Princess Health and Health ranking of Kentucky seniors moves up, but they are still last in health outcomes, says America's Health Rankings. Princessiccia

Princess Health and Health ranking of Kentucky seniors moves up, but they are still last in health outcomes, says America's Health Rankings. Princessiccia

dental care exercise federal spending health rankings hospitals immunizations local government nursing homes obesity oral health physical activity poverty seniors state government vaccinations

Gusty 12:57 Add Comment

By Melissa Patrick and Al Cross
Kentucky Health News

Kentucky moved up three spots, from 48th to 45th, in the fourth annual Senior America's Health Rankings Report. But the state ranked last in health outcomes and 44th in determiners of those outcomes, so it remains one of the least healthy places in the nation for seniors to live.

Among negative measures, Kentucky seniors ranked first in preventable hospitalizations, second in tooth extractions and premature death; and third in physical inactivity and hospital re-admissions within 30 days of discharge.

Among positive measures, the state also ranked poorly: for example, 46th in the percentage (34%) of seniors who reported that their health status was good or excellent and 48th in the percentage (56.9%) who reported having no disability.

The state's best ranking was No. 3 in influenza vaccinations, reflecting an increase to 70 percent from 62 percent of seniors vaccinated in the past two years. It was No. 8 in the percentage of seniors with arthritis who self-report arthritis or joint pain does not limit their usual activities. It tied for 10th in the percentage of seniors with a "creditable prescription-drug plan" and was 17th in the percentage of senior who reported having a mammogram or a colonoscopy or similar screening.

Kentucky ranked low in volunteer activity by seniors (45th) and nursing home quality (43rd) but has fewer people in nursing homes who perhaps shouldn't be there. Only 7 percent of its nursing-home residents, the No. 7 ranking, were considered "low care" and thus candidates for living in less restrictive environments. However, it was 46th in the number of personal-care and home-health aides per 1,000 adults aged 75 or older.

The state tied for 44th in the percentage (32.1) of seniors who reported falling in the previous 12 months. It was 44th in the percentage (42.8) of seniors who were enrolled in hospice during the last six months of life after being diagnosed with a condition that carried high probability of death.

It was also 44th in a related measure, the percentage (16.6) of seniors who spent seven or more days in an intensive- or critical-care unit during their last six months. Generally, use of an ICU correlates with the number of ICU beds, which "could indicate a supply-induced remand," the report says. "Overusing the critical care system often goes against the wishes of dying patients and is costly. Research indicates many patients receive care they would not choose in their final days."

The rankings are based on 35 measures of health, as well as supplemental measures such as education and mental health. Combined, they paint a picture of how individual behavior, our communities and their environments, health policy and access to care influence health.

One area that Kentucky consistently ranks low in is government support for seniors in poverty. It was 45th again this year, spending $382 per senior when federal, state and local funds were all counted. Massachusetts, which ranked first in overall senior health this year, spends $4,053 per senior in this category, more than any other state but Alaska, which has many rural elderly. The national average, which has been declining, is $811.

Kentucky leads the nation in smoking, so it's no surprise that its seniors also rank in the bottom five states for this negative category (47th). Kentucky seniors' smoking rate is 12.4 percent; the national average is 8.8 percent. Both have declined about 40 percent in the last 15 years.

Smoking is the leading cause of preventable death in the United States," says the report. "Cessation, even in older smokers, can have profound benefits on current health status as well as improve long-term outcomes."

Kentucky was fifth from the bottom in dental visits by seniors, but the good news is that the share of seniors having such visits rose to 57 percent from 53 percent last year.

"Poor oral health is associated with such chronic diseases as diabetes and cardiovascular disease, and can have a large impact on quality of life resulting in pain and affecting the ability to chew or speak," says the report.

Kentucky improved its senior obesity ranking, another negative measurement, to 24th from 41st. About two out of every seven Kentucky seniors are obese, or 27.5 percent, the same as the national average. Last year the rate was 29.6 percent.

"Obese seniors experience more hospitalizations, emergency department visits, and use of outpatient health services than non-obese seniors, leading to higher health care costs," says the report. "Physical activity, healthy diet, supportive communities and social networks, and an environment that encourages exercise all play a role in reducing obesity in older adults."

The report says that between 1999 and 2014, Kentucky's middle-aged population (50-64) saw a 34 percent increase in in obesity and a 68 percent increase in diabetes. These findings were similar across the nation.

The report says Kentucky's senior population is expected to increase 44 percent by 2030. "Over the next 15 years, the health of this population will be challenged by large numbers of new people becoming seniors and the additional health challenges, such as diabetes, that this groups brings with them," it says."These higher rates of diabetes and obesity are expected to put significant strains on the Medicare program and the overall health-care system."

The report, sponsored by the United Health Foundation, is a call to action for states, offering specific benchmarks that can be changed to improve health.

Louisiana again ranked last for overall senior health, followed by Oklahoma. Kentucky, West Virginia, Arkansas and Mississippi had similar scores. The top six states for overall senior health are Massachusetts, Vermont, New Hampshire, Minnesota, Hawaii and Utah. Click here for the full report. (Click on chart for another version that may be clearer)

Princess Health and Medicaid stakeholders OK with healthy behavior incentives, oppose penalizing recipients who don't take part in cost sharing. Princessiccia

Princess Health and Medicaid stakeholders OK with healthy behavior incentives, oppose penalizing recipients who don't take part in cost sharing. Princessiccia

federal spending health care costs health insurance insurance coverage managed care Medicaid obamacare Patient Protection and Affordable Care Act state government

Gusty 13:11 Add Comment

By Melissa Patrick and Al Cross
Kentucky Health News

Groups of people concerned about changes in Kentucky's Medicaid program are open to the state offering incentives for healthy behaviors, but they don't want to penalize recipients who can't or won't pay premiums, deductibles or co-payments.

So reports the Foundation for a Healthy Kentucky, which convened a meeting May 12 to hear from people with stakes in the program: individual health-care providers, health systems, consumers, consumer advocates, payers, public-health professionals and representatives of higher education.

�Participants were unified in opposing penalties to enforce cost-sharing provisions� such as premiums, deductibles or co-payments, the foundation's consultant said in a report on the meeting.

However, they supported cost sharing for procedures not deemed medically necessary and �had diverse perspectives on this matter, ranging from opposing any cost-sharing in Medicaid to proposing specific premium and co-payment amounts,� such as $5 monthly premiums.

Also, �Participants were generally very supportive of implementing incentives for healthy behaviors such as smoking cessation and health risk assessments,� the report said. �Incentives might be reductions in the amount of cost-sharing or themselves supportive of healthy behavior,� such as gym membership.

Gov. Matt Bevin has said he wants Medicaid recipients to have "skin in the game" through cost-sharing, arguing that Kentucky can't afford to have more than a fourth of its population getting free medical care.

Under federal health reform, then-Gov, Steve Beshear expanded Medicaid eligibility to households with incomes up to 138 percent of the federal poverty level, adding more than 400,000 more people to the rolls. The federal government pays for the expansion through this year, but next year the state will be responsible for 5 percent, rising in annual steps to the reform law's limit of 10 percent in 2020.

Bevin's administration is working on getting a waiver from the federal Centers for Medicare and Medicaid Services to create new ways to cover those in the expansion. Six states have such waivers, including Indiana, which Bevin has cited as an example of how Kentucky might change its program.

In Indiana, recipients who pay premiums based on income levels, ranging from $1 a month to 2 percent of income ($27 a month for those at 138 percent of poverty) get expanded benefits and are charged co-payments only for non-emergency use of emergency rooms, according to the Kaiser Family Foundation. Those above the poverty level who fail to pay are disenrolled and barred from re-enrolling for six months, in what is known as a "lock-out" rule.

Bevin has indicated that he wants to announce his plan this summer. By law, states that seek a waiver must hold at least two public hearings: one at least 20 days before submitting the application to CMS, and the second after CMS accepts the application.

Stakeholders who attended the foundation's May 12 convening wanted to make sure their voices were heard early on in the process.

"Our goal is to help inform the process of changing the way Kentucky provides Medicaid services to ensure that we maintain the gains achieved under the Affordable Care Act, while also enabling the state to try new methods of ensuring access to affordable quality health care for Medicaid beneficiaries," Foundation President and CEO Susan Zepeda said in a news release.

"The biggest takeaway for me was the energy and commitment in the room," Zepeda said in a telephone interview. "A lot of thoughtfulness clearly went into sharing their experience and making suggestions on how to make the system more cost effective."

Before breaking into groups to offer their imput, stakeholders were given an overview of the state's Medicaid expansion and an overview of an issue brief created by the State Health Access Data Assistance Center at the University of Minnesota that looked at how waiver provisions are set up in five other states. Foundation staff wrote the 25-page "Stakeholder Input Report" that summarized suggestions and concerns and broke them into eight areas:

Cost-sharing and penalties: Health-care providers strongly opposed any cost-sharing, and uniformly opposed to any measure that involved "lock-out" penalties for failure to pay premiums, co-pays or deductibles.

"Our shared experience has been that we�ve been prohibited from denying care if a patient refuses or is unable to pay," the Physical and Oral Health Provider group said. "Therefore, the desired behavior isn�t actually enforced."

The Behavioral Health Provider group offered a compromise: �If the administration chooses to explore lock-outs we recommend that lock-outs be immediately lifted (upon payment) and payment be retroactive to the date the consumer re-enrolls.�

Participants in general were open to the idea of low co-payments, cost-sharing for non-medically necessary services, using Medicaid dollars to pay premiums for employer-sponsored insurance plans and charging co-payments for non-emergency use of the ER. They also agreed that certain groups, like those with chronic illnesses or disabilities, should be exempted.

Incentives: Most post-ACA waiver programs have implemented incentives for healthy behavior, and those at the meeting generally supported implementing evidence-based incentives, such as smoking cessation and health-risk assessments.

Zepeda said that most of the stakeholders wanted to see healthy behavior incentives used as credits against premiums, especially for recipients who can't afford them. "There is a recognition that people have a role to play in their own health care and the health decisions that they make," she said.

Benefits: Benefits include services covered under the health insurance plan. Some participants opposed any changes to current benefits; others wanted to expand existing benefits and still others suggested adding new benefits like housing. All agreed that medically necessary services should be covered for all enrollees.

Reimbursement: Kentucky shifted Medicaid in 2011 to managed care, in which managed-care organizations (usually insurance-company subsidiaries) are paid a flat fee per person as an incentive to limit claims. Providers have complained about the slow and low reimbursement, and participant suggestions included streamlining and accelerating the reimbursement process, increasing provider reimbursement rates, and adding new categories of reimbursed services and providers, like telehealth.

Systems improvement: Participants suggested simplifying administrative processes for providers; expanding providers' scope of practice; adding review panels; reducing the number of managed-care organizations; and creating a single list of drugs for all MCOs.

Health system transformation: Waivers allow states to explore ways to provide care differently through various transformation approaches. Suggestions included creating price transparency, through an all-payer, all-claims database; improving consumer health literacy; and moving beyond coverage issues to addressing access and quality.

�There was also interest among our group in examining a PCMH (patient-centered medical home) or health homes model to promote care coordination, and we feel strongly that pharmacists are essential part of the team and should be used in novel and more expansive ways,� the Colleges and Universities group said.

Evaluation: Waivers require states to perform an evaluation and make it public. Participants agreed that the process should include stakeholders and that findings should be made public periodically.

The Physical and Oral Health Provider group suggested the evaluation should answer the questions, �Have we maintained coverage levels? Have we improved access to care?�

Overarching themes: Many of the stakeholders mentioned two issues that were not included in the issue brief or discussion: integrating behavioral, physical and oral health services, and addressing the wide set of social factors that shape Kentucky's relatively poor health.

�Waivers should include methods to address social determinants of health as these areas are proving most effective in improving outcomes and reducing cost,� the Physical and Oral Health Provider group said. �We encourage inclusion of community health workers, peer support, medical respite care and other innovations to support social needs of patients.�

Zepeda said the Medicaid waiver drafting team faces many challenges. "We consider the rich conversation that happened on May 12 to be the start of the conversation," she said. "We have to find the cost effective win/win strategies that can reduce the cost of Medicaid going forward and let us continue to serve this expanded number of Kentuckians who now have health insurance."

Princess Health and Obama asks public to tell Congress to fund the $1.9 billion Zika fight he wants; Senate passed $1.1 billion, House $622 million. Princessiccia

Princess Health and Obama asks public to tell Congress to fund the $1.9 billion Zika fight he wants; Senate passed $1.1 billion, House $622 million. Princessiccia

birth defects Congress federal spending infectious diseases insects mosquitoes politics research vaccines viral infections

Gusty 12:14 Add Comment

The Zika funding package of Appropriations Committee Chair Hal Rogers and other House Republicans "doesn't make a lot of sense" and the somewhat larger Senate package backed by Majority Leader Mitch McConnell and a bipartisan Senate majority falls well short of what is needed, President Obama told reporters Friday.

The Senate has passed a $1.1 billion package and the House approved $622 million. Obama wants more than three times the House figure, $1.9 billion, to fight the virus that causes a serious birth defect.

"We didn�t just choose the $1.9 billion from the top of our heads," Obama said. "This was based on public-health assessments of all the work that needs to be done. And to the extent that we want to be able to feel safe and secure, and families who are of childbearing years want to feel as if they can have confidence that when they travel, when they want to start a family that this is not an issue -- to the extent that that's something that we think is important, then this is a pretty modest investment for us to get those assurances."

Obama said the House package is not only inadequate, "That money is taken from the fund that we're currently using to continue to monitor and fight against Ebola. So, effectively, there�s no new money there. All that the House has done is said, you can rob Peter to pay Paul. And given that I have, at least, pretty vivid memories of how concerned people were about Ebola, the notion that we would stop monitoring as effectively and dealing with Ebola in order to deal with Zika doesn�t make a lot of sense."

The president added, "This is something that is solvable. It is not something that we have to panic about, but it is something we have to take seriously. And if we make a modest investment on the front end, then this is going to be a problem that we don't have to deal with on the back end." He said each child who has a small brain as a result of Zika "may end up costing up to $10 million over the lifetime of that child in terms of that family providing that child the support that they need. . . .  It doesn�t take a lot of cases for you to get to $1.9 billion. Why wouldn't we want to make that investment now?"

Part of the money would go to develop a vaccine for Zika, and part of that work is going on at the University of Kentucky. "You don't get a vaccine overnight," Obama said. "You have to test it to make sure that any potential vaccine is safe. Then you have to test to make sure that it's effective. You have to conduct trials where you're testing it on a large enough bunch of people that you can make scientific determinations that it's effective. So we've got to get moving."

Obama said the Centers for Disease Control and Prevention and the National Institutes of Health are "taking pots of money from other things -- universal flu funds or Ebola funds or other funds -- just to get the thing rolling. But we have to reimburse those pots of money that have already been depleted and we have to be able to sustain the work that�s going to need to be done to finish the job. So, bottom line is, Congress . . . needs to get me a bill that has sufficient funds to do the job."

The president said that should happen before the summer congressional recess in August, "to provide confidence to the American people that we're handling this piece of business." He said the money would be insurance for young families or couples thinking about having children.

"To the extent that we're not handling this thing on the front end, we're going to have bigger problems on the back end," Obama said. "Tell your members of Congress, get on the job on this. This is something we can handle. We should have confidence in our ability to take care of it. We've got outstanding scientists and researchers who are in the process of getting this done, but they�ve got to have the support from the public in order for us to accomplish our goal."

Princess Health and Kentucky Center for Economic Policy report warns about impact of Bevin's proposed Medicaid changes. Princessiccia

Princess Health and Kentucky Center for Economic Policy report warns about impact of Bevin's proposed Medicaid changes. Princessiccia

economy federal spending health reform jobs Medicaid obamacare Patient Protection and Affordable Health Care Act politics prevention state budget state government

Gusty 13:15 Add Comment

By Danielle Ray

Kentucky Health News

A research group with a liberal outlook warned Monday that Republican Gov. Matt Bevin should be careful in changing the state Medicaid program.

The Kentucky Center for Economic Policy said the state�s expansion of Medicaid eligibility under Democratic Gov. Steve Beshear has increased health screenings and job growth in health care.

Tobacco counseling and interventions increased 169 percent from 2013 to 2014, the first year of the expansion, the report noted. Influenza vaccinations went up 143 percent and breast cancer screenings increased 111 percent, it noted.

In addition, Medicaid expansion brought Kentucky health-care providers nearly $3 billion through mid-2015 and resulted in a 4.6 percent job growth in the health-care sector from 2014 to 2016, according to the report.

�No matter how you look at Medicaid expansion in Kentucky, it�s clear it has had a positive effect on access to health care that will improve our state�s economy and quality of life,� Jason Bailey, executive director of KCEP, said in a news release.

However, Bevin says the state can�t afford to have more than a fourth of its population on Medicaid and is seeking a waiver from the federal government to make changes in the program, such as �skin in the game� for beneficiaries: co-payments, deductibles or health savings accounts, as used in a year-old experiment in Indiana, which he has cited as an example.

The KCEP reports says the Medicaid waiver Bevin is seeking could result in additional costs to recipients and benefit changes. Arkansas was the first state to design a Medicaid expansion using such a waiver. So far, five other states have implemented similar waiver-based programs.

Waiver programs differ from standard Medicaid expansion in that they utilize some or all of the following: health savings accounts, a cost-sharing account to be used for health care expenses; lockouts, periods in which recipients who have been dis-enrolled for failure to pay premiums are barred from re-enrolling; and premium assistance, the use of Medicaid funds to buy private insurance plans.

These waivers are designed to grant states the freedom to enact experimental programs within Medicaid, so long as the programs continue to reflect the overall goal of Medicaid, increasing coverage of low-income individuals and improving overall health care, as well as efficiency and stability of health care programs that serve that population.

The Foundation for a Healthy Kentucky, which convened a meeting of Medicaid stakeholders last week, is holding off on making judgments of the proposed waiver program. �We believe that diverse input is essential to sustaining these gains, and to continue improving our health care system and health outcomes in Kentucky,� said Susan Zepeda, president of the foundation.

Zepeda said research the foundation has funded has shown a greater decrease in the number of Kentuckians who lack health insurance than any other state, which she attributes largely to Medicaid expansion adding about 400,000 Kentuckians to the rolls.

More than 1.4 million Kentuckians are enrolled in Medicaid, 39 percent of whom are children. Nearly 32 percent are enrolled under the expansion: childless adults in households that earn less than 138 percent of the federal poverty line, currently $33,000 for a family of four.

The KCEP report also asserts that Kentucky�s Medicaid benefits are on par with those of other states, specifically that 12 out of 13 of Kentucky�s optional benefits are also covered in at least 40 other states and territories. Kentucky Medicaid only covers services that are deemed medically necessary.

KCEP noted that Medicaid is a partnership in which the federal government funds a minimum of half of traditional Medicaid spending in each state, with poorer states receiving a larger federal match. In Kentucky, the federal share is about 70 percent. For people covered by the expansion, the federal government is paying the full cost through this year, but the state will pay 5 percent in 2017, rising in annual steps to the law�s limit of 10 percent in 2020.

The full KCEP report is at http://kypolicy.org.

Princess Health and Rogers says House Republicans want $622 million for Zika; McConnell, Senate plan $1.1 billion; Obama wants $1.9 billion. Princessiccia

Princess Health and Rogers says House Republicans want $622 million for Zika; McConnell, Senate plan $1.1 billion; Obama wants $1.9 billion. Princessiccia

Congress epidemic federal spending infectious diseases

Gusty 19:13 Add Comment

UPDATE, May 16: The Republican package totals $622 million. May 17: Obama calls that "woefully inadequate," says he would veto it.

House Republicans' funding to fight the Zika virus will be about half the $1.9 billion President Obama requested, but still "adequate," U.S. Rep. Hal Rogers of Kentucky's Fifth District, chair of the House Appropriations Committee, said Friday.

Dierdre Walsh and Ted Barrett report for CNN, "Ever since they sent the request to Capitol Hill, the White House has complained that Republicans are ignoring a public health crisis and need to sign off on more money soon, especially before the potential risks from the mosquito-borne virus increase with the summer months."

Rogers told reporters the bill he plans to introduce Monday will provide "less than a billion" for Zika but will be "adequate funding to face the problem." Also, "the money will be targeted for agencies to spend right away," Walsh and Barrett report. Rogers said the House could vote on the bill as early as Wednesday, May 18.

"Rogers and other congressional Republicans said they hadn't acted before now because the Obama administration wasn't giving Congress the details on how they would spend" the money, CNN reports, "and they were working through their own analysis on how much the various agencies needed to deal with the immediate needs. House conservatives also demanded that any new money for Zika needs to be paid for with cuts to other programs."

His bill is "fully offset" with cuts, Rogers said, but he declined to say where, "saying his committee was still finalizing those details," CNN reports. "But the White House and congressional Democrats argue in these cases Congress doesn't traditionally specify cuts to pay for additional funding. An unnamed Democratic aide on the appropriations staff told the network, "We don't offset emergency funding, period. And this is the definition of a public health emergency."

Meanwhile, Senate Majority Leader Mitch McConnell, R-Ky., and Democrats in that chamber "worked out a bipartisan $1.1 billion Zika proposal that they plan to attach to a separate spending bill" and scheduled it for a vote Tuesday, May 17, CNN reports. "The Senate will also vote on two competing proposals -- one from the two Florida senators, Bill Nelson, a Democrat, and Marco Rubio, a Republican. It would fully fund the President's request. The second is from Sen. John Cornyn, R-Texas, that would provide about $1 billion and be offset with cuts elsewhere. Those last two proposals are not expected to pass."

Princess Health and Zika update: Local anti-mosquito action needed; McConnell, Rogers at center of debate over Obama's request for more funds. Princessiccia

Princess Health and Zika update: Local anti-mosquito action needed; McConnell, Rogers at center of debate over Obama's request for more funds. Princessiccia

birth defects Congress federal spending mosquitoes pregnancy prevention public health virus

Gusty 17:14 Add Comment

Mosquitoes can carry Zika. (NPR photo)

By Melissa Patrick
Kentucky Health News

While all 388 Zika virus cases confirmed in the continental U.S., including six in Kentucky, have been in people who were infected abroad and then returned to the states, a health official said on "Fox News Sunday" that it is likely the U.S. will have its own outbreak.

"It is likely we will have what is called a local outbreak," said Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, Diane Bartz reports for Reuters.

Fauci said he did not expect a large number of people to become ill: "We're talking about scores of cases, dozens of cases, at most."

Dr. Ardis Hoven, infectious disease specialist for the Kentucky Department for Public Health, agreed and said the potential exists for Kentucky to have a local outbreak.

"I think it would be unreasonable for us to assume that we would not be at risk," she said in a telephone interview. "So therefore, we have to plan accordingly."

Hoven said mosquito control in the state is a "top priority," but said the bulk of this will have to happen at a local level.

She encouraged Kentuckians to talk about mosquito prevention with their friends and family and ask themselves, "What can I do in my community, in my yard, on my street to prevent mosquitoes from hatching and infecting those around me?"

Zika virus prevention strategy: Dress, Defend and Drain

The state has adopted a "3 D" approach to decrease the risk of infection by mosquitoes: Dress in light-colored long sleeved shirts and pants; Defend against mosquitoes with approved insect repellents; and Drain all standing water.

"If we can control mosquitoes in our region, we will go a long way to minimize the potential risk from infected mosquitoes," Hoven said.

The World Health Organization declared Zika a global health emergency in February. Those who have traveled to affected areas, such as Central and South America, are at the highest risk of contracting the virus, which is spread primarily by infected Aedes aegypti mosquito. It can also be spread through sexual intercourse. Aedes aegypti can be found in about 30 U.S. states, including Kentucky.

Zika virus is especially dangerous to pregnant women because it has been linked to thousands of cases of microcephaly, a condition where the infants head is smaller than normal, as well as other severe fetal brain defects, according to the federal Centers for Disease Control and Prevention. The state health department has reported that one of the confirmed Zika cases in the state is a pregnant woman.

The CDC is investigating the link between Guillain-Barre syndrome, a rare disorder in which the body's immune system attacks its nerves. And Fauci said there could be other neurological conditions caused by Zika that affect adults, Bartz reports.

"There are only individual case reports of significant neurological damage to people, not just the fetuses, but an adult that would get infected. Things that they call meningoencephalitis, which is an inflammation of the brain and the covering around the brain, spinal cord damage due to what we call myelitis," Fauci said. "So far they look unusual, but at least we've seen them and that's concerning."

Common symptoms of the virus are fever, rash, joint pain and red eyes, with symptoms lasting for about a week, though many with the virus have no symptoms. Currently there is no vaccine for Zika.

Funding to fight Zika held up in Congress

In February, President Obama asked Congress for an additional $1.9 billion in emergency funds to fight the Zika virus, including funds to develop a vaccine. This is in addition to $589 million in previously appropriated funds that have already been transferred to the effort.

That money should last through Sept. 30, the end of the federal fiscal year, but "There's going to need to be additional money, I don't think there's any doubt about that," Rep. Tom Cole, R-Okla., who chairs the House health appropriations subcommittee, told Susan Cornwell of Reuters April 13.

Top senators from both parties said "they are getting close to a deal to provide at least some emergency funding to fight the Zika virus, making it likely that the Senate will move ahead on the issue without waiting for the House," David Nather writes for STAT, an online health journal.

Senate Majority Leader Mitch McConnell, R-Ky., said at a news conference April 19 that congressional Republicans were working with the administration on the funding details, Peter Sullivan reports for The Hill.

�We're working with them on it to figure out exactly the right amount of money,� McConnell said at a press conference. �You know, how is it going to be spent? And I don't think, in the end, there will be any opposition to addressing what we think is going to be a fairly significant public health crisis."

Nevertheless, House Republicans kept saying they don't have enough information to approve the request.

On April 20, House Appropriations Committee Chairman Hal Rogers, R-Ky., said the Obama administration �continues to delay response efforts by refusing to provide basic budgetary information to Congress on their Zika funding request. This includes not answering our most basic question: �What is needed, right now, over the next 5 months in fiscal year 2016, to fight this disease?� In the absence of this information, the House Appropriations Committee will work with our colleagues in the House and the Senate to make our own determinations on what is needed and when, and to provide the funding that we believe is necessary and responsible.�

Five days earlier, White House Press Secretary Josh Earnest said Republicans have all the information they need to move forward, ABC reports. He said, �They've had ample opportunity to collect information, to ask questions of senior administration officials, to read letters, to read the legislative proposal that was put forward by the administration.� 

Princess Health and Women in small-town America aren't living as long as before; alcohol, drugs, food, housing, jobs, education, pollution to blame. Princessiccia

Princess Health and Women in small-town America aren't living as long as before; alcohol, drugs, food, housing, jobs, education, pollution to blame. Princessiccia

addiction drug abuse drug treatment drug use drugs federal spending life expectancy women women's health

Gusty 08:02 Add Comment

By Trudy Lieberman
Rural Health News Service

Those of us who grew up in small rural communities in the 1950s and '60s expected to have longer life spans than our parents.

The trends were in our favor. White women born in 1900 could expect to live, on average, just shy of 49 years; white men 46.6 years. Those were our grandparents and our neighbors. By 1950, life expectancy had climbed to 72 years for white women born that year and 66.5 for white men. By 2000, life expectancy was still increasing, with female babies expected to live to nearly 80 and males to almost 75.

America was on the rise, jobs were plentiful, antibiotics kept us from dying of strep throat, and polio vaccine kept us out of the iron lung. We thought things would only keep getting better. So I was dismayed to read a story in The Washington Post in April that blew holes in those childhood expectations.

The Post found �white women have been dying prematurely at higher rates since the turn of this century, passing away in their 30s, 40s, and 50s in a slow-motion crisis driven by decaying health in small town-America.�

That �small town America� was where I grew up. I contrasted the Post�s findings to the claims made by all those politicians who have told us we have the best health care in the world and who point to gobs of money lavished on the National Institutes of Health to find new cures and to hospitals promoting their latest imaging machines.

The Post found that since 2000, the health of all white women has declined, but the trend is most pronounced in rural areas. In 2000, for every 100,000 women in their late 40s living in rural areas, 228 died. Today it�s 296.

If the U.S. really has the best healthcare, why are women dying in their prime, reversing the gains we�ve made since I was a kid? After all, mortality rates are a key measure of the health of a nation�s population.

Post reporters found, however, that those dismal stats probably have less to do with health care � which we like to define today as the latest and greatest technology and insurance coverage albeit with high deductibles � and more to do with what health experts call �the social determinants of health,� such basics as food, housing, employment, air quality, and education.

Landmark studies examining the health of British civil servants who all had access to health insurance under Britain�s National Health Service have found over the years that those at the lowest job levels had worse health outcomes. Some of those outcomes were related to things like work climate and social influences outside work like stress and job uncertainty.

In its analysis, the Post found that the benefits of health interventions that increase longevity, things like taking drugs to lower cholesterol and the risk of heart disease, are being overwhelmed by increased opioid use, heavy drinking, smoking and obesity.

Some researchers have speculated that such destructive health behaviors may stem from people�s struggles to find jobs in small communities and the �dashed expectations� hypothesis. White people today are more pessimistic about their opportunities to advance in life than their parents and grandparents were. They are also more pessimistic than their black and Hispanic contemporaries.

A 42-year-old Bakersfield, California, woman who was addicted to painkillers for a decade explained it this way: �This can be a very stifling place. It�s culturally barren,� she said. There is no place where children can go and see what it�s like to be somewhere else, to be someone else. At first, the drugs are an escape from your problems, from this place, and then you�re trapped,� she told Post reporters.

I recently heard U.S. Surgeon General Dr. Vivek Murthy talk about his upcoming report on substance use. About 2.2 million people need help, he said, but only about one million are actually getting it. Murthy wants his report to have consequences as far reaching as the 1964 surgeon general�s report linking tobacco use to lung cancer. In 1964, Murthy noted, 42 percent of Americans smoked; today fewer than 17 percent do.

The Post story concludes that the lethal habits responsible for increasing mortality rates are cresting in small cities where the biggest manufacturer has moved overseas or in families broken by divorce or substance abuse or in the mind and body of someone doing poorly and just barely hanging on.

The Surgeon General has taken on an enormous task, but his efforts just might help the nation move its life expectancy trends back in the right direction.

What do you think is causing poor health in your community? Write to Trudy at trudy.lieberman@gmail.com.

Rural Health News Service is funded by a grant from The Commonwealth Fund and distributed by the Nebraska Press Association.