HIV and AIDS cases are on the rise in Kentucky; officials blame lack of education and increase of heroin use

Despite readily available information and awareness about practicing safe sex, and avoiding sharing needles, HIV and AIDS cases are on the rise in Kentucky. And the reason, say officials, is ignorance and an increase in heroin use, Mary Meehan reports for the Lexington Herald-Leader. Mark Royse, executive director of AVOL, which serves clients with HIV and AIDS in 72 Kentucky counties, said "his nonprofit routinely offers support services, including housing assistance, to about 400 families affected by HIV and AIDS."

Lauren Kirk, HIV and AIDS outreach specialist for the Lexington-Fayette County Health Department, "said a lot of the people they see are young and were born after the AIDS epidemic was at its lethal peak," Meehan writes. Another specialist, John Moses, told hr that the health department is seeing more young people with HIV. Part of that surge, he said, is from the use of shared needles as heroin use in Kentucky is on the rise." Heroin drug deaths in Kentucky increased by 550 percent in 2012, John Cheves reports for the Herald-Leader.

Another problem is that many people refuse to get tested, because discussion of HIV and AIDS includes talk of sexuality, homosexuality and drug abuse, Meehan writes. Royse told her, "It is a perfect storm of things we don't like to talk about." Royse said "a 'silence-is-better' policy is especially prevalent among Latinos and blacks, who account for the majority of new infections in Kentucky. He's concerned that if people stop talking about HIV and AIDS and become complacent, the infection will continue to spread." (Read more)

The state Cabinet for Health and Family Services, in its annual report from June, 2012, said 8,513 Kentuckians are diagnosed with HIV, with 7031 men and 1,482 women. Most of the cases are in urban areas, with 3,849 in Jefferson County and 1,099 in Fayette County. Of those cases, 4544 are classified as from men having sex with men (MSM), 917 as injection drug users (IDU) and 425 as people who reported to having engaged in both MSM and IDU.

The overall total of HIV and AIDS cases includes 21 boys under 13 years old, 107 between ages 13-19, and 1,269 between ages 20-29. For women, it includes 13 girls under 13 years old, 39 between ages 13-19, and 203 between ages 20-29. (Cabinet graphic: Newly diagnosed HIV cases in 2010 for Kentuckians ages 20-29 years old accounted for 32 percent of all new cases, even though that age group only makes up 13 percent of the total population)

Kentucky ranks 25th in HIV infections. In 2010, the state had 85 new HIV cases for people ages 13-24, accounting for 25 percent of all new cases in the state, which is higher than the national average for that age group of 21 percent. The average age of Kentuckians diagnosed with HIV went down from 37.1 years of age in 2006 to 35 years of age in 2010. To read the full report click here.

Feds allow people whose health plans were canceled, and haven't gotten a new one, to keep old one or get catastrophic plan

If you were among the 280,000 or so Kentuckians whose health plan didn't meet the requirements of the federal health-reform law, and you haven't enrolled in a qualified plan, you will be able to keep your old plan for a while, or buy a cheap, catastrophic-coverage plan that has been available only to people under 30, the U.S. Department for Health and Human Services announced Friday.

The Obama administration acted under the law's "hardship" exemption  for people who "experienced financial or domestic circumstances, including an unexpected natural or human-caused event, such that he or she had a significant, unexpected increase in essential expenses that prevented him or her from obtaining coverage under a qualified health plan."

"For these people, in other words, Obamacare itself is the hardship," writes Ezra Klein of The Washington Post. "The administration agreed with a group of senators, led by Mark Warner of Virginia, who argued that having your insurance plan canceled counted" as an unexpected human-caused event.

The White House estimates that only 500,000 people who had their plans canceled because of Obamacare have not yet obtained insurance. However, insurance companies "worry the White House is underestimating," Klein reports.

In Kentucky, 48,302 of the approximately 280,000 whose plans didn't qualify are in "grandfathered" plans that were extended in advance by insurance companies, according to the state Department of Insurance. Another 63,832 were offered transitional relief by their insurance company under President Obama’s request to states, which Kentucky approved. "The remaining had the option to take early renewal to continue current health insurance policies through at least 12-1-14," department spokeswoman Ronda Sloan told Kentucky Health News in an email.

The move "puts the administration on some very difficult-to-defend ground," Klein writes. "Normally, the individual mandate applies to anyone who can purchase qualifying insurance for less than 8 percent of their income. Either that threshold is right or it's wrong. But it's hard to argue that it's right for the currently uninsured but wrong for people whose plans were canceled. Put more simply, Republicans will immediately begin calling for the uninsured to get this same exemption. What will the Obama administration say in response? Why are people who plans were canceled more deserving of help than people who couldn't afford a plan in the first place?" (Read more)

"Catastrophic plans generally have lower premiums than other plans but offer more limited benefits," writes Louise Radnofsky of The Wall Street Journal. "They typically cover three primary-care visits a year and some preventive benefits, but beyond that they only cover large medical costs after a high deductible. Carriers offering them for the coming year already have cleared the plans with state regulators and set prices in the expectation that few people over the age of 30 would be purchasing them."

Statewide farm editor identifies self-employed workers' problems with Obamacare, and hers with Congress

Farmers and other self-employed people may have special trouble maneuvering through the process of obtaining health insurance on the state exchange, writes Sharon Burton, editor and publisher of The Farmer's Pride, Kentucky's statewide agricultural newspaper.

Sharon Burton

"The first thing I realized is the system doesn’t know how to deal with people who are self-employed," Burton writes. "I figure that’s just about every farmer in the commonwealth" of Kentucky, which is operating its own exchange, Kynect.

"My husband is a owner/operator commercial truck driver, so his income can fluctuate from year to year. When I adjusted our income based on that fluctuation, the system was not happy with me because I estimated our 2014 income to be different than our 2012," Burton writes, adding that her kynector, a state-paid adviser who helps people use the exchange about it, "She said she too had problems signing up anyone who was self-employed. She also warned me that we should notify Kynect if our income varied even within $1,000 or could face serious ramifications at the end of the year."

Kynect spokeswoman Gwenda Bond told Kentucky Health News, "If self-employed individuals have variable incomes there might be an extra step for them to accurately verify income. They would have to submit additional information, in some cases, because the income verification system accepts the amount reported only if it is within 10 percent of what the IRS has on file for the most recent year."

Burton adds, "There are a lot of bugs in the system. For one, if your spouse’s employer offers family coverage – even if they don’t pay any portion of it – you are not eligible for any subsidies. We all know insurance offered through companies often provides family coverage but it isn’t affordable.
Now you will be disqualified from Obamacare because that unaffordable plan is out there."

Burton has also lost patience with Congress. "The ones who voted for it spend all their time defending it, and the ones who voted against it spend their time trying to make sure it fails," she writes. "Just fix it people. Get on with it. It’s like starting a business. You have a plan, but where you end up often looks a lot different than where you start because you make changes as needed. This is a starting point; let’s move on to the next stage and stop bellyaching." (Read more)

McConnell shares excerpts from letters he received from Kentuckians who are frustrated by health-reform law

By Melissa Patrick
Kentucky Health News

Continuing his attack on Obamacare, Senate Republican Leader Mitch McConnell took to the floor last week to read excerpts from letters he received from Kentuckians who are angry about the Patient Protection and Affordable Health Care Act. UPDATE, Dec. 17: He did so again today; video is here.

Generally, the main issues cited by McConnell are frustration with President Obama's promise that people happy with their health insurance could keep it; anger that their premiums and deductibles had increased under new policies that meet the law's requirements; and dissatisfaction with their inability to choose and pay for only the services they wanted. For example, several constituents said they did not have children, but were required to pay for pediatric dental care and maternity care.

A 35-year-old college graduate and married father of two from Bowling Green told McConnell that his plan, which he said best met his family's needs, had been canceled. As he sought a new plan that met the requirements, he was told it would cost 124 percent more. He noted that Vice President Joe Biden said Sept. 27 that a family of four with $50,000 income could get health insurance for "as little as $106 per month." McConnell said the Bowling Green man was quoted a price eight times that amount and asked him, "Why should the price of a product be based on my ability to pay?" The law provides subsidies for insurance coverage based on income and the type of plan purchased through the state insurance exchange, Kynect, up to $94,000 for a family of four.

Sherry Harris of Nicholasville told McConnell she was concerned that Lake Cumberland Hospital in Somerset was not on the Anthem network, "which means anybody in Pulaski and surrounding counties that qualify for a subsidy and want to use it will have to drive to London, Corbin or Lexington to get care" if they have an Anthem policy. Insurance companies are being more selective about their care networks in an effort to reduce costs; for details, click here.

A "Mr. and Mrs. Spears" of Louisville told McConnell that when they signed her up for the Kentucky Health Cooperative plan on Kynect, they did not sign up for a subsidy and thus were told no income verification was necessary.  Since then, they have received mailings from the insurance exchange declining coverage unless they sent income verification.

Exchange spokeswoman Gwenda Bond told Kentucky Health News in an email, "A request for additional documentation related to income verification might be generated, if they are likely to qualify for a subsidy based on the information provided on the application. Everyone is eligible to purchase a qualified health plan at sticker price at any time." The sticker price is the amount before the subsidy is subtracted.

Mrs. Spears also questioned the exchange's request for her voter-registration information. Bond said the federal "motor voter" law requires public-assistance agencies to ask applicants if they would like to register to vote. "Because Kentucky’s exchange is a single streamlined system for both Medicaid and subsidies, applicants are asked if they would like to register to vote," she said. "A voter registration form is mailed to them if they request one. There is no follow-up related to whether an individual registers or not, and it does not have an impact on coverage."

Mike Conn of Prestonsburg was upset that a policy with similar coverage to his previous policy would cost double.  He told McConnell that he was informed by the individual who helped him find coverage that it was because he lived in Eastern Kentucky and his old insurance company was "apparently not available there." Humana Inc. chose not to offer plans in all parts of the state.

Kentucky spends less than a penny of its tobacco-settlement money on prevention programs; few states do very much

By Molly Burchett
Kentucky Health News

A new report says that 15 years after the 1998 state tobacco settlement, Kentucky ranks 38th in the nation in funding tobacco prevention and cessation programs, only 3.7 percent of the amount recommended by the federal Centers for Disease Control and Prevention.

The CDC recommends that the state spend $57.2 million a year on programs to help people quit smoking, but Kentucky is only planning to spend $2.1 million in 2014 on them, says the new annual report from the Campaign for Tobacco-Free Kids. Last year's report ranked Kentucky 37th as it planned to spend the same amount.

The goal of these programs is to help kids and adults quit smoking. Of the $320.3 million in revenue the state will get from the settlement in the current fiscal year, Kentucky will spend just 0.7 percent of it on tobacco-prevention programs, or less than a penny of every dollar it collects in revenue, the campaign says in a news release and a chart.

Kentucky has the highest smoking rates in the country, a an estimated 28.3 percent of adults and 24.1 percent of high-school students smoke. Each year, tobacco claims 7,800 lives and costs the state $1.5 billion in health care bills, about $487 million of which are covered by the federal-state Medicaid program, and each Kentucky household pays an estimated $582 per year in taxes to cover smoking-caused government expenditures, the release says.

To reduce smoking and its negative consequences, health advocates are calling on Kentucky leaders to pass a comprehensive, statewide ban on smoking in workplaces and enclosed public spaces. Some advocates also call for an increase in the state's tobacco tax. The report says Kentucky has the 40th lowest cigarette tax in the country at 60 cents per pack, 93 cents below the state average. It was doubled a few years ago.

"Tobacco takes a terrible health and economic toll on Kentucky, but state leaders can do something about it by increasing funding for tobacco prevention and passing a comprehensive, statewide smoke-free law," said Matthew L. Myers, president of the campaign. "The evidence is clear that reducing tobacco use not only saves lives, it also saves money by reducing tobacco-related health care costs. It's one of the smartest investments Kentucky can make."

Nationally, the report finds that most states are failing to adequately fund tobacco prevention and cessation programs. States will collect $25 billion from the tobacco settlement and tobacco taxes in 2014, but will spend just 1.9 percent of it on prevention programs.

States are spending only 13 percent of the CDC's recommended $3.7 billion in funding for these prevention programs, and only two states – Alaska and North Dakota – spend the recommended amount.

Green = State spends 50 percent or more than recommended amount; Orange= 25-45 percent of recommended amount; Yellow = 10-24 percent of recommended amount; Gray = less than 10 percent of recommended amount 

"Tobacco use is the number one cause of preventable death in the U.S., killing more than 400,000 people and costing $96 billion in health care bills each year. Nationally, about 18 percent of adults and 18.1 percent of high school students smoke." says the report.

Since the states settled their lawsuits against the tobacco companies in November 1998, the Campaign for Tobacco-Free Kids has issued annual reports to hold states accountable for settlement spending, an amount estimated to be $246 billion over the first 25 years.

The annual report on states' funding of tobacco prevention programs, titled "A Broken Promise to Our Children: The 1998 State Tobacco Settlement 15 Years Later," was released by the campaign, the American Heart Association, the American Cancer Society Cancer Action Network, the American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers' Rights.

Beshear says other governors will follow his lead on Medicaid

Associated Press file photo

Gov. Steve Beshear says states that have not expanded the Medicaid program under the federal health-reform law, as he did, will do so in the next few years because their voters will demand it.

“I believe the pressure will be so great over the next three or four or five years, on the states that haven’t gone in this direction, that they will end up just where Kentucky is,” Beshear told Alexander Burns of Politico, in the governor's latest appearance in a national publication.

Burns writes, "It’s precisely the message national Democrats are aching to hear, even – or perhaps especially – from a source as unexpected as a pro-gun, pro-coal, red-state governor who once endorsed using state tax incentives to build a creationist theme park."

The story, headlined "Kentucky's unlikely health care heartthrob," focuses on Beshear's high national profile stemming from his expansion of Medicaid to people earning up to 138 percent of the federal poverty line and the state's successful rollout of a website that is enrolling about 1,000 people a day in Medicaid or private insurance -- unlike the federal government's site, which seems to be getting in order after a disastrous rollout that made many Democrats nervous. He is the only Southern governor to take both steps.

"For anxious national Democrats who have pined for a white knight in the health-care reform debate, Steve Beshear is starting to look like the one they’ve been waiting for – implausible as that development may be," Burns writes. "Amid a torrent of negative national headlines about the Affordable Care Act, the 69-year-old Kentucky governor – a canny Southern operator who’s spent his career at arm’s length from the [national] Democratic base – has charged out of Frankfort as a kind of ambassador-by-default for the controversial law."

Burns says the verdicts on the state and national programs are "far from decided, but Beshear says his mind is entirely made up on both the merits and the politics of health care. From his perspective, voters’ opposition to the ACA is driven largely by a sense of anxiety about how the program may change their lives. If they find a year from now that the law has left their personal care unchanged, or even improved it, public opinion could shift quickly."

State Senate Republican Floor Leader Damon Thayer, "a leading Obamacare critic in the state, said Democrats would pay a price for Beshear’s decision to 'channel his inner liberal Democrat with no election ever facing him again in the future'," Burns writes, quoting Thayer: “While it appears that Kentucky has done a competent job implementing a website, it’s still a bad policy. . . . The people of Kentucky don’t like the fact that he has unilaterally implemented Obamacare without legislative approval, and they don’t like Obamcare.” (Read more)

Anthem says Kynect has delivered inaccurate enrollment forms, but is nevertheless a model for insurance exchanges

Some health-insurance companies say Kentucky's Kynect exchange for acquiring coverage is giving them inaccurate or incomplete enrollment forms, and that is also a problem in other state-operated exchanges, Kyle Cheney and Jason Millman reported for Politico Dec. 4.

"It’s a new twist in the unfolding saga of so-called 834 forms — industry jargon for the application files that insurers receive when someone signs up for coverage through an exchange," the reporters write. "Insurers in Kentucky and New York, for example, say they’ve received flawed 834 enrollment forms from their local exchanges, though the extent of the errors is unclear. Washington state has already had to correct thousands of 834s with faulty information about federal tax credits. . . . It’s uncertain how deep the problems go, in part, because the states themselves aren’t sure — and are reluctant to divulge much about their technical challenges."

As for Kentucky specifically, "Although a Kynect spokeswoman said the exchange has dealt with only 'minor issues' since it started sending enrollment files to insurers a month ago, she didn’t indicate whether those issues had resulted in flawed forms or if they’d been resolved."

Tony Felts, a Kentucky spokesman for Anthem Blue Cross and Blue Shield, told Politico that it's too early to say if the problems have been solved: “In general, the situation is the same for the state-run exchanges as it is for the federally facilitated exchanges. As far as the quality of the data that’s coming in, I can’t say that everything has been completely accurate.” Still, he told Kentucky Health News Dec. 9, "There is no question that Kentucky's exchange is performing substantially better and is a model for how the exchanges could be running."

Robert Zirkelbach, spokesman for America’s Health Insurance Plans, a lobbying group, told Politico, “While there is significant variation from state to state, health plans in many state-based exchanges are seeing similar problems with enrollment files.” (Read more)

Beshear says Ky. is 'gold standard' for implementing Obamacare, trades shots with McConnell in Washington

"Kentucky has become the gold standard when it comes to implementing the Affordable Care Act, and I'm very proud of that," Gov. Steve Beshear said Thursday morning at a press conference in Washington with Democrats in the U.S. House.

"There is a tremendous pent-up demand in Kentucky for affordable health care," Beshear said. "People are hungry for it." Citing studies that led him to expand the Medicaid program under the reform law, he said that "will generate $15 billion for Kentucky's economy and create 17,000 new jobs," Jennifer Bendery reports for The Huffington Post.

Beshear also took a shot at Republican Sen. Mitch McConnell, who calls for repeal of the law: "I have a U.S. senator who keeps saying Kentuckians don't want this. Well, the facts don't prove that out." He said more than 550,000 people have visited the state's health-insurance exchange website since it launched on Oct. 1, and about 69,000 have signed up for coverage, 41 percent of them under 35.

"Asked if he thinks Obamacare will be a factor in McConnell's reelection campaign in 2014, Beshear said 'It may well be,' but perhaps not in the way McConnell hopes," Bendery reports. The governor said, "I predict it will be an issue where people start looking at the critics and say, 'What was all that yelling and screaming about? I think you must have misinformed us about the Affordable Care Act.'"

Wednesday night, McConnell called the law a "catastrophic failure" for people everywhere," Bendery notes. "This is beyond fixing. It needs to be pulled out root and branch and we need to start over," the Senate minority leader said on Fox News Channel's "On The Record With Greta Van Susteren."

"McConnell spokesman Don Stewart responded by citing an article about 280,000 Kentuckians being forced to give up their current insurance policies as a result of Obamacare requiring stricter guidelines for coverage," Bendery reports. McConnell later issued a statement saying in part, "The things my constituents now have to put up with as a result of this law are simply unacceptable." (Read more)

Obama, fighting to regain traction, calls out McConnell on health care; Kentucky senator replies, and president does it again

White House file photo

President Obama called out U.S. Sen. Mitch McConnell two days in a row in speeches defending the Patient Protection and Affordable Care Act as an example of the administration's efforts to help the middle class in a time of increasing economic inequality.

“As people in states as different as California and Kentucky sign up every single day for health insurance, signing up in droves, they’re proving they want that economic security,” Obama said in a speech Wednesday. “If the Senate Republican leader still thinks he is going to be able to repeal this someday, he might want to check with the more than 60,000 people in his home state who are already set to finally have coverage that frees them from the fear of financial ruin.”

Washington Post columnist and Georgetown University professor E.J. Dionne Jr. used the quote in a column he wrote from Louisville after interviewing journalist-author Chris Matthews Tuesday night at the latest Kentucky Author Forum sponsored by the University of Louisville. Dionne said the issue of inequality "could be joined in a particularly stark way" in Kentucky because Democratic Gov. Steve Beshear "has turned his state into a national model for how the law can be made to work — and because polls suggest that McConnell is facing a serious Democratic challenge next year from Alison Grimes, the secretary of state." McConnell also faces a primary challenge from more conservative Republican Matt Bevin, a Louisville businessman.

Dionne called up Audrey Haynes, secretary of the state's Cabinet for Health and Family Services, and got some "figures suggesting how expanding health coverage can dent inequality: Among Kentucky’s uninsured, 61 percent have a high-school education or less; only 7 percent are college graduates. Underscoring Obama’s point in his address that inequality is not simply a matter of race, 88 percent of the state’s uninsured are white."

Obama's first call-out of McConnell came Tuesday, as the president began a concerted effort to defend and sell the health-reform law in the wake of its troubled website and insurance companies' cancellation of millions of policies, putting the lie to Obama's promise that people who liked their plans could keep them. That has put him at "a new low in his presidency," the Post's Chris Cillizza wrote.

Obama said, "Just the other day, the Republican leader in the Senate was asked what benefits people without health care might see from this law. And he refused to answer, even though there are dozens in this room and tens of thousands in his own state who are already on track to benefit from it. He just repeated 'repeal' over and over and over again. And obviously we’ve heard that from a lot of folks on that side of the aisle. Look, I’ve always said I will work with anybody to implement and improve this law effectively. If you’ve got good ideas, bring them to me. Let’s go. But we’re not repealing it as long as I’m President and I want everybody to be clear about that. We will make it work for all Americans. . . . If, despite all the millions of people who are benefiting from it, you still think this law is a bad idea, then you’ve got to tell us specifically what you’d do differently to cut costs, cover more people, make insurance more secure. You can’t just say that the system was working with 41 million people without health insurance."

In reply, McConnell issued this statement: “Another campaign-style event won’t solve the myriad problems facing consumers under Obamacare. Consumers didn’t need another 20,000 pages of regulations and higher premiums and deductibles to let a 25-year old stay on his parents’ plan — and they really didn’t need Obamacare’s cancellation of millions of plans that people already have and like in order to provide help to those with pre-existing conditions. The American people have been learning about the impact Obamacare will have on individuals and families in the form of higher premiums, disrupted insurance, and lost jobs—more broken promises from the administration. And they’re becoming increasingly aware of the fact Obamacare is broken beyond repair. The only ‘fix’ is full repeal followed by step-by-step, patient-centered reforms that drive down costs and that Americans actually want.”

Beshear says Medicaid plan will transform Ky. in a generation; acknowledges it was easier because he wouldn't face voters

In a generation, Kentucky will be a very different state because the federal health-reform law and expansion of Medicaid has made health insurance available to all residents of the state, Gov. Steve Beshear told Los Angeles Times political reporter Mark Z. Barabak for a story the paper published on Thanksgiving Day. And he acknowledged that his Medicaid decision was easier because he can't seek re-election.

"I knew if I was going to make a huge difference in the health status of Kentucky, it was going to take some kind of transformational tool to do that, and that's what the Affordable Care Act is for me," Beshear told Barabak. "I think we've started something here that a generation from now you'll see a very different Kentucky than what you see today."

Beshear "conceded, with a small smile, that it was easier knowing he would never face voters again," Barabak writes. "Embracing Obamacare is not without political risk. Undaunted by the early success in Kentucky, Republicans plan to make the controversial program a major issue in 2014, when the GOP will be vying to take control of the state House for the first time in close to a century."

Politics aside, "The need for care in this pretty but hard-pressed state is unarguable," Barabak writes. "Kentucky leads the nation in cancer deaths and preventable hospitalizations and suffers some of the highest rates of diabetes, cardiovascular illness and premature death." But he says "Kentuckians may feel understandably whiplashed" because the state's Republican U.S. senators firmly oppose "Obamacare." (Read more)

Obama says health policies that don't comply with reforms can be renewed for another year; state will let insurance firms decide

People with insurance policies that don't measure up to the federal health-reform law will be able to renew them for another year, President Obama announced today in an effort to quell outrage about policy cancellations that made hash of his promise "If you like your plan, you can keep it."

An estimated 280,000 Kentuckians have policies that are being canceled because they do not comply with the law's coverage requirements. Obama said insurance companies will be required to tell such policyholders "what protections these renewed plans don't include" and that they have alternatives that may be better and cheaper, with the help of federal tax subsidies.

The president also said state insurance commissioners will still have the power to decide what plans can and can't be sold in their states. "Kentucky will comply with the president’s request to allow Kentucky’s insurers the option of determining whether to extend existing health insurance policies to current policyholders for one more year," Gov. Steve Beshear said in a written statement. "This will be a business decision for each insurer to make, as many of them have invested a great deal of time and money into preparing for the transition to new standards under the Affordable Care Act."

At a White House press conference, Obama was asked why he kept repeating that people could keep their plan when his own administration had said in the Federal Register that people in the individual and small-group markets, about 6 percent of Kentucky's policyholders, would lose policies.

"There's no doubt that the way I put that forward unequivocally ended up not being accurate," he said. "It was not because of my intention not to deliver on that commitment. . . . We put a grandfather clause into the law but it was insufficient." The law said people could keep policies they had in place when it was passed, but that protection disappeared if an insurance company changed the policy, which seems to have happened in most cases.

Obama said he thought that most people whose policies were canceled "could find better policies at lower costs or the same costs in the marketplaces" run by the federal government and individual states like Kentucky, and the rest would be covered by the grandfather clause. "There's a good chance they'll be able to buy better insurance at lower costs," he said.

Asked if his broken promise creates a breach in public trust and confidence in government, Obama said, "There is no doubt that people are frustrated" and think that in Washington, "'not enough is being done that helps me with my life.' They expect me to do something about it. . . . It's legitimate for them to expect me to have to win back some credibility on this health-care law in particular and on a whole range of these issues in general."

U.S. Sen. Mitch McConnell issued this statement: “President Obama’s announcement doesn’t even come close to fixing the problems that so many Americans are facing right now as a result of cancelled health care plans and skyrocketing premiums. But, it does represent the clearest acknowledgment yet that his oft-repeated pledge ‘if you like your plan, you can keep it’ was false all along. What makes this admission even worse is the fact that it was prompted not by the heartbreaking stories of millions of Americans, but by the private pleadings of a handful of endangered Democrats. Americans are becoming increasingly aware of the fact Obamacare is broken beyond repair. The only ‘fix’ is full repeal followed by step-by-step, patient-centered reforms that drive down costs and that Americans actually want.”

Obama said at the press conference that the law will work and he is not backing away from it: "We’re going to do everything we can to help the Americans who have received these cancellation notices. But I also want everybody to remember there are still 40 million Americans who don’t have health insurance at all. I’m not going to walk away from 40 million people who have the chance to get health insurance for the first time. And I’m not going to walk away from something that has helped the cost of health care grow at its slowest rate in 50 years."

Tacitly acknowledging that it makes some people pay more, he said society and governments often make decisions carrying initial costs that are outweighed by long-term benefits, such as requiring motor vehicles to have seat belts. Speaking of the law's ineffective grandfather clause, he said “It's almost like we said to folks, 'You gotta buy a new care even though you can't afford it right now.'”

Many questions at the press conference dealt with the faulty federal website, which Kentuckians to not use. Obama said, "These are two fumbles . . . on a big game, but the game's not over."

"This solution combines a clever public-relations stunt, a stalling tactic, an act of retribution, the genuine possibility of transition assistance for some, and a large political and substantive gamble," Brian Beutler writes for Salon. "It bears the hallmarks of desperation and frustration and determination, but it just might work."

Friedell Committee will consider what it will take for Kentucky to become a healthier state at meeting Sunday and Monday

What will it take for Kentucky to become a healthier state? That will be the question at the fall meeting of the Friedell Committee for Health System Transformation, at the Marriott Griffin Gate in Lexington Sunday, Nov. 10 and Monday, Nov. 11. Participants will examine how the committee can work with communities and individuals to create a Kentucky that is “healthier, wealthier, and wiser,” a possible motto for a campaign the committee is considering.

“We have learned that building a healthier Kentucky will depend largely on what we do beyond the health-care system,” said Richard Heine, executive director of the committee. ”Efforts to promote good health must take place in the environment where people live, work, and play. For Kentuckians to be healthier, we must address the factors behind the problem of poor health, such as lack of education, poverty, poor nutrition, lack of employment, violence, transportation, and housing.”

Topics at the meeting include the state Health Benefit Exchange, managed-care Medicaid, the state’s financial situation, successful local policy changes, and the prevention and control of Kentucky’s major health challenge: diabetes.

Lee Todd, former president of the University of Kentucky, will be the keynote speaker Sunday evening and will introduce components of the committee’s campaign for a healthier Kentucky, now being formulated. Monday’s morning sessions will focus on public health, with discussions of county health rankings, public health partnerships with communities, and opportunities for progress in the health of Kentucky. Afternoon sessions will look at education partnerships and Kentucky’s workforce.

This meeting is funded in part by a grant from the Foundation for a Healthy Kentucky. For a copy f the full agenda, click here. For more on the committee, click here.

280,000 Kentuckians, almost all those with individual and small-group insurance policies, will have to change under Obamacare

By Molly Burchett
Kentucky Health News

About 280,000 Kentuckians will have to give up their current insurance policies, which are being discontinued because they don't comply with the Patient Protection and Affordable Care Act, according to the state Department of Insurance.

Department spokeswoman Ronda Sloan said individual policies for about 130,000 people and small-group policies for about 150,000 more will be discontinued. This means that almost all Kentuckians in the individual (134,086) and small group (153,943) private insurance market segments will face policy discontinuation, requiring them to get different insurance coverage even if they like their current coverage.

These Kentuckians join the millions of Americans who are getting or will get cancellation letters for their health insurance under Obamacare. An estimated 50 to 75 percent of the 14 million consumers who buy their insurance individually can expect to receive this type of letter over the next year because existing policies don’t meet the standards mandated by the health care law, reports NBC News.

NBC says the Obama administration has known this would happen for three years, despite President Obama's statement that people who liked their health insurance would be able to keep it under the health law.

The plans that are being discontinued do not meet the requirements of the law, which standardized policies and set minimum standards. "This is not a ‘cancellation’ or a ‘termination.’ No one is losing coverage,” Sloan  said in an email to The Associated Press. Discontinuation letters will offering a compliant plan that the consumer can switch to upon renewal, she said.

The consumer can also take this opportunity to shop around for other options through an insurance agent or on the state's Kynect website, where they may qualify for a subsidy or Medicaid coverage, Sloan noted.  Kentuckians should be sure to purchase a plan that is from a licensed Kentucky company and is a qualified health plan, she said.

The health law requires all plans to offer 10 essential benefits, such as mental health care, prescription drug coverage and maternity and newborn care. Plans that don't cover such services typically have lower premiums.

In the small-group market, businesses can shop for employee coverage in the same way that individuals shop for coverage, through an insurance company, agent or Kynect.

Small employers have expressed concern about being able to afford coverage for their employees, citing rising premiums, and Sloan says there is no way for the Insurance Department to know whether or not an employer is planning to continue offering coverage to employees whose policies are being discontinued. "If not, those employees could purchase coverage on the individual market," she said.

Humana's misleading letter to policyholders

After Humana Inc. sent discontinuation letters to 6,543 policyholders, the Insurance Department fined it $65,430 because the letters were misleading. They called for customers to renew their plans for 2014 within 30 days or choose a more expensive option that complies with the health law, and didn't clearly say that policyholders could compare and choose competing plans, for which they could possibly qualify for federal subsidies. In addition, they said that a customer could get the cheaper premium option by agreeing to changes not yet approved by the Insurance Department.

“The Department of Insurance fined Humana for providing members with a policy amendment form that was not approved. This was a clear-cut violation of Kentucky’s insurance code,” Insurance Commissioner Sharon Clark told Chris Kenning of The Courier-Journal.

State officials are also reviewing a letter sent by Anthem Blue Cross Blue Shield that asked people to "call now to lock in "today's affordable rates,", reports USA Today. The insurance department determined that the letter was marketing to potential customers, and thus did not violate the insurance code. "Humana’s letter, by contrast, went to current policyholders," Kenning reports.

Flu vaccine recommended for all over 6 months; pneumonia vaccine recommended for those 65 and older and at high risk

Vaccination is the best way to keep from getting the flu, and with two influenza cases already reported in Kentucky, now is the time to schedule your annual flu shot, says the state Department for Public Health.

Kentucky's flu season typically begins in October or November, so many health-care providers have vaccine supplies on hand. Adequate supplies of flu vaccine should be available for this year's season, according to a news release from the department.

It is best to get your flu vaccine early because it takes about two weeks for the vaccination to take effect, but flu shots can be given any time during the flu season.  It is recommended that you have a new flu vaccination each season, and children younger than 9 who did not receive a flu shot last season should get a second dose four or more weeks after their first vaccination, according to the release.

"Getting the flu can be debilitating and sometimes life-threatening, and vaccination is the best tool we have to prevent illness,” said Stephanie Mayfield, M.D., commissioner of the department. She suggested following a few simple steps to reduce the risk of getting the flu and other illnesses: Wash your hands frequently, cover your mouth when you cough or sneeze, and stay home when you’re sick.

The Department for Public Health and the federal Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends flu vaccine for all individuals older than 6 months. The vaccine is especially recommended for people who are at higher risk for complications or negative consequences from the flu. 
 These include:
 • Children 6 months to 19 years
 • Pregnant women 
 • People 50 years old or older
 • People of any age with chronic health problems
 • People who live in nursing homes and other long-term care facilities
 • Health care workers
 • Caregivers of or people who live with a person at high risk for complications from the flu
 • Out-of-home caregivers of or people who live with children less than 6 months old

A variety of vaccine options are available, including injections, nasal vaccine spray, intradermal vaccination and high dose flu vaccines, so many consumers have a choice about how they get vaccinated.  Ask your health care provider which option is best for you.

Flu is a contagious disease caused by the flu virus and spreads from person to person. Symptoms include fever, headache, cough, sore throat, runny nose, sneezing and body aches. Seasonal flu and its complications cause an average of 23,000 deaths  each year in the U.S.

In addition to the flu vaccine, the Department for Public Health also strongly encourages all adults 65 or older and others in high risk groups to ask their health care provider about the pneumococcal vaccine.  This vaccine can help prevent a type of pneumonia, one of the flu's most serious and potentially deadly complications, according to the release.

High risk groups for invasive pneumococcal disease are:

• persons with chronic pulmonary disease
• asthma
• chronic heart disease
• diabetes
• chronic renal disease
• chronic liver disease
• smokers aged 19 through 64 years

Between 20,000 and 40,000 deaths are attributed to flu and pneumonia nationally each year, with more than 90 percent of those deaths occurring in people age 65 and older, according to the release.

For more information on influenza or the availability of flu vaccine, contact your local health department or visit http://healthalerts.ky.gov.

Scammers taking advantage of new health-insurance system

Scammers are using the new health-insurance system "as an opportunity to try to collect consumers’ personal information or to make false claims," Gov. Steve Beshear and Attorney General Jack Conway warned Tuesday.

Conway's office sent civil investigative subpoenas and cease-and-desist orders Monday to the operators of two websites that had brought complaints from consumers to the Cabinet for Health and Family Services, which oversees Kynect, the state's health-insurance marketplace.

Scam sites try to mimic legitimate government sites, the officials said. People who register on the sites have reported getting telephone calls as a result. That is not the way the secure, state-operated website works. Its web address is Kynect.ky.gov; beware of sites ending in .com or .net, Conway advised.

“If something seems suspicious, do not share your personal information, and if you suspect fraud, report it immediately,” Conway said. He also warned Kentuckians to be on guard for attempts by identity thieves to collect personal or financial information by email, phone or mail.

Scammers may also try to sell bogus “discount medical plans” or mislead older consumers on Medicare by making false claims that Medicare coverage is affected by the new law, Conway said. It is not, but the annual Medicare re-enrollment period runs through Dec. 7, perhaps creating confusion.

“It’s appalling to think there are individuals out there who would prey on Kentuckians during this process,” Beshear said. “Everyone should be on guard and report any questionable websites or businesses. There is a lot of misinformation on the Affordable Care Act, which is why we have qualified staff who can answer questions and point consumers in the right direction.”

The attorney general's Office of Consumer Protection offered these tips:

• Make sure you’re working with a registered insurance agent or certified Kynector. Only legitimate insurance agents and government-contracted assisters, called “kynectors,” are authorized to assist Kentuckians with signing up for health care. A list of approved agents and kynectors maintained by the Cabinet for Health and Family Services can be found online or by calling 1-855-459-6328.
• Protect your personal information. Only a registered insurance agent, a certified Kynector, or customer-service representative at a contact center should ask for your personal information to help you apply. Keep personal and account numbers private to any others who offer assistance. Don’t give your Social Security number, credit card or banking information to companies or individuals you didn’t contact. Never give your information to someone whose identity you question.
  
• Do not pay for help. Insurance agents and Kynectors will not solicit money. There is no charge to use Kynect services with the help of an insurance agent or certified Kynector. If consumers get an offer to register for a fee, they should hang up the phone or walk away.
• Remember that you can only get tax credits through Kynect. Most Kentuckians who buy insurance through Kynect will qualify for tax credits to subsidize their premiums. No one but Kynect can offer these credits, and there is no charge to apply for them.
  
• Beware of phishing scams online. Consumers should be cautious of any email claiming to be connected to the Affordable Care Act, including any emails claiming to be affiliated with kynect and asking for personal information.
  
• Ask questions. Don’t sign anything you don’t fully understand, and verify the answers you get with trained kynect representatives.

If people think their personal information may have been compromised, they can visit www.ag.ky.gov, the attorney general’s website, which has an identity-theft toolkit.

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.

Information session on state health insurance exchange to be offered at Paducah Thursday, Nov, 7

The Kentucky Health Benefit Exchange will present an information session and allow time for questions about Kentucky's online health insurance exchange, KYnect, Nov. 7 at the West Kentucky Community and Technical College in Paducah from 11 a.m. to 1 p.m.

This event is geared toward health-care providers, administrators, directors, community agencies, coalitions, Kynect navigators, mid-level managers, front-line staff and other health-care workers.

Bill Nold, deputy director of the exchange, will present this program, sponsored by the University of Kentucky Center of Excellence in Rural Health, the Kentucky Office of Rural Health, the Purchase Area Health Education Center and the Western Kentucky Rural Health Network.

The event is free, but pre-registration is required because seating is limited. Contact Alice Combs, Kentucky Office of Rural Health, alice.combs@uky.edu, or call 606-439-3557, ext. 83703.

School nurses are an unfunded mandate for schools, which are picking up more of their cost as health department budgets shrink

Marion County nurse Renee Schooling helps
Levi Hardin, a Marion County first grader with
diabetes, check his blood sugar. (Lebanon
Enterprise Photo by Stevie Lowery)

Kentucky school nurses are stretched thin across the districts they serve and the budgets to pay for  them are stretched even thinner, because of budget cuts in the state Department of Public Health.

School districts are picking up the load, but often not all of it, because of their own financial challenges. "Basically it's one of the many unfunded mandates," Editor Stevie Lowery writes for The Lebanon Enterprise.

Lowery reports that the Marion County Schools currently share the cost of nurses with the Lincoln Trail District Health Department, with the schools paying 58 percent, or $161,000 a yera, and the department paying 42 percent, $116,000.

In some counties, schools are bearing the entire cost, which in some cases has reduced the availability of nurses, but Thursday night, the Christian County school board voted to hire another nurse, giving it one at every school, Editor Eli Pace reports for the Kentucky New Era in Hopkinsville.

Marion County Supt. Taylora Schlosser told Lowery that while her district values the services nurses provide, she and the school board will need to keep evaluating who pays for that service. The district plans to compare the cost of its contract with the health department and the cost of hiring its own nurses, with a commitment to not allow the level of service to change, Lowery reports.

“We will always have school nurses because we are going to take care of our kids,” Schlosser told Lowery. “How we pay for school nurses might change.”

In Kentucky, if a student requires medical care in order to attend school, state law requires school districts to provide the care.  Districts may hire nurses, contract with the health department, or use the medical supervision and delegation of medical tasks to district staff by local medical professionals, Lowery reports.

School nurses take care of students and staff who are injured or not feeling well, care for students with special medical or dietary needs, administer medications, conduct screenings, give flu shots, provide nutrition and wellness education, certify and give immunizations, and train staff in CPR, first aid and emergency administration of medication, Lowery reports.

“We’re not just boo-boos and Band-Aids,” Keown told Lowery. "Our main goal is to keep kids in school and keep them healthy so they can get a better education. Healthy kids make healthy students.” (Read more)

In Christian County, nurses have been called on almost 13,000 times this year, nurse coordinator Megan Kidd reported to the school board Thursday night. She said many students in the district don't have primary-care physicians and are told by their parents to see the school nurse, Pace reports.

"Kidd said 11 out of the district’s 15 schools have at least one diabetic student who depends on insulin," Pace writes. "In addition to insulin injections, other common reasons for trips to the nurse include allergic reactions requiring EpiPens and asthma attacks. Seizures also seem to be on the rise, Kidd said.

"But even though most of the visits were related to fairly common issues, Kidd told a story of a school nurse who once saw a student starting to show signs of leukemia. The nurse didn’t diagnose the child with cancer — that’s something a school nurse would be not allowed to do anyway, Kidd said — but the nurse pushed the child’s parents to go to the doctor, and the child did in fact turn out to have cancer." (Read more; subscription required)

Beshear says his managed-care plan is saving money and improving health outcomes; state points finger at hospitals

Six months ago, Gov. Steve Beshear applied an intensive plan to solve Medicaid managed-care implementation issues. On Thursday, he said the system is working more effectively for both providers and managed care organizations. He also said hospitals' complaints were overstated and some of them need to adapt to the new system, which will be two years old Nov. 1.

Gov. Steve Beshear

"There will still be a few—be they hospital or individual medical providers—who will say the program doesn't work, but it's tough to refute the facts," Beshear said at a news conference and in a press release. All but three states use managed care to save money and improve health.

Beshear asked each managed-care organization (MCO) to meet with every hospital in their networks to look over their accounts receivable to resolve billing disputes. "The final analysis—the MCOs and hospitals agreed that what was actually disputed and owed was a tiny fraction—just 2 percent of the original $346.6 million claim," the release says in boldface type.

The Kentucky Hospital Association said in a news release Friday, "The overwhelming majority of hospitals still report significant dollar amounts owed to them by the MCOs in unpaid claims. . . . While hospitals have seen a slight improvement in current claims processing and a slight decline in overall accounts receivables since the Governor issued his directive to the MCOs to clean up these claims, the amount of unpaid claims actually owed to hospitals (not billed amounts) is 60 to 70 percent higher compared to unpaid bills in October 2011 before managed care was implemented."

Beshear ordered that complaints about MCOs' payments be handled by the Department of Insurance instead of the Department for Medicaid Services. He said it has closed or nearly closed two-thirds of the 1,935 complaints it received. "Most complaints were related not to prompt pa y— which is what hospitals alleged — but instead related to claim denials, prior authorization disputes or unsatisfactory settlement offers," the release says.

The Insurance Department said MCOs often failed to offer a good explanation for denying claims. The Medicaid agency "sent corrective action plans to Coventry and Wellcare," the two MCOs operating outside the Louisville region. They will report progress each quarterly.

In general, the reviews didn't find that MCOs were holding payments on a regular basis, but concluded that Coventry Cares did not follow the state law requiring prompt payment if insurance claims. The Insurance Department has proposed that the company pay a civil penalty of $9,000.

Managed care has reduced "unnecessary ER use and inpatient hospital days in favor of more consistent disease management and prevention," Audrey Tayse Haynes, secretary of the Cabinet for Health and Family Services, said in the release. Kentucky has many people who go to the ER 10 times or more in a year, contributing to total ER expenses of $340 million for Medicaid. Unfortunately, Haynes said, some hospitals have used ERs to create revenue to support operations, "even advertising the average wait time in their ERs on their websites. For some communities, the ER has been the de facto primary care center." Haynes said hospitals have to put together a new business model that "dovetails with the goal of preventive care and wellness instead of high-cost emergency treatment."

The hospital association said it supports the state's efforts to reduce ER abuse, but "That project does not and will not solve the ongoing problem of WellCare and Coventry continuing to pay hospitals only $50 for emergency room care by reclassifying, on average, 50 percent of all ER patients, as non-emergency — under criteria they refuse to share with hospitals."

The implementation of the managed health care plan has saved money and improved health care, Beshear said. Per-patient costs are below predicted amounts and new enrollment is the same or declining. In November 2011, budget analysts predicted that the state would save $1.3 billion in the next two years, and "to date, Kentucky is still on target to meet that savings amount," the release said.

Statistics about health show the improvements to the system. For example, there has been a 93 percent increase in consultations to stop smoking, a 33 percent increase in flu vaccines for children, huge increases in mammograms and screenings for heart problems, and a 17 percent decrease in amputations (often because of untreated diabetes), and nearly an 11 percent decrease in CT scans.

KET program to feature citizens who work in three programs to improve the health of Kentucky children

The next episode of  KET's "Health Three60" series will be a program that features citizens who have made a difference in the health of Kentucky children. "Champions for Children's Health" premieres Monday, Oct. 21 at 9 p.m. Eastern Time. It is available online at www.ket.org.

Featured will be guest from HANDS (Health Access Nurturing Development Services), a  home-visitation program for new and expectant parents; Better Bites, of Lexington, whose goal is to transform the snacking culture to reduce childhood obesity; and Doctors and Lawyers for Kids, a Louisville group that helps families with legal issues, such as housing, custody and immigration, that may impact children’s health.

HANDS is a well-regarded, statewide program that works toward healthy pregnancies and births, healthy child growth and development, safe homes and self-sufficient families.  Referred participants begin the process with a home visit that determines the needs and concerns a family might have about pregnancy or a baby's first year.  Families then receive information and learn about resources available in the community to help them and based on the needs of the family, some will receive continued home visits.  This program is available not only to first-time Kentucky moms and/or dads, but also to expectant parents. The premise of the program is that early family intervention improves the well-being of the entire community.