Princess Health and More dental patients using ERs, showing lack of dental coverage, shortage of dentists and the stepchild status of oral health.Princessiccia

Princess Health and More dental patients using ERs, showing lack of dental coverage, shortage of dentists and the stepchild status of oral health.Princessiccia

Affordable Care Act dental care dental health dentistry dentists emergency rooms health reform hospitals obamacare oral health

Gusty 19:26 Add Comment

More patients are going to hospital emergency rooms for dental care, illustrating how oral health remains the stepchild of the health system despite health-care reform.

"An analysis of the most recent federal data by the American Dental Association shows dental ER visits doubled from 1.1 million in 2000 to 2.2 million in 2012, or one visit every 15 seconds, Laura Ungar reports for The Courier-Journal and USA Today.

Christopher Smith of Jeffersonville, Ind., had a dental
infection that put him in a Louisville hospital for a
week. (Courier-Journal photo by Sam Upshaw Jr.)

"This is something I deal with daily," Dr. George Kushner, director of the oral and maxillofacial surgery program at the University of Louisville, told Ungar. "People still die from their teeth in the U.S."

A longstanding federal law requires ERs to treat patients regardless of their ability to pay. "Although they often provide little more than painkillers and antibiotics to dental patients, the visits cost more than three times as much as a routine dental visit, averaging $749 if the patient isn't hospitalized � and costing the U.S. health care system $1.6 billion a year," Ungar reports.

Private dental insurance is not common. "Just over a third of working-age adults nationally, and 64 percent of seniors, lacked dental coverage of any kind in 2012, meaning they had to pay for everything out of pocket," Ungar writes. The Patient Protection and Affordable Care Act "requires health plans to cover dental services for children but not adults," and "Medicare generally doesn't cover dental care at all," she notes.

In Kentucky, the expansion of Medicaid under Obamacare has increased dental visits in the program by 37 percent, but it offers "only a short list of dental services," such as extractions, which patients often choose instead of restorative work, for which they would have to pay.

Another big issue is that many dentists don't accept Medicaid, which pays them only 41 percent of private reimbursement, Ungar reports. Also, Kentucky has a shortage of dentists. "A 2013 workforce study by Deloitte Consulting found the state needs 612 more to meet demand," Ungar notes.

More dentists would encourage more preventive treatment, which dentists say would save a lot of money. "If we were going to the dentist more often, we could avoid a lot of this," Dr. Ruchi Sahota, a California dentist and consumer adviser for the ADA, told Ungar. "Prevention is priceless."

Fewer than 60 percent of Kentuckians saw a dentist in 2013, making their dental-visit frequency 43rd in the nation, according to the Kentucky Health Issues Poll.

Princess Health and Supreme Court upholds Obamacare subsides in all states; ruling has no direct effect on Kentucky, but focuses political debate.Princessiccia

Princess Health and Supreme Court upholds Obamacare subsides in all states; ruling has no direct effect on Kentucky, but focuses political debate.Princessiccia

Affordable Care Act federal government governor's race health care law health insurance insurance coverage insurance exchange obamacare Patient Protection and Affordable Care Act U.S. Supreme Court

Gusty 15:40 Add Comment

By Molly Burchett
Kentucky Health News

The U.S. Supreme Court ruled Thursday that the tax subsidies provided under the Patient Protection and Affordable Care Act are legal in every state.

While the ruling has no effect on Kentucky, and would have had no direct effect if it had gone the other way, it sets the table for continued political debate about health policy in Congress and in Kentucky's race for governor.

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Chief Justice John Roberts wrote in the 6-3 majority opinion. "If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter."

The law says the federal government can pay subsidies to help people afford insurance bought through �an Exchange established by the State.� The lawsuit argued that Americans in the 34 states using the federal exchanges were not eligible for the subsidies, which are crucial to the law's success, helping to make health insurance more affordable, reducing the number of uninsured Americans. Proponents of the law say not providing subsidies to individuals in those 34 states relying on the federal exchange would have upended the law, notes CNN.

President Obama called on critics to accept the law as permanent, saying after the ruling, "The Affordable Care Act is here to stay."

But Senate Majority Leader Mitch McConnell, R-Ky., called Obamacare �a rolling disaster for the American people,� with a �multitude of broken promises, including the one that resulted in millions of Americans losing the coverage they had and wanted to keep. Today�s ruling won�t change the skyrocketing costs in premiums, deductibles, and co-pays that have hit the middle class so hard over the last few years.�

Maps: Percentage uninsured in 2012, above, and 2014, below

Obama countered, "The setbacks I remember clearly. But as the dust has settled, there can be no doubt that this law is working. It has changed, and in some cases saved, American lives. It set this country on a smarter, stronger course." He added, "The law has helped hold the price of health care to its slowest growth in 50 years" and "Nearly one in three Americans who was uninsured a few years ago is insured today. The uninsured rate in America is the lowest since we began to keep records."

A White House fact sheet noted that the law also expanded "access to preventive care, including immunizations, well-child visits, certain cancer screenings, and contraceptive services, with no additional out-of-pocket costs as well as no more annual caps on essential benefit coverage and new annual limits on out-of-pocket costs."

Since Kentucky established its own exchange, Kynect, for buying subsidized health insurance or signing up for Medicaid, the ruling may seem moot for Kentuckians. However, it establishes some of the facts for a health-care policy debate in the governor's race between Republican Matt Bevin and Democratic Attorney General Jack Conway.

The exchanges and the expansion of the federal-state Medicaid program are choices for the states, and Bevin has said that if elected he would shut down Kynect and end the Medicaid expansion, which has covered about 430,000 Kentuckians. The federal government is paying their entire cost through next year; in 2017 the state would start picking up a small share, rising to the law's limit of 10 percent in 2020.

Conway has acknowledged questions about whether the state can afford to pay its share, but to �say you�re going to kick a half a million people off of health insurance based on what we may or may not be able to afford in 2021 is irresponsible.� A Conway spokesman said he "appreciates the court's careful consideration of this case and agrees with today's decision," reports the Lexington Herald-Leader.

The Herald-Leader's Mary Meehan interviewed officials and experts for a package of questions and answers about the law and Kentucky. It is published at http://www.kentucky.com/2015/06/25/3917832_in-light-of-the-supreme-court.html.

Outgoing Gov. Steve Beshear, a Democrat who expanded Medicaid, said in a statement that the decision �reaffirms that, from the very start, we did the right thing for the more than 500,000 Kentuckians who have qualified for health-care coverage through Kynect since January 1, 2014.�

Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, said in a release, "While many have been awaiting this important decision, we must remember that much remains to be done to assure that all Kentuckians � and all Americans � have timely access to safe, effective and affordable quality care." Zepeda said Kentuckians continue to work on ways to improve and protect Kentuckians' health, such as reforming the way we pay for care and making health care cost and pricing more transparent.

"As people who have forgone care too long because of its expense now gain access to care, it will place a larger short-term burden on the health-care system, which approaches like these can help to address," said Zepeda. "The Affordable Care Act permits � and incentivizes � local health care innovation. We can and must shape Kentucky solutions to Kentucky�s health challenges."

Princess Health and Aetna is close to a deal to buy Humana, Bloomberg reports.Princessiccia

Princess Health and Aetna is close to a deal to buy Humana, Bloomberg reports.Princessiccia

Affordable Care Act health insurance mergers obamacare

Gusty 12:00 Add Comment

Getty Images, via CNBC

Health insurer Aetna "is said to be closing in on a deal to buy" Louisville-based Humana Inc., Julie Hyman reports for Bloomberg News, "and a deal could come "as soon as this weekend."

Humana is also expecting an offer from Cigna Inc., but Humana's board of directors "prefers the Aetna offer," Hyman reports, citing unnamed people familiar with the negotiations. The deal has been discussed for weeks, but Aetna didn't make a formal proposal until this week.

The last major obstacle to a deal may have been the Supreme Court's ruling today that people in all states are entitled to tax subsidies for health insurance under the Patient Protection and Affordable Care Act, Hyman suggests, noting higher stock prices for health-insurance companies.

"Shares of Humana rallied more than 8 percent after trading was briefly halted for volatility," Reem Nasr of CNBC reports.

Humana is an attractive buy because "a great deal of its business � 73 percent of its premiums revenue � comes from contracts with the federal government," David Mann reports for Louisville Business First. "That means Humana is flush with Medicare business, which is a fast-growing category in the industry as many baby boomers are reaching the eligibility age. Its competitors, including Aetna, don't have nearly as much of this business."

"Consolidation among the country's top insurers follows a massive consolidation among providers in pharmacy, hospital and patient care, which has increased the leverage against insurers like Humana and Aetna," Grace Schneider reports for The Courier-Journal.

Princess Health and Bevin says he will end all Obamacare programs in Ky., including Medicaid expansion that has added more than 400,000 to rolls .Princessiccia

Princess Health and Bevin says he will end all Obamacare programs in Ky., including Medicaid expansion that has added more than 400,000 to rolls .Princessiccia

Affordable Care Act courts doctor shortages elections governor governor's race health insurance health reform insurance exchange Medicaid politics

Gusty 13:00 Add Comment

Matt Bevin, the Republican nominee for governor, has made clear that if elected he would end the Medicaid expansion that has provided free health coverage for more than 400,000 poor Kentuckians.

During his primary campaign, Bevin never made that quite plain, saying he would close the state's health-insurance exchange, Kynect, because it would cost "hundreds of millions of dollars." Kynect is paid for by insurance companies, so Bevin was alluding to to the state's projected cost of expanding Medicaid, which enrolls through Kynect.

The Washington-based publication Politico reported on June 10, after interviewing Bevin, that he would not only close Kynect but roll back the Medicaid expansion: �You may or may not have access to Medicaid going forward,� he said. �People are not on it for extended periods of time. It�s not meant to be a lifestyle. It really isn�t. The point of it is to provide for those who truly have need.�

Democratic nominee and Attorney General Jack Conway, with Gov.
Steve Beshear; GOP nominee Matt Bevin (AP photos via Politico)

Gov. Steve Beshear "is furious" about Bevin's plan, Politico reported. �I am not going to allow someone to become governor of this state who wants to take us back to the 19th century,� the governor said in a telephone interview. �For a serious candidate for governor to be advocating a simple repeal of the whole program without offering any kind of alternative which will continue health care for these people is irresponsible.�

Beshear expanded the eligibility rules for Medicaid as part of implementing the Patient Protection and Affordable Care Act, raising the income limit to the law's required 138 percent of the federal poverty level, from the state's previous level of 69 percent.

The federal government is paying the entire cost of the newly eligible Medicaid recipients though next year. In 2017, the state would begin to pay 3 percent, rising to the reform law's cap of 10 percent by 2020. A study by Deloitte Consulting and the Urban Institute at the University of Louisville  � "which Republican critics have rejected as spin," Politico says � has said the expansion more than pays for itself through 2020 by expanding health-care jobs and generating tax revenue.

Jobs are growing as projected by the study, according to the Cabinet for Health and Family Services, which handles Medicaid.

Cabinet spokeswomnan Jill Midkiff said the study estimated that 32,000 jobs would be created through 2015 as a result of the expansion. "U of L projected this growth would primarily be in the areas of retail trade, finance and insurance, administrative services, health and social services, accommodations and food services and other services," Midkiff said. "These sectors were estimated to account for more than 28,000 of the 32,000 jobs created." She said the latest Bureau of Labor Statistics figures show that "these sectors have grown by more than 29,000 jobs from 2013 until April 2015. Therefore, the most recent BLS numbers indicate that UofL�s estimates are on target to meet projections."

Politico says a Bevin victory could "blot an Obamacare bright spot," since Kynect has "worked virtually glitch-free." Through April, 106,000 Kentuckians had obtained tax-subsidized, private insurance coverage through Kynect, which is also the portal for enrolling in Medicaid.

Bevin says he would move those people to the federal exchange, which has been marred by technological issues and charges insurance companies much more to use it than Kynect does. But that plan would not work if the U.S. Supreme Court rules this month that the tax subsidies are not legally available through the federal exchange.

"That doesn�t worry Bevin," Politico reports, quoting him: �You�re worrying about a hypothesis. Let�s let the Supreme Court rule.�

And what about the new Medicaid recipients who would lose their benefits if Bevin wins? He "insists that Obamacare is coverage in name only � that Kentuckians still lack access to high-quality health care, partly because Medicaid pays doctors such low rates, partly because he says too many people rely on emergency rooms," Politico reports, quoting him: �Just having health insurance doesn�t mean you�re going to get health care.�

Attorney General Jack Conway, the Democratic nominee, declined Politico's request for an interview. Campaign spokesman Daniel Kemp said, �Jack wants to make sure that the hundreds of thousands of Kentuckians who now have health insurance through Kynect, especially kids, keep their health insurance � not play politics or push an ideology that�s out of touch with Kentucky�s values.�

Politico observes, "Conway is in the tricky spot of embracing Kynect while trying to keep his distance from Obama and Obamacare, a term that still generates ire among Kentucky residents. A September 2014 Marist [College] poll found that 61 percent of registered Kentucky voters had an unfavorable impression of Obamacare. Only 17 percent had negative feelings about Kynect."

Princess Health and Citing costs, Bevin has said he would shut down Kynect; actually, insurance companies pay for it; Medicaid is another matter.Princessiccia

Princess Health and Citing costs, Bevin has said he would shut down Kynect; actually, insurance companies pay for it; Medicaid is another matter.Princessiccia

Affordable Care Act courts elections health insurance insurance coverage insurance exchange Kynect Medicaid politics

Gusty 06:46 Add Comment

By Molly Burchett and Al Cross
Kentucky Health News

The governor's race between Democrat Jack Conway and Republican Matt Bevin will spotlight the Patient Protection and Affordable Care Act, an issue that affects all Kentuckians at least indirectly.

Conway, in his eighth year as attorney general, says he would have voted for the law. Bevin, who was the most conservative candidate in his primary, has said he would shut down the state's health-insurance exchange, Kynect, that was established under the law, because it will cost the state hundreds of millions of dollars.

Actually, Kynect is paid for by insurance companies that sell policies in Kentucky. Bevin appears to be referring to the projected cost of expanding Medicaid, another Obamacare-related move that Democratic Gov. Steve Beshear made at the same time he created Kynect. It raised the program's income limit to 138 percent of the federal poverty level, from 69 percent.

The federal government is paying the entire cost of the Medicaid expansion for the first three years. In 2017, the state will pay 3 percent, gradually rising to the law's cap of 10 percent in 2020. A study for the state projects that the expansion will pay for itself until 2021 by expanding health-care jobs and generating economic activity and tax revenue.

Bevin has scoffed at those projections. Conway has said the state needs to provide health coverage, but only what it can afford.

As Kentuckians, voters, and consumers of health insurance, you may be asking: What's going on with Obamacare in the state? Are we able to afford it? Who and what should we believe? While the cost of Medicaid expansion is debatable, it's becoming clear that Kynect has avoided the problems plaguing other state-run exchanges.

So far, the Centers for Medicare and Medicaid Services has dispensed more than $4.9 billion in grants to help launch state-run exchanges. Kentucky received $253 million for the initial planning and development phases of Kynect. Now its $28 million annual cost is covered by a fee on insurance companies, state officials say.

Despite federal support and their own revenue sources, many of the 17 state-based exchanges are expecting deficits this year and in the future. Many will continue to rely on leftover federal funds to pay for operations this year, report Darius Tahir and Paul Demko of Modern Healthcare. Hawaii announced this week that it would close its exchange and transfer clients to the federal exchange because of continued funding problems.

Kynect officials say it isn't having such problems because the state has ensured that Kynect is self-supporting through fees on insurance plans.

"The governor committed that the exchange would be self-supporting and would not rely on state General Fund dollars," said Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services. "Kentucky�s sustainability plan employs an existing assessment on insurers that was previously used to fund Kentucky Access, the state�s high-risk pool, which was closed [since] individuals previously enrolled are now eligible to purchase a plan through Kynect."

But to transform Kentucky Access into Kynect, Beshear used executive orders that bypassed the General Assembly, where Republicans control the Senate. They have questioned his use of executive powers but generally have not been critical of Kynect.

The fee on insurers is a 1 percent, broad-based assessment on all policies sold by companies offering plans through the exchange. While insurers don't pass this fee directly to consumers, it almost certainly figures into their calculation of premium calculation and thus is indirectly paid by policyholders. The federal exchange is financed in a similar way, but its fee is 3.5 percent, meaning higher costs for insurers and policyholders.

In most cases, premiums for Kynect policies are reduced by a federal income-tax subsidy that is a key part of Obamacare.

"The vast majority of Kentuckians buying health insurance through Kynect are eligible for some kind of payment assistance or subsidy," Beshear said in commenting on most health-insurance companies recent requests for premium increases. "That cost will vary from family to family, so talking about rate changes in a vacuum isn�t a very effective way to gauge how much those rate fluctuations may affect policyholders or those shopping for insurance."

Bevin says he would move Kynect customers to the federal exchange, but the U.S. Supreme Court could rule this month that the tax subsidies are not supposed to be available through the federal exchange. The plaintiffs in the case cite a passage of the law that opponents say was a drafting error and does not make sense when the law is viewed as a whole.

If the court agrees with the plaintiffs, and Congress doesn't change the law, states using the federal exchanges will see spikes in insurance premiums, and millions of people could be at risk of losing their insurance. Bevin has not said what he would do in case of such a ruling.

Independent Drew Curtis is also running for governor.

Princess Health and Most insured through Kynect will pay more in 2016; Kentucky Health Cooperative seeks 25 percent increase.Princessiccia

Princess Health and Most insured through Kynect will pay more in 2016; Kentucky Health Cooperative seeks 25 percent increase.Princessiccia

Affordable Care Act health care reform health insurance insurance coverage insurance exchange Kynect Patient Protection and Affordable Care Act

Gusty 19:16 Add Comment

By Molly Burchett
Kentucky Health News

The federal health law requires that insurers planning to significantly increase premiums for policies on a health-insurance exchange to submit their rates by June 1 for review. Many insurance carriers across the country, including four in Kentucky, are requesting double-digit increases in insurance premiums for 2016.

For the individual market, the requested average rates from companies already participating in the Kynect exchange are:

• Anthem Health Plans, 14.6 percent increase;
• CareSource Kentucky, 11.8 percent increase;
• Humana Inc., 5.2 percent increase;
• Kentucky Health Cooperative, 25.1 percent increase;
• WellCare Health Plans, a 9.28 percent decrease.

The rates are not final, but are subject to approval by the state Department of Insurance, "so we don�t yet know what the final numbers will be," Gov. Steve Beshear said. "Changes still may occur. Rates should be finalized sometime in mid-July. We do expect that some plan rates will go down, some will go up and some will stay close to the same as last year."

Consumers will have more choices when enrollment opens, because the exchange is adding three new insurers to its individual market. United Healthcare will be offering coverage statewide, Aetna policies will be available in 10 counties, and Baptist Health Plan, now Bluegrass Family Health, will offer coverage in 79 counties. CareSource will expand its coverage area from 16 to 67 counties.

With these additions, at least three insurers will be offering Kynect coverage in every county, said Ronda Sloan of the Department of Insurance.

"When open enrollment begins this fall, Kentuckians should seek information about their individual plans, not average costs," Beshear said. "System-wide averages don�t give a good picture of what an individual�s out-of-pocket costs may be."

It is also important to keep in mind that premiums cannot be viewed in isolation, and you should look at the individual market dynamics that impact how much consumers pay for their health care coverage.

Why are most rates going up?

For an insurance company to survive, its cost of providing benefits should be less than the premiumums paid for those benefits. Companies now have had more than a full year of claims data to inform pricing structures, and many insurers are finding that people who buy policies on exchanges are considerably older and sicker than anticipated, reports Megan McArdle of Bloomberg News.

As a result, insurers are incurring greater costs of providing benefits than expected. Initially, the U.S. Department of Health and Human Services said that about 40 percent of the exchange policies should be bought by people between 18 and 35, the most healthy age group, to keep the exchanges financially stable. However, according to HHS data, that group accounted for only 28 percent of the policies in 2014 and 2015.

Not only do older people have more complex and more costly health needs, rising premiums in some state-based exchanges are due in part to the uncertainty in the overall health-insurance marketplace. First, there is much uncertainly about the reform law's "risk corridor program," which was designed to have insurers share the financial risk of offering policies on Obamacare exchanges from 2014 through 2016.

The program creates a pool of money to reduce risk for insurers: Those that pay out less in benefits than they collect in premiums pay into the pool; those whose premiums don't cover the cost of providing benefits take money from the pool. However, a recent Standard & Poor's report says the risk corridor will probably not get enough money from insurers with profitable exchange plans, so many insurers must raise premiums to support themselves.

Kentucky Health Cooperative needs shoring up

In another potentially worrisome sign, some insurers had risk-corridor receivables that exceeded half of their reported capital, and Kentucky Health Cooperative had the second-highest level of receivables as a percentage of capital: 117 percent, reports CNBC. That helps explain why it has asked for the largest average increase in premiums this year, 25 percent, and last year, 20 percent. The cooperative is one of several start-ups funded by the reform law to encourage competition in states; it sells most of the 106,000 private policies on Kynect.

Other reasons for the overall premium increases include rising health-care costs, especially for prescription drugs, Larry Levitt, senior vice president of the Kaiser Family Foundation, said on "PBS NewsHour" Wednesday night.

Speaking nationally, Levitt said state regulation means the requested premiums "will come down, in some cases by a lot." He said "Insurers are jockeying for position in these new marketplaces [so] there are some good deals to be had, but consumers really have to look around,"

David Blumenthal, president of The Commonwealth Fund, which researches health and social policy, said exchanges like Kynect "give people the ability to comparison-shop much more easily than before."

Princess Health and Beshear is Communicator of the Year for efforts with Kynect.Princessiccia

Princess Health and Beshear is Communicator of the Year for efforts with Kynect.Princessiccia

Affordable Care Act awards governor health insurance

Gusty 07:54 Add Comment

Governor Steve Beshear ?has been named 2014 Communicator of the Year by ?the Public Relations Society of America's Thoroughbred chapter.

He received the award for his communication to Kentucky residents about Kynect, the state's online healthcare marketplace created under federal health-care reform.

More than half a million Kentuckians have gotten coverage through Kynect, most of them through Medicaid, which Beshear expanded under the federal law.

Princess Health andHigher-income Kentuckians' reported health keeps declining; reports from those with lower incomes go up, marginally.Princessiccia

Princess Health andHigher-income Kentuckians' reported health keeps declining; reports from those with lower incomes go up, marginally.Princessiccia

Affordable Care Act Foundation for a Healthy Kentucky health health reform income Patient Protection and Affordable Care Act poll polls

Gusty 20:29 Add Comment

A statewide poll again finds that Kentuckians with higher incomes consider themselves in better health than those with lower incomes.

The latest Kentucky Health Issues Poll, taken Oct. 8 through Nov. 6, found that 55 percent of Kentucky adults who are above 200 percent of the federal poverty level (FPL) said their health was either "excellent" or "very good," compared to 29 percent of Kentucky adults at or below 200 percent of the FPL. The FPL for a family of four in 2014 was $47,700.

However, the percentage of Kentucky adults in the higher-income category reporting excellent or very good health has dropped significantly since the poll started asking this question in 2008, to 55 percent in 2014 from 66 percent in 2008. So has the overall percentage of Kentucky adults reporting excellent or very good health, dropping to 41 percent in 2014 from 49 percent in 2008.

The percentage of lower-income Kentucky adults reporting excellent or very good has been about the same since 2008. This year the poll found a 3 percent increase among those in this group who reported very good or excellent health. The difference is not statistically significant, but coincides with implementation of federal health reform, and and if it continues could show the law's impact.

The poll also found that 52 percent of adults age 45 and younger considered their health as excellent or very good while 33 percent of those over age 45 reported excellent or very good health.

�KHIP provides important data regarding the connections among a person�s age, earnings level and perceived health status,� said Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. �By asking the same question year to year, we can spot trends in perceived health. The latest results are an important reminder of the links between poverty and poor health.�

The poll is conducted by the Institute for Policy Research at the University of Cincinnati and is co-sponsored by Interact for Health, formerly the Health Foundation of Greater Cincinnati. It surveyed a random sample of 1,597 adults via land lines and cell phones, and has a margin of error of plus or minus 2.5 percentage points. That applies to each figure, making the 3 percent difference statistically insignifcant.

Princess Health andNew diabetes cases in expanded-Medicaid states much higher than other states; 46,000 new Ky. Medicaid clients got screened.Princessiccia

Princess Health andNew diabetes cases in expanded-Medicaid states much higher than other states; 46,000 new Ky. Medicaid clients got screened.Princessiccia

Affordable Care Act diabetes health reform Medicaid obamacare Patient Protection and Affordable Care Act rese research

Gusty 19:55 Add Comment

By Melissa Patrick
Kentucky Health News

New diabetes cases among poor Americans are much more numerous in Kentucky and other states that have embraced the Patient Protection and Affordable Care Act, a medical testing company has found. The diagnoses rose 23 percent in the Obamacare states and barely rose in the others, apparently because state Medicaid programs are encouraging screening for diabetes.

Quest Diagnostics conducted the study by analyzing laboratory test results from all 50 states and the District of Columbia in its large database over two six-month periods, Sabrina Tavernise reports for The New York Times. The authors determined that because in January 2014, 26 states and the District of Columbia had expanded Medicaid and 24 had not, it was a good time to conduct this study, which is reported in the journal Diabetes Care.

The research team used the results of the basic test for diabetes, which measures a form of hemoglobin that has interacted with glucose, A1c. "In the states that expanded Medicaid, the number of Medicaid enrollees with newly identified diabetes rose by 23 percent, to 18,020 in the first six months of 2014, from 14,625 in the same period in 2013," Tavernise reports. "The diagnosis rose by only 0.4 percent � to 11,653 from 11,612 � in the states that did not expand Medicaid."

A Kentucky study indicates that more screening isn't the only reason for such numbers; the Medicaid expansion population appears to be more susceptible to diabetes than normal.

The study by Deloitte Consulting found that chronic conditions, including diabetes, were more than twice as prevalent in the expansion population than other people of the same age and gender who were on Medicaid before it expanded. That comparative group was considered to be the group most similar to the Medicaid expansion population, since the state lacks historical data for the expansion group.

The study found that the Medicaid expansion group had a 102.5 percent higher prevalence of diabetes than the comparative group. About two of every 1,000 in the expansion group had diabetes, compared to one of every 1,000 members of the traditional-Medicaid group.

About 46,000 of the 400,000 people in the expansion group had a diabetes screening in the first year of the expansion. Both studies suggest better access and utilization of preventive care and early diagnosis will promote earlier treatment and better long-term outcomes.

Kentucky ranks 17th among the states in prevalence of diabetes, according to the 2014 "States of Obesity" report.  The state Cabinet for Health and Family Services reports an estimated 233,000 adult Kentuckians have pre-diabetes. For county-by-county data on diabetes, click here.

Quest Diagnostics recognized that its study only looked at changes in raw numbers of the lab results from one company and did not have access to a federal data set. This has caused some to voice skepticism that the study results are a result of the Medicaid expansion. Others, while recognizing that the study did not "have the precision of a scientific drug trial," Tavernise writes, said "the changes in the numbers are real ... 23 percent versus zero," and that "the health-care law was the most plausible explanation for the findings." Another said, "for an observational study, it�s really very strong."

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.

Princess Health andAuditor will hold meetings in Prestonsburg, Princeton and Somerset to discuss his report on financial status of rural hospitals.Princessiccia

Princess Health andAuditor will hold meetings in Prestonsburg, Princeton and Somerset to discuss his report on financial status of rural hospitals.Princessiccia

Affordable Care Act health reform indigent care managed care Medicaid Medicare obamacare Patient Protection and Affordable Care Act rural hospitals state government

Gusty 19:33 Add Comment

State Auditor Adam Edelen will hold three public meetings in rural communities to discuss the findings of his special report about the financial health of rural hospitals.

The meetings will be held Monday, April 21 at 1 p.m. at the Mountain Arts Center in Prestonsburg; Monday, May 4 at 11 a.m. (CT) at the Caldwell County Memorial Hospital in Princeton; and Thursday, May 6 at 1 p.m. at the Liberty center of Somerset Community College.

The report, which covers fiscal years 2011 through 2013, found that as many as one-third of Kentucky's rural hospitals were in poor financial shape, with 68 percent of them ranking below the national average financially.

�Although closure may be an unfortunate reality for some," Edelen said in the press conference, "I believe more can and should be done to help these hospitals rethink their models of business in delivering health care in the 21st century." He went on to suggest rural hospitals consider hiring outside managers, merge with larger hospitals, form coalitions with other rural hospitals or find a specialized health niche as possible alternate business models to consider.

The report calls for the creation of a state work group to monitor rural hospitals, including making sure state law gives them the flexibility to retool their business models. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, suggested that the proposed work "could be incorporated into the work already under way under a State Innovation Model grant, which is engaging many sectors of health service in Kentucky in an ambitious, collaborative redesign effort."

Edelen said some of the primary problems faced by rural hospitals stem from the many changes in health care since the inception of Medicaid managed care, a decrease in the number of health-care providers, and an economic climate in some areas that doesn't support the current health payment model, which depends on the majority of its users to have private health insurance.

The report suggested that the Cabinet for Health and Family Services negotiate better contracts with managed-care organizations as it approaches the June 30 deadline, especially to address provider payments, stricter penalties for non-compliance and increased administrative burdens that managed care has put on hospitals. Edelen and Haynes sounded hopeful that this was going to happen.

Gov. Steve Beshear called Edelen's report "a dated snapshot" because the 2013 data used in the report does not include 2014 information,when the federal health reform was fully implemented through expansion of Medicaid to people with incomes up to 138 percent of the federal poverty line. Beshear said hospitals received $506 million to care for such people in 2014 while seeing significant reductions in losses on patients who couldn't or wouldn't pay.

Edelen's spokeswoman, Stephenie Hoelscher, said in an email that Edelen believes the full effect of all the changes in health care to hospitals' bottom line is still not clear, and his report establishes a baseline for critical analysis going forward.

Princess Health and Princess Health andAt least one additional health-insurance company is expected to sell policies on Kynect exchange next year.Princessiccia

Princess Health and Princess Health andAt least one additional health-insurance company is expected to sell policies on Kynect exchange next year.Princessiccia

Affordable Care Act health insurance health reform insurance coverage insurance exchange obamacare Patient Protection and Affordable Care Act state government

Gusty 10:15 Add Comment

The five insurance companies that sold policies this year on Kynect, Kentucky's health-benefit exchange, want to return in 2015, and Dayton, Ohio-based CareSource wants to join as well. Officials said they believe other insurers will sign up to sell policies next year, too, which will benefit consumers, Jack Brammer writes for the Lexington Herald-Leader.

""Consumers benefit from the choices that come with more competition," Insurance Commissioner Sharon P. Clark said. Cabinet for Health and Family Services Secretary Audrey Tayse Haynes said she hopes than even more Kentucky residents will set aside time to examine the plans on Kynect when the second round of open enrollment begins Nov. 15.

Anthem, Humana, Bluegrass Family Health, United Healthcare of Kentucky and Kentucky Health Cooperative offered plans on the exchange this year, and Humana was the only one that didn't offer small group market insurance, for two to 50 people. Humana, Anthem and the cooperative offered individual coverage.

Jonathan Copley, CareSource's executive director for Kentucky, said the company's participation in Kynect is "an extension of our commitment to provide affordable coverage to Kentuckians who need it most. We are expanding our reach to one of Ohio's bordering states to offer affordable health care coverage. Kynect represents a successful model on the marketplace, and we are excited to offer CareSource."

Though the tentative deadline for insurers to request to be on the exchange was April 1, the official deadline has been extended as a result of inquiries, Brammer reports.

In Kynect's first open-enrollment period, from Oct. 1 through March 31 about 421,000 Kentuckians enrolled for coverage, and the increasing number of insurers seems to be a sign even more people will sign up next year. Last month The New York Times reported that "8 million people signed up for coverage in 2014 under the federal health care law and that estimates put next year's national enrollment near 13 million," Brammer writes.

This year monthly rates for those enrolled in Kynect ranged from $47 for older couples without dependents to $403 for families of four with a total income of $70,000 per year. Health and Family Services spokeswoman Jill Midkiff told Brammer that an average premium wasn't calculated because of the many variables such as age and family membership. (Read more)

Princess Health and Princess Health andSteven J. Stack will be second Lexington physician in three years to lead the American Medical Association.Princessiccia

Princess Health and Princess Health andSteven J. Stack will be second Lexington physician in three years to lead the American Medical Association.Princessiccia

Affordable Care Act physicians

Gusty 11:05 Add Comment

Dr. Steven J. Stack, an emergency physician in Lexington, is the new president-elect of the American Medical Association, the nation�s largest organization for physicians

Stack, at 43, is the youngest president of the organization in a century, Laura Ungar reports for The Courier-Journal. He is the first board-certified emergency physician elected to the post, which he will fill in June 2015.

�It�s an immense honor and a total joy and a thrill,� Stack told Ungar.

Stack will be the second Lexington doctor in three years to hold the office. AMA's immdiate past president is Dr. Ardis Dee Hoven, an infectious disease specialist.

�It�s a fluke of history,� Stack told Ungar.

Stack is a practicing physician and former medical director for emergency departments at St. Joseph East in Lexington and St. Joseph Mt. Sterling.

Stack's experience as the chair of the AMA�s Health Information Technology Advisory Group from 2007 to 2013 and also as a member of the federal advisory groups for the Office of the National Coordinator for Health Information Technology puts him in a position to help further one of the many goals of the Affordable Care Act�to expand information technology.

Stack told Ungar he also plans "to work on improving medical education, reducing diabetes and pre-diabetes in the population and helping ensure doctors are satisfied with their jobs so they can better help patients."

Stack came to Lexington with his wife Tracie, a pediatric allergist, and their 9-year-old daughter in 2006, Ungar writes. He has been active in the AMA for years and has held several offices. He has also been a legislative voice for local Kentucky issues, such as prescription drug abuse and medical liability reform. (Read more)

Princess Health and Princess Health andNational poll finds many who need health coverage didn't even shop for it because they didn't think they could afford it.Princessiccia

Princess Health and Princess Health andNational poll finds many who need health coverage didn't even shop for it because they didn't think they could afford it.Princessiccia

Affordable Care Act health insurance health reform insurance exchange Medicaid Patient Protection and Affordable Care Act state government

Gusty 12:58 Add Comment

By Melissa PatrickKentucky Health News

The top two reasons people gave for getting health insurance under the Patient Protection and Affordable Care Act were compliance with the law and a desire to see a doctor, according to a recent survey by PerryUndem Research/Communication for Enroll America, a group promoting the law.

The poll also found that many people needed health coverage but didn't even shop for it because they thought they couldn't afford it. UPDATE, June 14: "Convincing Americans that they could afford insurance was the White House's biggest challenge in making Obamacare work," Ezra Klein reports on Vox.

Four in 10 of those surveyed who did enroll that they might not have signed up if the 2010 law hadn't required them to do so. Mike Perry of PerryUndem told Louise Radnofsky of The Wall Street Journal that the poll suggested that "The mandate was a big factor even if it wasn't politically popular."

The survey also found there was a high demand for health insurance during the first open enrollment period, which ended in April. Kentucky also found this to be true, said Gwenda Bond, assistant communications director for the Cabinet For Health and Family Services.

"In Kentucky, we definitely experienced high demand from the beginning of open enrollment Oct. 1, which continued to increase right up through the end of the open enrollment period," Bond said in an e-mail.

Kentucky ended up providing coverage to about 420,000 people in the state, with about three-fourths reporting they did not have insurance before signing up through Kynect, the state's health-insurance exchange.

Despite the demand,the national poll found that 61 percent of those who did not enroll still wanted coverage and the main reason they did not even look for it was because they thought they couldn't afford it.

Some of these people may not have been aware that they could qualify for free coverage through Medicaid. Almost 25 percent of the newly enrolled cited "I qualified for Medicaid" as a reason they enrolled, and over half of that population said it was the main reason.

Kentucky is working on this issue of affordability perception, Bond said. "We will be working to make it easier for individuals and small businesses to get information or a quote up front that estimates the amount of subsidies or discounts they may qualify for, before they ever begin an application,"she said in the email.

More than eight out of 10 surveyed nationally said they will consider enrolling next time.

The poll surveyed 671 newly enrolled people and 853 who remained uninsured. It was conducted April 10-28. The margin of error for the total sample is plus or minus 2.9 percentage points.

Other key findings in the poll included: 69 percent of the newly enrolled thought the process was "easy," especially if they enrolled in person instead of the phone; 74 percent of those in private plans felt confident they can afford their premiums, and many more think their plans have enough doctors than not (56 percent vs. 13 percent). The self-reported health status of those who enrolled and those who didn't was similar.

Princess Health and Princess Health andDoctors in emergency rooms say they are busier since Obamacare began; hospitals struggle to handle extra patients.Princessiccia

Princess Health and Princess Health andDoctors in emergency rooms say they are busier since Obamacare began; hospitals struggle to handle extra patients.Princessiccia

Affordable Care Act emergency rooms health insurance hospitals Medicaid obamacare Patient Protection and Affordable Care Act state governments

Gusty 12:38 Add Comment

Nearly half of emergency-room doctors say their ERs have seen an increase in patients since health reform went into effect, and 86 percent say they expect the increase to continue, according to a poll by the American College of Emergency Physicians. Of the 1,845 completed surveys, 9 percent said ER visits had increased greatly and 37 percent said they had increased slightly. When asked what they think will happen over the next three years, 41 percent said visits will increase greatly and 45 percent said they will increase slightly. (ACEP graphic)

"Dr. Jay Kaplan, a member of ACEP's board of directors, said he wasn't surprised by the findings given the large influx or Medicaid enrollees and the difficulty in locating primary-care doctors who will see those patients," Paul Demko reports for Modern Healthcare. Kaplan told him, �When people get insurance, they feel like they deserve healthcare. When they deserve health care, and there's nobody else they can see, they come to us.�

77 percent of respondents
said their ER is not prepared
for an increase in patients

But some hospitals say many patients are going to the ER for ailments that are not emergencies, Laura Ungar reports for The Courier-Journal. Lewis Perkins, vice president of patient care and chief nursing officer at Louisville's Norton Hospital, said the emergency room is seeing 100 more patients per month, an increase of 12 percent. "We're seeing patients who probably should be seen at our (immediate-care centers)," he told Ungar. "And we're seeing this across the system."

ER visits at the University of Louisville Hospital are up 18 percent, while Dr. Ryan Stanton of Lexington, president of the Kentucky chapter of the ER physicians' group, said ER services are up 7.5 percent in that city. He told Ungar, "It's a perfect storm here. We've given people an ATM card in a town with no ATMs." (Read more)

Phil Galewitz of Kaiser Health News reports that a study in Massachusetts following its Obamacare-like expansion showed an initial surge in ER use followed by a decline over several years. Hospital officials around the country told him that the biggest impact of the expansion of Medicaid is that patients can now go to a primary-care doctor instead of the emergency room for routine care.

Princess Health and Princess Health andSafety-net hospitals, haven for the uninsured, are seeing more covered patients since the expansion of Medicaid.Princessiccia

Princess Health and Princess Health andSafety-net hospitals, haven for the uninsured, are seeing more covered patients since the expansion of Medicaid.Princessiccia

Affordable Care Act alcohol insurance coverage Medicaid

Gusty 10:19 Add Comment

By Melissa Patrick
Kentucky Health News

Hospitals that most often treat the poor and uninsured  are seeing fewer uninsured patients since the new health law's expansion of Medicaid, Phil Galewitz reports for Kaiser Health News. Kentucky's safety-net hospitals have also seen a drop in their uninsured patients.

Safety-net hospitals, which are often not paid for the billions of dollars it costs to care for the disproportionate share of poor and uninsured people they care for, will benefit most from the health law's expansion to more than 13 million people this year, Galewitz writes.

Hospitals across the country had expected this outcome, but told Galewitz in interviews that it has happened "faster and deeper" than anticipated -- "at least in the 25 states that expanded Medicaid in January."

Kentucky is one of the states that agreed to the Medicaid expansion and has expanded health coverage to some 413,000 people, with 75 percent of them reporting that they did not have coverage before signing up on Kynect, the state's health insuance exchange.

Michael Rust, president of Kentucky Hospital Association, said figures from his members won't be available until July, but "Anecdotally, I can tell you that more people do have coverage," adding later that "most are on Medicaid."

The University of Kentucky has seen a decrease in uninsured patients. �The number of uninsured patients seeking care at UK HealthCare since Medicaid expansion took effect in January has decreased,� said Mark D. Birdwhistell, UK vice president for health system administration. �Even though we have seen a double-digit increase in the number of services provided, request for financial assistance is down when compared to this period last year.�

Investor-owned hospitals are also being affected by the expansion of coverage. HCA, Tenet Healthcare Corp., Community Health Systems, some of which own safety-net hospitals, told Galewitz "they saw their rates of uninsured patients drop by as much as a third in the first quarter of 2014 in hospitals located in Medicaid-expansion states," he writes.

"An Urban Institute study published in the May edition of Health Affairs estimated the costs of uncompensated care to hospitals were as high as $45 billion in 2013, with government programs defraying an estimated 65 percent of those costs," Galewitz reports. That made the hospital industry one of the first to support the Affordable Care Act, he notes, agreeing to take funding cuts "exceeding $150 billion over a decade" in return for more paying patients.

However, because the Supreme Court ruled that states could not be forced to expand Medicaid, hospitals in the 24 states that didn't are suffering the funding cuts, without the "corresponding reduction in uncompensated care," Galewitz writes.

Hospital officials told Galewitz that the biggest impact of the expansion of Medicaid is that patients can now go to a primary-care doctor instead of the emergency room for routine care. Kentucky ERs have reported a surge in patients since the law took effect. Galewitz notes that a study in Massachusetts following its Obamacare-like expansion showed an initial surge in ER use followed by a decline over several years.

Princess Health and Princess Health andRepublican governor of Indiana wants to expand Medicaid under Obamacare and existing state program; federal OK needed.Princessiccia

Princess Health and Princess Health andRepublican governor of Indiana wants to expand Medicaid under Obamacare and existing state program; federal OK needed.Princessiccia

Affordable Care Act health insurance health reform Medicaid obamacare Patient Protection and Affordable Care Act

Gusty 13:28 Add Comment

Approximately 24 states still have not participated in health reform's Medicaid expansion, which provides coverage for adults who earn up to 138 percent of the federal poverty level. Some Republican-controlled states are "still looking for alternative ways to accept hundreds of millions, and even billions, federal dollars to expand coverage�all the while trying to maintain some rhetorical policy distance" from the controversial law, Jason Millman writes for The Washington Post.

Republican Gov. Mike Pence of Indiana is discussing a new plan to provide coverage for low-income people through an existing state insurance program. remains to be seen whether the federal government will approve Pence's plan or ask him to make changes. It also remains unclear whether the program will be better than traditional Medicaid.

When Pence said last year he would only consider expanding coverage if it was through the Healthy Indiana Plan, the Obama administration said the state couldn't do that because the program had an enrollment cap and potential cost-sharing issues. Now, Pence plans to get rid of the enrollment caps and make the program available to all adults who earn less than 138 percent of the poverty line. "Between 334,000 and 598,000 people will be covered under the plan, according to Pence's office," Millman writes. "Enrollment will open in 2015, with federal approval."

The current program only provided coverage for those under the poverty line and required them to pay for the first $1,100 of their care, the new program will provide two levels of coverage. Participants will be allowed to make monthly payments, but if they do not, they'll be given simpler coverage that doesn't include vision and dental benefits. The lesser coverage calls for co-payments for services but not for preventive care and family planning services. Participants living above the poverty line who do not give a monthly payment within 60 days will be "locked out of the program for six months. They can't opt into the basic coverage level," Millman writes.

"Exposure to and awareness of the cost of care are key components of the consumer-directed model that encourages price and quality transparency from providers," according to a document from Pence's office. "The increased deductible aligns with private market high deductible health plans paired with a health savings account, providing members valuable experience with a private market plan design." (Read more)

Though Pence does not support President Obama's health-care overhaul, the governor said that states "have an obligation to lead the way on health care reform," Maureen Groppe and Barb Berggoetz write for The Indianapolis Star. Pence said, "Reforming traditional Medicaid through this kind of market-based, consumer-driven approach is essential to creating better health outcomes and curbing the dramatic growth in Medicaid spending." (Read more)

Princess Health and Princess Health andPoll finds contrasting views of Obamacare and Kynect.Princessiccia

Princess Health and Princess Health andPoll finds contrasting views of Obamacare and Kynect.Princessiccia

Affordable Care Act health reform insurance exchange obamacare Patient Protection and Affordable Care Act poll state government

Gusty 20:19 Add Comment

Most registered voters in Kentucky have an unfavorable view of the Patient Protection and Affordable Care Act when it is called Obamacare, but a plurality think favorably of Kynect, the brand name of the health-insurance marketplace that state government created under the law.

Those were among the findings of a poll taken April 30 through May 6 for NBC News by the Marist College Institute of Public Opinion in New York. It asked, "Overall, do you have a favorable or unfavorable impression of Obamacare?" The result was 33 percent favorable and 57 percent unfavorable, which was very close to voters' opinion of President Obama: 32 percent approval and 56 percent disapproval.

Last fall, the Kentucky Health Issues Poll found that people who weren't sure how Obamacare would affect them and their families had an unfavorable opinion of it, while those who said they did know how it would affect them had a favorable opinion.

In the recent poll, half the people were asked about Obamcare and the other half were asked, "Overall, do you have a favorable or unfavorable impression of Kynect?" The term was not defined. The poll found that 29 percent had a favorable opinion and 22 percent had an unfavorable opinion, while 29 percent said they had never heard of Kynect and 21 percent said they were unsure how to rate it.

Among people who identified themselves as Democrats, 39 percent were favorable and 15 percent were unfavorable; among Republicans, it was 16 percent favorable and 32 percent unfavorable. Among independents (who were 14 percent of the survey), opinion was 31 percent favorable and 22 percent unfavorable.

The only polling region where Kynect was not rated favorably was the Bluegrass and some surrounding counties, where opinion was 25 percent favorable and 28 percent unfavorable.

The poll asked all registered voters, "From what you have heard about the new health care law, do you think it is a good idea, a bad idea?" Then they were asked if they felt that strongly or not so strongly. The results showed polarization: 27 percent strongly felt it is a good idea, 43 percent said they felt strongly that it was a bad idea, and those who said their opinions weren't so strong were in the single digits. Eleven percent said they didn't have an opinion either way, and 4 percent said they weren't sure.

The poll, taken via landline and cell phones, has an error margin of plus or minus 1.9 percentage points. The Obamacare and Kynect questions have an error margin of plus or minus 2.9 percentage points. NBC News and Marist College took the survey mainly to gauge opinions in Kentucky's race for the U.S. Senate. For its release and the poll results, click here.

Princess Health and Princess Health andBeshear says Kynect signups show importance of health-care reform to Kentucky's health; Republican foes keep attacking it.Princessiccia

Princess Health and Princess Health andBeshear says Kynect signups show importance of health-care reform to Kentucky's health; Republican foes keep attacking it.Princessiccia

Affordable Care Act health insurance health reform insurance exchange Medicaid obamacare Patient Protection and Affordable Care Act state government

Gusty 08:36 Add Comment

By Al Cross
Kentucky Health News

Opponents of federal health reform kept up their drumbeat Tuesday as Gov. Steve Beshear announced the latest, but still not quite final, signup figures from Kynect, the state health-insurance exchange.

Kynect Executive Director Carrie Banahan listened to Beshear.
(Lexington Herald-Leader photo by Pablo Alcala)

Beshear held a news conference to announce that 413,410 Kentuckians enrolled for coverage via the exchange through April 11, when most enrollment in private insurance plans closed until Nov. 15. he said "A significant number" of paper enrollments are still being processed. Enrollment is open year-round for the Medicaid program and for people who experience a major event such as change of jobs or birth of a child.

So far, 68 percent of those who signed up for a private insurance policy through the exchange have paid their premiums, according to a state press release. About three-fourths of the policies are from the Kentucky Health Cooperative, a non-profit insurance company created under the Patient Protection and Affordable Care Act, known as Obamacare. The rest of the market was about equally divided between Humana Inc. and Anthem, the only for-profit company offering exchange policies statewide.

Beshear said state officials estimate that three-fourths of exchange enrollees did not have health insurance when they signed up, and Health and Family Services Secretary Audrey T. Haynes estimated that the number of uninsured Kentuckians has dropped to around 200,000, from an estimated 640,000. She said an unknown number of the uninsured obtained insurance outside the exchange.

About three-fourths of the exchange enrollees are in Medicaid, which Beshear expanded to cover people with household incomes up to 138 percent of the federal poverty threshold. The previous income limit was only 69 percent of poverty. The federal government will pay the entire cost of covering the newly eligible people through 2016, when the state will have to start picking up a small share, reaching a cap of 10 percent in 2020.

The federal government pays about 71 percent of benefits for previously eligible Medicaid recipients in Kentucky. Some who had been eligible but never enrolled signed up through the exchange; Haynes said she didn't know the number, but said she still feels good about the estimate of 17,000, made before the exchange opened Oct. 1.

Beshear reiterated his belief, based on a study by the international accounting firm PriceWaterhouseCoopers, that expansion of Medicaid will pay for itself by expanding the health-care industry and creating 17,000 jobs. Republicans in the General Assembly have expressed skepticism about that but have offered no countervailing information.

The leading Republican attacker has been U.S. Sen. Mitch McConnell, who sent Kentucky newspapers his latest column on the subject Monday, saying claims that the law has been successful are refuted by the experiences of those who had their policies canceled despite President Obama's promise that they could keep them, and have had to pay higher premiums and deductibles, "often for a plan that offers less access to hospitals and their favorite doctor."

McConnell called "shocking" the signup of inmates by jails and prisons, which he said could limit access to care because the demand for it may outstrip the supply of doctors, nurse practitioners and other health-care providers. Officials have said the signups save the state money by transferring costs to the federal government.

Asked about McConnell's criticism, Beshear said, "These critics continue, apparently, to sit in their own echo chambers and talk to each other, because when you get out and talk to these 413,000 people, they are very thankful that we have moved forward both in expanding the Medicaid program and in setting up our own health-benefits exchange." Haynes said the program has been "overwhelmingly successful by all measures."

Read more here: http://www.kentucky.com/2014/04/22/3207241/beshear-says-more-than-413000.html?sp=/99/322/&ihp=1#storylink=cpy

Tea party activist David Adams, who is appealing initial adverse rulings in two lawsuits he filed to challenge Beshear's actions, disputed the estimate that three-fourths of the exchange enrollees had been uninsured, "arguing that enrollment questions on the Kynect website prompted people to falsely claim that they lacked insurance when submitting applications," Mike Wynn reports for The Courier-Journal.

Beshear said the reform law is "a tool to improve people's health, to help those who are vulnerable to to remove lack of health coverage as the determining actor in a family's financial security." He said the nearly-final enrollment figure is "a milestone that shows just how important health-care reform is to our families and our future. . . . We're going to keep enrolling people until everybody in Kentucky who needs health coverage has health coverage."

Skeptics of the law say research has shown that enrollment in Medicaid doesn't improve enrollees' health, but defenders say that study didn't last long enough. Beshear said, "It'll probably take several years to see a change in our rankings, but you will see a change in our rankings over the next generation." He said the reform law's emphasis on prevention and wellness will give the state a healthier workforce that will attract more jobs.

Republicans are making Obamacare the centerpiece of their campaigns for the Nov. 6 elections, but Beshear told The Washington Post in January that by Election Day the law will be a net plus for Democrats. Asked yesterday if he would recommend to Democrats in the legislature that they use the reform law in their campaigns, he said candidates will have to make their own decisions, but "The Affordable Care Act, some next November, is going to be looked at a lot differently than it was looked at last November," when the national rollout was very troubled.

"The 80 percent of Americans and Kentuckians whom the Affordable Care Act will not affect at all are gonna know that it's not gonna affect them, so it's not gonna be a big issue for them one way or the other," Beshear said, and the 20 percent who are affected "like what they're getting. . . . I would say to those who think they're gonna make this the crowning issue and defeat somebody on it, have at it, because I don't think they're gonna get to first base by next November."

Reminded that Republicans use the law's nickname to run against a president who is unpopular in Kentucky, and asked when the tipping point in public opinion might come, Beshear suggested that he will find a way to gain political advantage.

"Whether you see a big change in the polling numbers when you use the phrase Obamacare or not, I don't think is gonna be all that relevant come next November, because people out here in Kentucky are gonna hear a lot about Kynect and the Affordable Care Act and the successes that we've had," he said. "I think you are seeing the polling now, when you talk about Kynect and what is going on in Kentucky, that people are very favorably disposed to it."

Democrat Elisabeth Jensen, running for Congress in the 6th District, has run a radio ad embracing "Kentucky Kynect" and said, "It polled well." (Read more)

Princess Health and Princess Health andRepublicans wait for elections and chance to roll back Medicaid expansion; few Kentucky Democrats defend Obamacare.Princessiccia

Princess Health and Princess Health andRepublicans wait for elections and chance to roll back Medicaid expansion; few Kentucky Democrats defend Obamacare.Princessiccia

Affordable Care Act Appalachia elections General Assembly governor health insurance health reform legislature Medicaid obamacare Patient Protection and Affordable Care Act politics poverty

Gusty 17:38 Add Comment

Though thousands of their constituents have benefited from it, Republican state legislators say they are planning to roll back Democratic Gov. Steve Beshear's expansion of Medicaid under the Patient Protection and Affordable Care Act if they take control of the state House this fall or win the governorship next year.

In other words, the "wildly successful" rollout of the health-reform law in Kentucky has not changed the politics of it in the state, reports Louisville native Perry Bacon Jr., political writer for Yahoo! News.

Stivers and Beshear

Bacon starts his story by focusing on the home county of state Senate President Robert Stivers, a Republican from Manchester: "In one of the poorest areas of Appalachia, about 2,500 people have signed up to get health insurance over the last six months � a number that represents more than a tenth of Clay County�s residents. One hundred and twenty miles way, the county�s state senator, Robert Stivers, is laying out his plans to gradually gut the Affordable Care Act in Kentucky, which provided his constituents with insurance."

Stivers acknowledged that the Medicaid expansion has benefited his neighbors, but told Bacon that it is �unsustainable� in the long run. For the first three years, the federal government is paying the entire cost of the expansion, but starting in 2017, the state will have to pay 5 percent, rising in steps to a cap of 10 percent in 2020.

Beshear cites a study showing that the expansion will pay for itself, largely by creating jobs in health care, and Health Secretary Audrey Haynes told Kentucky Health News that the expansion brought $45 million to health-care providers in the state in January, the first month it was in effect.

Republican Rep. Robert Benvenuti of Lexington, a former state health official, doesn't buy the Democratic sales pitches. �I think it�s immoral to give you something you know we can�t pay for,� he told Bacon. �Why are you creating dependency you know you can�t afford?�

Stivers suggested that Republicans could gradually reduce the income limit for Medicaid eligibility, now 138 percent of the federal poverty level, to reduce costs, but "The Obama administration has long said it would not support such a partial expansion of Medicaid," Bacon reports.

Also, "Some Republicans privately concede it will be difficult to roll back expansion of health insurance to so many," Bacon reports, quoting a "top GOP operative" as saying, "Three hundred thousand people are on this now. It's going to be hard to take this away from people." And since that anonymous person spoke, the number is close to 400,000.

House Republicans tried to force a floor vote on Obamacare in the current legislative session, but Democrats foiled that through a parliamentary maneuver.

"Steve Robertson, chairman of the Kentucky Republican Party, said the GOP statehouse candidates would run this fall on the mantle of repealing the health care law, looking to gain five seats and the House majority," Bacon reports. "And a Republican could replace Beshear," who can't seek re-election in 2015. Robertson said, �It�s a question of when, not if, when Kentucky will become just truly a red state.�

Bacon writes, "Democrats acknowledge the political challenge in defending the law. They say the policy success has done little to shift the politics because anything associated with Obama is unpopular in Kentucky. . . . The stories of the newly insured are drowned out, politicians in both parties here say, by the enduring unpopularity of Obamacare and the man it is named after, concerns (often unfounded) that the law has caused premiums to increase for people who previously had insurance and general confusion about the law, particularly the individual mandate" to buy insurance.

"Other than Beshear, many of the state's leading Democrats, aware of the lingering tensions around the ACA, avoid speaking about it publicly, wary of being seen as too supportive of 'Obamacare'," Bacon reports.

Princess Health and Princess Health andKentuckians who ran into problems signing up for insurance on state website get a second chance through April 11.Princessiccia

Princess Health and Princess Health andKentuckians who ran into problems signing up for insurance on state website get a second chance through April 11.Princessiccia

Affordable Care Act health insurance insurance insurance exchange Medicaid Patient Protection and Affordable Care Act state government

Gusty 14:26 Add Comment

Kentuckians who had trouble starting or completing their application during the open enrollment period can still apply for subsidies and purchase health coverage at Kynect.ky.gov through midnight April 11.

This applies only to those who completed their applications by March 31. All individuals must select a plan by midnight April 15, with coverage beginning May 1, according to a state press release.

�This will be the last chance for most people to sign up for private health plans and possibly receive discounts until the fall open enrollment period,� Carrie Banahan, executive director of Kynect, said in the release. �We strongly encourage those who still need to select a plan to do so as soon as possible. Those who have started applications should work to complete them quickly too, to reduce possible wait times toward the end of the grace period.�

To sign up during the special enrollment period, you will be asked to attest that you attempted to complete an application by March 31, and had problems doing so. When you connect to the Kynect website, there will be a button to select when the special enrollment screen comes up.

Kentuckians who need assistance can also contact the Kynect call center at 1-855-4kynect weekdays from 7 a.m. to midnight Eastern time or from 8 a.m. to 4:30 p.m. Eastern time Saturday and Sunday. They can also search at Kynect.ky.gov to find a Kynector or insurance agent who can assist them with enrollment, or visit a local Department for Community Based Services office.

Individuals who qualify for Medicaid can apply at any time. But only those who experience a qualifying event, such as the loss of employer-sponsored health insurance coverage, will be able to purchase private health plans.

The next open enrollment period begins Nov. 15, 2014.

More than 370,000 Kentuckians have enrolled in new health coverage through Hynect between Oct. 1 and March 31. This is more than 1 out of every 12 Kentuckians, or 8.6 percent of the state�s population, according to the release.