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.