Student loses 175 lbs. in 14 months after gastric-sleeve surgery

Elizabeth Whitt and Don McNay

Elizabeth Whitt, an Eastern Kentucky University communications major from Richmond, Ky., decided to have gastric sleeve weight loss surgery when she was 19, and now, 14 months later, she has lost 175 pounds, Don McNay writes for The Huffington Post. McNay had the same surgery on Dec. 1 last year and has lost 70 pounds since then. He is writing a book called Project 199: My Business Plan to Lose 175 Pounds because he wants to drop from his original weight of 377 pounds to 199.

While McNay had the surgery at age 55 as a last chance to avoid an early death, Elizabeth had the surgery in college, when most people are not thinking about death. Dr. Derek Weiss at Bluegrass Bariatric in Lexington, Ky., operated on both of them. Weiss said that "doing weight loss surgery on a teenager had been rare before the gastric sleeve became more common as the risk of complications is lower than the other surgeries," McNay writes. Weiss said that "LSG is a tool. It limits the amount you can eat very successfully. But I think all LSG patients who succeed can take most of the credit themselves; they chose what to eat (and drink) and how much to exercise."

Whitt before (above) and after (below) with her health team

McNay talked with Whitt because although he had interviewed many experts already, he wanted to hear from someone who had been through the surgery. Whitt said the surgery has allowed her to be much more energetic and active. McNay asked Whitt how she was dealing with the sudden surge of attention from people who are drawn to success. She said she doesn't pay attention to men who express interest in her now but didn't talk to her when she was overweight. Whitt also noted that her parents did not support her having surgery until she presented them with research showing the benefits.

Michael and Debi Benson, the president and first spouse at EKU, said Whitt babysits their three children. President Benson said, "Debi and I are very grateful for Elizabeth and have marveled at her physical transformation. This change has allowed her inner beauty, which has always been radiant and contagious, to shine through even more."

"It took all of my forcus and courage to have the surgery at age 55," McNay writes. "There is no way I would have undertaken it at age 19. . . . When I weigh in at 199 pounds and hit the same 175 weight loss number that Elizabeth hit, I will say one thing for certain: she has been my inspiration. And my hero." (Read more)

Poll analysis indicates Kentucky has the largest percentage of people who have gained health coverage under Obamacare

Kentucky has the nation's highest percentage of formerly uninsured people who have gained coverage under federal health reform, according to an alternative interpretation of the latest national polling data from The Gallup Organization.

Gallup again ranked Kentucky second to Arkansas in the expansion of insurance, but those rankings are based on percentage-point declines. However, the more illustrative ranking may be the percentage of formerly uninsured who are now covered.

That can be calculated, roughly, by dividing the percentage-point decline by the original percentage of uninsured. That shows Kentucky ranking first, with 52 percent of the formerly uninsured now having coverage, either with private insurance or the federal-state Medicaid program. Connecticut ranks second at 51.2 percent and Arkansas third at 49.3 percent.

The state Cabinet for Health and Family Services recently issued a press release about Kentucky staying at second in the Gallup rankings. Told about the alternative calculation, cabinet spokeswoman Jill Midkiff wrote, "While we certainly do not dispute Gallup's findings, it is accurate to say that Arkansas’s decrease in the uninsurance rate has been larger. However, Kentucky has seen the highest percentage of formerly uninsured who have become insured." Gallup did not respond to a request for comment.

Foundation for a Healthy Kentucky wants a claims database to increase transparency about health-care cost and quality in Ky.

Kentucky has experienced rapid changes in health care since the implementation of the Patient Protection and Affordable Care Act, and the next step is to implement a program that will provide more transparency about the cost and quality of health care so consumers can make informed, value-based health decisions, says a news release from the Foundation for a Healthy Kentucky.

A recent Kentucky Health Issues poll found that most Kentuckians think they can find out what doctors charge for treatments and procedures if they need this information. They seem to believe that transparency already exists, but this is often not the case.

The foundation recommends that Kentucky develop and establish an all-payer claims database, or APCD, for consumers and stakeholders as a tool to address this issue of price transparency.

"Clear, factual information about the cost and quality of health care is necessary for consumers to select value-driven care and for consumers and providers to be involved and accountable in their decision about their health and health care services," says the release.

The APCD Council defines APCDs as “large-scale databases that systematically collect health-care claims data from a variety of payer sources which include claims from most health-care providers," says the news release. The information includes patient demographics, provider codes, and clinical, financial and utilization data. This information is then made available to the public.

The foundation said it analyzed national and state expert presentations, reviewed studies and held a meeting in October with more than 60 Kentucky leaders in government, business, policy and health care to discuss the issue.

Participants discussed barriers, feasibility, solutions and other factors in implementing price transparency in Kentucky from the perspectives of the consumer, provider, policymaker and researchers. Here are some of their collective findings, according to the release:

• Current cost and health service information are difficult to understand. 
• Price and quality data need to be useful to the consumer through simple, useful tools, currently it is not. 
• The state must be involved in implementing an APCD by passing laws to require the collection and sharing of data and requiring the data to be reported publicly. 
• An effective APCD would allow estimates and cost comparisons between providers; would include expected out-of-pocket costs and quality measures that can be compared across providers; would have the ability to see spending patterns over time for all enrolled under one policy; would offer individual level data; and would offer health care value-based cost saving tips.
• There is a significant variation in health-care pricing, and physicians may need an incentive to consider cost when making decisions for patients.

Colorado was one of the first states to establish price transparency legislation, data collection and reporting on a state-wide level. Representatives from that state's APCD said it was initially funded by foundations, but will use fees to sustain itself going forward.

Bill to cap co-payments for drugs is backed by emotional testimony, but opposed by health insurers and employer groups

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- People with chronic conditions are often denied the best medication for their condition because it is not on their insurance plan's preferred formulary, which makes the co-payment more for that medication than they can afford.

Sen. Tom Buford

Senate Bill 31, sponsored by Tom Buford, R-Nicholasville, would put a $100-per-month cap on co-payments for a 30-day supply of a medication for drugs subject to a tiered formulary, and not to exceed $200 per month total for all medications. House Bill 146, sponsored by Rep. James Kay, D-Versailles, has a similar bill that is currently in the House Banking and Insurance committee.

The Senate Health and Welfare Committee heard discussion on this bill Feb. 25, which opened with an impassioned plea from Buford to pass it. He said 18 states have passed or are in the process of passing similar bills. But they face strong opposition from the insurance industry and employers, and the bill has been on the committee agenda "for discussion only."

Buford said insurance companies have avoided big increases in premiums by raising co-payments, "which have gone over 54 percent and some 80 percent." Saying the average salary of Kentuckians is $23,700, he said many have to chose between living expenses and paying for medicine. "You may have insurance, but you may not have health care," he said.

The state Department of Insurance estimates that the bill would increase premiums by $3.20 to $4 per month and, because of greater utilization of services, raise the ultimate health-care costs of all insured Kentuckians (except those on state plans) by $2.58 to 3.23 per month.

Buford disputed the estimate, saying it essentially comes from the insurance industry. He acknowledged that capping co-pays would raise costs, but said the increase could be modest. He said that after Vermont passed a cap, the cost averaged only 32 cents per month per member for large-group plans and 74 cents per month for small-group plans.

Tom Underwood, state director of the National Federation of Independent Business, said the bill would primarily affect small-group employers, partly because small businesses have no power to negotiate with insurance companies.

Julie Davis of Glasgow, who has epilepsy, told the committee that she was forced to switch insurance this year, and a $60-per-month medication that she had been taking for seizures now cost $1,200 per month. She said they made her switched to a generic medicine, against the advice of her neurologist, and since has had her first breakthrough seizure in two and one-half years.

Getting emotional, Davis said that when she has such seizures, "I am out of commission for almost a month" and this has forced her to give up a job that she loved, move in order to be closer to a support group, and only allows her to work from home. She also said that at times she "fears for her life," and her insurance company has denied her appeals.

Deb McGrath of the Epilepsy Foundation said it had found that the most commonly prescribed and effective epilepsy drugs are on the non-preferred list of the "silver" plans on the state health-insurance exchange, the most common type of plan. A patient must pay a 40 percent co-insurance or a high deductible plus a co-pay to get a preferred drug on these plans.

She said the U.S. Department of Health and Human Services has called the practice of limiting coverage and imposing high cost-sharing for drugs that treat certain conditions "discriminatory."

McGrath said, "These barriers make it impossible, near impossible, for individuals, for those living with chronic health conditions like epilepsy, like arthritis, Alzheimers, crones disease, diabetes, and AIDS access to care that they desperately need."

Carl Breeding, a lobbyist for American Health Insurance Plans, gave the committee a letter from the Insurance Commissioner Sharon Clark, which he summarized as saying this bill would "prevent the state from being able to work" under federal health reform because of the way deductibles work and would "eliminate the bronze plan," the lowest-cost plan.

But Mark Guimond, a lobbyist for the Arthritis Foundation, said the lack of co-pay caps can increase costs because the resulting lack of medication can lead to hospitalizations, surgeries and time off work. "These are extremely expensive medications: $1000, $2000, $3000 a month," Guimond said, and patients "are being stuck with co-pays or co-insurance that may be 30-40-50 percent of these amounts."

The Kentucky Association of Manufacturers, which opposes the bill, wrote in the Lexington Herald-Leader that "These increased costs take away capital that state manufacturers could otherwise deploy to reinvest in their plants and more importantly remain competitive globally, so that we can continue to employ hard-working Kentuckians."

In animated remarks to the committee, Buford replied, "I hate to say this, but I could care less if we beat Japan in making toys if it depends on someone's life and health and the ability for them to live. It's more important apparently for some to deny the insurance than it is to make that profit on the bottom line of their company."

Grant will fund Lexington signs, maps to encourage walking

A $182,000 grant will fund a pilot project in Lexington to encourage citizens to walk more, by erecting way-finding signs for pedestrians and updating walking maps.

The new Walk Lexington program will also feature signs that tell people how easy it is to get from one spot to another such as "It's only two minutes to the library." The signs are used to help people realize that walking is often faster than driving.

The grant is from the John S. and James L. Knight Foundation, which awards grants to programs in cities where the Knight brothers once owned newspapers, including the Lexington Herald-Leader.

A Herald-Leader report on the grant indicted that the recipient is the NoLi Community Development Corp., a nonprofit trying to make the North Limestone corridor a more livable place, through the Blue Grass Community Foundation, which announced it.