Latest New York Times look at Obamacare in Kentucky examines highs and lows of enrollees and people helping them

 Navigator Kelli Cauley helps an applicant. (Luke Sharrett, NYT)

While many states have suffered through complications in signing up uninsured people for health insurance under the Affordable Care Act, Kentucky has been leading the way in efficiency, enrolling about 1,000 people per day. Abby Goodnough of The New York Times was already using Kentucky as a lens to view the rollout of health reform, and in her latest story looks at major players in the enrollment process -- including the navigators for the state's Kynect website, insurance agents, and the uninsured -- exploring the ups and downs of each group.

"Though people can sign up on their own, navigators can help those confused by the sea of insurance options," Goodnough writes. "The navigators listen to people voice their hopes and fears about the law, and their hard stories about being uninsured. Often hugs are exchanged. Sometimes tears flow." One such navigator, or Kynector, is Kelli Cauley. The Louisville resident has put 1,000 miles on her car in the last month, and the stress of the high pressure job has caused her to lose 12 pounds. As part of her job, Cauley is one of eight Kynectors who have "to enroll 699 people per month in Medicaid or private plans through the exchange. They are required to hold educational events around the region, and the agency’s phones have been ringing nonstop with requests for enrollment help at health fairs, cultural festivals and other events that the uninsured might attend."

Cauley, a former home-economics teacher, said she "expects the job to get harder as she comes under pressure to help people who might be more reluctant to sign up than the early enrollees," Goodnough writes. "But she has some strategies: visiting small day-care centers, for example, where workers are likely to be uninsured. For now, just meeting the initial flood of requests is a strain." Cauley told Goodnough, "You do have to be on your A game constantly." The reward, though, is that she has been able to help dozens of people get coverage.

Insurance agents aren't getting the same warm feeling. Some agents "refuse to sell plans through the exchanges, which they see as a threat, and have instead focused on selling other insurance, like property and casualty," Goodnough writes. Some agents who are selling the plans, aren't seeing a silver lining in the results. Donald Mucci, who has been "an insurance agent for more than three decades, has yet to get comfortable with the new system and does not much like it. (He) resents that the health care law prompted insurance companies to cut commissions paid to agents. And he thinks the exchange website makes it hard for people to understand the pros and cons of various plans, such as which hospitals and doctors they cover. Yet Mucci, an affable man in monogrammed shirt cuffs, said he wants the system to work."

Mucci, whose firm, the Garrett-Stotz Co., has been in Louisville 82 years, has only enrolled a few customers in exchange programs. During a recent enrollment, his commission was $18, far less than what he normally gets, Goodnough writes. "The law requires insurers to spend at least 80 percent of money from premiums on medical care instead of on administrative costs, which include commissions to agents and brokers. Consequently, some insurers cut commissions, infuriating many agents and brokers."

Despite the long hours put in by navigators, and the concerns of insurance agents, the plan appears to be helping people in dire need of insurance. And in some instances, people are getting what they need, without feeling like they're being handed charity. One such case revolves around a woman Cauley helped, who would identify herself only as Kay. The well-dressed substitute teacher "learned that she would be eligible for Medicaid under the new law, but she was unwilling to enroll because of what she saw as a stigma attached to the program," Goodnough writes. She told Goodnough, “I don’t want to be a freeloader.”

But the cheapest option for Kay "through the exchange would be a plan with a $356 monthly premium and a $6,300 deductible," Goodnough writes. With that amount being too high, Cauley was able to find her an alternative. "Kay could sign up for Medicaid, but only use it in catastrophic events. For checkups and other routine care, Kay could pay her own way, perhaps negotiating a discount with her doctors." She summed up her situation, and perhaps the point of what health reform hopes to accomplish, saying, “You’re giving me an alternative I can live with." (Read more)

Appalachian Ky. newspapers emphasized political voices in coverage of Obamacare in 2 months before exchange opened

Newspaper readers in Appalachian Kentucky rarely had the opportunity to read factual, impartial information about health-care reform in the two months before the new health-insurance system opened for enrollment.

That is among the preliminary findings of an ongoing study by the Institute for Rural Journalism and Community Issues, part of the School of Journalism and Telecommunications at the University of Kentucky and publisher of Kentucky Health News. The research found that coverage was dominated by opinions of public officials, largely those opposed to the law.

The research examined most newspapers in one of the unhealthiest and poorest regions of the country to see how well they were preparing their communities for a huge change in the health-insurance system. For the story by UK student Justin Richter, click here.

15 to 25% of uninsured Kentuckians may be eligible for free, non-Medicaid coverage, but watch those out-of-pocket costs

Millions of Americans who don't quite qualify for Medicaid could still get free health insurance through federal subsidies, but this free coverage hasn't gotten much attention, since most of the zero premium plans come with some trade-offs.

An analysis by an independent consulting firm, McKinsey and Co., found that 5 to 6 million uninsured Americans will qualify for subsidies greater than the cost of the cheapest "bronze" or "silver" plan. However, many insurers have been careful not to publicize this free coverage because these plans have high out-of-pocket costs and some people will be better off paying higher premiums to get more coverage, reports The New York Times.

In a zero-net-premium plan, the federal subsidy covers the entire premium, but many people still face significant out-of-pocket costs for health services. Most zero-net premium plans are bronze plans, which are the least expensive available on exchanges and cover about 60 percent of a person's medical costs; the consumer must pay for the remaining 40 percent. So, choosing this type of plan means that you may sacrifice coverage compared to other plans on the exchange.

As the metal level increases in value from bronze to platinum, so does the percentage of medical expenses that the plan will cover. Silver plans cover about 70 percent, gold plans cover about 80 percent and platinum plans cover about 90 percent of medical costs. Regardless of the plan tier, all plans must cover standard benefits like prescription drugs, maternity care and mental health treatment. Preventive services are free in all plans.

The McKinsey report says 15 to 25 percent of Kentucky's non-elderly uninsured will be eligible for a zero-net-premium plan that will either be a bronze or silver plan. Nationwide, about half of the individuals who qualify for a zero-net-premium plan are younger than 39 and are uninsured.

Individuals with lower incomes are more likely to be eligible for these plans and most will have income levels not far above the Medicaid coverage threshold, which is 138 percent of the federal poverty level. Remember persons with income up to 400 percent of the poverty line qualify for federal tax subsidies to assist with premium payment.

Experts say the higher deductibles and higher annual out-of-pocket costs of the bronze plans may not be suited for someone with a lower income. “They may be getting zero premiums, but they’re also leaving a lot of money on the table if they don’t enroll in a silver-level plan,” Sabrina Corlette, a professor at Georgetown University’s Health Policy Institute told The New York Times.

Low-cost plans may encourage younger, healthier people to enroll in Obamacare, but they have the highest out-of-pocket cost limit and highest deductible amounts. Out-of-pocket costs, including the deductible, co-payments and co-insurance (a percentage of charges), are limited to $6,350 for individuals and $12,700 for families in bronze plans. So, for some, the silver plan may be a better option, and some individuals may also qualify for a zero-net premium silver plan.

When choosing a lower-tier plan, be ready for significant cost sharing, and be careful to check that your doctors and nearby hospitals are in the plan's network. When it comes to health insurance coverage, for individuals who don't qualify for programs like Medicaid and Medicare, there's free coverage but no free lunches.

Primary care clinics added to Ky. Health Cooperative's network

The Kentucky Primary Care Association, a nonprofit charitable organization that promotes access to comprehensive primary health care services for the under-served, has been added to the Kentucky Health Cooperative’s provider network. This will significantly increase prospective members’ access to clinical providers, according to a press release from the co-op.

Physicians in member clinics will be added to the provider lists maintained by the co-op and Kynect, the state's online health-insurance marketplace, in the coming weeks.

The Kentucky Health Cooperative is a new, private, non-profit, consumer-governed health insurance company and is available through enrollment on Kynect. Its coverage begins as early as Jan. 1.

“We are pleased to add the Kentucky Primary Care Association’s physicians to our growing provider network,” said Janie Miller, the co-op’s chief executive officer. "This is a partnership between like-minded organizations that will potentially benefit tens of thousands of Kentuckians.”

Kynect allows consumers to compare and select insurance plans. Consumers can also determine if they qualify for premium payment assistance, special discounts or tax credits to help decrease the cost of services.

Find out more about Kentucky Health Cooperative at www.mykyhc.org or the its Facebook page. Information about the Kentucky Primary Care Association is at http://www.kypca.net/index.cfm.

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.

New CEO of Owensboro Health says hospitals are working to improve care, regardless of federal health reform

Philip Patterson, the new CEO of the Owensboro Health, says hospitals are moving towards health reform regardless of what happens with the Patient Protection and Affordable Care Act.

Patterson is coming to Owensboro from Bon Secours Charity Health System in New York and New Jersey, a three-hospital system with net patient revenue of nearly $500 million.  Patterson says he wants to build a stronger network for regional care in the Owensboro area.

The Affordable Care Act has changed physician and hospital payment structures, encouraging wellness participation, Patterson said in an interview with Ryan Alessi of cn|2's "Pure Politics." Patterson said the law creates incentives for hospitals to keep patients from being readmitted, and to only provide necessary care.

Regardless of what happens with the law, health organizations and providers need to be more than providers, Patterson said: They need to be health partners to their communities, to improve community members' overall health by managing care through screenings and education.

The health care law penalizes health systems for providing care that is not needed, and it encourages a change in thinking for providers who need to start providing care more economically, said Patterson. One way to do that is by building a strong network of providers who coordinate care.

"To create a sustainable system, you've got to cover a unique and significant population," he told Alessi. To cover a larger geographic area in New York and New Jersey, Patterson said, he created a loosely affiliated network of independent facilities that all worked toward the common goals of improving care coordination and quality.

As a result of Medicaid expansion in Kentucky, which now covers households earning up to 138 percent of the poverty level, an additional 400,000 people may have health insurance coverage that have never had it before.

"There's always a cost when you build something new and try to integrate a population into it," said Patterson. Unfortunately, those who lack insurance tend to have lower education levels and potentially neglected health care needs as a result of not having coverage or the perception of not having access to health care, Patterson told Alessi.

"The process of making this [integration] work is going to be clearly on the structure of health care providers as they try to manage that population to keep them out of the hospital where the most expense is," he said. Provider networks can coordinate to manage disease processes before they require care, and education and communication about how to access care is crucial, Patterson told Alessi.

Asked what will happen to hospitals if the health law is delayed or repealed, Patterson said, "It really hasn't been rolled out yet. We are still in a wait and see mode in a lot of these pieces." He said if health care systems buy into the law's overall goals, and they are already working towards the goal of better health care management. "The issue is the infrastructure and how to pay for it," he said.

"Repeal? I don't know what's going to happen there. I think as long as the goals are to create a better health model for a community, you're going to work towards them anyway," said Patterson.

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.