Health reform should make Medicaid and Medicare more interested in preventing chronic diseases in young, expert says

Dr. Wayne Myers

While some rural areas may not have enough doctors (or those who accept Medicaid patients) to treat new patients generated by federal health reform, the key to healthy living is more education, not more physicians, rural medical expert Dr. Wayne Myers opines in The Rural Monitor. As an example, Myers points to Hazard and Perry County, where he once worked. The Appalachian county leads the nation in shortest average life span for women (72.65 years) and is third shortest for men (66.52 years) despite having an abundance of doctors and health facilities. The reason, Myers says, is bad habits that lead to unhealthy lives, something no amount of medical attention can cure.

"In Perry County, as in much of America, medical care is losing to unhealthy behavior," Myers writes. "Clinicians aren’t trained, nor is our clinical system structured, to accomplish changes in long-term cultural behavior, or to respond to the needs of groups of people. Certainly the 15-to-20-minute acute-care visit is a poor situation to try to work with a person on diet, level of activity, his/her addictions. We can’t modify family and social patterns with tools developed to treat strep throat, sprained ankles or breast cancer."

Myers, who headed the federal and Kentucky rural-health offices, said the solution is education at the local level, with "a lot more health educators, community health nurses and nutrition educators" that are trained within the community. Areas with community colleges can build partnerships with schools to receive training, he suggests. His hope is that the Patient Protection and Affordable Care Act will provide the resources and motivation necessary to bring about changes.

As the law generates enrollees, the Center for Medicare and Medicaid Services’ "book of business will shift from old people on Medicare toward younger people on Medicaid," he writes. "When the main business of CMS was Medicare, the rational business strategy was to seek the most economical quality care for those with only a few years to live. As the business shifts toward Medicaid and subsidized private insurance customers, the rational business strategy for CMS shifts toward preventing chronic disease. From an insurer’s point of view, a 70-year-old obese hypertensive diabetic is a self-limited problem. She’ll die soon. A 30-year-old with the same diagnoses will be a very long-term financial drain.  It will be good business for CMS to keep their 'covered lives' healthy."

This, he said, is kind of forward thinking we need to ensure young Americans get healthy. "We need new approaches to keeping people healthy, instead of trying to heal them after they get sick," Myers writes. "Clinicians can’t change the way people live and raise their kids, even if some of the choices the parents make turn out to be pretty dangerous for the kids. These are sensitive life and death issues. We need to tackle them." (Read more)

'Faces of Lung Cancer' photo exhibit at Markey Cancer Center is meant to spread awareness about disease and its prevention

Lung cancer survivor Juanita Meade

"Faces of Lung Cancer," a photo exhibit with portraits and inspirational messages from nine lung cancer survivors in Kentucky, is on display at the University of Kentucky Markey Cancer Center on the 1st floor atrium of the Combs Research Building, 800 Rose St., until Monday, Dec. 16.

This exhibit was coordinated by the Kentucky Cancer Program to spread awareness about lung cancer and prevention, according to a UK press release.

Lung cancer kills more Kentuckians every year than the next eight most common cancers combined, and Kentucky leads the nation in both lung cancer and deaths from it, and by some estimates also leads in smoking, the leading cause of lung cancer.

An estimated 25 to 28 percent of Kentuckians are smokers, compared to 18 or 19 percent nationally.

Kathy Sinclair, lung cancer survivor

And while tobacco use increases your risk, the UK release notes that anyone can develop the disease: "Lung cancer kills nearly twice as many women as breast cancer, and is the leading cause of cancer deaths for both men and women in the U.S."

Symptoms are generally not noticeable in the early stages of lung cancer, according to UK's Health Education through Extension Leadership newsletter.

Signs and symptoms of lung cancer include:
• Chronic cough
• Hoarseness
• Coughing up blood
• Weight loss
• Loss of appetite
• Shortness of breath
• Unexplained fever
• Wheezing
• Repeated bouts of bronchitis and/or pneumonia
• Chest pain

Draft plan for a statewide campaign for better health gets endorsement, much talk at Friedell Committee annual meeting

By Al Cross
Kentucky Health News

A statewide committee of volunteers is on target with its plan for a campaign to make Kentucky a healthier state, an expert in state and local health told the committee Monday.

“You guys are absolutely on the right track,” Julie Willems Van Dijk of the University of Wisconsin told the Friedell Committee for Health System Transformation at its annual meeting in Lexington.

The committee is developing a campaign that would involve many partners around the state, including health-care providers, education and business leaders, state and local health officials, and other groups and individuals interested in improving Kentucky’s poor health. The draft campaign’s working motto is “healthier, wealthier and wiser,” reflecting how education, health and economic development are related.

“Your three-legged stool of health, industry and education fits solidly within the model we’re talking about,” said Van Dijk, deputy director of the County Health Rankings and Roadmaps Program funded by the Robert Wood Johnson Foundation.

Dr. Lee T. Todd Jr.

Kentucky’s health rankings – we’re first in smoking, cancer deaths and preventable hospitalizations – prompted Dr. Lee T. Todd Jr. to dub such statistics “the Kentucky uglies” when he was president of the University of Kentucky. Now part of the group developing the campaign, he told the committee in a keynote speech Sunday night, “Those are things we need to remember and repeat.”

Noting the low life expectancy in many Kentucky counties, and the wide range of life expectancy among Louisville neighborhoods, Todd asked, “Why can’t people get excited about that, or disappointed, or just mad about it?”

Kentucky ranks 44^th among the states in health, and “The bottom line is, it hurts us economically,” Audrey Haynes, secretary of the state Cabinet for Health and Family Services, told the committee Monday.

Todd noted how San Antonio reduced its obesity rate after losing a prospective employer that cited how fat the city’s sixth-graders were. He said local communities should “get mad about something and decide you’re going to change something. . . . We have just got to stop tolerating ill health.”

As examples, he cited Grant County’s successful effort to improve its health ranking, the Hopkins County oral-health program that reduced premature births, and Clark County’s effort – now funded by a small extra tax – to varnish students’ teeth to prevent cavities.

“Why can’t we get this stuff to roll across this state and make a big difference?” Todd asked. He suggested that one reason has been a shortage of leadership and courage, as demonstrated by the political dominance of traditional industries with health implications, such as coal and tobacco.

Todd said the committee needs to find “a market driver” like the state Supreme Court ruling that forced education reform in 1990 or the Russians’ launch of the first man-made satellite in 1957, which prompted national reform of science and math education.

He said the federal health-reform law could provide that spark, because it will bring many people into the health-care system and provide free preventive services. He suggested a targeted effort, such as getting the newly enrolled to check their A1C hemoglobin (a rough measure of blood sugar and an indicator of diabetes), and predicted the tests would show many of them “are diabetic but didn’t know about it.”

While the statewide campaign can focus on certain things, Todd said, it “can’t be viewed as outsiders” giving direction to local communities. He said the effort must be led by people in local communities, focusing on their local health problems. Willems said the committee could set strategic priorities from which communities could select.

As the committee met Monday, Todd and Committee Chair Jane Chiles of Lexington said the campaign needs grant money and a staff. “This subject is too important for us to nickel-and-dime it,” he said.

As Chiles adjourned the meeting, she said of the proposal, “This is a winning concept, a winning strategy.”

For a PDF copy of the committee’s draft proposal, click here.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky. Al Cross is director of the Institute and a member of the Friedell Committee.

Kentucky, in Diabetes Belt, needs to do more to keep percentage of residents with costly disease from rising, advocates say

By Dr. Gilbert Friedell and Isaac Joyner

World Diabetes Day is Nov. 14, and we urgently need to address this plague right here at home. Diabetes is a major public health problem — an epidemic — in the United States. One out of 10 people over the age of 20 now has diabetes, primarily Type 2 or “adult onset” diabetes, and the disease is rapidly increasing. This increase has been particularly striking in the several Southeastern states comprising what the federal Centers for Disease Control and Prevention calls the “Diabetes Belt.”

PERCENTAGE
OF ADULTS

In Kentucky, one of eight people now has the disease — a frightening fact. Even more frightening: one-fourth of those with diabetes do not know they have the disease! If this epidemic is not interrupted, by 2050 about one out of three people in this country will have diabetes. For minorities, that figure will be closer to one out of two.

Diabetes itself poses a significant health problem, but the real burden of the disease is its complications. The high blood-sugar levels characteristic of diabetes, plus the effects of high blood pressure and elevated cholesterol levels, damage both small and large blood vessels. Over time, those with diabetes frequently go blind, have a toe or foot amputated, lose kidney function and frequently die of a stroke or heart attack. These complications are BAD: blindness, amputations and dialysis.

The cost of diabetes is staggering. In 2025 its annual direct and indirect cost to the country is projected to exceed $500 billion. Here’s what we need to do about this epidemic.

First, we need to focus on primary prevention of the disease, and that means stressing proper nutrition and regular exercise. Early childhood is the time to begin good dietary habits, and the conscious selection of food for school snacks and lunches provides an excellent opportunity for establishing these habits.

With young people and adults, a structured program of weight loss and exercise can prevent the onset of diabetes among about half of the overweight population that has elevated but not diabetic levels of blood glucose.

At the community level, we need active engagement by local health departments and officials interacting with the population. We recommend the creation of broad-based Community Diabetes Control and Prevention Councils, with health providers, business leaders and teachers, along with diabetes patients and their advocates.

At the state level, we need mandatory screening of all adults, and mandatory reporting of all new cases of diabetes to a state diabetes registry. Strong support from the federal government must be provided for these efforts, and for local health departments.

Diabetes prevention will require a significant change in the behavior of patients, health providers, communities and government. This will not be easy, but the current fragmented way in which we deal with diabetes is not working. It is long past time for greater public recognition of the grave threat that the diabetes epidemic poses — and for a rational, coordinated response to it.

Gilbert Friedell and Isaac Joyner, of Lexington, are co-authors of The Great Diabetes Epidemic: A Manifesto for Action.

KET offers program about diabetes prevention and control

KET's "Connections with Renee Shaw" is offering a program about diabetes prevention and control on KET2 Friday, Nov. 8 at 5 p.m. and KET Sunday, Nov. 10 at 1:30 p.m.

This programming could not be more timely, since Kentucky, along with parts of Appalachia and the Deep South, is part of the nation's Diabetes Belt. Diabetes rates are 11 percent or higher in many counties, and as much as 25 percent of Kentucky's Medicaid budget goes towards treating the complications of type 2 diabetes, according to the program guide.

Experts will discuss statewide education and prevention methods and the changes individuals can make to avoid diabetes.

This show will explain the difference between type 1 and type 2 diabetes, the function of the pancreas and insulin, and the role that diet and exercise play to help control diabetes complications and even prevent the onset of diabetes.  It will offer personal stories of people who are living with diabetes, explain the concept of pre-diabetes and how to prevent it, and discuss specific ways we can help resolve this growing problem.

Program guests include Dr. Raymond Reynolds, professor of internal medicine, endocrinology fellowship program director, and director of the Barnstable Brown Diabetes and Obesity Center at the University of Kentucky; Theresa Renn, coordinator of the Kentucky Diabetes Prevention and Control Program; Tami Ross, a registered dietitian, certified diabetes educator, and nationally recognized speaker and health and nutrition writer; Stewart Perry, a Lexington insurance broker who has been living with Type 2 diabetes for more than 20 years and is a policy advocate on the state and national level for the Kentucky Diabetes Prevention and Control Program and the American Diabetes Association.

1 in 3 don't get potentially life-saving screening for colon cancer, second leading cause of cancer death in Ky. and U.S.

Federal officials said Tuesday that although detecting colon cancer early saves lives, only about two-thirds of Americans aged 50 to 75 have undergone recommended screening.

The U.S. Preventive Services Task Force recommends that men and women 50 and older get screened for colon caner, which is about 23 million Americans. However, only 28 percent of people who should be screened have ever done so and about 7 percent of people have received but are not up-to-date with their screening, says the federal Centers for Disease Control and Prevention.

Colon cancer is the second leading cause of cancer mortality in Kentucky and nationwide, and it affects men and women of all ethnicities. Kentuckians have a higher than average risk of colon cancer due to higher rates of obesity, diets high in fat, and lack of regular exercise.

"Despite research that shows colorectal cancer screening saves lives, screening rates remain far too low," CDC Director Dr. Tom Frieden said during a noon press briefing Tuesday. "Colon cancer is the second-leading cancer killer for both men and women. In fact, it's the leading killer of nonsmokers in this country, killing about 50,000 people a year," he said. The CDC report was published online Nov. 5 in its Morbidity and Mortality Weekly Report.

The number one reason people aren't being screened is because their doctor didn't recommend it, Frieden said, and the CDC is encouraging doctors to talk with their patients about screening. Certain preventive screening tests may be free under the Affordable Care Act, but be sure to check your individual policy.

"It is also important that individuals learn about testing options and get the test that's right for them," Frieden said. "But, we also know that not having health insurance greatly reduces the likelihood that someone will get tested and that's why increasing coverage is another way of saving lives."

MedLine Plus reports that several screening options can be used alone or in combination, including the following: Fecal occult blood test or fecal immunochemical test every year. These tests can be done at home; Flexible sigmoidoscopy, done every five years, with home fecal tests done every three years; Colonoscopy done every 10 years.

All these tests are effective and one is not necessarily better than another, Frieden said.  The CDC says that as many as 60 percent of deaths from colorectal cancer could be prevented if everyone age 50 and older were screened regularly.

"The best test is the one that gets done," he said. For some people, however, colonoscopy may be the best option, Frieden said. "These are people with a strong family history of colon cancer or an intestinal condition such as inflammatory bowel disease, or people who have had polyps removed in the past. But for everyone else, and that's the majority of people, there is no proven benefit to one versus another," Frieden said.

November is National Diabetes Month; here are some tips to stay healthy and keep the disease from stealing your vision

November is National Diabetes Month, and if you're one of more than 370,000 Kentuckians with the disease, in addition to watching your diet and keeping track of your blood sugar, it’s also important to have regular eye exams.

A comprehensive dilated eye exam can catch
diabetic eye disease early, before symptoms appear

Diabetic eye disease is the leading cause of vision loss among working-age Americans, says a release from the National Institutes of Health.  Diabetic retinopathy is the most common form of this disease, affects=ing more than 7 million Americans, a number that is expected to reach 11 million by the year 2030.

Since diabetic retinopathy has no symptoms until it reaches an advanced stage, it is important to get regular dilated eye exams so it can be detected early, says the release. Fortunately with early detection and timely treatment, the risk of severe vision loss from the diabetic retinopathy can be reduced by 95 percent.

If you have diabetes, controlling the disease will reduce your risk of developing diabetic eye disease. It’s now a good time to remember these health tips too:

• Get a comprehensive dilated eye exam at least once a year. 
• Tell your doctor if you're feeling down or if your eyesight changes.
• Control your blood sugar, blood pressure and cholesterol levels.  
• Take your medicine even when you feel Ok.
• Be active for 30 to 60 minutes on most days of the week.
  
• Eat healthy foods like:
• fruits, vegetables, fish, lean meats and poultry, dried peas or beans, lentils, and low-fat or skim milk and cheese
• whole grain foods such as whole wheat bread and crackers, oatmeal, brown rice, and cereals
• food prepared with little added fat, oil, salt, or sugar
• smaller servings of meat, fish, and poultry
• larger servings of fruits and vegetables. 

Click here to learn more about diabetic eye disease from the National Eye Institute. Click here to learn more about preventing and managing diabetes from the National Diabetes Education Program or here for additional tips on staying healthy with diabetes.

A Ky. guide to the Patient Protection and Affordable Care Act

By Molly Burchett
Kentucky Health News

Few laws have generated as much confusion, opposition or news coverage as the Patient Protection and Affordable Care Act. Despite the flood of news stories about the law widely known as Obamacare, there is still much confusion about it.

That's not surprising. The 906-page law is complex and is accompanied by 10,535 pages of regulations. This guide to the law is designed to clear up confusion and offer various perspectives about how the law may affect you, your family or your business.

What does the Affordable Care Act do?

The law is a set of reforms that impose many requirements on insurance companies and requires all Americans, with very few exceptions, to have health coverage or pay a penalty starting Jan. 1.

Kynect home page

In addition to those mandates, the law created online health-insurance marketplaces and encouraged states to expand the federally subsidized Medicaid program for the poor and disabled. Gov. Steve Beshear expanded Medicaid and decided the state would run its own marketplace or exchange, Kynect, which launched Oct. 1.

Why did Congress pass the law?

The law is designed to extend health coverage, either through private insurance or Medicaid, to Americans without health insurance. More than 47 million Americans were uninsured in 2012, says the Kaiser Family Foundation, and about 640,000 of them were Kentuckians.

The law's rules for insurance will increase costs for many, so it provides Medicaid or subsidized coverage to help qualifying individuals pay for coverage. Those with incomes under 138 percent of the federal poverty threshold qualify for Medicaid, and those with incomes up to 400 percent of the poverty line get premium subsidies. The line for a family of four is $23,550, so such a family would qualify for subsidies if it makes less than $94,200 a year.

Who will be affected by the law?

Obamacare will affect almost everyone, but it will have less impact on people 65 and up because they're eligible for Medicare. Virtually everyone must have health insurance coverage by 2014 or pay a penalty. Beginning in 2015, employers of 50 or more full-time workers (defined as working at least 30 hours a week) must provide coverage for their employees.

Insurance companies can no longer deny coverage because of pre-existing conditions such as a disability, pregnancy, or chronic disease. Under one part of the law that took effect early, parents are able to keep their children on their insurance until the children turn 26.

The law aims to help people who can't get affordable insurance through an employer or who aren't ineligible for public coverage through Medicare or Medicaid. It also affects the self-employed, small businesses and employees of businesses that don't provide coverage.

Because the law is making fundamental changes in the health-insurance system, "In the long run, pretty much every American will be affected by Obamacare," reports Abby Hayes of The Dough Roller, a financial-advice site. "Next year, employer-sponsored insurance premiums are likely to fluctuate as insurance companies adjust their offerings."

Will the law lower health costs?

It's too soon to tell what impact the law will have on costs. Remember, there are two types of health costs: the country's overall cost and the cost that you feel in your pocketbook from the money your household spends on health services.

If you buy an insurance policy through the state exchange, www.kynect.ky.gov, your cost will depend on your individual situation, such as the size of your household and the number of smokers in it, and your income, which will determine your eligibility for subsidies or Medicaid.

Most people who buy coverage in the individual market will pay higher premiums in 2014, mainly because companies are required to cover people with pre-existing conditions and a broader range of services, such as prescriptions, than many people have been paying for.

Rates in the individual market will change yearly, as explained in a report from the Kaiser Family Foundation. It says the broader coverage, and limiting surcharges due to age, will spread the overall cost of care across the insurance marketplace, tending to lower premiums for people who are older and sicker and raise them for people who are younger and healthier. Thus, the trade-off for pre-existing coverage is the individual mandate, which requires everyone to purchase coverage to spread the cost.

Think of it this way: When you go out to eat with two grade-school children, they can order off the kids' menu, so you pay less for their smaller portions. The total bill is $30. Your kids' chicken finger platters are $5 each, and you and your spouse both have $10 items. However, if the restaurant must charge all patrons equally for the same meal, the $30 cost would be assessed differently. The cost for each individuals would be $7.50; the cost of your kids' meals would be higher and you and your spouse's meal would cost less.

Many Kentucky businesses have expressed concern about rising premiums for employee coverage. Some are moving to high-deductible plans that require employees to pay a larger share of their costs, and some may drop coverage, letting employees obtain insurance and subsidies through the government exchanges.

How do I get coverage from the exchange?

The Kynect website will determine your eligibility for Medicaid or subsidies, allow you compare plans and process the insurance application. If you don't have a computer, you can call toll-free to 1-855-459-6328 to apply or locate a local "Kynector."

Unless you qualify for a special enrollment period, you must enroll in a health plan by March 31, 2014. A "life-changing event," such as moving to a new state, major changes in income and changes in family size, can make you eligible for a special enrollment period, says Healthcare.gov, the federal website. (Kentuckians do not use the federal site because the state has its own site, Kynect.)

The date coverage starts depends on when you buy it. If you enroll before Dec. 15 and pay your first premium, your coverage starts Jan. 1. Likewise, in succeeding months, if you enroll between the 1st and 15th, your coverage starts on the 1st of the next month. If you enroll after the 15th, coverage starts the month after the next one.

What do the health plans cover?

Regardless of which plan you chose, the law requires all plans offered by any insurance company to cover these essential health benefits:

1. Ambulatory patient services (outpatient care)
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance abuse services (including behavioral health treatment)
6. Prescription drugs
7. Rehabilitative and habilitative services/devices
8. Laboratory services
9. Preventative, wellness, and chronic disease management services
10. Pediatric services (including oral and vision care) 

What will I pay for a plan?

Premiums depend on individual circumstances, such as income and the level of coverage, such as the amounts of deductibles and co-payments. Kynect is connected to federal databases — including Internal Revenue Service databases — to determine whether you qualify for assistance in paying a premium. People on Medicaid do not pay premiums.

Plans on Kynect vary widely. In addition to comparing premiums, it is important to consider deductibles, co-payments and other plan details. Kynect offers four basic types, labeled bronze, silver, gold and platinum. Bronze plans have the lowest premiums but have a $6,300 deductible. As you move up the plan spectrum to platinum, your premiums increase and your deductibles decrease. The exchange also offers people under 30 a plan that provides only catastrophic coverage with a "very high deductible" and no subsidy.

Let's consider a basic example. A 45-year-old Floyd Countian named John Smith earns $36,000 a year, which means he is eligible to buy subsidized insurance through Kynect.

The individual market in Floyd County is limited to two companies, Anthem Blue Cross and the non-profit Kentucky Health Cooperative; Humana Inc. isn't offering individual coverage there. Depending on the type of plan John chooses, his premiums will range from $182 (bronze) to $421 (platinum), with deductibles ranging from $6,300 (bronze) to $500 (platinum).

Kynect shows selected plans' ranges of premiums, 
deductibles and out-of-pocket limts.

John has several options. Let's say he decides that he needs to keep his premium payments below $250 per month because he just bought a house and is on a tight budget. He doesn't expect to have many doctor visits because he's pretty healthy, but he doesn't have enough money saved to afford a $6,300 deductible if things went south.

Considering his obligations, John decides to set aside 15 percent of his monthly income for health care. Based on this budget, he narrows his options down to three plans. The Kynect website displays them.

After eliminating the gold plan, John decides he would prefer to pay an additional $40 per month to reduce his deductible to $2,000, so he purchases the cooperative's PPO Silver plan. About 7 percent of his income each month will go toward the premium. He will save the other 8 percent ($240) to apply to his deductible, prescription drug costs and co-pays for office visits.

A $2,000 deductible means that John must pay all of his medical costs, excluding certain preventive services like immunizations and screening, until he reaches this threshold. Co-payments and premiums cannot count toward the deductible.

John really likes his family doctor, whom he's been seeing for 20 years, and the doctor is in the cooperative's network. This plan has a $30 co-pay for primary care and mental health services, and he feels comfortable paying this amount for an office visit. If he were to see an out-of-network doctor, he would pay co-insurance: 60 percent of the doctor's full charge for the visit. For prescription drugs, there is a $500 deductible, and John will pay $20 per prescription for generic drugs after reaching this amount.

John has peace of mind knowing that he's covered if he were to have an accident. The total amount he may have to pay each year is his out-of-pocket limit of $6,350, and since he has purchased this plan during the enrollment period, he will not face a penalty for not having coverage.

As he navigates the site, John sees that he qualifies for a payment assistance in the form of a tax credit that will either reduce the amount John will pay in taxes or increase his refund, depending on his personal situation; or it will reduce his monthly premiums, if he so chooses.

What happens if I don't get covered?

The penalty for 2014 will be the larger of either $95 per adult and $47.50 per child under 18, up to a total of $285 per family or 1 percent of household income in excess of $10,000 for an individual or $20,000 for a family.

For example, let's say an individual making $40,000 per year doesn't buy health insurance in 2013. This person would would pay 1 percent of $30,000, or $300, in 2014. What about a family with a $50,000 household income? It would pay a penalty of 1 percent of $50,000, or $500.

The initial penalties are much less than the cost of health insurance, but will go up each year. The minimum penalty may increase to as much as $695 per person by 2016.

What if I'm on Medicare or Medicaid?

Almost nothing will change if you have coverage through Medicaid, but there are some changes for Medicare beneficiaries. The law doesn't require Medicare beneficiaries to buy more insurance and won't force beneficiaries to see different doctors, reports Andrea Adleman of U.S. News.

Obamacare does, however, increase premiums or prescription-drug costs for some Medicare beneficiaries, and it mandates $716 billion in Medicare payment reductions over the next 10 years. These cuts are made by changing payment formulas for hospitals, nursing homes, home-health agencies, hospice agencies and Medicare Advantage plans, says the Congressional Budget Office.

The law already affects higher-income Medicare beneficiaries. Those who earn more than $85,000 ($170,000 for a couple) are paying higher Part B premiums, which cover physician and outpatient services, and for Part D, which covers prescription drugs, says Kaiser Health News. As a result of this sliding scale, about 5 percent of Medicare beneficiaries are paying more for premiums and prescription drugs.

It is projected that by 2019, 7.8 million beneficiaries will be paying the higher Part B premiums and of that group, 4.2 million will pay the higher Part D premiums. Kaiser estimated the combined premium in 2019 would be $299 to $683 a month, depending on income.

However, typical Medicare beneficiaries, those below the $85,000/$170,000 income threshold, will pay less for their premiums since the the law closes the "doughnut hole," the coverage gap in prescription benefits, by 2020. The National Council on Aging estimates the savings could reach $1,800 for some beneficiaries.

Also, both Medicaid and Medicare beneficiaries will qualify for more free preventive care, such as a yearly wellness visit, vaccinations and colorectal screenings, starting Jan. 1.

What if my employer covers me?

About 57 percent of Americans have health insurance through an employer with fewer than 200 employees, and those who are covered do not have to purchase a new plan on Kynect. If your employer’s plan covers less than 60 percent of allowed medical expenses, or costs you more than 9.5 percent of your household income, you can shop on the exchange.

Over the past 10 years, employers have been shifting more health costs to employees. Worker contributions increased 89 percent during the decade, and are 14 percent higher than in 2009, Kaiser Health News reports. So, while the nature of your work plan may be changing, this is not a direct result of the health law.

If you aren't covered by your employer or if your employer decides to drop your coverage, you must obtain coverage or face a penalty. Religious conscience and hardship exemptions to this mandated coverage exist, and you will need to complete an application to request such an exemption.

What if I'm an employer?

Steve Wilson, senior vice president of Benefit Insurance Marketing in Lexington, said in an email that employers with fewer than 50 employees are facing 2014 premium increases that may lead them to drop coverage for their employees.

Wilson said unless companies act quickly to renew early based on 2013 underwriting rules, the average 2014 renewal for his company's small business clients will increase 63 percent. He said his clients represent a broad range of industries that will, on average, pay $3,508 more per employee for coverage next year.

On the other hand, a study by the RAND Corp. says Obamacare could alleviate some of the difficulties for small employers by putting their employees into a single risk pool. The study predicts that the number of workers offered coverage will increase after the reform, mainly because more small businesses will offer coverage.

If you have a small business with 25 or fewer employees, there may be significant tax credits available through Kynect to help cover the cost of insurance.

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.

Ovarian cancer screening is critical in detecting tumors that don't show up on clinical exams, and increases chance of survival

Kentucky First Lady Jane Beshear joined some of the state's female legislators to highlight the importance of screening for ovarian cancer, which can be done for free through the University of Kentucky Markey Cancer Center's ovarian cancer screening program.

Ovarian cancer is fifth among cancer killers of American women and accounts for more cancer-related deaths, causing more deaths than any other cancer of the female reproductive system, says the federal Centers for Disease Control and Prevention.

SYMPTOMS OF OVARIAN CANCER (CDC)

When ovarian cancer is found in its early stages, treatment is most effective, but most women with ovarian cancer don't have symptoms of it until the disease progresses into a more advanced stage. As it progresses, survival rates drop sharply, making screening and early detection critical. Data from the screening program at UK shows that regular screening increases survival rates, says a UK news release.

"This preventative ovarian cancer screening is free, quick and confidential – an easy way for women to protect themselves from this life-threatening illness," Jane Beshear said. "This simple procedure is available to women in all parts of Kentucky, not just the Lexington area, and I encourage all who are at-risk for the disease to participate in the program."

Dr. John van Nagell, professor of obstetrics and gynecology at the Markey Cancer Center, said "While regular pelvic examinations are important and can detect many other abnormalities, including cervical cancer, they are not effective in detecting ovarian cancer in its earliest and most treatable stages."

Van Nagell started the screening program in 1987 to test the use of transvaginal sonography to detect ovarian tumors that are too small to be detected during an annual exam, says the release. Over the program's 26 year period, more than 241,000 free screening examinations have been provided to more than 41,000 Kentucky women, and 558 ovarian tumors and 86 malignancies have been detected.

Women from every county in the state have participated in this program, says the release. Screenings through the program are now being performed in Lexington, Elizabethtown, Somerset, Prestonsburg, Maysville, Paducah and Greenup County.

All women are at risk for ovarian cancer, but older women are more likely to get the disease. About 90 percent of women who get it are older than 40, says the CDC.

The UK screening program is free and open to women age 50 or older, or women over the age of 25 who have a family history of ovarian cancer. For more information, call (859) 323-4687 or (800) 766-8279. Click here for more CDC information.

Increased contact with bats leads to more rabies vaccinations in N. Ky.; health officials say all encounters should be reported

Fruit bat roosting in a home

Northern Kentucky health officials are warning residents to be more wary of bats after an unusually high number of residents have made contact with bats inside their homes and have had to receive the rabies vaccine. They are asking them to report any encounter with bats to the health department.

Bats are commonly infected with rabies and have very small teeth, and so someone who wakes up with a bat in their bedroom might not realize it has bitten them, Northern Kentucky Health Department spokeswoman Emily Gresham-Werle told Brenna Kelly of The Kentucky Inquirer.

It is crucial to vaccinate against rabies after contact with a bat, if the bat cannot be captured to receive testing for rabies. "If someone is exposed to the rabies virus and not treated, the result is neurological disease and death," Kelly notes.

Each year, tens of thousands of people are successfully protected from developing rabies through vaccination after being bitten by an animal like a bat that may have rabies, says the Center for Disease Control and Prevention. "There are usually only one or two human rabies cases each year in the United States, and the most common way for people to get rabies in the United States is through contact with a bat," says the CDC. Some of these reported cases resulted from known encounters with bats.

The problem In Northern Kentucky may be due to development in the area that has caused bats to lose their natural habitat. So far this year, 13 people who were exposed to bats have decided to get the vaccine. Usually only two to three people a year in the area have to get the vaccine because of a bat, Gresham-Wherle said. "Local and state health officials speculate that the weather and loss of bat habitat have contributed to the high number," reports Kelly.

"The rabies vaccine, which is nearly 100 percent effective against the virus, involves four rabies shots and one antibody shot over a period of two weeks. The vaccine, which is given by shots in the arm, can also be expensive, with costs ranging from $2,000 to $6,000 for the series, with additional fees for doctors or emergency room visits," Gresham-Werle told Kelly.

All exposure to bats and all bites by mammals must be reported to the local health department. In some instances the animal may be captured for rabies testing so that the bitten individual will not need to be vaccinated against the deadly disease. You can't tell if an animal carries the rabies virus just by looking at it, because rabies can only be confirmed in a laboratory, warns the CDC.

Anthem gift will let Kentucky Homeplace expand diabetes self-management and education project to counties in Western Ky.

Kentucky Homeplace has been awarded a second gift of $150,000 from the Anthem Foundation to continue its diabetes self-management education project in Appalachian Kentucky counties that have high rates of diabetes but lack providers to help address it.

With this gift, Kentucky Homeplace community health workers can continue work to improve diabetes outcomes in Appalachia through a Diabetes Self-Management and Education program, which are designed to help people better manage their diabetes through improved self-testing and lifestyle changes, says a release from the University of Kentucky Center of Excellence in Rural Health.

DIABETES BELT (CDC map)

Sixty-eight of Kentucky's 120 counties are included in the “Diabetes Belt” of the rural Southeast, counties in which 11 percent or more of adults have been diagnosed with having diabetes, compared to the national average of 8.5.

In these areas, about a third of the excess risk of becoming diabetic is associated with risk factors that can be modified, such as sedentary lifestyle and obesity, says the Centers for Disease Control and Prevention.  In Kentucky, the number of certified diabetes educators in these counties is much lower than in other areas of the state, the UK release says.

The first study, in Eastern Kentucky, showed more glucose testing by patients and lower measures of hemoglobin A1c, the key indicator of diabetes. The new grant will let Kentucky Homeplace expand to include parts of Western Kentucky and enroll more than 300 additional participants.

Kentucky Homeplace was originally developed in 1994 by the UK Center for Excellence in Rural Health as a demonstration project. It now gets state funding and has worked for two decades to provide tens of thousands of rural Kentuckians with medical, social and environmental services they might not have had otherwise, says the release.

Kentucky has nation's first statewide, comprehensive plan for diabetes prevention; 10 percent of us have the disease

Kentucky leads the way in the fight against diabetes and towards improving health for future generations of Kentuckians by becoming the first state to legislatively require a statewide, comprehensive action plan for addressing this disease epidemic.

Over 500,000 Kentuckians, 10 percent of the state’s population, are living with diabetes, costing the state about $4.8 billion a year in direct and indirect medical costs, write R. Stewart Perry and Larry Smith, co-chairs of the American Diabetes Association's national board of directors, in an op-ed piece in The Courier-Journal. While it hasn't been widely reported, state policymakers recently tackled the issue.

In 2011, the General Assembly passed a law (KRS 211.752), sponsored by Sen. Tom Buford, R-Nicholasville, and Rep. Ruth Ann Palumbo, D-Lexington, directing the Cabinet for Health and Family Services to report every two years on the impact of diabetes on the commonwealth.  The report must include the scope of the disease, its costs and what state government is doing about it.

The law requires the Department for Medicaid Services, the Department for Public Health, the Office of Health Policy and the Personnel Cabinet to “collaborate to identify goals and benchmarks while also developing individual entity plans to reduce the incidence of diabetes in Kentucky, improve diabetes care, and control complications associated with diabetes,” Perry and Smith note.

Such reporting will encourage the development of prevention strategies that are more effective and efficient, representing an unprecedented, coordinated effort against diabetes, they write. Many other states are using Kentucky’s plan as a model for legislation. "We call on every Kentuckian to enlist in the effort to step up the fight against diabetes," they urge.

Obama and allies tout preventive-services and drug benefits of health-reform law to Medicare beneficiaries in Ky.

The federal health-reform law has made drugs more affordable for seniors, broadened coverage for preventive services and made Medicare more solvent, the Obama administration and its allies are pointing out today, the 48th anniversary of the enactment of the Medicare program.

According to the Department of Health and Human Services, Medicare beneficiaries in Kentucky have saved nearly $141 million on prescription drugs because of the Patient Protection and Affordable Care Act. Last year, 72,391 Kentuckians saved more than $51 million, or an average of $703 each, on prescriptions because those in the “donut hole” of Medicare Part D got a 50 percent discount on covered brand-name drugs and a 14 percent discount on generic drugs. The law will keep expanding coverage for both types of drugs until it closes the donut hole, the gap in coverage between modest and huge prescription needs.

The law also eliminated deductibles and co-payments for screening and other preventive services for seniors and people with disabilities. Last year, 485,843 Kentuckians with traditional Medicare used one or more free preventive service.

"The health care law extends the life of the Medicare Trust Fund by 10 years," said a news release from U.S. Rep. John Yarmuth, D-Louisville. From 2010 to 2012, Medicare spending per beneficiary grew 1.7 percent a year, much more slowly "than the per capita rate of growth in the economy," the release said. "And the health care law helps stop fraud with tougher screening procedures, stronger penalties, and new technology."

Earlier, the administration noted that Americans received $504 million in rebates from insurance companies because of the law's requirement that a certain percentage of premiums paid must be used for health care. In Kentucky, the rebates totaled $14.4 million to 206,771 consumers (slightly more than half, totaling almost $11 million, in the individual market) and averaged $100 per family. For other data on the effects of the law in Kentucky, click here.

Eastern Kentucky reluctant to accept HPV vaccination that helps prevent cervical, mouth and throat cancers

By Molly Burchett
Kentucky Health News

New research indicates that HPV, the sexually transmitted human papilloma virus, is now the leading cause of mouth and throat cancers in the United States, ranking above both alcohol use and smoking. This problem has a solution, since some cancers caused by HPV can be easily prevented by vaccination, but many Kentucky women are stiff-arming the solution as researchers found they "literally could not give the vaccine away to young women" in Eastern Kentucky.

In Kentucky, vaccination rates remain low, particularly in the east, where the percentage of women who die from cervical cancer is significantly greater than in the rest of state or the nation, notes Tom Collins in a recent Lexington Herald-Leader article. Collins is the associate director of the University of Kentucky's Rural Cancer Prevention Center, which initiated a project to explore the acceptance of the HPV vaccine.

Read more here: http://www.kentucky.com/2013/06/30/2698240/rural-kentucky-slow-to-embrace.html#storylink=cpy

Since 2000, scientists have known that certain strains of HPV are responsible for nearly all cervical cancer in women, and newer studies link HPV to head and neck cancer for many men too. This year, about 14,000 people in the United States will be diagnosed with oropharyngeal cancer, most of them will be young, between 40 and 50 years old and 75 percent will be male, says a Newswise article. A decade ago, patients with head and neck cancer were smokers or drinkers, but now 80 percent of the cancers are caused by HPV.

About half of all Americans will become infected with HPV at least once their lifetime and it's difficult to recognize the symptoms of the virus, making vaccination even more important. The federal Centers for Disease Control and Prevention now recommends that boys and girls both be vaccinated against HPV between the ages of 11 and 12 and up to the age of 26, says Collins.

Collins writes that Eastern Kentucky is slow to accept the vaccine, even when promoted at community events such as hog roasts. Despite the initial reluctance, "Researchers at the center hope that if a community is engaged in the process and allowed to direct the delivery of the necessary change, outcomes can be achieved that will lead to a healthier population," he Collins.

And, there's still hope. The national prevalence of infection in young women has declined by more than half since the introduction of the HPV vaccine, despite low vaccine usage, says recent findings by the CDC. This decline occurred even though only a third of eligible patients received the vaccine, so imagine the benefits afforded to Kentuckians with efforts to improve vaccination acceptance and usage.

Kentucky will soon require simple screening at birth to detect silent killers of newborns

A new state law taking effect in January will require all babies born in Kentucky to be screened for critical congenital heart disease, which is often a silent killer of newborns who appear to be healthy and who are discharged from the hospital with the unrecognizable disease.

Since Indiana became the first state in the nation to get such mandatory screening signed into law in May 2011, more than 20 states have passed legislation requiring a non-invasive, inexpensive screening test called pulse oximetry at birth, reports Laura Ungar of The Courier-Journal. The test can detect this life-threatening disease and allow health care providers to act quickly to save the baby's life.

Don Shieman, Kentucky state director of the March of Dimes, who helped lobby for the law with the state legislature, said about 65 infants are born with CCHD in Kentucky each year. “If we can detect the problem soon enough, we can save lives,” Shieman told Ungar. State Sen. Dennis Parrett, an Elizabethtown Democrat who helped sponsor the state’s new law, said this requirement is a simple solution to a deadly problem he know something about.

“My wife and I have some experience with this,” Parrett told Ungar. “Our younger daughter was born with a severe heart defect” called tricuspid atresia, and underwent surgery at Kosair Childen's Hospital and her heart is doing fine, Parrett told Ungar. “There’s a lot of infants whose heart defects are not caught,” Parrett said. “What we wanted to do is make it a part of normal infant screening.”

Each test costs about $4, so Parrett said there’s no real fiscal impact to adding pulse oximetry to the list or required screenings for newborns, says Ungar. In general, hospitals already have the equipment for the test, many of which are already doing the test.

The legislation could lead to success stories similar to that of Shooter Bratcher of Caneyville, right, who was treated for infection and underwent surgery for CCHD recently at Kosair. Shooter was born full-term and and seemed normal at birth, but about five days after going home, things just didn't seem right, and he kept getting worse. Shooter's parents took him to the ER at their local hospital, Twin Lakes Regional Medical Center in Leitchfield, where doctors didn't pick up on his CCHD, Ungar reports. A day later, he went by ambulance to Kosair, and could have died if his parents didn't notice the little signs of a problem. Unfortunately, such signs sometimes show up at night, when parents are asleep or not paying close attention. Other times, the disease isn't caught quickly enough, leading to serious serious problems such as infections, brain damage, disability or death, Ungar reports.


Pulse oximetry will allow health care providers to detect seven types of CCHD. For more information about the test, the law or to watch a video in which Shooter's parents share their story, click here.

Study shows a 15-minute, moderate-speed walk a half-hour after eating can control older folks' spikes in blood sugar

It's no news that walking is good for your health or for preventing diabetes, but a new study published in Diabetes Care says a 15-minute, moderate-speed walk about 30 minutes after eating, which is when blood sugar spikes, is most beneficial for older individuals needing to control blood-sugar levels.

As you age, the process in which insulin converts sugar and glucose from your food into muscle cells, and the liver where it's stored for energy, doesn't work as well as it did when you were younger. Leaving too much glucose in the blood can lead to Type 2 diabetes and cardiovascular damage.

Exercise has long been known to helps prevent these effects. And while many individuals may not be able to get the recommended 45 minutes of exercise most days of the week, the study shows how you can be smart and get the most out of your exercising time. Compared to 45-minute walks in the morning and afternoon, the study says that only the 15-minute, post-meal walks managed to significantly reduce blood sugar spikes during the important three-hour post-meal window, reports Brian Alexander of NBC News.

This is the first controlled experiments of its kind and could be useful for pregnant women at risk for gestational diabetes who may not be able to exercise for 45 minutes,” the study’s leader, Loretta DiPietro of the Department of Exercise Science at The George Washington University, told NBC.

“This is not for weight loss, and it’s not going to increase your cardiovascular fitness very much,” DiPietro said. “It’s very specifically for glycemic control with older age.” But the study's findings benefit everyone because we all experience glucose spikes after eating, said DiPietro.

Remember to take precautions when walking at night, especially considering less than half of Kentucky adults live in communities with elements such as sidewalks or shoulders that allow for safe walking or bicycling.

Free HIV testing available from health departments and community-based health groups in June; key to AIDS prevention

In honor of National HIV Testing Day on June 27, community-based organizations and local health departments are hosting free HIV testing throughout the month of June. HIV is an infection that can lead to AIDS, and early screening and detection of HIV are critical to fighting the disease, avoiding further health complications and ensuring it isn't unknowingly transmitted to others.

“Routine testing ensures HIV-positive individuals are made aware of their status early before the disease progresses to AIDS,” said Dr. Stephanie Mayfield, commissioner of the state Department of Public Health, which is promoting the HIV testing and awareness events through mini-grants. “Testing remains one of the most critical and effective strategies for preventing transmission, ensuring good health outcomes, keeping service costs low and keeping infected individuals healthy.”

About 20 percent of people with HIV don't even know they are infected, which is very problematic because these individuals are believed to transmit HIV to more than half of the people who become newly infected each year, and one-third of the people is diagnosed so late that they develop AIDS within one year, says the federal Centers for Disease Control and Prevention.

In 2010, 32 percent of Kentucky's 7,751 HIV cases led to an AIDS diagnosis within 30 days of the initial infection, says a Cabinet for Health and Family Services release. This highlights the importance of routine testing, which the CDC recommends for everyone, regardless of risk factors, especially for all people age 13 to 64.

"A delay in diagnosing HIV is a life and death issue, with many individuals receiving a concurrent diagnosis of HIV/AIDS upon initial testing. Early intervention and linkage to care is critical to enhance the quality of life and reduce costs for treatment,” said Gayle Yocum, HIV/AIDS prevention section supervisor, in the CHFS release.

In Kentucky, HIV disproportionately affects racial minorities, particularly the African-American and Hispanic populations. Although African-Americans represent 7 percent of the state’s population, they account for 34 percent (2,884) of new HIV infections. Individuals who are at a higher risk for infection should be tested at least annually, including those with multiple sex partners, injection drug-users and their sex partners, people who exchange sex for money or drugs, men who have sex with men and sex partners of someone with HIV, says the CDC.

Kentucky testing sites

The Department of Public Health's statewide network of HIV testing sites provide risk reduction counseling and helps individuals develop a behavior-change plan to reduce the risk of getting or spreading HIV. Here's a list of the statewide events providing free HIV rapid testing in the next two weeks:

◾ June 17, free testing and education, 10:30 a.m. to 2 p.m., Salvation Army of Bowling Green, 400 W. Main Ave., Bowling Green.
◾ June 20, afternoon gospel fest, noon to 5 p.m., New Beginnings Church, 4127 Flintlock Drive, Louisville.
◾ June 22, church health fair, 10 a.m. to 5 p.m., Faith Fellowship, 727 S. 15th Street, Louisville.
◾ June 25, free testing, 11 a.m. to 3 p.m., 2106 St. Louis Ave., Louisville.
◾ June 28, free testing and education, 10 a.m. to 3 p.m., Housing Authority of Bowling Green, 247 Double Springs Road, Bowling Green.
◾ June 28, neighborhood test fest, 10 a.m. to 4 p.m., Nia Center, 2900 W. Broadway, Louisville.
◾ June 29, free testing, 11 a.m. to 1 p.m., Walgreens, 110 Town Center Dr., Lexington.
◾ June 29, free testing, 11 a.m. to 1 p.m., Crossings, 117 N. Limestone, Lexington.
◾ July 3, free testing, 8 p.m. to midnight, The Bar Complex, 224 E. Main Street, Lexington.

Click here for more information about HIV and AIDS, about the National HIV Testing Day/Month Campaign or other programs and services.

Working with a local, regional or state health coalition? A simple step can help make healthy changes in Kentucky

The Foundation for a Healthy Kentucky is asking you to help update last year's Kentucky Health Coalitions Directory, a list of local groups working to better Kentucky's health, so that additional coalitions can be identified and groups can work together toward their shared goal of bettering the state.

“These are local residents working on solutions to health issues in their cities and towns,” said Susan Zepeda, CEO and president of the foundation. “These groups have differing levels of organization and are pursuing various goals. The Coalitions Directory is a resource for them and allows them to connect with other groups working to make their community a healthier place to live, work, and play.”

Now, across the state's 120 counties, there are 143 coalitions with varying health interests: some are increasing access to healthy food and physical activity, others focus on education about risk-factors for serious health problems like diabetes and other chronic diseases and others are improving working conditions through smoke-free ordinances.

All groups are working to positively change Kentucky's health, and an updated directory will help the foundation raise awareness of the coalitions' local efforts, foster collaboration, build local capacity and provide assistance to groups. Follow this link to submit new or revised information to the Coalitions Directory.

Bankruptcy filing by mental-health agency is a loser for Kentucky, where such services can be scarce and little used

By Molly Burchett
Kentucky Health News

The decision of Seven Counties Services Inc. to file bankruptcy to avoid paying into the Kentucky Employee Retirement System has created a "no win" situation for the state, and the issue may add yet another obstacle for Kentuckians to get the mental health care they need.

Louisville-based Seven Counties is one of the state's largest mental-health agencies, serving more than 30,000 adults and children with mental-health services, alcohol and drug-abuse treatment, developmental-disabilities services and preventive programs, according to its website.

And while Kentucky's mental-health system has received an F grade for its funding, the state pension system needs agencies like Seven Counties to pay in more because the system is just 27 percent funded. "Employers will have to ante up around 38 percent of annual payroll, compared with the 23 percent now required," Mike Wynn notes in The Courier-Journal.

Kentucky's need for mental health services is much greater than the supply, and an estimated 1.7 million Kentuckians live in areas designated as a "mental health professional shortage area," which means almost 40 percent of Kentucky residents lack proper access to such professionals, says a report by the Kaiser Family Foundation. About 24 percent of residents' mental-health care needs are under-served, and this situation could be worsened by federal health reform, which will expand mental-health and substance-abuse treatment benefits to more Kentuckians without adding to the number of providers.

Bankruptcy for Seven Counties is a lose-lose proposition: It could close its doors in 2014 and stop providing services to 30,000 Kentuckians or, if the bankruptcy goes through, the state's retirement system wouldn't get anticipated agency payments into the system, reports Ryan Alessi of cn|2, a news service of the Time Warner and Insight cable-TV companies.

“The only two paths this can go is we could stay in KERS until we have given them our last nickel, which is a year (or) year-and-a-half from now … (and) we close the doors and go out of business and KERS gets no more money because we’re out of business,” Dr. Tony Zipple, president of Seven Counties, told Alessi.

In addition to funding problems for mental-health services, many people with mental-health issues don't seek treatment because of its stigma, said Sheila Schuster, executive director of the Kentucky Mental Health Coalition, in a recent opinion piece sent to Kentucky newspapers.  Shuster calls on elected leaders to increase funding of mental health services and highlights the prevalence of mental health illness.

"At least one-fourth of us will experience a behavioral health issues (mental illness or substance use disorder) in a given year," Schuster writes. That number, and the number of people needing treatment, will continue to grow, she says.

Schuster also writes about the societal impact of not treating mental illness: "Depression is rated as the #1 cause of disability in this country, and is a leading cause of absenteeism and decreased productivity in the work force." Because some people avoid treatment due to stigma, they may self-medicate with drugs or alcohol, and "the effects of stigma and failure to treat the whole person can have catastrophic results," she writes.

In addition to calling for more mental health funding, Schuster asks all Kentuckians to get educated about mental illness so that its stigma can be erased. Click here to read more from Schuster about mental health and resources for help. For a PDF of her op-ed, click here; for a text version, here.

W. Va. plans private-public model to provide school breakfast, improve child health, fight obesity; could this approach help Ky.?

By Molly Burchett
Kentucky Health News

Breakfast has been said to be the most important meal of the day, and it can be important in fighting obesity. Policymakers in West Virginia are pushing for breakfast food programs in schools through public-private partnerships, and a new report says similar programs could save $41 billion in federal dollars long-term by preventing obesity. Does this make sense, and does it make sense for Kentucky?

Like West Virginia, Kentucky has a high obesity rate among middle and high school students but has many children who don't always get the food they need to live a healthy life. Kentucky ranks fourth highest in food insecurity among children because 23 percent of Kentucky's children do not always know where they will find their next meal, according to Feeding America’s "Map the Meal Gap" study. (Here's a link to its interactive map, where you can see food insecurity rates by county in order to find out more about your county. One example appears below; orange dots are headquarters of regional food banks.)

A recent bill passed by West Virginia lawmakers addresses the problems of food insecurity, obesity and education simultaneously and serves as the first example for a statewide public-private funding partnership to improve school meals programs, reports David Gutman of The Associated Press. The bill would also require every county to set up a fund to collect private food donations.

The bill aims to require every school to have breakfast food programs so no student goes without it because of costs, says Gutman. Poor nutrition and diet are sometimes issues of cost and income level since healthy foods can be more expensive than unhealthy ones. For example, a bag of 10 apples may costs $4.99, but a package of Little Debbie oatmeal creme pies could be $1.79. A medium-sized apple has 93 calories and less than 1 gram of fat while an oatmeal creme pie has 318 calories and 13 grams of fat.

What does this have to do with obesity? The research-based logic is that a healthy, daily breakfast improves diet and can replace sugary alternatives such as donuts. Eating a healthy breakfast also improves education by combating hunger and aiding concentration and has been found to be associated with overall health and mental functioning. Overall, these factors may work together to improve education and diet, reports Gutman.

Such a program could help Kentucky address the state's problems related to food insecurity, obesity and education, while generating long-term savings. Similar food programs that provide meals to low-income children could generate as much as $41 billion in long-term federal saving by preventing obesity, says a new report from the Campaign to End Obesity.

The report says that the S-CHIP childhood obesity demonstration project, which combines changes in preventive care with community and school efforts to reduce childhood obesity in low-income communities, could prevent a child from becoming obese, saving an estimated $41,500 for an average female and $30,600 for an average male Medicaid beneficiary, says the report.

Three other programs were highlighted as huge cost-savers because they would prevent obesity and related chronic conditions in the long run, which would reduce health care costs and increase wages, says the report. These include increasing obesity screenings by physicians, bringing the Diabetes Prevention Program to scale and covering certain weight loss drugs under Medicare Part D. Preventive health policies aimed at obesity prevention could significantly reduce government expenditures, could save tax dollars and could improve the overall health of Kentuckians.

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