Sponsor of local opt-out amendment says smoking-ban bill needs it to pass; sponsor and House leaders don't care for it

By Melissa Patrick
Kentucky Health News

UPDATE: The House didn't vote on this amendment, but Sen. Jimmy Higdon, R-Lebanon, says it or something like it would give the bill a better chance of passing the Republican-controlled Senate.

FRANKFORT, Ky. – Rep. Steve Riggs of Louisville has proposed an amendment to the statewide smoking ban bill that would allow cities and counties to opt out of the ban every two years, saying he wants to improve the bill's chances of becoming law.

Riggs

“This amendment would negate a lot of concern about taking away local rights,” Riggs, a Democrat who supports the ban, said in a press release.

His Floor Amendment 9 to House Bill 145 proposes that local governments be able to opt out of the ban, but would be required to take another vote every two years to prevent the ban from taking effect in their jurisdiction.

Rep. Susan Westrom, five-year sponsor of the ban, first said she welcomes amendments because that is "how we edit our legislation," but still needed to talk to Riggs – and when asked if she thought this amendment was a good idea, she said it "goes against the intent of the bill."

"It is a little bit too late for this amendment," the Lexington Democrat said. "We have made too much progress."

House Speaker Greg Stumbo, who says he supports the bill but has clashed with Westrom about its handling, agreed. "I think if you started from day one with that as the idea," he said, "it might have been more palatable."

Stumbo and Republican Leader Jeff Hoover said the amendment would defeat the bill's purpose.

Hoover

Hoover noted, "Advocates have said for many years that we have to have a state-wide smoking ban because of the health concerns all across Kentucky."

Riggs said in an interview that the legislation hasn't had the votes for the past five years and it is time to do something different.

"If you keep swinging at the ball and missing time after time, you probably ought to change your stance," he said. "And that is what they need to do. They need to make a change to get more votes so it will pass."

Westrom said, "We have the votes." But House leaders told her Friday, Feb. 6, that she would need to have commitments from 55 of the 100 House members before they would bring her bill up for a vote.

"What it really says is, it takes 51 votes to pass, but we want 55 commitments because we can't trust everybody," Hoover said. "It's not about having a cushion; it's about they can't trust their own members when they say they are going to vote for something." He said Democratic leaders "should have the discipline to keep amendments, such as this one, from being filed."

Riggs said as chair of the House Local Government Committee, he is sensitive to the needs of cities and counties, and "If we give those people an option to opt out of it, we might be able to get some votes up here to pass the bill."

He said his amendment would allow the bill's advocates to get 90 to 95 percent of what they want to accomplish. "Most people consider that an A, excellent," he said. "This bill might bring in another 10 votes, because people feel if they have the option to opt out, that is liberty and freedom."

Riggs also said the idea might improve the bill's poor chances for passage in the Senate because some senators showed interest in the approach last year.

This is the right thing to do because they don't have enough votes to pass the bill in the House and the Senate," Riggs said.

He said smoke-free advocates don't want any changes to this bill and have not been willing to compromise for the past five years, and asked, "How much illness can we put at their feet because they won't change their swing?"

James Sharp of the American Cancer Society's lobbying arm, the Cancer Action Network, declined to comment.

Hoover, one of the relatively few Republicans for the bill, said he is mindful of opponents' arguments about personal property rights, but also of the "associated health risk with smoking and second hand smoke and the cost that this state is incurring in treating those folks who have diseases related to smoke and second hand smoke."

He concluded, "When I do the balancing test for me personally, I come down on the side that this is a step in the right direction to reduce health care cost and save lives."

With 55 votes needed instead of the usual 51, it just got harder to pass a smoke-free workplace law in the House

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – A bill to ban smoking in public places and places of employment will require the commitment of a supermajority to get a vote on the House floor, making it more difficult to pass.

Rep. Susan Westrom, D-Lexington, said in a telephone interview that when she told leaders of the House's Democratic majority yesterday that her bill had 49 votes, two short of a majority, Democratic Floor Leader Rocky Adkins of Sandy Hook told her she would need 55 votes for him to bring the bill before the House.

Asked why she thought there had been a change from the usual 51 votes needed for a floor vote, Westrom said the only reason she could imagine was "There are some members of leadership that don't want to make anyone uncomfortable . . . don't want to ask them to take a vote."

Last year, House leaders declined to bring the legislation to a vote, and Speaker Greg Stumbo of Prestonsburg said many members didn't want to vote on it during an election year.

Adkins said yesterday that a supermajority requirement is not unusual for any bill that is a "high priority" or "one that has been discussed a lot." He said the rule applied to Stumbo's House Bill 2, to raise the state minimum wage. It passed in the House Tuesday, 56-43.

Democratic Rep. Tom Burch of Louisville, the longest-serving member of the legislature and chairman of the committee that approved the bill, said requiring 55 votes to get a floor vote happens from time to time. He said this will "provide a cushion" because "some of these guys will crawfish," or will back off when they see there are 51 votes.

Offering an example of why it it is best to go into a vote with a cushion, Burch recalled 1980, when new Gov. John Y. Brown Jr. took his gas-tax bill to a vote, thinking he had 51. But someone who had committed to vote for it reneged during the vote, leaving Brown one vote short. Burch said he cast the 51st vote at the request of House leaders, who had told him that his vote wouldnt be needed.

"We need a cushion," Burch said.

Westrom said the request from Adkins for 55 votes "comes as no surprise to me."

"We must roll with the punches and keep moving forward," she said. "I am making connections with those in the middle, providing them with information to help them with their comfort zone."

She said that she and other advocates had been educating her colleagues for five years about the importance and need for a smoking ban, but some were just not receptive.

"There are some freshman legislators from rural areas who get it, and seasoned legislators that still don't," she said.

When House Bill 145 passed the Health and Welfare Committee 11-4 last week, Westrom said, "I feel very confident we will get a floor vote." But at that time, she was aiming for 51.

The bill has never gotten out of committee in the Senate and chances in the Senate this year continues to remain doubtful.

James Sharp, lobbyist for the American Cancer Society's Cancer Action Network, said that with 66 percent of Kentuckians statewide supporting the bill, it is time for state leaders to make "the health and economic viability of our commonwealth" a priority by passing this bill.

"We need our leaders in either chamber, in either party, to step up and lead on this issue," Sharp said. "Bring this bill for a vote. Get it passed for the health of all Kentuckians, sooner than later."

Adkins, asked if leaders are doing enough, said they were listening to and working with their caucuses. "So, I think we are working our way through the process," he said. He commended Westrom and advocacy groups for "an outstanding job of really educating people on this piece of legislation, educating Kentuckians."

Burch said, "I am voting for this bill because it is the right thing to do" and encouraged lawmakers to listen to their constituents.

"If these people would listen to what their districts thought, they would be for this bill 100 percent," he said. "Because 75 percent of Kentuckians don't smoke and don't want somebody blowing smoke in their face and they don't want the results of second-hand smoke."

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

At least 14 counties had vaccination rates in 2011-12 below level experts say is needed to protect kindergartners from measles

As concern about the spread of measles from lack of vaccination grows, many Kentucky counties probably have vaccination rates below the minimum that experts say is needed to create "herd immunity" and prevent spread of the highly contagious disease among students in kindergarten.

At least 14 Kentucky counties had measles vaccination rates below 90 percent in the 2011-12 school year, according to state data analyzed by USA Today, in a survey of states that track vaccination rates and make them public. The Courier-Journal published the Kentucky figures in an online database.

The counties under 90 percent were Bath (89%), Boyle (83%), Bullitt (88%), Christian (89%), Harlan (88%), Jefferson (86%), Laurel (85%), Lawrence (88%), Lee (80%), Nelson (82%), Robertson (88%), Rowan (86%), Taylor (82%) and Webster (86%). Data from several counties was not available. For the database with county-by-county figures, click here.

The statewide vaccination rate was 93 percent, pulled down by a rate of 86 percent in Jefferson County, the state's most populous. The lowest rates were 80 percent in Lee County and 82 percent in Nelson and Taylor counties.

Jefferson County officials told The Courier-Journal that the county's rate rose above 90 percent in the last two to three years. Bullitt County school-health coordinator Lesa Bodine told the Louisville newspaper that her data show 94.3 percent of the county's kindergarten students "have been properly immunized," The C-J's Darla Carter reports. "However, she said there are some parents who choose not to immunize their children. She also noted that there can be a delay in receiving proof of vaccination because a child has, for example, transferred from another county or state."

Like many states, Kentucky allows parents to exempt their children from required vaccinations for medical or religious reasons. Measles outbreaks in other states have been blamed at least partly on parents who still believe discredited reports that vaccines cause autism or other disorders. Generally, the stricter the laws, the higher the vaccination rate, Stateline reports. Here's a Stateline map showing how states differ:

Ten-county Lake Cumberland District Health Department is the latest to ask schools to foot more of the bill for school nurses

The Lake Cumberland District Health Department told school districts in its 10-county area in December that it would no longer be able to pay for nurses for each school, setting off negotiations with the districts.

Somerset Independent Schools Supt. Boyd Randolph said one option would have the schools employ the nurses but contract them back to the health department in order to bill for the full extent of Medicaid services, Chris Harris reports for The Commonwealth-Journal.

Health Department Executive Director Shawn Crabtree told the Somerset newspaper that his agency was "running a deficit" because it wasn't being paid as much for treating Medicaid patients. 

Schools all over Kentucky have been faced with this "unfunded mandate," as Editor Stevie Lowery called it in an article for the The Lebanon Enterprise. If a student requires medical care in order to attend school, state law requires school districts to provide the care, but doesn't necessarily provide a way to pay for it.

The dwindling number of school nurses last year prompted a new law to allow school personnel who aren't licensed health care professionals to administer or help a student self-administer insulin and otherwise treat diabetes symptoms if they take certain training.

Surrounding Somerset, each school in the Pulaski County School District has its own in-house nurse, as does every school in the regional health department's coverage area, with the cost shared by the school system and the health department, Harris reports. Asst. Supt. Sonya Wilds told the Commonwealth Journal last month that the schools pay approximately $20,000 per nurse.

The department has proposed that the schools pay the full cost of employing 12 nurses, which will fall "in the neighborhood" of $750,000, about three times what they pay now, Supt. Steve Butcher told Harris. “Of course, we would receive money back from the health department on Medicaid claims, but . . . it’s hard for me to wrap my head around how much that would be worth to us,” he said.

As school officials consider all of their options, they are also looking at the individual needs of schools, with the understanding that these needs constantly change and are like a "moving target."

“We’ve got some schools that have kids with feeding tubes, and some schools that are heavy on [students with] diabetes,” Butcher told Harris. “It’s not necessarily bigger schools that have more issues, it’s just schools have specific kids that have got needs that we can’t do anything about and need additional help."

Medicare to pay for CT scans of people at high risk of lung cancer

Medicare will now pay for low-dose CT scans for people at high risk of getting lung cancer, a change welcomed by officials in Kentucky, which leads the nation in lung cancer and deaths from it.

"This is an important new Medicare preventive benefit since lung cancer is the third most common cancer and the leading cause of cancer deaths in the United States," Dr. Patrick Conway, chief medical officer for the federal Centers for Medicare and Medicaid Services, said in a press release.

Lung cancer is especially deadly because it doesn't cause symptoms until it's too late, killing nearly 160,000 people a year, according to the American Cancer Society.

This new preventive coverage will allow Medicare to pay for a once-a-year, low-dose CT exam for people aged 55-77 who are either current smokers, have quit smoking within the last 15 years or who have smoked at least a pack a day for 30 years, or the equivalent and have a written order from a doctor, reports Maggie Fox of NBC News.

Some doctors question how many people will benefit from the test, which costs $250 to $300, and have voiced concerns that it doesn't always produce clear results, causing patients to endure further testing than might turn out to have been unnecessary. Federal officials disagree, and experts say it will prevent as many 20 percent of U.S. deaths from lung cancer, "making it akin to mammograms and colonoscopies in terms of saving lives," Fox reports.