Wednesday, 2 October 2013

Here are tools and resources to help you understand how the health reform law impacts you, your family and your business

By Molly Burchett
Kentucky Health News

The rollout of the insurance-buying section of the Patient Protection Affordable Care Act started Oct. 1, and regardless of where you stand on the law, it's important to be informed about what will happen Jan. 1 when the law's major provisions are set to go into effect. To help you understand how the health law impacts you, your family or your business, the Foundation for a Healthy Kentucky has compiled a list of links to information about the health law.

The law, informally known as Obamacare, is a set of health care reforms signed into law by President Obama on March 23, 2010. The law includes insurance mandates and requires everyone to have health insurance or pay a penalty starting Jan. 1.  In addition to insurance mandates, both the establishment of online health-insurance exchanges and expansion of Medicaid are two essential elements of the law.

In June 2012, the Supreme Court upheld the health law in a 5-4 vote, saying its requirement that most Americans obtain insurance or pay a penalty was authorized by Congress’s power to levy taxes. The Internal Revenue Service will administer that provision of the law. The court ruling limited the law’s blanket expansion of Medicaid, which attempted to require all states to expand the program in order to receive federal funding, saying that each state could make its own decision.

The Kentucky Health Benefit Exchange, Kynect, was established in July 2012 and opened for enrollment Tuesday. Calling it “the single-most important decision in our lifetime for improving the health of Kentuckians,” Gov. Steve Beshear announced his decision to expand Medicaid in Kentucky in May. As a result of this decision, Medicaid has expanded to provide coverage to Kentuckians under 65 in households up to 138 percent of the federal poverty level—currently $15,856 for an individual or $32,499 for a family of four.

About 640,000 Kentuckians are uninsured, and 308,000 of them qualify for expanded Medicaid because their incomes are less than 138 percent of the federal poverty threshold. The remaining 332,000 Kentuckians must purchase private insurance through Kynect. Of those purchasing private plans, an estimated 83 percent will be eligible for at least some tax credit to do so, reports Kentucky Voices for Health, a group of health-reform advocates.

Currently, the federal government pays 71 percent of Medicaid costs, and the state covers 29 percent of the costs. Under Medicaid expansion, the federal government will cover 100 percent of the costs of the newly eligible people for the first three years. Starting in 2017, the federal government will cover 95 percent of the costs for this expanded population, and federal funding will phase down to 90 percent by 2020.

The Kentucky Voices for Health presentation, found here, gives more details about the overall purpose of the Affordable Care Act and its implementation in Kentucky. Get Covered Kentucky, a coalition spearheaded by Kentucky Voices for Health, compiled additional information about Medicaid expansion. Click here for these tools and resources.

Beshear says Medicaid expansion is the right choice for Kentucky, providing numerous reasons and county-level data to explain why not expanding the program would hurt both Kentucky’s health, which already ranks poorly in many health categories, and taxpayers’ bottom line. Click here to see the impact of health reform on your local community.

You may be eligible for coverage through Medicaid or tax subsidies to help you purchase private insurance. Go the the Kynect website to determine your eligibility for Medicaid coverage or private insurance subsidies and to enroll Medicaid, the Kentucky Children’s Health Insurance Program or private plans. "It’s easy to apply, with just one application to fill out. When you apply online, you get enrolled quickly. We also have insurance agents and Kynectors who will help you apply using computers," says the website. If you want to apply by mail or fax, click here for paper applications.

The law does not require small employers (businesses with 50 or fewer employees) to provide insurance coverage. If you own a small business with 25 or fewer employees, there may be significant tax credits available through Kynect to help cover the cost of insurance. Since the mandate to cover employees has been delayed for a year, businesses with more than 50 employees will not face penalties in 2014 for not providing health insurance, but they may face penalties starting in 2015.

The foundation resource page includes additional resources to help you understand health reform efforts at the federal level, including those from the Kaiser Family Foundation, which includes a subsidy calculator, the Robert Wood Johnson Foundation and a fact page from the U.S. Department of Health and Human Services. In addition, a foundation report outlines how the health law creates opportunities to address public health issues, decrease health disparities and reform care delivery.

Kentucky Health Cooperative partners with UK HealthCare, extending coverage to all 120 Kentucky counties

As a result of an exclusive partnership with UK HealthCare, the Kentucky Health Cooperative, the state's new non-profit insurance carrier, expanded its coverage Wednesday to the University of Kentucky's network of over 1,000 clinicians across Kentucky.

For Kentucky residents who enroll in a Kentucky Health Cooperative insurance plan, the agreement is bringing a statewide network of high-level, accessible clinicians to all 120 Kentucky counties, Janie Miller, chief executive officer of the organization, said in a news release.

The cooperative is Kentucky's non-profit, or Consumer Operated and Oriented Plan under the federal health reform law. The co-op offers coverage to individuals and families and to employees of businesses employing two to 50 full-time equivalent employees, which can be purchased on the state health-benefits exchange, branded as Kynect, directly from the co-op website and from many brokers and agents in Kentucky.

Both Anthem and the co-op offer plans throughout the state, while Humana is offering a limited service area. Since the co-op is a new insurance carrier, forging this type of partnership with UK is an important step; UK HealthCare hass multiple locations across Kentucky, including hospitals, clinics, outreach locations and patient care services, says the release. In addition, it ensures that co-op coverage will be accepted by the more than 1,000 clinicians affiliated with the UK health system.

Part of UK HealthCare's mission is to provide Kentuckians with advanced subspecialty care, while collaborating closely with community providers, says its website. Miller said the co-op's collaboration with UK will significantly benefit both Kentuckians who seek advanced medicine and those who require rural health care, the co-op says in the release.

“We look forward to teaming up with some of the nation’s top clinicians and researchers as well as with community providers dedicated to the delivery of well-integrated health services at the community level,” Miller said. (Read more)

Beshear to speak in Washington Thursday about health care's next era; session to be videostreamed

Gov. Steve Beshear will deliver the keynote address to the National Journal forum "Countdown to Transformation: A Roadmap to Health Care's Next Era—90 Days Out" tomorrow at 12:15 p.m. Eastern time. The event will take place in the Ronald Reagan Building and International Trade Center in Atrium Hall at 1300 Pennsylvania Ave. NW in Washington, D.C. It will also be live-streamed on the magazine's website, a press release from Beshear's office said.

The American health care system is about to enter a new era, the National Journal says: "Countdown to Transformation will examine the complex political, medical and business ramifications of the implementation of Affordable Care Act." Beshear has taken a high profile in the rollout of federal health reform because Kentucky is the only Southern state to expand Medicaid and run its own health-insurance exchange.

Leaders in Medicaid, public health and advocacy entering UK College of Public Health Hall of Fame

The father of Kentucky's Medicaid program, the co-author of a popular smoking-cessation program and a leading advocate for mental health and the disabled will join the University of Kentucky College of Public Health's Hall of Fame Oct 11. The inductees are Roy Butler, Richard Clayton and Sheila Schuster.

Butler started working for the state in January 1951 and concluded as commissioner of Medicaid in 1992, serving 11 governors. When Medicaid began in 1965, Butler concentrated on developing the program to increase coverage, funding and the range of services. In 1985, his office introduced a managed patient access and care system that became the model for the nation and potentially saved taxpayers millions of dollars, according to a UK press release.

 Clayton came to UK in 1970, and was a professor of sociology until January 2001, when he became Good Samaritan Foundation endowed chair in the College of Public Health. He was founding chair of the college's Department of Health Behavior and its first associate dean for research. He also helped establish the college. The Cooper/Clayton Method to Stop Smoking was created by Clayton and Thomas Cooper (a 2006 hall of fame inductee). They have trained more than 1,500 community-level volunteers to deliver the program. More than 12,000 Kentuckians are non-smokers, says the release.

Schuster, after 27 years as a child psychologist, now works full time on public-policy advocacy on mental-health, health-care and disabilities issues. She helped establish and now leads the Kentucky Mental Health Coalition and was executive director of the Kentucky Psychological Association, serving from 1989-2000, and continues to represent that organization as a federal and state lobbyist. She heads the Advocacy Action Network, an umbrella organization of lobbies. She was an incorporator of the Foundation for a Healthy Kentucky and served two terms as its chair.

The three will be inducted during a lunch Oct. 11 at the Hyatt Regency Hotel in Lexington. The college says it will accept reservations until Friday, Oct. 4.

Tuesday, 1 October 2013

Diabetics have increased risk of complications from flu

Certain groups of people, including diabetics, are at risk of serious flu complications each year, according to a report from the University of Alabama at Birmingham.

More than 500,000 Kentuckians, over 11 percent of the state’s population, are living with diabetes, wrote 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.

“Diabetes can weaken your immune system against the flu, and it also puts you at an increased risk of flu-related complications,” Fernando Ovalle, M.D., professor of medicine in the UAB School of Medicine and senior scientist in the UAB Comprehensive Diabetes Center, said in a news release. “The weakening of the immune system makes it harder for your body to fight the flu virus. Being sick can also raise your blood glucose and prevent you from eating properly. You are also at risk of flu-related complications like pneumonia.”

 There are several things Ovalle said diabetics and parents of diabetics can do to give some protection from the virus:
 • Get a flu vaccine shot. The nasal spray vaccine is not safe for people with diabetes.
 •Talk to your health care provider about the pneumococcal vaccine. It will help protect against pneumonia.
 • Keep track of blood glucose. It can be affected by illness.
 • Wash your hands often with soap and water or an alcohol-based hand rub.
 • Try to avoid close contact with sick people.
 • Practice the good-health habits like getting plenty of sleep and exercise, managing stress, drinking plenty of fluids and eating healthy food.

 For diabetics who think they have the flu, Ovalle suggests these steps:
 • Contact a health care provider immediately. Symptoms include fever or feeling feverish or experiencing chills, cough, sore throat, runny or stuff nose, muscle or body aches, headaches and fatigue. In children, vomiting and diarrhea can be common.
 • Continue taking diabetes pills or insulin.
 • Test blood glucose every four hours and track results.
 • Stay hydrated; drink lots of calorie-free liquids.
 • Try to eat normally.
 • Weigh every day. Losing weight without trying is a sign of high blood glucose.

“Be vigilant and smart, especially when it comes to washing your hands." Ovalle said. "And if you every have any questions or concerns, contact your health care provider.” (Read more)

State health-insurance website crashes after 24,000 use it; later, officials say almost 78,000 visited it by 7 p.m.

The website of Kynect, the state's new health-insurance marketplace, crashed at 8:30 a.m. today, because so many people were trying to use it, Gov. Steve Beshear's office said. Similar problems were reported in several other states. The site was restored, and by officials said almost 78,000 people had visited it by 7 p.m.

Beshear's office said 70,467 people ran screenings to determine their qualifications for subsidies, discounts, Medicaid or other programs, and "4,691 applications for health care coverage have been started; 2,902 are completed." Kynect's call center received nearly 6,000 calls, the governor's office said.

"Of the initial 1,000 applications . . . about 440 were for Medicaid and the rest were for private plans," Chris Kenning of The Courier-Journal reports.

Read more here: http://www.kentucky.com/2013/10/01/2853632/glitches-hamper-access-to-kentuckys.html#storylink=cpy

Conway says ruling in his Oxycontin lawsuit means he will seek settlement of $100 million or more

Attorney General Jack Conway says he wants Purdue Pharma to settle for $100 million or more after it missed a deadline to respond to his arguments in his lawsuit over the marketing of Oxycontin, Nick Strom reports for cn|2, a news service of Time Warner Cable. After Purdue Pharma failed to respond to a court motion, "all the admissions the commonwealth sought in the case were deemed admitted" by the circuit judge hearing the case in Pike County.

"Judge Steven Combs ruled Monday that Purdue could not withdraw those admissions which include that the drug maker: misrepresented and/or concealed the addictive nature of OxyContin, knew OxyContin was being abused and wasn’t being used for its stated purpose, continued to market and promote OxyContin despite knowing that, and encouraged physicians to overprescribe the drug," Storm reports. Conway told him, "I expect that a jury would be very very harsh on Purdue Pharma. I’m not going to be really negotiating much less or below nine figures. I want to see something well into nine figures.” (Read more)

Purdue Pharma has been blamed for starting, in Central Appalachia, the national epidemic of prescription-painkiller abuse and deaths. More than 1,000 Kentuckians die each year from prescription overdoses, the sixth highest rate in the country. Forbes ranked the Kentucky as the fourth most medicated state, according to Conway's office. More Kentuckians die from overdoses than in traffic accidents. (Read more) Map by Kentucky Justice and Public Safety Cabinet: