader.

The state estimated that 340,000 Kentuckians would buy private insurance through its Kynect marketplace, but only 80,000 have done so. However, Meehan writes, some of those who did "might have qualified for Medicaid under the state's expanded income guidelines, said Carrie Banahan, who heads Kynect."

Jill Midkiff, spokesman for the state Cabinet for Health and Family Services, told Meehan, "There are too many variables at play here to do simple arithmetic for estimated populations. It would be safe to say that thousands of Kentuckians will likely face a tax penalty this year for not obtaining health insurance."

Banahan said, "A lot of people are going to be very surprised." And that will include some people who were eligible for Medicaid, but didn't enroll in it. Medicaid enrollment is open year-round, but private-insurance enrollment closes Sunday, Feb. 15 and won't reopen until next fall unless someone has a life-changing event "such as a birth, divorce or loss of a job," Meehan notes.

"The penalty for not having insurance during 2014 is $95 for each person in a household or 1 percent of the household income, whichever is higher," Meehan notes. "The bill will come due when 2014 taxes are filed, she said. If a person is due a refund, it will be deducted from the tax refund." Next year, the penalty will be 2 percent, with a minimum of $325 per adult or $162.50 per child, under provisions of the Patient Protection and Affordable Care Act.

Economic upturn boosts share of Kentuckians on employer-based health coverage; health reform boosts number on public plans

Half of Kentucky's working-age adults now get health insurance through their employers, up from 37 percent two years ago, reversing a downward trend that began with the Great Recession.

Meanwhile, under federal health reform, many more Kentuckians are on public insurance, mostly Medicaid, and many fewer report being uninsured. Those are among the findings in the latest Kentucky Health Issues Poll, taken Oct. 8 through Nov. 6.

In 2008, when the recession began, 55 percent of Kentuckians reported that they got insurance through their employer. That dropped to 44 percent in 2009 and declined to 37 percent in 2012. But the number rose to 44 percent in 2013, and to 50 percent last fall.

The expansion of Medicaid under federal health reform has greatly boosted the share of Kentuckians on public health insurance, to 29 percent. The number had risen from 11 percent to 27 percent between 2008 and 2012, then dropped to 20 percent in 2013.

Medicaid has been expanded to households with annual income up to 138 percent of the federal poverty level. In the poll, only 12 percent of people with such incomes said they were uninsured, down from 34 percent in 2013.

In the entire population, the percentage of uninsured is the same, showing the impact of Medicaid expansion. Overall, 12 percent in the latest poll reported being uninsured, and another 12 percent said they were insured but had been without health insurance at some point in the previous 12 months.

“This report gives us a snapshot of the changing health insurance situation for Kentucky adults,” ssaid Susan Zepeda, President/CEO of the Foundation for a Healthy Kentucky, which sponsored the poll with Interact for Health, formerly the Health Foundation of Greater Cincinnati. “Having health insurance is an important factor in having access to affordable, quality health care.”

Because 97 percent of seniors have Medicare or some other form of health coverage, the questions were asked only of working-age adults, ages 18 to 64. A random sample of 1,597 adults all over Kentucky was interviewed by telephone, including landlines and cell phones. The poll has a margin of error of plus or minus 2,5 percentage points.

Advocates of smoking ban, including victims of secondhand smoke, rally at Capitol

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Over 500 Smoke-Free Kentucky advocates spent Wednesday, Feb. 11, asking their lawmakers to pass a statewide smoking ban, wrapping up their day with a rally and news conference in the Capitol rotunda, featuring leaders of the effort and people who said they were victims of secondhand smoke.

"Our efforts are paying off; there is going to be a vote very soon," James Sharp of the American Cancer Society's Cancer Action Network said to a cheering crowd. "Keep up the good work, keep up the pressure, keep sharing those personal stories. We will get a smoke-free Kentucky because everyone deserves the right to breathe clean, smoke-free air in this state."

Lt. Gov. Crit Luallen, a colon-cancer survivor, said Kentucky "has some of the worst health statistics in the nation" and conditions like heart disease, lung disease and cancer are all linked to smoking. "If we truly care about our children, and our families and the future health of the commonwealth, it is time to pass House Bill 145 and create a statewide smoke-free law," she said.

"I don't know how any public leader today can sleep at night if they are not committed to help reforms like a statewide smoke-free law," Luallen said to a cheering room. "I don't know how they sleep at night knowing we have more Kentuckians dying of cancer than any other state in America."

"This should not be politically risky," Luallen said after the rally. Saying that many rural towns or businesses will not do this voluntarily and statistics support the correctness of this decision, so "Those legislators who are facing a difficult vote have to look at what is the right thing to do."

Health Commissioner Stephanie Mayfield, who has taken a strong stance against smoking and tobacco since she took office, said the law would be a strong, quick advancement toward better health. "Secondhand smoke can kill you,": she said. "The science is clear, The debate is over."

Joe Geraci, a volunteer for the cancer society and a lung cancer survivor, said he was there to represent those with cancer "who did not make it." He said that he attributed his lung cancer to the smoke-filled capitol building that he worked in as a lobbyist for 10 years.

Geraci said many of the legislators told him that they were getting more calls from people to vote against the bill than to vote for it, so he encouraged calls to the legislature's message line, 800-372-7181.

Denny Nafus of Northern Kentucky said his nonsmoking parents, who volunteered at church bingo for decades, died of lung disease, and Kentucky spends $1.92 billion a year on health care and loses $2.3 billion worth of production because of smoking and secondhand smoke.

Roger Cline of Olive Hill said he was there as a "secondhand smoke victim" because he lost his nonsmoking wife to lung cancer from exposure to smoke at her workplace.

Dr. Erin Frazier of Louisville, a breast-cancer survivor, said that she had no other contributing factors for the cancer other than waiting on tables in smoky bars and restaurants between the ages of 16 and 22. She said wait staff have the highest prevalence of exposure to secondhand smoke of any occupation.

"Young, pre-menopausal women who are exposed to secondhand smoke have a 70 percent greater risk of getting breast cancer than those exposed later in life," she said. "and regardless of the age, women who are exposed to secondhand smoke have a 25 percent increased risk of getting breast cancer."

Sandra Castle described herself as a nurse who loved to sing to her patients. She said she worked for 18 years around secondhand smoke, and blamed it for two different cancers, which caused her to lose a vocal cord and undergo spinal surgery. She said she had lost two of the greatest joys of her life, singing and the ability to lift her grandchildren.

Laura Tarakam said secondhand smoke is a trigger for asthma attacks, and a son died from an attack caused by an unknown trigger. Secondhand smoke is a known trigger for asthma attacks, so this puts her living son, an asthmatic, and others with this condition constantly at risk.

Rep. Susan Westrom, five-year sponsor of the bill, thanked the smoke-free advocates for the work they do and encouraged them to be persistent" saying that as lawmakers became more educated, they better realize their responsibility for improving the health of all Kentuckians, not just in the workplace.

Westrom, D-Lexington, also thanked Dave Adkisson, president and CEO of the Kentucky Chamber of Commerce, for its support of the bill. Adkisson said "92 percent of business leaders support this legislation" not only because "smoking is killing us as a health matter, but it is bankrupting us as a financial one."

Asked after the rally about the bill's chances in the Senate, Westrom said "our numbers are so positive" in the Republican-controlled chamber, and better than they have ever been. She said there aren't enough votes yet to get the bill to the floor, but it was "very, very close." Senate President Robert Stivers has said he plans to follow his policy of not allowing bills to the floor unless they are supported by a majority of the Republican caucus, which has 26 members of the 38-member Senate.